Lumbar I

Question 1

Red flags for severe spinal pathology

Answer 1

. Weight loss
. Fever
. Night sweats
. Bowel, bladder, or sexual function changes 
. Difficulty walking/loss of balance

Question 2

Gait observation

Answer 2

. HAve patient walk normally

. Walk on heels then walk on toes to screen for lumbosacral nerve root function

Question 3

Scoliosis screening test (adam’s test)

Answer 3

. Patient bends forward
. Follow “horizon” of spine to look for vertebral humping
. If curve present look for C or S shape

Question 4

Standing flexion test

Answer 4

. Palpate PSIS
. Patient bend forward and monitor PSIS as patient bends
. If one if higher than other, IS dysfunction on higher side
. Must raise thumb’s width to be considered positive test

Question 5

Pelvic side shift test

Answer 5

. Put lat. force on one side of pelvis while hand stabilizes opposite shoulder
. Iliac crest usually high on side of positive pelvis side shift test
. Pelvis shift right means lumbar compensation to the left and convex curve created
. Positive test caused by tight psoas or short leg on contralateral side of positive pelvic side shift, muscle imbalances, degeration of spine, or orthopedic trauma

Question 6

Seated flexion test

Answer 6

. Patient seated w/. Feet on floor
. Find PSIS and observe like the standing test
. Positive findings means SI joint dysfunction

Question 7

Straight leg raise

Answer 7

. Determined sciatica

. Positive when raising leg 30-70 degrees causes pain to radiate down to leg past knee, often down to big toe

Question 8

Thomas test

Answer 8

. Identifies hip flexion contracture from tight hip flexors or ant. Or lat. hip capsular restrictions
. Patient lies down with one knee pulled toward chest
. If leg horizontal neg., if leg lifted positive

Question 9

Modified Thomas

Answer 9

. Patient lies on edge of bed, hugs one knee to chest, and lies back on table
. If thigh not horizontal the psoas is tight
. If thigh drops but knee remains in extension the quads are tight
. If thigh abducts then tensor fascia lata is tight

Question 10

Prone psoas testing

Answer 10

. Physician can palpate the lumbar region for muscle tension when performing test
. Place 1 hand over lumbosacral region
. Grasp inside of patient’s leg prox. To knee
. Raise leg until hit hip flexor barrier
. Don’t let lumbar spine inc. in lordosis
. Compare both sides