Ranges of motion 1. Flexion 2. extension 3. R. rotation 4. L.rotation 5. R. Lat. Flex 6. L. Lat. Flex

1. 60˚ 2. 25˚ 3. 45˚ 4. 45 ˚ 5. 25˚ 6. 25˚

malingering sign / disc involvement pt flutters legs and leans back when getting up from seated position. If they truly have a disc problem. pt that's faking it will not lean back

Lumbar Region Examination Flashcards by Kemmy Ritter

Patients info + vitals

name, age, sex.
State that you would perform vital ( BP, resp rate, pulse height, temp) unilaterally and that for a normal patient you would mark alert and oriented in 3 spheres, there is no apparent stress and they aren’t well developed and well nourished)

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Standing ortophedic test

1) gait
2) toe walk
3) Hell walk

1) walk
2) S1, S2
3) L4, L5

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SOT

Adam’s test

checking for scoliosis
hands together and bend forward
Rib humps stays = structural
disappears when bending = functional

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SOT

Belt test

Patient bends and has pain.

Clock sacrum and have pt bend, if pain persists is LUMBAR involvement and if there is no pain then it is SACRAL.

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Ranges of motion

Flexion
extension
R. rotation
L.rotation
R. Lat. Flex
L. Lat. Flex

60˚
25˚
45˚
45 ˚
25˚
25˚

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Ranges of motion #2

1 - active
2- passive
3- resisted

1- Place hands in direction of tetrameters and state the normal ROM

2- pain = ligament injury

3- pain = muscular

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Dejerine’s Triad

herniated disc

Cough / sneeze
pain = space occupying lesion

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Valsalva

Herniated disc

Deep breath and hold
pain = nerve root compression/space occupying lesion
pooping

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Bechterew’s

backache/sciatic nerve involvement or pain in both legs is usually indicative of disc involvement
* pt is seated and extends each leg, one at a time. Examiner restricts its hip flexion by applying a downward pressure, eventually you will want them to place both legs out in front of them

Extend each leg and press own
(sciatica, disc lesion, spasm or subluxation)

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Tripod Sign

malingering sign / disc involvement

pt flutters legs and leans back when getting up from seated position. If they truly have a disc problem.
pt that’s faking it will not lean back

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Kemp’s

Spinal neuropathy
examiner places pressure on the the its sides as they take them through a seated ROM on both sides. Examiner is seated behind the patient.

Hold pelvis and obliquely move pt (med/lat. disc bulge - facet irritation - standing
dic irritation - sitting

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Examination of the low back

Tone , symmetry, tenderness, swelling, mass, heat

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Sensory
R and L
Nerve root levels

L1, , L2, L3, L4, L5, S1, S2

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Spinal Tracts - I would do bilaterally
Present and Absent
L and R

sharp/dull
vibratory perception
position sense
pain perception

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Deep tendon perception

patellar L4

achilles S1

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circumferential measurements

Thigh

@5” proximal to sup patellar pole

@7” proximal to sup patellar pole

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circumferential measurements

calf

5” distal to inferior patellar pole

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circumferential measurements

leg length

actual : ASIS to medial malleolus

apparent: Umbilicus to meal malleolus

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babinski response

upper motor neuron - do it bilaterally
flexor normal
extensor UMN lesion

we are testing corticospinal/ pyramidal tract

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Motor - muscles graded 0-5

hip flexion

iliopsoas

L1, 2,3

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Motor - muscles graded 0-5

Leg extension

Quadriceps

L2,3,4

Motor - muscles graded 0-5

hipp abduction

Gluteus medius

Motor - muscles graded 0-5

Hip extension

gluteus maximus

Motor - muscles graded 0-5

Hip adduction

adductors

L2,3,4

Motor - muscles graded 0-5 | foot dorsiflexion and inversion

tibialis anterior | L4

Motor - muscles graded 0-5 | great toe extension

extensor hallucis longus | L5

Motor - muscles graded 0-5 | foot eversion

fibularis longs and bravis | S1

myotome grading system | 5

normal | complete ROM against gravity with full resistance

myotome grading system | 4

complete ROM against gravity with some resistance

myotome grading system | 3

complete ROM against gravity

myotome grading system | 2

complete ROM with gravity eliminated

myotome grading system | 1

evidence of slight contraction with no joint motion

myotome grading system | 0

no evidence of contraction

deep tendon reflexes grading scale | 0

absent

deep tendon reflexes grading scale | 1

hyporeflexia

deep tendon reflexes grading scale | 2

normal

deep tendon reflexes grading scale | 3

hyperreflexia

deep tendon reflexes grading scale | 4

clonus

OT Supine Tests ( - ,+, pain) | straight leg raise

space occupying lesion/sciatica * examiners raise its leg, if this is limited by pain then the test is positive the greater the angle is when patient fells pain, the higher the location of the problem

OT Supine Tests ( - ,+, pain) | wright leg raise

nerve root/IVD | raise leg opposite effected leg and dorsiflex the foot

OT Supine Tests ( - ,+, pain) | braggard's

:::: sciatic neuritis/ spinal cord tumors, IVD lesions, or spinal nerves irritations raise the leg until the pt has pain and then dorsiflex the foot if the pain increases then t's positive dorsiflex foot lower

OT Supine Tests ( - ,+, pain) | sicard's

sciatic neuropathy its leg is extended just short of the pain and the big toe is dorsiflexed if pain increases then this is a positive test big tow lower

OT Supine Tests ( - ,+, pain) | milgram's

raise 6 in off table | pain = low back pain - indicates space occupying mass such as herniated disc

OT Supine Tests ( - ,+, pain) | goldthwait's

SI Lesion / (sacral vs lumbar ) dr. lifts up leg and has other hands under the L spine if pt experiences pain before the L spine actually starts moving the is a positive test L4,5,S2 - raise leg

OT Supine Tests ( - ,+, pain) | patrick Fabere

Coxa Pathological condition pt makes a 4 with their legs, if you pay attention to the name of the test you will remember that the thigh is flexed, ABDucted, externally totaled, and extended. Examiner places pressure on the knee and ASIS positive = NOT acetabular pain 4 leg push down

OT Supine Tests ( - ,+, pain) | thomas test

Hip Flexion Contracture / thigh pesos muscle pt brings knee to chest, if the L spine doesn't flatten to the back of the table then the test is positive indicates shortened iliopsoas - thigh other leg move

OT Supine Tests ( - ,+, pain) | gaenslen's

SI Lesion Examiners stands @ right angle and bends the its knees and thigh up to the abdomen, do the unaffected side first/ The examiner gently presses down on the its other leg, if pain is felt through the thigh this is a positive test put leg off side

OT Prone Tests ( - ,+, pain) | hibb's

SI Lesion / sprain/strain pain or tingling down anterior, medial thigh indicates femoral nerve entrapment * move its leg outward / laterally from the body

OT Prone Tests ( - ,+, pain) | nachlas'

SI Lesion / sprain/strain straight to butt move its leg to buttock

OT Prone Tests ( - ,+, pain) | ely's

SI Lesion other butt move its leg towards the opposite leg

OT Prone Tests ( - ,+, pain) | yeoman's

SI Lesion = pain = strain /sprain push down S joint, raise leg dr. lifts up leg and places stress on the SI

Spinal examination Palpatory 10

T12, L1 - 5 (6), sac, R.SI, L. SI