Lumbar spine tests (w/MRS) Flashcards
L1, L2 Nerve root motor test
Muscle: iliopsoas
Action: raise bent knee
Peripheral nerve: Ventral rami and Femoral n.
L3 Nerve root motor test
Muscle: quadriceps
Action: leg extension
Peripheral nerve: Femoral nerve
L4 Nerve root motor test
Muscle: Tibialis anterior
Action: ankle dorsiflexion
Peripheral nerve:
L5 Nerve root motor test
Muscle: tibialis anterior
Action: ankle dorsiflexion
Muscle: Peroneus longus and brevis
Action: ankle eversion
Peripheral nerve: Deep peroneal nerve
S1 Nerve root motor test
Muscle: Gastrocnemius/Soleus
Action: ankle plantar flexion
Muscle: Flexor hallucis longus
Action: big toe flexion
Peripheral nerve: tibial nerve
L4 nerve root reflex test
Muscle: patella
Response: brisk contraction of quadriceps m. and extension of leg at knee
L5 nerve root reflex test
Muscle: hamstrings
Response: brisk contraction of the medial hamstring m. (semitendinosus)
S1 nerve root reflex test
Muscle: achilles
Response: brisk contraction of gastrocsoleus and plantar flexion of foot
L3 nerve root sensory test
Central quad, high
L4 nerve root sensory test
Central quad, low
L5 nerve root sensory test
outside of the calf
S1 nerve root sensory test
lateral calf
Diagnostic Cluster for Lumbar Stenosis
- Relief during immediate sitting is strongly suggestive of spinal stenosis
- The most diagnostic combination included a cluster of:
- bilateral symptoms;
- leg pain more than back pain;
- pain during walking/standing;
- pain relief upon sitting;
- age >48 years.
- Meeting any one of five positive findings demonstrated a high sensitivity of 0.96 (95% CI = 0.94-0.97) and a low negative likelihood ratio (LR-) of 0.19 (95% CI = 0.12-0.29).
- Meeting four of five findings yielded a LR+ of 4.6 (95% CI = 2.4-8.9) and a post-test probability of 76%.
Diagnostic Cluster for Cauda Equina Syndrome
- Rapid symptoms within 24 hours 89% sensitivity
- History of back pain 94% sensitivity
- Urinary retention 90% sensitivity
- Loss of sphincter tone 80% sensitivity
- Sacral sensation loss 85% sensitivity
- Lower extremity weakness or gait loss 84%sensitivity
Diagnostic Cluster for Lumbar Radiculopathy
- Dermatomal pattern (OR = 4.1)
- Pain on cough, sneezing, straining (OR = 3.2)
- More pain Sitting (OR=1.9)
- Subjective muscle weakness (OR = 2.2)
- Subjective Sensory loss (OR = 2.1)
- Paresis/Motor Loss (OR = 3.7)
- +SLR (OR = 3.9)
- Unilat Ankle reflex (OR = 3.9)
Bechterew’s test
Positioning: Patient seated
Instruction: Keep your back straight and extend your leg
Technique: Observe. Don’t let pt lean back to reduce pain
Interpretation: Symptoms down posterior thigh past knee indicates possible L4, L5 or S1 radiculopathy due to: herniated disc stenosis osteophytes tumors … bone, meninges, soft tissue local infection or fracture
Slump test
Positioning: Pt seated upright, arms behind back; stand at the side
Instruction: Let me know if you feel anything at any point
Technique:
- patient “slumps” with cervical extension (stretching sciatic nerve)
- cervical spine is fully flexed and released
- one knee maximally extended … cervical spine is fully flexed and released
- dorsiflex ankle … cervical spine is fully flexed and released
Interpretation: Stretching the sciatic nerve to recreate pain. Lots of hamstring tightness, different quality of pain (burning, aching vs tingling, numbness of radiculopathy)
Kemp’s test
Positioning: Pt seated, stand behind. One hand on shoulder for support. other hand on the lamina (if testing the right side, left hand will be just off the right of the SPs)
Instruction: Let me know if there’s pain along the way.
Technique: Trunk extension, ipsilateral
lateral flexion, and slight
ipsilateral rotation around
contact hand
Interpretation: Positive is low back pain with or without pain radiating down leg
• Nerve root compression if pain radiates
• Local low back pain without radiating pain …muscle strain / ligamentous strain / facet irritation / capsular inflammation
Straight leg raise
Positioning: Pt supine. Stand to the side One hand above knee, other pressing up on heel.
Instruction: let me know when there’s pain
Technique: Passively elevate straight leg. Note angle of onset of pain
Interpretation:
o “Hard” positive – sharp, burning, electrical pain past knee with hip flexed 35°-70°
• Sciatic nerve irritation / L4-S1 nerve roots radiculitis from herniation, tumor, spinal canal stenosis, osteophytes
o “Soft” or “equivocal” positive – pain radiating into lower extremity but not past knee
• meaningful – other evidence of nerve root or sciatic n. is inflamed / compressed
• insignificant – no other evidence supports a radicular syndrome
Every soft positive: stop, drop leg a bit to relieve the pain. Then run sicard’s or bragard’s.
o Negative test – no pain, pain in back, pain to buttocks
• suggests nerve root is not involved / most likely sacroiliac or lumbar
o Focal point of pain in the leg or pelvis
• “alarm sign” suggesting a tumor in location of pain
Sicard’s test
Positioning: Immediately after positive straight leg raise
Instruction:
Technique: lower straight leg 5°-10° or to height just below the level causing symptoms then dorsiflex (extend) the great toe
Interpretation: Duplication or increase in pain suggests sciatic radiculopathy or nerve root compression
Bragard’s test
Positioning: Immediately after positive straight leg raise
Instruction:
Technique: lower straight leg 5°-10° or to height just below the level causing symptoms then dorsiflex (extend) the foot
Interpretation: Duplication or increase in pain suggests sciatic radiculopathy from …
disc herniation
encroachment
space occupying lesion
Well leg raise
Positioning: Pt supine, stand to the unaffected side
Instruction: Let me know where there’s pain, don’t try to help.
Technique: passively elevate the non-symptomatic straight leg from the table
Interpretation: Positive is increased symptoms in the symptomatic leg
• nerve root irritation : disc lesion – disc herniation, encroachment by osteophytes next step would be imaging
