Orthopedic & Neurologic Tests Flashcards
What does the Straight Leg Raise (SLR) test?
Sciatic nerve
Spinal nerve roots L5 - S2
What is the patient positioning for SLR?
What happens in the test?
- supine
- legs straight
- relaxed muscles
Doc lifts pt leg straight up - support ankle, cephalad hand by knee to encourage relaxation
During SLR, what does it mean if symptoms are produced or worsened 0 - 35 degrees of flexion?
Extradural sciatic involvement —>
Issue is distal to the IVD and dural sheath
During SLR, what does it mean if symptoms are produced or worsened 35 - 70 degrees of flexion?
Radicular pain into the leg
- IVD lesion
- nerve root compression
This is the danger zone!!
During SLR, what does it mean if symptoms are produced or worsened 70 - 90 degrees of flexion?
Mechanical lumbar pain likely the cause
If the patient experiences dull posterior thigh pain during the SLR what is wrong?
Tight hamstrings
What three tests make the triad for sciatic nerve testing?
What kind of orthopedic tests are these?
- straight leg raise
- braggard’s test
- bowstring test
These are all nerve traction tests.
What is the difference between performance of SLR and Braggard’s?
- Find pain point using SLR
- Back down a few degrees until pain stops
- dorsiflex foot
Does SLR work if the patient must bend their knee?
Yes, but the diagnostic ranges will be altered. Confirm results near the border with bowstring and/or braggard’s.
What is the patient positioning for Bowstring test?
What does the Dr do?
- supine
- lift leg, bend knee
- dr supports pt lower leg
Dr wraps hands into popliteal fossa and pulls upward, exerting pressure on hamstrings, lengthening posterior thigh
What are the 11 differential tests for lumbar versus SI pain?
- Goldthwait’s
- Supporting forward bend
- aSLR
- FABER
- Thigh thrust
- Gaenslen’s
- SI Stretch
- SI Compression
- Sacral thrust
- Hibb’s
- Yeoman’s
Goldthwait’s test looks like an SLR. What is the difference?
Dr. places hand under PSIS and feels what joint/bone is moving when pain recurs —> that is likely the problem joint
What is the patient/dr positioning for the supported forward bend test?
What is the action?
Dr stands behind pt, bracing pt sacrum with their thigh
Dr reaches and pulls on pt ASIS to hold pt against thigh
Pt bends forward at the waist
How are the results of a bsupported forward bend test interpreted?
If LBP is recreated during test, lumbar is implicated.
If LBP is NOT recreated during test, but happens when pt flexes forward unsupported, SI is implicated.
We know this bc the SI is blocked during this motion in this position.
How does aSLR differ from SLR?
The pt lifts their own leg in the same movement pattern as the SLR (a = active)
Dr applies downward force to shin of lifted leg —> pt resists
What are positive results from aSLR and what do they imply?
- familiar pain with raise
- difficulty or refusal to raise
- inability to raise legs to comparable height
- inability to resist dr pressure
All point to pelvic or SI instability
What is the patient positioning for FABER?
FABER =
Flexion
ABduction
External Rotation
Supine pt in figure 4 position
What does the Dr do in a FABER test?
With pt in figure 4 position, Dr braces opposite ASIS and presses down on bent knee
What does pain in the FABER test tell us?
- pain in the hip = acetabular joint issue
- pain in the SI = SI problem
What happens in the thigh thrust test?
Supine pt bends test knee to 90 degrees
Dr applies downward force on the knee, pressing down the femur
What does pain in the thigh thrust test tell us?
- pain in the hip = acetabular joint issue
- pain in the SI = SI problem
What is the patient positioning for Gaenselen’s test?
Supine pt with leg hanging off side of table (can also be straight on table)
Pt brings other knee to chest and stabilizes with their hands
What does the Dr do in Gaenslen’s test?
Dr supports pt bent knee and presses down on the thigh of the straight leg (that is hopefully hanging off the table)
What does pain in Gaenslen’s test indicate?
Pain on the affected side (leg that is pushed down) indicated SI lesion
What is the Dr positioning for the sacroiliac stretch test?
What does the Dr do?
Dr stands over supine pt with hands on ASIS (crossed arms and bent elbows)
Dr applies A-P and M-L pressure
What is being stretched in the SI stretch test?
What does a pain result mean?
Anterior portion of joints is being stretched
Pain indicates SI lesion, possibly an anterior SI ligament sprain
Which test is considered very effective for diagnosing SI Syndrome?
Sacroiliac Stretch Test
What is the Pt/Dr positioning in the sacroiliac compression test?
- Side-lying pt
- Dr stands behind pt and presses into ilium with both hands
What is being compressed in the SI compression test?
What does pain mean?
The posterior part of the SI joint is most affected by the compression test
Pain indicates SI lesion, likely in the posterior joint
What is the pt position and dr contact for the sacral thrust test?
- prone pt
- dr applies gentle P-A thrusts midline of sacrum around S2 or S3
What force is created in a sacral thrust test?
What is stressed by this procedure?
Shearing forces in the SI joint
Stresses anterior and posterior ligaments AND joint surfaces
What does pain in the sacral thrust test mean?
Joint pathology or dysfunction
What is the Pt/Dr positioning for Hibb’s test?
What does the Dr do?
- prone pt
- bend test leg to 90 and ABduct slightly
- Dr holds ankle of bent leg, gently braces opposite PSIS
- Dr pushes ankle down laterally
What motions are being created with Hibb’s test?
- Internal rotation of the hip
- Distraction of the SI joint
What does pain in Hibb’s implicate?
- pain in the hip = acetabular joint issue
- pain in the SI = SI problem
What is the Pt/Dr positioning for Yeoman’s test?
- prone pt
- knee of test leg flexed to 90
- Dr lifts leg at knee while gently bracing PSIS to create hip extension
Most likely cause of SI pain in Yeoman’s test?
Stress to the anterior SI ligament - possible sprain
Why is Gaenslen’s considered superior to Yeoman’s?
Gaenslen’s = supine pt with flexed knee to stabilize/ support lumbars so is better to separate SI and lumbar pain
Yeoman’s may not be tolerated by pt with lumbar extension pain or resistance
What is the cause of radicular pain vs sclerotongenous pain?
Radicular pain = nerve root compression or irritation
Sclerotongenous pain = referred pain from deep somatic structures
What are the characteristics of radicular pain?
Sharp and shooting
Follows dermatomal patterns
What are the characteristics of sclerotongenous pain?
Deep Dull Achy Diffuse Hard to localize
Pattern is not precisely dermatomal
What is the most common kind of referred pain?
Sclerotongenous
When testing for nerve root compression, what are the categories of tests performed?
- Sensory along dermatomal patterns
(Light touch, pinprick, vibration) - Motor (muscle tests)
- Reflexes (DTRs and superficial reflexes)
- Look for radicular pain
What is a common pt presentation that will lead you to perform neurologic tests on the low back and legs?
LBP that involves their legs!
