lumbar exams Flashcards
amoss sign
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
antalgic sign
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.
straight leg raiser
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
Bragards
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
well leg raiser
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
fajersztajns
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
slump test
seated nerve traction test. patient raises rounds shoulders - flex cervical and thoracic spine - passivley extend knee - passivley dorsiflex the ankle.
laseque
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
bechterews
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
cox sign
while performing a straight leg raiser the patients hip comes off the table. suspect prolapse of nucleus into IVF and sciatica pain distribution
linders sign
seated or supine. patients head is passively flexed to the chest. nerve traction sign seen with sciatica
elys test
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
femoral nerve traction test
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
heel/toe walk
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
kemps test
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
kernigs/brudzinski sign
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
milgrams test
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.
minors sign
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
nachlas test
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
quick test
patient is asked to squat. if patient can squat with no pain in ankles, knees, and hip are relatively free of disease
bilateral leg lowering test
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
adams position
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
