Lumbar Spine Flashcards
SLR procedure
- pt supine
- zeros out inclinometer at the tibial tuberosity
- pt leg to the point of pain/90 degrees
- bilaterally performed
SLR positive findings
- posterior leg pain/radicular pain elicited during passive hip flexion
- positive finding at 35-70 degrees
SLR indications
- 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
Bragards procedure
- 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
Bragards positive finding
reproduction of the posterior leg pain/radicular pain with dorsiflexion of the foot
Bragards indications
- 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
Sicards procedure
pt is supine inclinometer at the tibial tuberosity SLR to the point of pain lower 5 degrees and dorsiflex the great toe bilateral
sicards positive finding
reproduction of posterior leg pain with dorsiflexion of the toe
Sicards indications
- 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
Lasagues procedure
pt is supine
SLR
flex the leg at pain and then extends again
bilateral
lasagues positive findings
posterior leg pain
no pain with hip flexion and leg flexion
lasagues indication
lumbar nerve root compression/irritation
lumbar radiculopathy
bowstrings procedure
pt is supine SLR flex the leg at the point of pain rest leg on doctors shoulder exert pressure on popliteal fossa
bowstrings positive finding
pain reduction with flexion of knee, posterior leg/radiculopy with pressure in popliteal fossa
bowstrings indications
lumbar nerve root irritation/compression
sciatic tension procedure
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
sciatic tension positive finding
pain reduction with lowering leg
pain with p-a pressure
sciatic tension indication
- increase in pain indicates an irritation to the sciatic nerve (intramurally/extradurally)
- lumbar nerve root irritation/compression
Bechterew’s prodedure
pt is seated
actively extends legs one at a time
if no response, both at the same time
bechterew’s positive findings
unable to perform test because of radicular pain
performs test but leans back (tripods sign)
becterew’s indication
compression of sciatic nerve
lumbar nerve roots either intradurally or extradurally
tripods procedure
seated
passively extends one knee at a time
bilaterally
tripods positive finding
patient leans back
extension of the spine
tripods indication
- patient extends trunk if hamstrings are tight to relieve tension in hamstring
- lumbar nerve root irritation - stretching of the sciatic nerve or meningeal irritation
minors sign procedure
instructs seated patient to stand
minors sign positive finding
patient with lumbar radiculopathy will stand on healthy side and keep affected leg flexed to decrease tension on the sciatic nerve
minors sign indication
lumbar radiculopathy
antalgic lean sign procedure
observation of the standing patient
antalgic lean positive finding
lateral disc: pt leans away
medial disc: pt will lean toward
central: flexed posture
antalgic lean indication
disc herniations
neri’s sign procedure
standing patient bends over
neri’s sign positive finding
pt flexes the knee on affected side
neri’s sign indication
lower lumbar nerve root irritation/disc problem
L/S or SI subluxation
well leg raise procedure
ONLY ON UNINVOLVED LEG
pt is supine
SLR on unaffected side
not bilaterally
well leg raise positive finding
posterior leg pain
pain os reproduced on the affected leg side
well leg raise indication
medial disc herniation: increase pain
lateral disc herniation: decrease in pain
Fajersztan’s procedure
pt is supine
unaffected leg to 75 degrees
dorsiflex the its foot
not bilaterally
Fajersztan positive finding
posterior radicular pain
pain produced on affected side
Fajersztan indication
medial disc protrusion
lateral disc protrusion
slump test procedure
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
slump test positive finding
pain at any phase
inability to extend the knee due to pain
pain w/ foot dorsiflexion
knee cannot fully extend
slump test indication
meningeal tract irritation usually due to disc defect, l/s nerve root, sciatic nerve irritation/compression
kemps procedure
- pt is seated
- stabilizes at PSIS
- other hand reaches around and grasps its shoulders and bends the spin obliquely backwards (lateral flex then extend)
Kemps positive finding
radicular pain
localized low back pain
Kemps indications
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)
