Lumbar Spine Exam

Question 1

Establishing an outcome/asterisk

Answer 1

“Where is your pain?”

“is that the same pain you are here to see me about today?”

Question 2

Medical screening

Answer 2

BP, HR, RR, O2 level sat, Well’s criteria for PE/DVT

Question 3

What is the Well’s criteria for DVT?

Answer 3

Active cancer
Paralysis, paresis, or immobilization of LE
Recently bedridden >3 days or major surgery within 4 weeks.
Localized tenderness in deep venous system
Entire LE swelling
Calf swelling by >3cm
Putting edema
Collateral superficial veins
Anything 3 or greater is a 75% of DVT

Question 4

What is the Well’s criteria for PE?

Answer 4

Clinical symptoms of DVT
Other diagnosis than PE
Pule rate >100 BPM
Immobilization greater than 3 days in last 4 weeks
DVT/PE previous
Hemoptysis
Malignancy

Greater than 4, likely

Question 5

Sensation on LE

Answer 5

L1: Inguinal area
L2: Mid anterior thigh
L3: Medial Knee
L4: Medial Malleolus
L5: Distal medial dorsum of foot
S1: Lateral border of foot
S2: Medial / Posterior calcaneus

Question 6

Lower Quarter Scanning Exam:

Answer 6

Hip Flexion: L2-L3
Knee Extension: L3-L4
Ankle dorsi: L4-L5
Walk on toes L5-S1
Great Toe Extension: L5
Ankle Eversion S1-S2

Question 7

Deep Tendon Reflex: Quadriceps

Answer 7

L2-L4 @ patellar tendon - knee extension

Question 8

Deep Tendon Reflex: Achilles

Answer 8

L5-S1 @ achilles tendon - ankle plantarflexion

Question 9

Cutaneous reflexes to assess UMN Lesion that are above anterior horn or motor nuclei cranial nerve

Answer 9

Abdominal Reflex
Babinski
Hoffman

Question 10

Hoffman’s sign

Answer 10

Flick distal end of middle finger to illicit flex of thumb and index finger

Question 11

Lumbar Spine Radiculopathy can cause:

Answer 11

Myotomal strength changes
Reflex Changes
Sensory Changes
Radiating pain along nerve

Question 12

If there is an UMN lesion observed, what should happen?. What about a LMN lesion?

Answer 12

Upper= referred
Lower= referred but can proceed with treatment

Question 13

To determine leg length discrepancy? What is the most reliable?

Answer 13

Standing is most reliable. Have them stand and have knees extended. See if pelvis @ ASIS is level.

Question 14

When most a LLD be taken?

Answer 14

After hip fracture, ORIF, THA.

Question 15

What is a non-weight bearing method for LLD?

Answer 15

Supine, ASIS to medial malleolus

Question 16

What is a meaningful LLD?

Answer 16

Less than 5 mm is hard to clinically detect . Supine method is very unreliable. Less Reliability in obese individuals.

Question 17

What is a lateral shift?

Answer 17

Acute visible frontal plane deviation where there is low back and leg pain.

Named by the side the shoulders are shifted to.

Question 18

What can cause a lateral shift?

Answer 18

Disc herniation or other multiple etiologies.

Question 19

Scoliosis is named how?

Answer 19

Name for the side of the convexity.

Thoracic: apex between t2-t11; often t9
Thoracolumbar t12-l1 ; often t11/12
Lumbar: apex between l2 and l4 ; often l2/l3

Question 20

During a movement analysis; the functional tests of: squats, step down, heel walk and toe walk are for which spinal root levels?

Answer 20

Functional Squat and Step Down L3-L4
Heel Walk: L4-L5
Toe Walk: L5-S1

Question 21

What tests can be ran for a movement analysis?

Answer 21

Functional Squat, Step down, Heel Walk, Toe Walk, LQ scan, Gait analysis, Muscle Length Tests

Question 22

Which hip tests should be ran?

Answer 22

FADIR (99 sensitivity; hip pain in groin)

FABER- Passive Flexion with ABduction and External Rotation (pain in groin)

Question 23

What are the muscle length tests?

Answer 23

Modified Thomas Test
Ely’s Test
Ober’s Test
Popliteal Angle Test

Question 24

What is normal lumbar AROM?

Answer 24

Flexion- 60
Extension 25
Side Bending- 25
Rotation -45

Question 25

Treatment progression:

Answer 25

Know baseline pain and perform repeated movement 5-20 in one direction.

If pain worsens, stop

If pain has no effect, proceed with caution

If pain decreases/centralizes, GO!