Lumbar Spine Exam

Question 1

What is normal Ferguson’s angle?

Answer 1

30-40 degrees

Question 2

What is Ferguson’s angle?

Answer 2

Represents angle of the lumbosacral junction as measured by inciniation of the first sacral vertebra to the horizontal

Question 3

In spondylolysis as seen as the scottie dog collar, where exactly is the fracture?

Answer 3

Pars interarticularis

Question 4

what is spondylolisthesis?

Answer 4

anterior slippage of one vertebra on another after a pars-interartularis fracture

Question 5

what muscle can you use to check the motor function of L1?

Answer 5

Ilipsoas (hip flexion) - innervation form L1-L3

Question 6

What muscle you can check to check for the motor function of L4?

Answer 6

Quadriceps (knee extension)

Question 7

what muscle can you check to check for the motor function of s1?

Answer 7

Gastrocnemius (ankle planterflexion)

Question 8

Hip adductors are innervated by what nerve root?

Answer 8

L2-L3

Question 9

when you’re asking patient to walk on their heel, what nerve root are you checking?

Answer 9

L5 (dorsiflexors)

Question 10

What nerve root is the most common radiculopathy affecting the lumbosacral spine?

Answer 10

L5

Question 11

when pt is asked to walk on their toes to test for strength of plantarflexor (gastrocnemius/soleus complex) what nerve root is being checked?

Answer 11

S1

Question 12

what is the straight leg test used for?

Answer 12

Used to test for lumbosacral radiculopathy and/or sciatic neuropathy.

Question 13

where it the most common site of disc herniation in the lumbar region?

Answer 13

L5-S1

Question 14

How do you perform a straight leg test?

Answer 14

Pt supine, raise pts relaxed and straightened leg, flexing at the hip.

Question 15

what is a positive test for straight leg test?

Answer 15

Positive sign usually occurs at 30-60 degrees.

Question 16

why do you have to raise at least to 30 degrees to to check for nerve root compression as seen in straight leg test?

Answer 16

Dura is not stretched until 30 degrees.

Question 17

in straight leg test, pain in greater than 70 may still indicate nerve root compression, but increase likelihood that pain is due to _

Answer 17

mechanical low back pain due to muscle strain or joint disease.

Question 18

Straight leg by itself is not so specific. what else can you perform to increase the specificity of the straight leg test finding?

Answer 18

Perform the contralateral (crossed) straight leg raise test)

Question 19

what is Hoover’s sign?

Answer 19

It is a test for malingering or functional weakness (conversion disorder)

Question 20

How is Hoover’s sign test performed? what is positive

Answer 20

Pt supine, hold hand under the heel of the unaffected leg and ask pt to flex the affected leg against slight resistance while maintaining extension at knee. + = no downward force on the unaffeted leg as they attempt to lift the affected leg.

Question 21

What is the Thomas test, how do you perform it and what is a positive test?

Answer 21

psoas tension. Pt tested in supine position with buttocks towards ends of table. Flex both hips and knes to chest and drop the affected leg toward the table, keeping the other knee at chest. Positive test is that the lower extremity on the involved side will be unable to fully extend at hip. Indicates ilipsoas tension, shortening or contracture which is a common finding in acute and chronic low back pain.

Question 22

What is Gaenslen test, how do you perform it and what is positive?

Answer 22

Tests for SI joint pain. Pt supine, flex on hip and knee to chest while simultaneously extending oppsoite hip (off side of the table). Maneuver stresses both SI joints. Positive pelvic pain indicates a positive test for SIJ dysfunction or pathology

Question 23

What is the rationale behind valsalva as a way to test for sciatica/lumbar?

Answer 23

Sciatica due to disc herniation usually increase with coughing, sneezing or performance of valsalva maneuver.

Question 24

What is Kerng’s sign, how do you perform it and what is positive test?

Answer 24

Kernig’s sign is testing for meningeal irritation. Pt supine, and flex hip and knee to 90. Attempt to passively extend the leg at knee. Positive = increased resistance to extension and pain behind knee.

Question 25

What other test is kernig sign paired with, and together indicates patient with meningeal signs.

Answer 25

Brudzinski’s

Question 26

What is Stork Test, how do you perform it and what is positive test?

Answer 26

It tests for possible pars defect/stress fracture. Stand normally, flex hip and knee of one leg. Stabilize at iliac crests, and have patient lean back extending the lower back. Positive test = pain in lower back as it stresses the posterior elements of the spine on the ipsilateral side

Question 27

what is cauda equina syndrome/

Answer 27

Condition of spinal nerve root compression usuauly by massive disc proturion, fracture/trauma or tumor that results in bowel/bladder dysfunction

Question 28

what are some clinical features of cauda equina syndrome?

Answer 28

Pain

• can precede neurologic symptoms by weeks in cases not secondary to immediate trauma
• bowel/bladder dysfunction
• sensory loss of perineum (saddle anesthesa
• bilateral sciatica and leg weakness

Question 29

what is spina bifida?

Answer 29

congenital malformation (usually failure of lamina fusion in vertebra) leading to neural tube defects in lumbar spine.

Question 30

What are the three types of spina bifida and what are their severity?

Answer 30

1. Spina bifida occulta - congenital and asymptomatic most common at L5-S1. May find coarse patch of hair or birthmark or dimple, small split in vertebrae, NO spinal cord protrusion
2. Meningocele - meninges forced out between vertebrae - requires surgery. usually no neurological damage
3. Mylomeningocele: most common type. unfused portion of spinal cord protrudes through opening. very severe (permanent) neurologic complications