lumbar lab exam

Question 1

take a moment to review the myotome/dermatome chart

Answer 1

Question 2

Our Rule-Out tests for lumbar screening are
(hint: rule-outs make us consider something L.E.S.S.)

Answer 2

lumbar percussion (fracture)
Extension -Rotation (z-joint pain)
Slump (HNP/Radic)
SLR (HNP/Radic)

Question 3

A positive slump or SLR test is achieved when: ___

Answer 3

pt reports symptom provocation for sensitization and alleviation w/ neutral position

Question 4

ThE SLR can be administered with biases in various directions such as:
Hip IR/ADD for ___
Ankle DF & Inv: ___
Ankle PF & Inv: ___

Answer 4

sciatic N (near piriformis)
sural N
fibular N

Question 5

this physical examination procedure allows us to assess quantity, quality , provocation and willingness to move

Answer 5

AROM

Question 6

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

Answer 6

hips, knees, and pelvis

Question 7

what are our landmarks for visual estimation of flexion AROM?

Answer 7

25%-mid thigh
50%-knees
75%-mid-lower leg
100%-feet/floor

Question 8

We have positional alternatives for both flexion and extension PROM (other than sitting) . What are they?

Answer 8

flexion: quadruped or DKTC
ext: prone press up

Question 9

3 muscle groups often prioritized with lumbar examination are….

Answer 9

hip flexors
HS
TFL/IT

Question 10

In addition to trunk mobility and pelvic elevation, we might also assess___ and ___ musculature as part of our initial lumbar evaluations.

Answer 10

scapulothoracic and hip

Question 11

Joint and bone palpation sites often addressed in lumbar examinations include: PSIS, ASIS, symphysis pubis, and ______(2)

Answer 11

spinous and transverse processes

Question 12

soft tissue palpation sites often addressed in lumbar examinations include glute max and med, erector spinae, and ____ (2)

Answer 12

iliolumbar ligament and inguinal canal

Question 13

______(PPIVM/PAIVM) is useful for locating segmental pathology while (PPIVM/PAIVM) is better for detecting mobility deficits.

Answer 13

PAIVM, PPIVM

Question 14

T/F: When testing ext/flexion/lat flexion at the joint, the examiner should start at T12/L1 and move downward.

Answer 14

false; they should start at L5/S1 and work up

Question 15

T/F: When testing rotation at the joint, the examiner should start at T12/L1 and move downward.

Answer 15

true.

Question 16

In the case of discogenic pathology or lumbar radiculopathy, we might expect to see ___with repeated motion (5-20 reps).

Answer 16

centralization

Question 17

HNP/ Lumbar radiculopathy can be best detected using what special tests?

Answer 17

Well leg raise
femoral nerve tension test
spring testing/CPA

Question 18

neuromuscular instability can be best detected using what examination processes ?

Answer 18

catch sign/ pseudogower’s sign
passive lumbar extension
prone instability test
pressure biofeedback test
CPAs

Question 19

describe a positive test for Well leg raise

Answer 19

concordant pain provocation in LE (contralateral to raised leg)

Question 20

About how high are you lifting the pt’s leg for the passive lumbar ext test to assess concordant pain?

Answer 20

~30cm

Question 21

describe the interpretation process for the prone instability test.

Answer 21

pain w/ CPAs that is alleviated when they activate the back ext.

Question 22

Given the multifidus’ role in proprio and stability of motion, it can be tested dynamically via ___(2)

Answer 22

rotation/extremity lifting

Question 23

what are some compensation patterns you should look out for when assessing TrA activation?

Answer 23

valsalva
pelvic tilting
quick contraction
IO activation

Question 24

In pts experiencing LBP, inefficiency of the TrA might result in:

Answer 24

altered recruitment
(delayed activation)
-decreased change in CSA during LE movement (asymmetry)

Question 25

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.

Answer 25

40mmHg, 5 mmHg
We Don’t WANT a significant change

Question 26

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

Answer 26

70mmHg,

We WANT a significant change
>/=4mmHg
(</=2 is impaired)