Lumbar Orthopedic Exams Flashcards
An antalgic lean away from the side of pain indicates what kind of lesion?
Posterolateral disc herniation
Which exams are done in the thoracics and lumbars?
Adam’s Position Test
Amos’s Sign
An antalgic towards the side of pain indicates what kind of lesion?
Posteromedial disc herniation
A forward antalgic lean indicates what kind of lesion?
Posterocentral (rhizal) disc herniation
Facet syndrome has similar findings of the antalgic sign. How would you differentiate between a disc herniation and facet syndrome?
Leg pain increases means a disc herniation
Back pain increases means facet syndrome
What is a classic positive of the Straight Leg Raiser?
Reproduction or increase of the pain
Radiating pain down the leg
A positive SLR would indicate?
Sciatica: sacroiliac or Lumbosacral problem
SOL or IVD lesion
What orthopedic test is the Hyndmann’s sign associated with?
Straight leg raiser
What is Hyndmann’s sign?
Neck flexion can cause pain during SLR, which is a confirmation of the findings
What is a classic positive sign for Bragard’s Sign?
Reproduction or increase of pain
What does a positive Bragard’s sign indicate?
Sciatica
What is a prerequisite for performing Bragard’s sign?
A positive SLR
What is a classic positive of Sicard’s Sign?
Reproduction or increase of radiating pain
What nerve does is tractioned during Bragard’s sign?
The tibial nerve
What nerve does is tractioned during Sicard’s sign?
Tibial nerve
A positive Sicard’s sign indicates?
MC irritation of the L5 nerve root, though L4 or S1 are possible
Sciatica
What are the prerequisites for doing a Sicard’s test?
SLR and Bragard’s must be positive
What is a classic positive finding for Bechterew’s Test?
Should correlate with pain findings from the SLR test. If SLR is positive then Bechterew’s should also be positive
What test has the highest likelihood ratio for disc herniation?
Slump test
What is a positive finding for Slump test?
Pain should correlate with SLR
What does a positive Bechterew’s sign indicate?
Sciatica: sacroiliac or Lumbosacral problem
SOL or IVD lesion
What would a positive slump test indicate?
Disc bulge or herniation
What is different about a Crossed Straight Leg Raiser/Well Leg Raiser/Contralateral Laseques?
You only test the asymptomatic side
What is a classic positive of Crossed Straight Leg Raiser/Well Leg Raiser/Contralateral Laseques?
Reproduction of pain on the symptomatic side
If the symptoms occur in the Crossed Straight Leg Raiser/Well Leg Raiser/Contralateral Laseques at the same level/angle as the SLR, there is potentially a _____________.
Posteromedial IVD bulge or herniation
If the symptoms occur in the Crossed Straight Leg Raiser/Well Leg Raiser/Contralateral Laseques at an increased angle as the SLR, there is potentially a _____________.
Posterolateral IVD bulge or herniation
If the symptoms occur in the Fajersztain’s Test at the same angle as Bragard’s, there is potentially a _____________.
Posteromedial disc bulge or herniation
If the symptoms occur in the Fajersztain’s Test at a greater angle as Bragard’s, there is potentially a _____________.
Posterolateral IVD bulge or herniation
A positive Fajersztajn’s Test would be?
Reproduction of pain on the symptomatic side
How is Fajersztajn’s Test performed?
Perform a crossed SLR/well leg raiser/Contralateral Laseques (SLR on the asymptomatic side) then lower the leg 5 degrees and dorsiflex the foot
What is Cox Sign?
An observation of the patient raising the Ipsilateral hip to alleviate the pain
Cox Sign may indicate?
SOL IVF encroachment Radiculopathy Nerve root tension Sciatica
How is Ely’s Test performed?
With patient prone attempt to touch the heel of one foot to the Contralateral buttock
A classic positive of Ely’s test is?
Pain in the anterior thigh and/or groin area
A positive Ely’s Test indicates?
Radiating pain may be from the femoral nerve or an upper lumbar spinal nerve root compression (dermatomal)
Localized pain is due to quadriceps muscle contracture (myofascial)
How is the femoral nerve traction test performed?
With patient lying on their unaffected side, with the bottom leg straight and the top leg bent at the knee, dr extends the thigh back on the affected side to traction the femoral nerve
What is a classic positive for the femoral nerve traction test?
Reproduction of pain in the anterior thigh in the distribution of the femoral nerve
What would a positive femoral nerve traction test indicate?
Radiating pain to the groin may indicate L1 nerve root radiculopathy
Radiating pain to the anterior mid thigh may indicate L3 nerve root radiculopathy
If patient is unable to walk on their heels what would this indicate?
L5 problem (L4 IVD)
If patient is unable to walk on their toes what does this indicate?
S1 problem (L5 IVD)
How is Kemp’s Test performed?
Circumduction of the lumbar spine towards the side of involvement - “foramina compression test” of the lumbar spine
*make sure to watch video
What is the positive sign for Kemp’s Test?
Eliciting pain or localized low back pain
A positive Kemp’s Test would indicate?
Nerve root irritation
Radiculopathy
Local pain with slight rotation or on convex side (capsulitis)
Local pain on extension or concave side (facet problem)
General pain at the waist (lumbar spine sprain/strain)
Radiating leg pain with flexion (IVD lesion)
Local pain with slight rotation or on convex side during Kemp’s Test indicates?
Capsulitis
Local pain on extension or on concave side during Kemp’s Test indicates?
Facet problem
General pain at the waist during Kemp’s Test indicates?
Lumbar spine sprain/strain
Radiating leg pain with flexion during Kemp’s Test indicates?
IVD lesion
How is Kernig’s Sign performed?
With patient supine, dr flexes patient’s hip and knee to 90 deg, then tries to extend the leg
What is a classic positive of Kernig’s Sign?
**Elicits pain in the head
Pain in the spine
Involuntary flexion of Contralateral hip or knee
A positive Kernig’s Sign in addition to fever indicates?
Meningitis
How is Brudzinski Sign performed?
With patient supine, dr flexes patient’s head toward the xiphoid process
How is Brudzinski Sign different from Soto Hall?
Soto Hall is looking for cervical problems
Brudzinski Sign is looking for meningitis
The differentiating factor is fever and pain in the head versus the spine to indicate meningitis
What is a positive for Brudzinski Sign?
***Pain elicited in the head
Pain in the spine - nuchal rigidity
Involuntary flexion of the hip or knee
A positive Brudzinksi Sign with fever indicates?
Meningitis
How is Lasegue Test performed?
With patient supine, dr flexes hip and knee to 90 deg, then tries to extend the leg
Performed the same as Kernig’s sign
What is the difference between Lasegue Test and. Kernig’s sign?
Kernig’s sign is looking for increase in headache for meningitis
Laseque Test is looking for increase in low back pain for nerve root compression/irritation
What is a classic positive of Lasegue Test?
Elicit pain in the hip, low back, or thigh
A positive finding for Lasegue test would indicate?
Pain in hip: hip pathology
Pain in thigh or leg: radiculopathy
Bilateral pain: tight hamstrings
(Sciatica)
How is Lindner’s Sign performed?
Patient is either seated or supine, dr passively flexes patient’s chin to their chest
What is the purpose of Lindner’s Sign?
To put traction on the meninges and nerve roots
A positive Lindner’s Sign indicates?
If pain is elicited in the low back and sciatic nerve, it indicates nerve root inflammation or irritation
Supine version: same as Brudzinski’s sign - meningitis
Seated version: same as Lhermitte’s procedure - cervical myelopathy or meningitis
If Lindner’s Sign is positive in the supine position what does this indicate and what other test is this similar to?
Meningitis
Brudzinksi Test
If Lindner’s Sign is positive in the seated position what does this indicate and what other procedure is it similar to?
Cervical myelopathy or meningitis
Lhermitte’s procedure
How is Milgram’s Test performed?
Patient lies supine and lifts feet 6 in off the table with knees in full extension and holds this position for 30 seconds
What is a positive finding for Milgram’s Test and what does it indicate?
Patient is unable to hold the position due to:
Low back pain - herniation or lumbar sprain/strain
No pain - may have weak core muscles
What is Minor’s Sign?
Patient uses upper body strength to stand from a seated position - recruitment of upper body
A positive Minor’s Sign may indicate?
SI joint lesion L5 strain/sprain Lumbopelvic fracture IVD syndrome Muscular Dystrophy Sciatica
How is Nachlas’s Test performed?
With patient lying prone dr attempts to touch the heel of one foot to the Ipsilateral buttock
A classic positive of Nachlas’s Test would be?
Pain in the anterior thigh and/or groin area
A positive Nachlas’s Test may indicate?
Radiating pain may be from femoral nerve or lumbar spinal root compression
Localized pain is due to quadriceps muscle contracture
How is Quick Test performed?
Patient supports him/herself with hand on wall or table and then does 5 deep squats with a bounce at the bottom
What is a positive Quick Test?
Pain/locking/crepitus in the low back, hips, knees or ankles
How is the bilateral leg lowering test performed?
Patient lies supine, dr flexes hips to 90 degrees with legs extended. Patient then lowers legs until dr says to stop, around 45 degrees.
What is a positive finding for bilateral leg lowering test?
Pain in the buttocks, SI joint or lower extremity
The leg drops due to pain
What does a positive bilateral leg lowering test indicate?
Mechanical limbo pelvic problem such as Lumbosacral sprain/strain, facet syndrome, or IVD lesion
