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Clinical Assessment Special Tests > Lumber > Flashcards

Lumber Flashcards

1
Q

4 Lumber Movements

A

FL
EX
LF
Rotation

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2
Q

Straight Leg Raise (SLR)

AKA Lasegue’s Test

A

Posterolateral herniation
Space occupying lesion in the lumber spine

Positive
Numbness/ Tingling/ Pain travelling down the leg

  1. Px - supine- passive hip FL with straight leg raise until pain/tightness behind knee- lowering leg
    * positive- Pain and tightness behind knee
  2. Bragard’s test
    Px- passively foot Dorsiflex (Tibial nerve)
    *positive - Pain
  3. Brudzinski’s Sign/ Sotho-Hall test/ Hyndman’s test
    If Dorsiflextion is - , Px actively Flex Neck
    *Neck FL- ↑tension through meninges
    (esp dura matter down through the sciatic n)
  • Can not FL neck- meningitis!
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3
Q

Well Leg Raise

A

Posteromedial disc herniation

Positive
Reproduction of Symptoms
1.down the AFFECTED LEG at 40 degree Hip FL
2.less in the Unaffected leg

  1. Px- Supine- Passively FL UNAFFECTED hip with full knee EX
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4
Q

Slump Test

A

Herniated Disc ( affecting Dural Sheath of Spine)

Positive
Reproduction of S/S
1. Relieve with Neck Neutral/ Knee FL

  1. Px- High seated with hands behind back
  2. Slump forward at T and L spine
  3. Th Overpressure - Px C spine FL
  4. Px Knee EX
  5. Passively DorsiFL

*If Knee EX with Pain, EX C Spine (neutral)
With C spine Neutral - Can’t EX Knee- Positive

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5
Q

Bowstring Test

A
  1. Lumber disc herniation
  2. Sciatic n pathology

Positive

  1. Reproductive of symptoms
  2. N Braided cord-Severe and Chironic
  3. Px Supine - Hip FL with Knee EX till Pain or Parasthesia
  4. Knee FL (= Hip FL) Px leg on Th’s shoulder
  5. Th Strum the Tibial N (medial to Biceps tendon in popliteal fossa
  • SLR- positive– Sciatic n may be palpated
    Local pain and pain down the leg
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6
Q

Nachlas Test

Femoral Nerve Strech

A

Neural Tension Test by

  1. Stress Femoral N
  2. Mid Lumbar (L2-L4) Nerve Roots

Positive
Reproduction of Pain or Paresthesia over L2 &/or L3 &/or L4 dermatome area (Lower back and anterior thigh)
→ lesion or irritation to the Femoral N

  1. Px - Prone
  2. Th - passively EX hip (15 degree) with knee EX
  3. Passively and slowly FL the heel to Buttocks.
  • Femoral N on Stretch
  • Unilateral Pain on L2-4 dermatome (mostly L2,3)-if no contracture and lesion to Quads
  • Feeling Parasthesia—- Formication (snake / Insects walk on skin)
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7
Q

Valsalva Test

A

Intrathecal pressure Test

  1. Herniated Disc
  2. Osteophyte
  3. Space occupying Lesion

Positive
Reproduction of Symptoms Locally in Spine/ Down the Leg

  1. High seated
  2. Px - take a breath and Hold 6 secs
  3. Thumb in mouth and blow
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8
Q

Milgram’s test

A
  1. Intrathecal (herniated disc)
  2. Extrathecal (soft tissue injury )pathology

Positive

  1. Pain
  2. Inability to raise or hold the leg on the table
  3. Px Supine - both legs off table- Hold 30secs
    * Optimistic
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9
Q

Hoover’s Test

A

ウソ発見 (px malingering of LB pain)

Positive
1. No transferring of force

  1. Px - Supine
  2. Th - take Px’s each heel in palm - ask px raise each legs
  3. Th- feel a downward pressure in opposite leg
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10
Q

Kemp’ s/ Quadrant Test

A

↓ Intervertebral foramen of the L spine

  1. Facet jt Irritation
  2. Foramental stenosis

Positive
Localized Pain on ipsilateral side (Facet Pain)

*Localized pain on same side may also come from
- injured mm shorted position and SPASM
- pressure on Inflamed ILIOLUMBAR Lig
- compression of the jt surfaces of SACROILIAC jt
(Neurological Pain in Gulteal and Hip region)

  1. Facet - Closed pack position
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11
Q

Pheasant Test

A

Spinal Instability (L-spine)

Positive
1. Hyperlordotic in Lumber
2. Pain in Lowe limb
(* Achilles Tendon Reflex test at beginning and end of test)

  1. Px- Prone
  2. Th- one hand on Lumbar spine and compress
  3. Th- other hand grab px ankles and passively bring them to buttocks
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12
Q

Segmental Instability Test

A

Spinal Instability

Positive

  1. LB Pain with pressure when px is relaxed
  2. NO LB Pain when pressure is applied while active mm contraction
    * NO PAIN= area of Instability protected by mm contraction
  3. Px - Prone with legs on ground (Hip FL 90 degree)
  4. Th- Posterior and Anterior Glide segmentally over individual SPs
  5. Once Pain identified specific segment- PX lifts legs Up OFF floor by contracting hip and spinal extensor
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13
Q

Disc Herniation Tests

A
  1. Straight Leg Raise
  2. Well Leg Raise
  3. Slump
  4. Valsalva
  5. Milgram’s
  6. Bowstring
    * Pain behind of legs
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14
Q

Spinal Instability / Ankylosing pondylitis (Bamboo spine)

A
  1. Pheasant
  2. Segmental Instability
  3. MM test
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15
Q

Facet Irritation Tests

A
  1. Kemps
  2. Myotone
  3. Dermatone
  4. DRT
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16
Q

Nerve Compression (peripheral n)

A
  1. Straight Leg Raise
  2. Femoral Nerve Stretch / Nachlas
  3. Bowstring
  4. Myotone
  5. Dermatone
  6. DTR
  • Specific myotone
17
Q

Degenerative Disc Disease

A
  1. SLR
  2. WLR
  3. Slump
  4. Valsalva
18
Q

MM Tightness

A
  1. MM test
  2. Myotone
  3. Dermatone
  4. DTR
19
Q

Nerve Roots Compression

A
  1. Myotone
  2. Dermatone
  3. DTR
  4. Kemps (SLR/ WLR)
20
Q

Dermatone (specific nerve roots level)

A

L1- oblique band on the upper thigh below inguinal lig from iliac crest down to groin

L2- Middle anterior thigh
L3- Anterior Thigh immediately proximal to the patella
L4- Patella, Medial leg and medial aspect of foot
L5- Lateral leg and Dorsum of the foot, web space b/w first two toes
S1- Lateral malleolus and lateral and plantar aspect of foot
S2- back of leg and thigh

*Bilaterally /7-10times

21
Q

Myotone

*Weakness (w/o pain)- Spinal Nerve Root Impingement

A 
L2- Hip FL
L3- Knee Ex
L4- Ankle Dorsiflextion
L5- Big toe EX
S1- Foot Eversion
S2- Knee FL or Hip EX
22
Q

Disc L3-L4

  1. Root
  2. Reflex
  3. Mms
  4. Sensation
A
  1. L4
  2. Patellar
  3. Tib An
  4. Medial leg and foot
23
Q

Disc L4-L5

  1. Root
  2. Reflex
  3. Mms
  4. Sensation
A
  1. L5
  2. None
  3. EHL
  4. Lateral Leg, Dorsum of foot
24
Q

Disc L5-S1

  1. Root
  2. Reflex
  3. Mms
  4. Sensation
A
  1. S1
  2. Achilles
  3. Peroneals
  4. Lateral foot

Clinical Assessment Special Tests (10 decks)

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