TEST 3: Lumbar Spine Dx OSCE

Question 1

what are landmarks to watch out for when assessing the lumbar spine?

Answer 1

• SP are in the same plane as the TP

- most superior portion of the iliac crests corresponds with SP of L4

Question 2

what nerve root and disc is responsible for the patellar reflex?

Answer 2

L4 nerve root at L4-5 disc

Question 3

what nerve root and disc is responsible for the achilles reflex?

Answer 3

S1 nerve root at S1-2 disc

Question 4

what nerve root and disc is responsible for ankle dorsiflexion?

Answer 4

L4 nerve root at L4-5 disc

Question 5

what nerve root and disc is responsible for great toe dorsiflexion?

Answer 5

L5 nerve root at L5-S1 disc

Question 6

what nerve root and disc is responsible for ankle plantar flexion?

Answer 6

S1 nerve root at S1-2 disc

Question 7

what is TART?

Answer 7

tissue texture changes
asymmetry
restriction of motion
tenderness

Question 8

how to assess ROM of the lumbar spine

Answer 8

• pt standing with feet 4-6 inches apart
• physician kneeling behind, eyes level with lumbar spine
• hands on iliac crests monitoring the ASIS anteriorly

Question 9

ROM of forward flexion of the lumbar spine

Answer 9

105 deg

Question 10

ROM of backward extension of the lumbar spine

Answer 10

60 deg

Question 11

ROM of side bending of the lumbar spine

Answer 11

40 deg

Question 12

ROM of rotation of the lumbar spine

Answer 12

90 deg

Question 13

lateral lumbar flexion (hip drop test)

Answer 13

• pt instructed to bend one knee, keeping both feet on ground but displacing weight to the leg that is not bending the knee
  
  • causes a compensatory shift in body weight
• note the amt of lumbar side bending which should be 25-30 deg
• repeat with opposite side and compare
• if the hip on unsupported side drops 25 deg, it is a normal test
• if the hip on the unsupported side does not drop 25 deg, it is a positive test
  
  • if right iliac crest drop 10 deg, it is a positive R hip drop and they have problem with L SB

Question 14

straight leg raising test

Answer 14

• tests for sciatic N irritation
• pt is placed in supine position
• with knee extended, medially rotate and adduct pt’s hip
• then flex the hip while maintaining knee extension
• continue hip flexion until the pt experiences pain in the BACK of the symptomatic leg
  
  • pain should not occur until 30-35 deg
• if pain occurs at a lesser angle or in the opposite leg, there may be a disc protrusion
• dura stretches b/w 30-70 deg; pain above this angle may indicate nerve root irritation or be related to mechanical low back pain secondary to muscle strain
• check in seated and supine

Question 15

prone neutral rotational testing of lumbar spine

Answer 15

• locate lumbar vertebrae
• load and spring on the TP
• compare ease of motion with opposite side and repeat for L1-5
• feel for hard end feel or restriction of motion
• if segment rotates freely to left when pushing on R TP, but not to R, it is rotated left

Question 16

prone extension rotational testing of lumbar spine

Answer 16

• pt in TV watching position
• physician standing at side of table w/ the dominant eye over the midline of the body, horizontal to the examining surface
• monitor fingers on TP with restricted rotation
• have pt prop head on hands to cause an extension of segment in question
• determine if worse, better, or the same
  
  • if worse, segment is living in flexion (L3 F RrSr)
  • if better, segment is living in extension (L3 E RrSr)
  • if unchanged, lesion is neither flexed nor extended but in neutral (L3 N RrSl)

Question 17

prone flexion rotational testing of lumbar spine

Answer 17

• cat back
• have pt arch and round back to cause flexion while you monitor the restricted segment until you feel flexion localized to that segment
• determine if end feel better worse or the same
• if worse, segment is living in E (L3 E RrSr)
  
  • if better, segment is living in F (L3 F RrSr)
  • if unchanged, lesion is neither flexed nor extended but in neutral (L3 N RrSl)

Question 18

seated rotational testing

Answer 18

• pt is seated while examiner stands behind
• assess L1-5
• passive sidebending–monitor ipsilateral TP while pushing down on pt’s shoulder
• passive rotation–monitor ipsilateral TP while inducing rotation by pulling posterior
• ask pt to bend forward to assess in flexion and load and spring seeing if more symmetric in F
• ask pt to sit up very straight to assess E and load and spring seeing if more symmetric in E
• neutral dysfcn is no appreciable difference in ease of motion relative to SB and rotation in F and E
• F/E dysfcn by noting more symmetrical motion relative to SB and rotation in F OR E