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Pelvic Manipulation > Orthopedic & Neurologic Tests > Flashcards

Orthopedic & Neurologic Tests Flashcards

1
Q

What does the Straight Leg Raise (SLR) test?

A

Sciatic nerve

Spinal nerve roots L5 - S2

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2
Q

What is the patient positioning for SLR?

What happens in the test?

A
  • supine
  • legs straight
  • relaxed muscles

Doc lifts pt leg straight up - support ankle, cephalad hand by knee to encourage relaxation

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3
Q

During SLR, what does it mean if symptoms are produced or worsened 0 - 35 degrees of flexion?

A

Extradural sciatic involvement —>

Issue is distal to the IVD and dural sheath

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4
Q

During SLR, what does it mean if symptoms are produced or worsened 35 - 70 degrees of flexion?

A

Radicular pain into the leg

  • IVD lesion
  • nerve root compression

This is the danger zone!!

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5
Q

During SLR, what does it mean if symptoms are produced or worsened 70 - 90 degrees of flexion?

A

Mechanical lumbar pain likely the cause

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6
Q

If the patient experiences dull posterior thigh pain during the SLR what is wrong?

A

Tight hamstrings

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7
Q

What three tests make the triad for sciatic nerve testing?

What kind of orthopedic tests are these?

A
  • straight leg raise
  • braggard’s test
  • bowstring test

These are all nerve traction tests.

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8
Q

What is the difference between performance of SLR and Braggard’s?

A
  • Find pain point using SLR
  • Back down a few degrees until pain stops
  • dorsiflex foot
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9
Q

Does SLR work if the patient must bend their knee?

A

Yes, but the diagnostic ranges will be altered. Confirm results near the border with bowstring and/or braggard’s.

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10
Q

What is the patient positioning for Bowstring test?

What does the Dr do?

A
  • 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

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11
Q

What are the 11 differential tests for lumbar versus SI pain?

A
  1. Goldthwait’s
  2. Supporting forward bend
  3. aSLR
  4. FABER
  5. Thigh thrust
  6. Gaenslen’s
  7. SI Stretch
  8. SI Compression
  9. Sacral thrust
  10. Hibb’s
  11. Yeoman’s
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12
Q

Goldthwait’s test looks like an SLR. What is the difference?

A

Dr. places hand under PSIS and feels what joint/bone is moving when pain recurs —> that is likely the problem joint

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13
Q

What is the patient/dr positioning for the supported forward bend test?

What is the action?

A

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

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14
Q

How are the results of a bsupported forward bend test interpreted?

A

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.

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15
Q

How does aSLR differ from SLR?

A

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

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16
Q

What are positive results from aSLR and what do they imply?

A
  • 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

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17
Q

What is the patient positioning for FABER?

A

FABER =

Flexion
ABduction
External Rotation

Supine pt in figure 4 position

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18
Q

What does the Dr do in a FABER test?

A

With pt in figure 4 position, Dr braces opposite ASIS and presses down on bent knee

19
Q

What does pain in the FABER test tell us?

A
  • pain in the hip = acetabular joint issue

- pain in the SI = SI problem

20
Q

What happens in the thigh thrust test?

A

Supine pt bends test knee to 90 degrees

Dr applies downward force on the knee, pressing down the femur

21
Q

What does pain in the thigh thrust test tell us?

A
  • pain in the hip = acetabular joint issue

- pain in the SI = SI problem

22
Q

What is the patient positioning for Gaenselen’s test?

A

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

23
Q

What does the Dr do in Gaenslen’s test?

A

Dr supports pt bent knee and presses down on the thigh of the straight leg (that is hopefully hanging off the table)

24
Q

What does pain in Gaenslen’s test indicate?

A

Pain on the affected side (leg that is pushed down) indicated SI lesion

25
Q

What is the Dr positioning for the sacroiliac stretch test?

What does the Dr do?

A

Dr stands over supine pt with hands on ASIS (crossed arms and bent elbows)

Dr applies A-P and M-L pressure

26
Q

What is being stretched in the SI stretch test?

What does a pain result mean?

A

Anterior portion of joints is being stretched

Pain indicates SI lesion, possibly an anterior SI ligament sprain

27
Q

Which test is considered very effective for diagnosing SI Syndrome?

A

Sacroiliac Stretch Test

28
Q

What is the Pt/Dr positioning in the sacroiliac compression test?

A
  • Side-lying pt

- Dr stands behind pt and presses into ilium with both hands

29
Q

What is being compressed in the SI compression test?

What does pain mean?

A

The posterior part of the SI joint is most affected by the compression test

Pain indicates SI lesion, likely in the posterior joint

30
Q

What is the pt position and dr contact for the sacral thrust test?

A
  • prone pt

- dr applies gentle P-A thrusts midline of sacrum around S2 or S3

31
Q

What force is created in a sacral thrust test?

What is stressed by this procedure?

A

Shearing forces in the SI joint

Stresses anterior and posterior ligaments AND joint surfaces

32
Q

What does pain in the sacral thrust test mean?

A

Joint pathology or dysfunction

33
Q

What is the Pt/Dr positioning for Hibb’s test?

What does the Dr do?

A
  • 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
34
Q

What motions are being created with Hibb’s test?

A
  • Internal rotation of the hip

- Distraction of the SI joint

35
Q

What does pain in Hibb’s implicate?

A
  • pain in the hip = acetabular joint issue

- pain in the SI = SI problem

36
Q

What is the Pt/Dr positioning for Yeoman’s test?

A
  • prone pt
  • knee of test leg flexed to 90
  • Dr lifts leg at knee while gently bracing PSIS to create hip extension
37
Q

Most likely cause of SI pain in Yeoman’s test?

A

Stress to the anterior SI ligament - possible sprain

38
Q

Why is Gaenslen’s considered superior to Yeoman’s?

A

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

39
Q

What is the cause of radicular pain vs sclerotongenous pain?

A

Radicular pain = nerve root compression or irritation

Sclerotongenous pain = referred pain from deep somatic structures

40
Q

What are the characteristics of radicular pain?

A

Sharp and shooting

Follows dermatomal patterns

41
Q

What are the characteristics of sclerotongenous pain?

A 
Deep 
Dull 
Achy 
Diffuse 
Hard to localize

Pattern is not precisely dermatomal

42
Q

What is the most common kind of referred pain?

A

Sclerotongenous

43
Q

When testing for nerve root compression, what are the categories of tests performed?

A
  • Sensory along dermatomal patterns
    (Light touch, pinprick, vibration)
  • Motor (muscle tests)
  • Reflexes (DTRs and superficial reflexes)
  • Look for radicular pain
44
Q

What is a common pt presentation that will lead you to perform neurologic tests on the low back and legs?

A

LBP that involves their legs!

Pelvic Manipulation (3 decks)

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