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musculo > objective examination: lumbar spine > Flashcards

objective examination: lumbar spine Flashcards

1
Q

list the order of the objective examination for the lumbar spine

A

observation
AROM
repeated movements
PROM/passive accessory motion testing (joint play)
muscle performance testing
neurological testing
special tests
palpation

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2
Q

what are some observations to watch for in the exam?

A

gait pattern
posture in standing
sitting posture (rate it)

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3
Q

how do we name a shift or acute defromity?

A

by the relationship of the shoulders to the pelvis

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4
Q

what do we do with AROM?

A

expose the area when possible, look for midline movement or deviations that can occur. derrangements may deviate away from painful side. ANRs may deviate to the side of the ANR.

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5
Q

what is the normal AAOS value for flexion?

A

60º

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6
Q

what is the normal AAOS value for extension?

A

25º

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7
Q

what is the normal AAOS value for side-bending?

A

25º

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8
Q

what is the normal AAOS value for rotation?

A

45º

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9
Q

what repeated movements can we do for the lumbar spine?

A

repeated flexion in standing (RFIS)
repeated extension in standing (REIS)
repeated flexion in lying (RFIL)
repeated extension in lying (REIL)
side gliding in standing

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10
Q

what is derangement syndrome?

A

a classification defined by the presence of directional preference with RAPID change in symptoms associated with the obstruction of a particular joint

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11
Q

what is dysfunction syndrome?

A

classification associated with symptoms from typical mechanical deformation of structurally impaired soft tissue

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12
Q

what is postural syndrome?

A

a classification associated with no pathophyisiological abnormalities but an abnormal stress to the tissue

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13
Q

what is the other group for mechanical diagnosis and therapy classifications?

A

do not display the anticipated responses or characteristics of the aforementioned syndromes; subgroups within the classification help narrow down the treatment

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14
Q

what are some responses to movement during?

A

decrease, abolished, increase, produced, no effect, centralizing, peripheralizing

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15
Q

what are some responses to movement after?

A

better, no better, worse, no worse, no effect, centralized, peripheralized

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16
Q

what is the progression of forces?

A

self generated joint AROM
self generated joint AROM and overpressure
clinician overpressure
clinician mobilization
clinician manipulation

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17
Q

what is PROM for lumabr?

A

performed in sidelying. looking to reproduce patient’s symptoms. looking to assess the motion between motion segments

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18
Q

what is the end feel for PROM flexion?

A

firm

19
Q

what is the end feel for PROM extension?

A

firm or hard

20
Q

what is the end feel for PROM sidebending/rotation?

A

firm or hard due to the approximation of the aygoapophyseal joints

21
Q

what are we looking for with passive accessory motion testing (joint play)?

A

performed in prone
looking to reproduce the patients concordant sign
looking to assess motion at a specific segment
note end feel- should be firm

22
Q

what muscle performance testing do we do?

A

MMT
resisted isometrics and muscle endurance testing (core endurance tests of McGill - front plank test)
hicks CPR on stabilization (treatment based classification scheme)

23
Q

what MMTs do we perform for lumabr?

A

trunk flexion, trunk extension, trunk rotation

24
Q

what is the point of hicks CPR on stabilization?

A

identifies more likely to benefit from a stabilization approach

25
Q

what are the variable of hicks CPR on stbailization?

A

younger than 40 y/o
greater general flexibility (SLR ROM >90)
“instability catch” or aberrant movements during flexion/extension ROM
positive findings on the prone instability test

26
Q

what does 3 out of the 4 variables of hicks CPR increase the likelihood of succes with a lumbar stabilization program to?

A

33% to 67%

27
Q

what are other important predictors of a successful outcome include for hicks CPR?

A

hx of episodic LBP: increased frequency of episodes
higher scores on the FABQ
higher pain rating scores
hypermobility detected during PAIVM testing

28
Q

what are neurological exam testing we can do in the presence of symptoms below the knee, vague pattern/behavior or red flags?

A

myotomes, dermatomes, MSRs/DTRs, CNS impairments: clonus, babinski, hoffman, LLNT (SLR, slump, prone knee bend)

29
Q

recap dermatome testing

A

L1 upper thigh
L2 middle thigh
L3 lower thigh, knee joint region
L4 medial (and post-med) shin, medial malleolus
L5 lateral (and post-lat) shin, top of foot, great toe
S1 lateral border of foot, heel, middle of posterior calf
S2 popliteal fossa, posterior thigh

30
Q

recap myotomal testing

A

L1-L2 hip flexion
L3 knee extension
L4 ankle DF
L5 great toe extension
S1 ankle PF
S2 knee flexion
S3-S4 toe flexion

31
Q

recap DTR/MSR

A

L3/4 patellar tendon
S1 achilles tendon

32
Q

what does the SLR and slump test do?

A

examines the mechanical and physiological properties of nervous tissue and related structures
looking for reproduction of patients symptoms or impaired mobility
3 criteria for considering test positive (reproduce comparable signs, asymmetrical findings, sensitizing movement changes in patients symptoms)

33
Q

how is the straight leg test performed?

A

pt lying supine on the table with head in and neck in and neck in neutral
support the leg at the heel and raise the leg to the point of symptom reproduction
sensitizing maneuvers
= test is reproduction of concordant symptom, sensitization, and asymmetry

34
Q

what is SLR interpretation?

A

Neurologic pain which is reproduced in the leg and low back between 30-70 degrees of hip
flexion is suggestive of lumbar disc herniation at the L4-S1 nerve roots.
Pain at less than 30 degrees of hip flexion might indicate acute spondyloithesis, gluteal abscess,
disc protrusion or extrusion, tumor of the buttock, acute dural inflammation, a malingering
patient, or the sign of the buttock.
Pain at greater than 70 degrees of hip flexion might indicate tightness of the hamstrings,
gluteus maximus, or hip capsule, or pathology of the hip or sacroiliac joints.
Positive Cross Straight Leg Raise – indicative of nerve root compression secondary to disc
protrusion or extrusion.

35
Q

what are common nerve bias and sensitizing maneuvers?

A

Sciatic n. - (supine) hip flexion/adduction, knee extension, ankle dorsiflexion
Tibial n. - (supine) hip flexion, knee extension, ankle dorsiflexion/eversion
Sural n. - (supine) hip flexion, knee extension, ankle dorsiflexion/inversion
Fibular n. - (supine) hip flexion, knee extension, ankle plantarflexion/inversion

36
Q

how is the slump test performed?

A

Pt sits straight with the arms behind the back,
legs together, back of knees against the edge
of the table
Ask the patient to slump as much as possible
(keep the sacrum vertical)
Maintain full spinal flexion with overpressure,
ask the patient to look down
Ask the patient to extend their knee
Add dorsiflexion of the patient’s ankle
Lastly, neck flexion is released to see if
symptoms abate

37
Q

what is a positive slump test?

A

Reproduction of concordant symptoms
Sensitization movement changes symptoms
asymmetrical findings (knee extension less on the involved side)

38
Q

how is the prone knee bend test performed?

A

Pt lies prone on the table, arms at the side or
above shoulder level (picture)
Examiner places one hand on pelvis, with the
other hand he/she flexes the pt’s knee.
Bend the knee until reproduction of symptoms
Sensitizing movements include hip extension- Femoral n.

39
Q

what are some special tests for the lumbar spine?

A

Special Tests for Stabilization Exercises
◦ Prone Instability Test
◦ Posterior Pelvic Pain Provocation (P4) Test
◦ Active Straight-Leg Raise Test
◦ Trendelenburg Test
Quadrant Test
Sign of the Buttock

40
Q

how is the prone instability test performed?

A

Pt lies with their torso on the table, legs off the
edge, feet resting on the floor
Examiner performs a central PA pressure over
the spine, looking to elicit pain
Maintaining contact with the painful segment,
the examiner asks the pt to lift their feet of the
floor
With the patient’s feet in the air the examiner
performs a central PA pressure again
+ test = significant reduction of painful
symptoms

41
Q

how is the posterior pelvic pain provocation (P4) test performed?

A

The patient is supine.
The therapist passively flexes the patient’s hip
to 90 degrees and applies a posteriorly directed
force through the longitudinal axis of the femur.
The test is positive if the patient reports a deep
pain in the gluteal area during the test.

42
Q

how is the active straight- leg raise test performed?

A

The patient is supine with straight legs and feet
20 cm apart.
The patient is instructed to lift the legs one after
the other approximately 20 cm above the table
without bending the knee.
The patient is asked to score the difficulty of the
task on a 6-point scale (0, no difficulty at all; 1,
minimally difficult; 2, somewhat difficult; 3,
fairly difficult; 4, very difficult; 5, unable to do).
Any score greater than 0 is a positive test.

43
Q

how is the trendelenburg test performed?

A

The therapist is behind the standing patient.
The patient is asked to stand on one foot while
flexing the opposite knee and hip to 90 degrees.
The test is positive if the hip descends on the
flexed side.

44
Q

how is the quadrant test performed?

A

Patient stands with feet shoulder
width apart
The examiner asks the patient to lean
back, rotate, and side-bend to one
side (“reach for the back of your
knee”)
Image: Ext, L SB, L Rot
The movement is repeated on the
opposite side
+ test is identified by reproduction of
the pt’s concordant sign

musculo (19 decks)

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