Lumbar examination

Question 1

Observation

Answer 1

Observation
BBRSS, muscle wastage, alignment, discoloration

Alignment:

Assess gait – foot drop (L4-5), Antalgic, Hemiplegic

Flexion positioning of relief in neurogenic claudication/stenosis

Lateral shift/antalgic posture with scoliosis d/t disc lesion/radiculopathy

Lordosis - Duchannes muscular dystrophy

Hyperlordosis - Spondylolisthesis sill sign d/t anterior translation of VB above (skin wrinkled around an area)

Bumps: step defect spondylisthesis

Fat pad prominence at lumbosacral junction (with or without tuft of hair) in spina bifida occulta – may
not have SP (would then check rest of spine)

Muscle Wastage:
 Symmetrical tone in erector spinae, muscle spasm (antalgic posture with lateral flexion/rotation)
 Observe leg (atrophy in long term radiculopathy) or changes in tone

Question 2

Palpation

Answer 2

Bony - Iliac crest, ASIS, PSIS AIIS & sacrum, Greater trochanter,

Iliac crest level of L4 – gluteal insertion, lateral = ITB,

PA on SPs with heel of hand & lateral to medial feeling for any tenderness in potential #s, posterior
facet syndrome, disc derangement (m/c L4-5), DDD,

Soft tissue - Paraspinal, QLS from iliac crest to lower ribs, Inguinal (Psoas)

Lumbar erector spinae for any tenderness (sprains & strains) or muscle guarding

Question 3

Active, Passive ROM

Answer 3

Standing: flexion 50, extension 15, LF 20, rotation 5

General decreased ROM in NSLBP, posterior facet syndrome, stenosis (relief on flexion)

Flexion - Ask patient to bend down ( Ask them to reach towards toes
Extension - Ask patient to lie on their sotmach and extend their trunk
Lateral flexion- Ask patient to run armd own thigh
Rotation - Seated aks patient to rotate

Question 4

Screening for Flexion range

Answer 4

An important evaluation when considering axial spondyloarthropathies, hyperostosis. Limited flexion may also be
suggested of discal or other soft tissue derangement.

• Finger-floor distance (FFD)
  Distance between fingertips and floor when bent over forward with
  legs and arms extended. The distance is an indicator for the flexion
  capcity of the spinal column.
• Schober’s sign (Lumbar spine flexion)
  In a standing position, a point 10cm above S1 tubercle is marked. With
  torso at maximum flexion the distance increases by approx. 5cm

Question 5

Tests

Answer 5

• Central canal *
  Dejrenes Triad
  well leg raise
  slump test
• Nerve Root Tension Tests *
  Straight leg raise test
  Lasegue’s
  Bragard & Sicard
  Bowstring
• Facet Joint, Nerve root or central canal *
  Kemp’s test
  Standing Kemps
• Femoral nerve/upper limb *
  Pheasant’s Test / H Pheasant’s
• Neurodynamic- tension test *
  Tibial neurodynamiv test
  Peroneal neurodynamic test
• Vascular or neurogenic claudication *
  Van gelderen test (Bike test)

*Lumbosacral *
Goldthwaite test
Adam’s and supported adams