Lumbar Flashcards
lumbar flexion
80
lumbar extension
35
lumbar lateral flexion
25
doctor observes that patient maintains a certain posture to alleviate pain or the patient will tell doctor that standing in a certain way alleviates the pain
antalgia sign
antalgic lean away from the side of pain is consistent with
posterolateral herniated disc
antalgic lean toward the side of pain is consistent with what
posteromedial herniated disc
forward antalgic lean is consistent with what
posterocentral(rhizal) herniated disc
posterolateral herniated disc
posteromedial; meaning the antalgic lean would be toward the side of pain
with patient lying supine doctor raises the symptomatic leg, with the knee straight, off of the table until the pain is reproduced or pain increases. doctor then notes the angle at which the pain occurred/increased and the location of the pain
straight leg raiser (SLR)
purpose of the straight leg raiser test
- testing for possible SOL or IVD lesion
- SI problem
- lumbosacral problem
pain at 0-30 degrees during SLR test most likely indicates what
SOL
pain at 30-60 degrees during the SLR test most likely indicates what
SI joint inflammation that is irritating the sciatic nerve
pain at >60 degrees during the SLR test most likely indicates what
lumbo-sacral problem
patient is seated on the table with back against wall and extends the leg at the knee while the doctor applies downward pressure just above the level of the knee
bechterew’s test
seated SLR
bechterew’s test
positive findings for bechterew’s test
same as SLR
if patient has +SLR, the doctor will lower the affected leg 5 degrees and then dorsiflex the foot.
braggards sign
which nerve is being tractioned when the foot is dorsiflexed during braggards sign
tibial nerve
patient is seated in a stooped over posture. head is flexed, knee is extended, and ankle is dorsiflexed
slump test
positive sign for slump test
radicular pain down leg (suspect disc bulge or herniation)
doctor performs SLR on the asymptomatic side in an attempt to reproduce pain on symptomatic side that was found on SLR
Crossed SLR (well leg raiser)
when performing crossed SLR test, symptoms occur at same level/angle as the SLR, what is indicated
potential posteromedial IVD bulge or herniation
when performing crossed SLR test, if symptoms occur at an increased angle compared to SLR test, what is indicated
potential posterolateral IVD buldge or herniation
crossed SLR test, then lower leg 5 degrees and dorsiflex foot
fajersztajn’s test
when performing fajersztajn’s test, pain at same angle as braggards indicates
posteromedial IVD bulge or herniation
when performing fajersztajn’s test, there is pain at a greater angle than braggards what is indicated
potential posterolateral IVD bulge or herniation
this will occur during the SLR, the patient will raise the ipsilateral hip to alleviate pain (roll away)
cox sign
if cox sign is present it may indicate
- SOL
- IVF encroachment
- radiculopathy
- nerve root
- tension
- sciatica
with patient lying prone the doctor attempts to touch the heel of one foot to the contralateral buttock
Ely’s Test
positive sign for ely’s test
pain in the anterior thigh and/or groin area
radiating pain found when performing ely’s test could indicate
femoral nerve or lumbar spine nerve root compression
localized pain found when performing ely’s test could indicate
quadriceps muscle contracture
with patient lying on their side (affected side up) with bottom leg straight and top leg bent at knee, the doctor will extend the thigh back on affected side
Femoral Nerve Traction Test
purpose of the femoral nerve traction test
reproduce pain in the anterior thigh in the distribution of the femoral nerve
radiating pain to the groin during femoral nerve traction test could indicate
L3 nerve root radiculopathy
radiating pain to the anterior mid-thigh during femoral nerve traction test could indicate
L4 nerve root radiculopathy
patient can’t walk on their heels (dorsiflex) indicates
may be an L5 problem (L4 IVD)
patient can’t walk on their toes (plantar flex) indicates
may be an S1 problem (L5 IVD)
patient not being able to walk on heels or on their toes
not being able to walk on their toes
pt seated dr stabilizes lumbar spine with one hand and supports shoulder with other; pt is laterally flexed away, flexed forward and laterally toward dr and finally extended with compression of shoulder on side being tested; lumbar circumduction trying to elicit radiating leg pain or localized low back pain
kemps test
pain with slight rotation or on convex side during kemps
capsulitis
pain on extension or concave side during kemps test
facet problem
geneal pain at the waist during kemps test
lumbar spine sprain/strain
pain with flexion during kemps test
IVD lesion
patient supine the doctor flexes the patient’s hip and knee to 90 degrees. doctor then tries to extend the leg
kernig’s sign
positive kernig’s sign
elicit pain in spine or involuntary flexion of the opposite knee or hip
patient supine the doctor flexes the head toward the xiphoid process
bradzinski sign
positive bradzinski sign
elicit involuntary hip and knee flexion
positive kernig’s or bradzinski sign and patient has a fever, what is indicated
meningitis
patient supine the doctor flexes the hip and knee to 90 degrees. doctor tries to extend the leg and is trying to elicit pain in the hip, low back or thigh
lasegue test
difference between lasegue test and kernig’s sign
what the doctor is observing:
- kernig’s looking for flexion of opposite knee or hip (meningitis with fever)
- lasegue looking for hip, low back, or thigh pain
patient is either seated or supine and doctor passively flexes the patient’s chin to their chest. no brudzinski or lhermitte’s
linder’s sign
difference between brudzinski’s sign, lhermitte’s, and linder’s sign
there is no difference in mechanics, the difference is what is being tested for
positive linder’s sign
pain is elicited in the low back and sciatic nerve indicating nerve root irritation or inflammation
patient lies supine with legs straight and lefts feet 6 inches off table and holds that position for 30 seconds
milgram’s test
positive findings for milgram’s test
patient is unable to hold the position due to:
- low back pain (herniation or lumbar strain/sprain)
- no pain (may have weak core muscles)
patient uses upper body strength to stand from seated position
minor’s sign
patient lying prone the doctor attempts to touch the heel of one foot to the ipsilateral buttock
nachla’s test
difference between ely’s and nachla’s
ely’s - heel to contralateral buttock
nachla’s - heel to ipsilateral buttock
positive sign for nachla’s test
same as ely’s: pain in anterior thigh and/or groin area
radiating pain found when performing nachla’s test could indicate
femoral nerve or lumbar spine nerve root compression
localized pain found when performing nachla’s test could indicate what
quadriceps muscle contracture
patient supports themself with their hand on the wall or table for balance and does 5 deep squats with a bounce at the bottom; do not perform on elderly or pregnant
quick test
doctor performs SLR then lowers leg 5 degrees and dorsiflexes the big toe
sicard’s sign
if positive sicard’s sign, which nerve root is most likely irritated
L5
patient lies supine and the doctor flexes both hips to 90 degrees with the legs extended. patient then lowers legs to 45 degrees
bilateral leg lowering test (BLLT)
positive findings for bilateral leg lowering test
pain in buttocks, SI or lower extremity, or the leg drops due to pain
Looking for what in Bilateral Leg Lowering Test
lumbo-sacral sprain strain, facet syndrome or IVD lesion
looking for what in quick test?
pain, locking/crepitus in LB, hips, knees or ankles
minors sign can occur due to (6)
- SI jt lesion
- L5 strain/spring
- lumbo-pelvic fx
- IVD syndrome
- muscular dystrophy
- sciatica
