Lumbar Spine Exam Competency

Question 1

What are some things that you should INSPECT while doing a lumbar exam?

Answer 1

• Gait
• Lordosis
• Slumped over: Could be depressed
• Standing Erect: Could be protecting from vertebral foramen stenosis or herniated disc
• Anatomical Landmarks: Scapular spine and angle, Greater Trochancter, Iliac crest

Question 2

What is indicated when you have a “Step-Off” in the Spinous Processes?

Answer 2

• Post-traumatic Issue (Spondylolisthesis)

Question 3

What are the different muscles and nerve roots that you are testing with muscle strength tests?

Answer 3

• Iliopsoas (L1-L3)
• Rectus Femoris (Primarily L4)
• Hip ADductors (L2-L4)
• Hip ABductors (L5)
• Tibialis Anterior (L5)
• Gluteus Max. (S1-S2)
• Gastrocnemius (Primarily S1)
• Walk on heels (Dorsiflexion, L5)
• Walk on Toes (Plantarflexion, S1)

Question 4

What are the Deep Tendon Reflexes of the Lower Extremities? Which nerve are you primarily looking at?

Answer 4

1. Patellar Reflex (L4)

2. Achilles Reflex (S1)

Question 5

What are you looking for in a straight leg Raise? When do you get a positive sign?

Answer 5

Looking for reproduction of symptoms (neurologic pain, paresthesia)

Positive Test is typically between 30-60 degrees

SENSITIVE but not very SPECIFIC

Question 6

What are you looking for in a Contralateral Straight Leg Raise?

Answer 6

Reproduction of paresthesia on the opposite side of the leg that was being raised (Positive Test)

Question 7

Explain Hoover’s Test.

Answer 7

• Monitor the patient’s asymptomatic leg around the achilles tendon
• Have patient attempt to lift symptomatic leg
• You should have involuntary EXTENSION of the asymptomatic leg
• Looking for if the patient is giving effort or not!

Question 8

Explain Thomas Test.

Answer 8

Iliopsoas Test (Positive Test means you have TIGHT Iliopsoas muscles)

Question 9

Explain the Gaenslen Test.

Answer 9

Testing for Sacroiliac Problems

Extend one hip and Flex the other.

Creating a Torsion

Positive Test: Reproduction of Pain in the sacral region

Question 10

Explain the Stork Test.

Answer 10

Looking for Spondylosis or Spondylolisthesis

• Balance on one leg and then extend lumbar spine backwards

Question 11

Explain Kernig’s Sign.

Answer 11

Testing for meningeal irritation

Have hip and knee both flexed

Extend the knee and see if you REPRODUCE the symptoms

Question 12

Explain Cauda Equina Syndrome.

Answer 12

• Bowel and Bladder dysfunction

- EMERGENCY management and surgical decompression within 48 hours or you can have permanent damage!

Question 13

What is Ferguson’s angle?

Answer 13

• 30-40 Degrees is normal

- Where L5 and S1 meet

Question 14

Explain the different stages of Spina Bifida.

Answer 14

1. Spina Bifida Occulta: NO spinal cord protrusion (failure of vertebral arch to close)
2. Meningocele: Meninges forced out between vertebra (usually no neurological damage)
3. Myelomeningocele: Spinal Cord and Meninges protrude through opening (Very SEVERE with neurologic complications)

Question 15

Explain a Positive Clinical Presentation of Babinski’s Sign.

Answer 15

Weakness, continuous contractions, hallux extends while other toes flex