Lumbar Orthopedics Flashcards
procedure for Antalgia sign
Dr will observe patient while standing to see if they maintain a certain posture to help alleviate pain
findings of Antalgia sign when leaning away from the side of pain
means posterolateral herniated disc
findings of Antalgia sign when leaning toward the side of pain
means posteromedial herniated disc
findings of Antalgia sign when leaning forward away from the pain
means posterocentral herniated disc
procedure for Straight leg raiser
patient lies face up, doctor raises the symptomatic leg until the pain is reproduced
purpose for Straight leg raiser
testing for possible SOL, disc lesion, sacro-iliac or lumbosacral problem
findings of Straight leg raiser
pain may suggest sciatica from lumbosacral lesion or SOL
with straight leg raiser, if pain is in first 30 degrees it means
means something major
with straight leg raiser, if pain is between 30 and 45 degrees it means
means sciatic irritation
with straight leg raiser, if pain is after 60 degrees it means
means lumbosacral problem
procedure for Bragard’s sign
(done if the patient has positive straight leg raiser)
perform a straight leg raiser then lower the leg 5 degrees and dorsiflex the foot
purpose of Bragard’s sign
attempt to reproduce leg pain
findings of Bragard’s sign
will be positive if there is an increase in leg pain
procedure for Sicard’s sign
(done if the patient has positive Bragard’s sign)
perform straight leg raiser, lower leg 5 degrees, dorsiflex foot & relax, then dorsiflex big toe
purpose of Sicard’s sign
to reproduce leg pain
findings of Sicard’s sign
irritation of usually L5 nerve root, but can be L4 or S1 as well
procedure for Bechterew’s test
(is a seated straight leg raiser)
patient sits with back straight then extends the leg at the knee; if no pain then Dr applies downward pressure right above the knee while patient lifts leg
purpose of Bechterew’s test
pain should be the same as in straight leg raiser
findings of Bechterew’s test
will be positive if straight leg raiser is positive
procedure for Slump test
patient is seated with back maximally slumped, knee is at 90 degrees, foot is fully dorsiflexed, then patient extends the leg at the knee
purpose of Slump test
pain should be the same as in straight leg raiser
findings of Slump test
if positive then possible disc bulge or herniation
procedure for Crossed straight leg raiser
is the same as straight leg raiser but done on ASYMPTOMATIC side first
purpose of Crossed straight leg raiser
attempt to reproduce leg pain
findings of Crossed straight leg raiser
if symptoms are at same angle as straight leg raiser then possible posteromedial disc bulge or herniation
if symptoms are at increased angle of straight leg raiser then possible posterolateral disc bulge or herniation
procedure of Fajersztajn’s test
performs crossed straight leg raiser (on asymptomatic side!), then lowers leg 5 degrees and dorsiflex foot
purpose of Fajersztajn’s test
attempt to reproduce leg pain
findings of Fajersztajn’s test
if pain is at the same angle as Braggard’s sign, then possible posteromedial disc bulge or herniation
if pain is at a greater angle than Braggard’s sign, then possible posterolateral disc bulge or herniation
procedure for Cox sign
perform straight leg raiser and the patient will raise ipsilateral hip to alleviate pain
findings of Cox sign
positive may indicate SOL, IVF enroachment, radiculopathy, nerve root tension, sciatica
procedure for Ely’s test
patient lies prone and Dr touches heel of foot to opposite buttock
purpose of Ely’s test
to produce pain in anterior thigh and/or groin
findings of Ely’s test
radiating pain could be from femoral nerve or upper lumbar nerve root compression
localized pain could be from quad muscle
procedure for Femoral nerve traction test
patient lies with unaffected side up, bottom leg straight, top leg bent at the knee then Dr extends the thigh back to traction nerve
purpose of Femoral nerve traction test
to reproduce pain in anterior thigh (femoral nerve)
findings of Femoral nerve traction test
radiating pain to the groin may mean L1 nerve root radiculopathy
radiating pain to the anterior mid thigh may mean L3 nerve root radiculopathy
procedure for Heel/toe walking test
patient walks on their heels a few steps (tests dorsiflexion), then walks on toes a few steps (tests plantar flexion)
findings of Heel/toe walking test
if patient can’t walk on heels then may be L5 problem (L4 disc)
if patient can’t walk on toes then may be S1 problem (L5 disc)
procedure for Kemps test
patient is seated, Dr hand on lumbars on side of pain and on shoulders for support, then patient is flexed obliquely away from side of pain, then circled forward around to side of pain, then jut belly out to come into extension, then Dr compresses shoulder on side of pain
purpose of Kemps test
to elicit pain in low back
findings of Kemps test
local pain with rotation or pain on convex side means capsulitis
local pain with extension or pain on concave side means facet problem
pain (radiating) with flexion means disc lesion
could also be radiculopathy, sprain/strain, etc
procedure for Kernig’s sign
patient lies supine, Dr flexes hip and knee to 90 degrees then Dr extends leg
purpose of Kernig’s test
elicit pain in head or spine (increasing headache means positive sign); opposite knee and hip may also flex
findings of Kernig’s test
pain with fever means meningitis
procedure for Brudzinski sign
patient lies supine and Dr flexes patient’s head toward xiphoid process
purpose of Brudzinski sign
trying to elicit pain in head or spine; opposite knee and hip may also flex
findings of Brudzinski sign
pain with fever means meningitis
procedure for Lasegue test
patient lies supine and Dr flexes hip and knee to 90 degrees, then try to extend the leg
purpose of Lasegue test
trying to elicit pain in hip, low back, or thigh
findings of Lasegue test
hip pain means hip pathology
thigh or leg pain means radiculopathy
bilateral pain means tight hamstrings
procedure for Lindner’s sign
patient is seated or supine and Dr passively flexes patients chin to chest
purpose of Lindner’s sign
puts traction on meninges and nerve roots
findings of Lindner’s sign
pain in low back and sciatic nerve means nerve root irritation
supine version means meningitis
seated version means cervical myelopathy or meningitis
procedure for Milgram’s test
patient lies supine and lifts feet 6 inches off table and holds for 30 seconds
findings of Milgram’s test
if patient is unable to hold because of:
low back pain means herniation or sprain/strain
no pain then weak core muscles
procedure for Minor’s sign
Dr has the patient stand from a seated position and sign is present if they have to use upper body strength to stand
purpose of Minor’s sign
to see if there is recruitment of upper body strength to stand up
findings of Minor’s sign
SI joint lesion, L5 strain/sprain, lumbo-pelvic fracture, disc syndrome, sciatica
procedure for Nachla’s test
patient lies prone and Dr attempts to touch the heel of foot to ipsilateral buttock
purpose of Nachla’s test
test attempts to produce pain in anterior thigh and/or groin area
findings of Nachla’s test
radiating pain may be from femoral nerve or lumbar spine nerve root compression
localized pain may be from quad muscle contracture
procedure for Quick test
patient supports themselves with hand against wall or table then they do 5 deep squats with a bounce at the bottom
purpose of Quick test
looking for pain/locking/crepitus in low back, hips, knees, ankles
don’t perform on elderly or pregnant
findings of Quick test
pain/locking/crepitus in low back, hips, ankles, knees
procedure for Bilateral leg lowering test
patient lies supine and Dr flexes hips to 90 degrees with legs extended (take both straight legs to 90 degrees), then patient lowers legs until Dr tells them to stop at about 45 degrees
purpose of Bilateral leg lowering test
looking for lumbo-sacral sprain/strain, facet syndrome, or disc lesion
findings of Bilateral leg lowering test
pain in buttocks, SI joint, or lower extremity, or leg drops because of pain
