lumbar exams

Question 1

amoss sign

Answer 1

watch patient getting off the table to see if there is any pain in the motion. Suggests lumbar sprain/strain, subluxation, lumbar IVD syndrome, or ankylosing spondylitis

Question 2

antalgic sign

Answer 2

observe patients gait. A posteriolateral disc bulge/herniation the patient leans away from the affected side, with posteriomedial bulge/herniation the patient leans to the affected side.

Question 3

straight leg raiser

Answer 3

supine. passively raise the patients affected leg and note where radiating pain occurs. This is a nerve traction test if pain is first 30 degrees a SOL is suspected, if between 30 an 45 degrees the sciatica, if at 60 degrees a lumbosacral lesion suspected. Works best with nerve roots L4 - S1

Question 4

Bragards

Answer 4

after a positive straight leg raiser note angle that pain was produced lower leg 10 degrees and sharply dorsiflex ankle to see if pain is produced. used to confirm straight leg raiser findings

Question 5

well leg raiser

Answer 5

straight leg raiser on un affected leg. to differentiate a lateral or medial disc bulge/herniation. if pain is produced on affected leg it is a medial disc bulge

Question 6

fajersztajns

Answer 6

performing a braggards on the well leg. to determine between a posterior medial and posterior lateral disc bulge. If pain is produced on affected leg a medial bulge is suspected

Question 7

slump test

Answer 7

seated nerve traction test. patient raises rounds shoulders - flex cervical and thoracic spine - passivley extend knee - passivley dorsiflex the ankle.

Question 8

laseque

Answer 8

supine. knee and hip flexed to 90 degrees, passive extension of the knee. If pain radiating to the posterior hamstring and buttocks should consider sciatica

Question 9

bechterews

Answer 9

seated. patient is asked to extend legs one at a time then both togather then pressure is applied to the raised legs, one at a time then both. determine type of pain could be sciatica, HNP, exostosis, adhesions, spasms or subluxation

Question 10

cox sign

Answer 10

while performing a straight leg raiser the patients hip comes off the table. suspect prolapse of nucleus into IVF and sciatica pain distribution

Question 11

linders sign

Answer 11

seated or supine. patients head is passively flexed to the chest. nerve traction sign seen with sciatica

Question 12

elys test

Answer 12

patient is prone and affected leg is approximated to contralateral buttock. anterior thigh pain indicated inflammation of lumbar nerve roots. suspect involvement of roots L2 - L4

Question 13

femoral nerve traction test

Answer 13

side lying. affected side up passively abduct the hip, extend the thigh, and flex the knee. anterior radiating thigh pain indicates radiculopathy involving L2 - L4

Question 14

heel/toe walk

Answer 14

patient walks on their toes and then walks on their heels. inability to heel walk indicates L5 nerve root compression from HNP of L4 disc or fibular nerve compression. inability to toe walk indicates compression of S1 nerve root by L5 disc

Question 15

kemps test

Answer 15

seated or standing. patients upper body is directed to the side then circumducted toward affected side then into extension. localized pain indicates facet irritation radiating pain indicates disc bulge/herniation

Question 16

kernigs/brudzinski sign

Answer 16

supine. brudzinskis - passively flex patients head to chest. Kernigs - affected leg and hip are flexed to 90 degrees and the leg is passively straightened. tests are positive if the opposite leg comes off the table. indicates meningitis

Question 17

milgrams test

Answer 17

supine. patient actively raises legs off the table 6 inches and holds. test is positive if patient cannot perform. indicates sub arachnoid pressure SOL must be ruled out.

Question 18

minors sign

Answer 18

sign is present if patient supports the weight of their back with their hands while standing. patient supports weight on uninvolved side by balancing on unaffected leg placing one hand on the hip and flexing knee on affected side. indicates sacroiliac subluxation, lumbosacral sprain/strain, lumbar HNP syndrome, fractures, dystrophies, and myotonia

Question 19

nachlas test

Answer 19

prone. passively flex leg approximating heel to ipsilateral buttock. positive if pain in lumbosacral area or radiation down the thigh. indicates sacroiliac or lumbosacral disorder

Question 20

quick test

Answer 20

patient is asked to squat. if patient can squat with no pain in ankles, knees, and hip are relatively free of disease

Question 21

bilateral leg lowering test

Answer 21

supine. passively raise patients legs to 90 degrees at the hip, patient is instructed to slowly lower legs to 45 degrees keeping the knees straight. test is positive if cannot be performed. indicates lumbopelvic problem, disc lesion, or exostosis

Question 22

adams position

Answer 22

visualize lumbar spine from anterior and posterior for scoliosis. If curve changes with forward flexion it is functional, if no change it it structural/pathological