Lumbar

Question 1

Lumbar Bony Palpation

Answer 1

Spinous Processes (count them out)
Sacral Tubercles (count them out)
Iliac Crests
PSIS

Question 2

Soft tissue Lumbar

Answer 2

Paraspinals (palpate as a unit & individual) = Spinalis, Longissimus, Iliocostalis
Sciatic Nerve
Gluteus Maximus
Gluteus Medius
Hamstrings = biceps femoris, semitendinosus, semimembranosus
Anterior abd muscles

Question 3

ROM lumbar

Answer 3

Flexion = 25
Extension = 30
Lateral bending = 25
Rotation = 30

Question 4

Hoover Sign

Answer 4

*used to differentiate organic versus hysterical leg paralysis.

+ : Lack of counter-pressure on the healthy side
Indicates: Lack of organic basis for paralysis (malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg.

Question 5

Straight leg raiser SLR

Answer 5

Positive: radiating pain and or dull posterior thigh pain
Indicates: sciatic radiculopathy or tight hamstrings. Positive between 35–70° = possible discogenic sciatic radiculopathy greater than 70° = tight hamstrings.

Question 6

Goldthwait Sign

Answer 6

Positive: localized pain in the low back or radiating pain down the leg

Indicates: lumbosacral or sacral iliac pathology. Pain occurring after the lumbar spine has moved indicates possible lumbo-sacral problem. Pain occurring before the lumbar has moved indicates possible sacral iliac problem.

Question 7

Bragard Sign

Answer 7

Positive: radiating pain in the posterior thigh.

Indicates: sciatic radiculopathy.

Question 8

Buckling sign

Answer 8

Positive: pain in the posterior thigh with sudden knee flexion (buckle).

Indicates: sciatic radiculopathy

Question 9

Bowstring sign

Answer 9

Positive: pain in the lumbar region or radiculopathy

Indicates: sciatic nerve root compression, helps rule out tight hamstring.

Question 10

Lasegue Test

Answer 10

Positive: reproduction of sciatic pain before 60°.

Indicates: sciatica

Question 11

Milgram Test

Answer 11

Positive: inability to perform test and/or low back pain.

Indicates: weak abdominal muscles or space occupying lesion.

Question 12

Valsalva Maneuver

Answer 12

Positive: radiating pain from site of lesion [usually re-creating the complaint and cervical or lumbar area of the spine].

Indicates: space occupying lesion e.g. disc pathology

Question 13

Bechterew Test

Answer 13

Positive: reproduction of radicular pain or inability to perform correctly due to tripod sign.

Indicates: sciatic radiculopathy.

Question 14

Neri Bowing Test

Answer 14

Positive: pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side.

Indicates: positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.

Question 15

Anterior Inominate Test aka Mazion Pelvic Maneuver (advancement sign)

Answer 15

Positive: the inability to bend at the waist more than 45°, because of either/or

1. Radiating pain along the sciatic nerve, either unilateral or bilateral.
2. Low back pain [lumbar or pelvic regions]

Indicates:

1. Sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology.
2. Anterior [rotational] displacement of the ilium relative to the sacrum.

Question 16

Lewin Standing Sign

Answer 16

Positive: radiating pain down the leg causing flexion of the patient’s knee or knees.

Indicates: gluteal, lumbosacral or sacroiliac pathology

Question 17

Heel Walk

Answer 17

Positive: inability to perform test.

Indicates: L4 – L5 disc lesion [L5 nerve root].

Question 18

Toe walk

Answer 18

Positive: inability to perform test

Indicates: L5 – S1 disc lesion [S1 nerve root]

Question 19

Ely Heel to Buttock Test

Answer 19

Positive: 1. Inability to raise the thigh.

2. Pain in the anterior thigh.
3. Pain in the lumbar region.

Indicates: 1. Iliopsoas spasm.

2. Inflammation of lumbar nerve roots.
3. Lumbar nerve root adhesions.