Lumbar Spine

Question 1

SLR procedure

Answer 1

• pt supine
• zeros out inclinometer at the tibial tuberosity
• pt leg to the point of pain/90 degrees
• bilaterally performed

Question 2

SLR positive findings

Answer 2

• posterior leg pain/radicular pain elicited during passive hip flexion
• positive finding at 35-70 degrees

Question 3

SLR indications

Answer 3

• 0-35: sciatic nerve is slack; Si joint disorder/muscle dysfunction; piriformis muscle/syndrome
• 35-70: sciatic nerve is tense over the IVD: sciatic nerve root irritation by IVD pathology, osteophyte or tumor
• 70-90: local lumbar joint disorder; dull posterior thigh pain at any degree, suspect tight hamstring

Question 4

Bragards procedure

Answer 4

• pt supine
• inclinometer at the tibial tuberosity
• flexes pt hip with knee extended to the point of pain
• at the point of pain, lower 5 degrees and dorsiflex the foot
• bilaterally performed

Question 5

Bragards positive finding

Answer 5

reproduction of the posterior leg pain/radicular pain with dorsiflexion of the foot

Question 6

Bragards indications

Answer 6

• 0-35: sciatic nerve is slack; Si joint disorder/muscle dysfunction; piriformis muscle/syndrome
• 35-70: sciatic nerve is tense over the IVD: sciatic nerve root irritation by IVD pathology, osteophyte or tumor
• 70-90: local lumbar joint disorder; dull posterior thigh pain at any degree, suspect tight hamstring

Question 7

Sicards procedure

Answer 7

pt is supine
inclinometer at the tibial tuberosity
SLR to the point of pain
lower 5 degrees and dorsiflex the great toe
bilateral

Question 8

sicards positive finding

Answer 8

reproduction of posterior leg pain with dorsiflexion of the toe

Question 9

Sicards indications

Answer 9

• 0-35: sciatic nerve is slack; Si joint disorder/muscle dysfunction; piriformis muscle/syndrome
• 35-70: sciatic nerve is tense over the IVD: sciatic nerve root irritation by IVD pathology, osteophyte or tumor
• 70-90: local lumbar joint disorder; dull posterior thigh pain at any degree, suspect tight hamstring

Question 10

Lasagues procedure

Answer 10

pt is supine
SLR
flex the leg at pain and then extends again
bilateral

Question 11

lasagues positive findings

Answer 11

posterior leg pain

no pain with hip flexion and leg flexion

Question 12

lasagues indication

Answer 12

lumbar nerve root compression/irritation

lumbar radiculopathy

Question 13

bowstrings procedure

Answer 13

pt is supine
SLR
flex the leg at the point of pain
rest leg on doctors shoulder
exert pressure on popliteal fossa

Question 14

bowstrings positive finding

Answer 14

pain reduction with flexion of knee, posterior leg/radiculopy with pressure in popliteal fossa

Question 15

bowstrings indications

Answer 15

lumbar nerve root irritation/compression

Question 16

sciatic tension procedure

Answer 16

pt is seated
passively extends to the point of pain
lower leg and put leg between drs leg
dr pushes p-a in the popliteal space
bilaterally

Question 17

sciatic tension positive finding

Answer 17

pain reduction with lowering leg

pain with p-a pressure

Question 18

sciatic tension indication

Answer 18

• increase in pain indicates an irritation to the sciatic nerve (intramurally/extradurally)
• lumbar nerve root irritation/compression

Question 19

Bechterew’s prodedure

Answer 19

pt is seated
actively extends legs one at a time
if no response, both at the same time

Question 20

bechterew’s positive findings

Answer 20

unable to perform test because of radicular pain

performs test but leans back (tripods sign)

Question 21

becterew’s indication

Answer 21

compression of sciatic nerve

lumbar nerve roots either intradurally or extradurally

Question 22

tripods procedure

Answer 22

seated
passively extends one knee at a time
bilaterally

Question 23

tripods positive finding

Answer 23

patient leans back

extension of the spine

Question 24

tripods indication

Answer 24

• patient extends trunk if hamstrings are tight to relieve tension in hamstring
• lumbar nerve root irritation - stretching of the sciatic nerve or meningeal irritation

Question 25

minors sign procedure

Answer 25

instructs seated patient to stand

Question 26

minors sign positive finding

Answer 26

patient with lumbar radiculopathy will stand on healthy side and keep affected leg flexed to decrease tension on the sciatic nerve

Question 27

minors sign indication

Answer 27

lumbar radiculopathy

Question 28

antalgic lean sign procedure

Answer 28

observation of the standing patient

Question 29

antalgic lean positive finding

Answer 29

lateral disc: pt leans away medial disc: pt will lean toward central: flexed posture

Question 30

antalgic lean indication

Answer 30

disc herniations

Question 31

neri's sign procedure

Answer 31

standing patient bends over

Question 32

neri's sign positive finding

Answer 32

pt flexes the knee on affected side

Question 33

neri's sign indication

Answer 33

lower lumbar nerve root irritation/disc problem | L/S or SI subluxation

Question 34

well leg raise procedure

Answer 34

ONLY ON UNINVOLVED LEG pt is supine SLR on unaffected side not bilaterally

Question 35

well leg raise positive finding

Answer 35

posterior leg pain | pain os reproduced on the affected leg side

Question 36

well leg raise indication

Answer 36

medial disc herniation: increase pain | lateral disc herniation: decrease in pain

Question 37

Fajersztan's procedure

Answer 37

pt is supine unaffected leg to 75 degrees dorsiflex the its foot not bilaterally

Question 38

Fajersztan positive finding

Answer 38

posterior radicular pain | pain produced on affected side

Question 39

Fajersztan indication

Answer 39

medial disc protrusion | lateral disc protrusion

Question 40

slump test procedure

Answer 40

``` pt seated/hands behind back drs hand under pts chin pt slumps overpressure to shoulders flex c/s overpressure to c/s extend 1 leg at a time w/ dorsiflexion of the foot both legs extend w/ flexion STOP TEST IF ANY PAIN ```

Question 41

slump test positive finding

Answer 41

pain at any phase inability to extend the knee due to pain pain w/ foot dorsiflexion knee cannot fully extend

Question 42

slump test indication

Answer 42

meningeal tract irritation usually due to disc defect, l/s nerve root, sciatic nerve irritation/compression

Question 43

kemps procedure

Answer 43

- pt is seated - stabilizes at PSIS - other hand reaches around and grasps its shoulders and bends the spin obliquely backwards (lateral flex then extend)

Question 44

Kemps positive finding

Answer 44

radicular pain | localized low back pain

Question 45

Kemps indications

Answer 45

radicular pain lateral disc: pain with ipsi bending medial disc: pain with contra bending local achy pain (facet problems, capsulitis, SI joint problem, muscle spasms)