lumbar lab exam Flashcards
take a moment to review the myotome/dermatome chart
Our Rule-Out tests for lumbar screening are
(hint: rule-outs make us consider something L.E.S.S.)
lumbar percussion (fracture)
Extension -Rotation (z-joint pain)
Slump (HNP/Radic)
SLR (HNP/Radic)
A positive slump or SLR test is achieved when: ___
pt reports symptom provocation for sensitization and alleviation w/ neutral position
ThE SLR can be administered with biases in various directions such as:
Hip IR/ADD for ___
Ankle DF & Inv: ___
Ankle PF & Inv: ___
sciatic N (near piriformis)
sural N
fibular N
this physical examination procedure allows us to assess quantity, quality , provocation and willingness to move
AROM
To ensure pure movement of lumbar spine, we may need to block/instruct pts to avoid motion at. __,___, and ___. For instance, the first ~60 degrees of hip flexion are from the lumbar section beyond that there may be compensation
hips, knees, and pelvis
what are our landmarks for visual estimation of flexion AROM?
25%-mid thigh
50%-knees
75%-mid-lower leg
100%-feet/floor
We have positional alternatives for both flexion and extension PROM (other than sitting) . What are they?
flexion: quadruped or DKTC
ext: prone press up
3 muscle groups often prioritized with lumbar examination are….
hip flexors
HS
TFL/IT
In addition to trunk mobility and pelvic elevation, we might also assess___ and ___ musculature as part of our initial lumbar evaluations.
scapulothoracic and hip
Joint and bone palpation sites often addressed in lumbar examinations include: PSIS, ASIS, symphysis pubis, and ______(2)
spinous and transverse processes
soft tissue palpation sites often addressed in lumbar examinations include glute max and med, erector spinae, and ____ (2)
iliolumbar ligament and inguinal canal
______(PPIVM/PAIVM) is useful for locating segmental pathology while (PPIVM/PAIVM) is better for detecting mobility deficits.
PAIVM, PPIVM
T/F: When testing ext/flexion/lat flexion at the joint, the examiner should start at T12/L1 and move downward.
false; they should start at L5/S1 and work up
T/F: When testing rotation at the joint, the examiner should start at T12/L1 and move downward.
true.
In the case of discogenic pathology or lumbar radiculopathy, we might expect to see ___with repeated motion (5-20 reps).
centralization
HNP/ Lumbar radiculopathy can be best detected using what special tests?
Well leg raise
femoral nerve tension test
spring testing/CPA
neuromuscular instability can be best detected using what examination processes ?
catch sign/ pseudogower’s sign
passive lumbar extension
prone instability test
pressure biofeedback test
CPAs
describe a positive test for Well leg raise
concordant pain provocation in LE (contralateral to raised leg)
About how high are you lifting the pt’s leg for the passive lumbar ext test to assess concordant pain?
~30cm
describe the interpretation process for the prone instability test.
pain w/ CPAs that is alleviated when they activate the back ext.
Given the multifidus’ role in proprio and stability of motion, it can be tested dynamically via ___(2)
rotation/extremity lifting
what are some compensation patterns you should look out for when assessing TrA activation?
valsalva
pelvic tilting
quick contraction
IO activation
In pts experiencing LBP, inefficiency of the TrA might result in:
altered recruitment
(delayed activation)
-decreased change in CSA during LE movement (asymmetry)
During a pressure biofeedback test, the cuff should be inflated to ___mmHG and the pt should draw in for 10s holds as the clinician assesses the ability to maintain between ___of baseline.
40mmHg, 5 mmHg
We Don’t WANT a significant change
During a prone drawing in test, the cuff should be inflated to ___mmHG and the pt should draw in for 10s holds as the clinician assesses the ability to create a pressure decrease (</>) 4mmHg
70mmHg,
We WANT a significant change
>/=4mmHg
(</=2 is impaired)
