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Clinical Assessment T3 > Lumbar Spine (Class 2) > Flashcards

Lumbar Spine (Class 2) Flashcards

1
Q

What is the purpose of the Valsalva Test?

A

The Valsalva Test increases intrathecal pressure in the spinal column to check for a space-occupying lesion (herniated disc, osteophyte, tumor) causing pain or paresthesia in the spine, potentially radiating down the leg(s).

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2
Q

How is the Valsalva Test performed?

A

A high-seated patient is asked to take a breath, hold it for at least 6 seconds, and bear down as if evacuating the bowels. Alternatively, the patient can blow into their thumb.

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3
Q

What indicates a positive result in the Valsalva Test?

A

A positive test is pain in the lumbar spine that recreates the patient’s signs and symptoms, indicating a problem in the lumbar spine affecting neurological tissues.

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4
Q

What is intrathecal pressure?

A

Intrathecal pressure refers to the pressure inside the covering of the spinal cord.

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5
Q

What other activities can increase intrathecal pressure, similar to the Valsalva Test?

A

Coughing, sneezing, deep breathing, straining, and laughing can all increase intrathecal pressure.

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6
Q

What is a common symptom of lumbar instability or lumbar muscle spasm?

A

The patient will have trouble moving to the seated position.

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7
Q

What is the procedure for the Passive Lumbar Extension Test?

A
  1. Patient lies in the prone position.
  2. The therapist passively lifts and extends both extremities to about 1 ft (30 cm).
  3. While maintaining the extension, the therapist gently pulls the legs.
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8
Q

What are the positive signs of the Passive Lumbar Extension Test?

A
  1. Strong pain in the lumbar region or a very heavy feeling in the low back.
  2. Feeling like the “low back is coming off” (disassociation from the rest of the spine), with pain disappearing when the legs are lowered.
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9
Q

What is NOT considered a positive sign in the Passive Lumbar Extension Test?

A

Numbness or prickling sensations are NOT positive signs.

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10
Q

What is the procedure for the Pheasant Test?

A
  1. The client is in the prone position.
  2. The therapist places one hand on the lumbar spine to feel for segments.
  3. With the other hand, the therapist picks up the patient’s ankles and passively brings them to the buttocks.
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11
Q

What is the effect of the Pheasant Test?

A

It lightly hyper-extends the lumbar spine.

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12
Q

What is a positive sign for the Pheasant Test?

A

If a spinal segment is unstable, it may produce pain in the lower limb.

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13
Q

What additional step is suggested in some versions of the Pheasant Test?

A

An Achilles Tendon Reflex test at the beginning and end of the test.

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14
Q

What is the purpose of the Prone Segmental Instability (PIT) Test?

A

To test for instability in the lumbar spine.

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15
Q

What is the procedure for the Prone Segmental Instability (PIT) Test?

A
  1. The patient is prone on the table with legs hanging off and toes on the ground.
  2. The therapist applies overpressure segmentally on the lumbar spine while the patient is relaxed.
  3. The patient is instructed to lift their legs off the floor by contracting hip and spinal extensors.
  4. The therapist then applies pressure again segmentally over the lumbar spine while the legs are lifted.
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16
Q

What is a positive sign for the Prone Segmental Instability (PIT) Test?

A
  1. Low back pain with pressure when the patient is relaxed.
  2. No pain with pressure when the muscles are activated (hip and spine extension).
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17
Q

Why does the patient experience no pain when muscles are activated during the Prone Segmental Instability (PIT) Test?

A

The lack of pain is attributed to the area of instability being protected by the muscular contraction.

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18
Q

What is the procedure for Milgram’s Test?

A
  1. The patient is supine.
  2. Instruct the patient to raise both extended legs about 2 inches off the table and hold for 30 seconds.
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19
Q

What is a positive sign for Milgram’s Test?

A

Pain and/or inability to raise or hold the legs off the table, which may indicate an intrathecal or extrathecal pathology.

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20
Q

Why might Milgram’s Test be overly optimistic for some patients?

A

Many people have trouble holding their ankles off the table, even without pathology.

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21
Q

What is the procedure for Kemp’s/Quadrant Test?

A
  1. The client stands.
  2. Instruct the client to rotate and extend their trunk while running their hand down the back of their thigh.
  3. This decreases the intervertebral foramen of the lumbar spine on the bending side.
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22
Q

What is a positive sign for Kemp’s/Quadrant Test?

A

Specific pain in the lower back, which may indicate facet joint pain, muscle spasm, iliolumbar ligament pressure, or compression of the sacroiliac joint.

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23
Q

What might localized pain on the same side during Kemp’s/Quadrant Test indicate?

A

It may come from an injured muscle spasming, inflamed iliolumbar ligaments, or compression of the sacroiliac joint, mimicking neurological pain in the gluteal-hip region.

24
Q

What could pain from the side not being tested during Kemp’s/Quadrant Test indicate?

A

The pain may come from tissue being stretched.

25
Q

What is the procedure for Hoover’s Test (malingering test)?

A
  1. The client is supine.
  2. The therapist holds each of the client’s heels in their palms.
  3. Ask the client to raise one leg at a time.
26
Q

What is a positive sign for Hoover’s Test?

A

If the therapist does not feel downward pressure in the palm of the opposite leg when the client tries to lift one leg, this indicates the client is not actually trying to lift their leg, suggesting malingering.

27
Q

Why is it impossible to test the Quadratus Lumborum in isolation?

A

The muscle cannot be tested in isolation, but specific procedures can give an indication of its strength or weakness.

28
Q

What is the procedure to assess the Quadratus Lumborum strength?

A
  1. Patient is prone with one thigh/leg slightly extended and abducted to mimic the muscle’s fiber line.
  2. Patient attempts to elevate the pelvis.
  3. Therapist applies longitudinal traction of the thigh/leg along the line of the muscle’s fibers.
29
Q

What influence does the Latissimus Dorsi have on the pelvis?

A

Though more of a shoulder muscle, it can tilt the pelvis anteriorly and laterally, and weakness may result in diminished lateral trunk flexion.

30
Q

What is the procedure to assess the Latissimus Dorsi strength?

A
  1. Patient is prone.
  2. Patient attempts to adduct the arm in a position of extension and medial rotation.
  3. Therapist applies pressure against the forearm in the direction of abduction and slight G/H flexion.
31
Q

Why is it clinically important to assess Lower Abdominals separately?

A

Though individual abdominal muscles cannot be tested separately, isolating lower and upper fibers of the abdominal group is clinically important.

32
Q

What is the procedure to assess Lower Abdominals strength?

A
  1. Patient is supine with hips flexed to 90° and knees fully extended.
  2. Patient tilts pelvis posteriorly to flatten lumbar spine against the table.
  3. Therapist places hand under the patient’s lumbar spine to check for loss of posterior tilt.
  4. Patient slowly lowers their legs to the table while continuing to press their low back into the therapist’s hand.
33
Q

How is Lower Abdominal strength graded during the leg-lowering test?

A

Based on the patient’s ability to maintain a posterior pelvic tilt while lowering their legs.

34
Q

What is the purpose of testing myotomes?

A

Testing myotomes involves assessing the strength of muscle groups that perform the same action and are innervated by the same nerve root. Weakness or pain in a motor function suggests spinal nerve root impingement at the corresponding level.

35
Q

How should you perform a myotome test?

A

Resist the action in mid-range for 5 seconds to assess the strength of the muscles innervated by the same nerve root.

36
Q

What is the nerve root, test action, and muscles involved for L1-L2?

A

• Nerve Root: L1-L2
• Test Action: Hip Flexion
• Muscles: Psoas, Iliacus, Sartorius, Gracilis, Pectineus, Adductor Longus, Adductor Brevis

37
Q

What is the nerve root, test action, and muscles involved for L3?

A

• Nerve Root: L3
• Test Action: Knee Extension
• Muscles: Quads, Adductor Longus, Magnus, Brevis

38
Q

What is the nerve root, test action, and muscles involved for L4?

A

• Nerve Root: L4
• Test Action: Ankle Dorsiflexion
• Muscles: Tibialis Anterior, Quads, TFL, Adductor Magnus, Obturator Externus, Tibialis Posterior

39
Q

What is the nerve root, test action, and muscles involved for L5?

A

• Nerve Root: L5
• Test Action: Toe Extension
• Muscles: Extensor Hallucis Longus, Extensor Digitorum Longus, Gluteus Medius & Minimus, Obturator Internus, Piriformis, Semimembranosis, Semitendinosis, Peroneus Tertius, Popliteus

40
Q

What is the nerve root, test action, and muscles involved for S1?

A

• Nerve Root: S1
•Test Action: Ankle Plantar Flexion & Eversion
• Muscles: Gastrocnemius, Soleus, Gluteus Maximus, Obturator Internus, Piriformis, Biceps Femoris, Semitendinosis, Popliteus, Peroneus Longus & Brevis, Extensor Digitorum Brevis

41
Q

What is the nerve root, test action, and muscles involved for S2?

A

• Nerve Root: S2
• Test Action: Hip Extension & Knee Flexion
•Muscles: Biceps Femoris, Piriformis, Soleus, Gastrocnemius, Flexor Digitorum Longus, Flexor Hallucis Longus, Intrinsic Foot Muscles

42
Q

What is the nerve root, test action, and muscles involved for S3?

A

Nerve Root: S3
Test Action: Knee Flexion
Muscles: Intrinsic Foot Muscles (except abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, extensor digitorum brevis)

43
Q

What is a dermatome?

A

A dermatome is an area of altered sensation corresponding to a specific nerve root level. Taber’s definition: “A delineated area of skin innervation by a spinal cord segment.”

44
Q

How do you test dermatomes?

A

By brushing the referral pattern areas listed below bilaterally and simultaneously 7-10 times, using the back of your hands.

45
Q

Where is the dermatome for L1 located?

A

Oblique band on the upper anterior thigh immediately below the inguinal ligament, from the iliac crest down to the groin.

46
Q

Where is the dermatome for L2 located?

A

Middle anterior thigh.

47
Q

Where is the dermatome for L3 located?

A

Anterior thigh immediately proximal to the patella.

48
Q

Where is the dermatome for L4 located?

A

Patella, medial leg, and medial aspect of the foot.

49
Q

Where is the dermatome for L5 located?

A

Lateral leg, dorsum of the foot, and the web space between the first two toes.

50
Q

Where is the dermatome for S1 located?

A

Lateral malleolus and lateral and plantar aspects of the foot.

51
Q

Where is the dermatome for S2 located?

A

Back of the leg and thigh.

52
Q

What is the reflex, muscle, and sensation involved with the L3-L4 disc root?

A

• Reflex: Patellar
• Muscle: Tibialis Anterior
• Sensation: Medial leg and foot

53
Q

What is the reflex, muscle, and sensation involved with the L4-L5 disc root?

A

• Reflex: None
• Muscle: Extensor Hallucis Longus (EHL)
• Sensation: Lateral leg and dorsum of foot

54
Q

What is the reflex, muscle, and sensation involved with the L5-S1 disc root?

A

• Reflex: Achilles
• Muscle: Peroneals
• Sensation: Lateral foot

55
Q

What should be examined during joint play examination?

A

Examination involves evaluating the mobility and function of the joint.

56
Q
A

Clinical Assessment T3 (4 decks)

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