Lumbar Spine Exam Flashcards
Straight Leg Raise Test
- sciatic neuropathy or lumbosacral radiculopathy
- pain during tedst from dura (being pulled when lift leg 30-70 degrees)
- dura press on already irritate nerve roots impringed upon
- compression of spinal nerve roots cause painful radiculopathy and muscle weakness and dermatomal sensory loss (usually from herniated disc)
Where do 90-95% of herniated discs occur?
-L4-L5 and L5-S1
What is the Straight Leg Raise Test?
- pt supine, passively raise pts relaxed leg flexing at the hip (add dorsiflexion)
- ensure pt not helping
- assess degree of elevation pain occurs (do not mistake hamstring/butt discomfort for positive test
- indicated increased dural tesnsion
POSITIVE test= presence of worsening radicular pain radiating into ipsilateral leg between 30-60 degrees
- if greater than 70 may be nerve root irriation but increases liklihood of mechanical low back pain due to muscle strain or joint disease
- High sensativity low specificity for dx of radiculopathy due to disc herniation
What is the contralateral (crossed) straight leg raise test
-passive elevation of unaffected leg by doc
POSITIVE test= when radicular pain produced in affected leg with lifting of the unaffected leg
*specific for radiculopathy due to disc herniation but poor sensitivity
What is hoovers sign?
-test for malingering or functional weakness “conversion disorder” (check if pt actually trying)
- pt supine hold hand under heel of unaffected leg and ask pt to try to flex up affected leg against resistance
- if honest effort made should feel unaffected legs heel pushing down as attempt to raise affected leg by flexing at hip
POSITIVE sign= no downward force unaffected leg as they “attempt” to lift affected leg indicating functional weakness or malingering of the patient
What is the hoovers sign based on?
-based on synergestic contraction where there is involuntary extension of nroaml leg when flexing contralateral leg against resistance
What is the thomas test?
- pt supine and flex both legs to chest (flatten lordosis and stabilize pelvis)
- drop affected leg toward table (keep other at chest) and ask pt to relax to allow full extension at hip
POSITIVE test= lower extremity on involved side unable to fully extend at hip and ilipsoas shortening/contracture
*iliopsoas hypertonicity common finding in acute and chronic lower back pain
What is gaenslen test (SI joint pain)
- helps r/o SI joint pain as cause of low back pain
- pt supine flex 1 hip/knee to chest while other extending hip off side of table
- can also do lateral recumbent, flex lower hip and hold, doc extends top hip
- maneuver stresses both SI joints
POSITIVE test= posterior pelvic pain–> indicates SI dysfunction
What is valsalva used for diagnosing?
- evidence of nerve root irritation typically manifest as sciatica (sharp burning pain radiating down posterior/lateral leg to foot/ankle)
- radiculopathy pain radiating down past knee
- associated with numbness and tingling
POSITIVE test= sciatica due to disc herniation increases with cough, sneeze, and valsaalva
What is kernigs sign (meningeal irritation)?
- similar to straight leg raise
- pt supine flex hip/knee to 90
- attempt to passively extend leg at the knee
POSITIVE test= increased resistance to extension and pain behind knees radiating to posterior thigh
- due to menigeal/dura irritation
- paired with nuchal rigidity and brudzinskis sign for patient meningeal signs
What is the stork test?
- single leg weight bearing hyperextension test
- flex hip and knee of 1 leg
- stabilize pt iliac crest and let them lean back extending lower back
POSITIVE test= pain in lower back as it stresses posterior elements of spine on ipsilateral side
- indicates possible pars defect/stress fracture
- increased risk spondylolisthesis
