Week 1- LQ Screening Examination Flashcards
Why do we perform a screening exam?
Allows us to progress and refine a hypothesis to guide making a primary plan of care
Describe the progression of the LQ screening examination
- Standing: observation and posture
- Standing: functional observation/clearing
- Standing functional myotomal assessment
- Standing Clearing Tests: Lumbar
- Seated Clearing Tests: Thoracic
- Seated Clearing Tests: Hip
- Seated: Neuromotor Sensory Screening Exam
- Myotomes
- Dermatomes
- LQ Reflexes
- LQ reflexes (upper motor neuron signs)
- Supine clearing tests: Straight leg raise
- Prone clearing: lumbar spring testing
Standing: observation and posture
Look for gross abnormalities, not subtle differences
Standing: functional observation/clearing
- Squat
- Step up
- Step down
Standing functional myotomal assessment
- Step up: L3-L4
- Heel walking: L4-L5
- Toe walking: L5-S1
Standing Clearing Tests: Lumbar
- Region specific
- Flexion
- Extension
- Quadrant motion (ext., rot, side bending)
- Used with or without overpressure
Seated Clearing Tests: Thoracic
- Block legs
- Rotate R/L upper back
Seated Clearing Tests: Hip
- FABER (flexion, abduction, & external rotation)
- F/ADD (flexion, adduction)
What patients require a neuromotor sensory screening exam?
- Those w/ lumbar/LQ pain
- Symptoms go below gluteal fold
- LQ symptoms of questionable origin
LQ Myotomes
- L2-3: Hip flexors
- L3-4: Knee extensors
- L4: Ankle dorsiflexors
- L5: Hallux extension
- S1: Ankle plantar flexors
What is a positive finding with myotomes?
Significant weakness or diminished resistance relative to opposite side
LQ Dermatomes
- L1: Inguinal area
- L2: Anterior mid-thigh
- L3: Medial knee
- L4: Medial malleolus
- L5: Distal medial dorsum of foot
- S1: Lateral border of foot
- S2: Medial/posterior calcaneus
What is a positive finding with dermatomes?
Significantly diminished sensation relative to opposite side
LQ Reflexes
- L2-L4: Patellar
- S1-S2: Achilles
What is a positive finding with LQ reflexes?
- Diminished/absent reflexes correlated w/ derm/myotome nerve root pathology
- Hyperactive may mean upper motor neuron pathology
How to grade reflexes
- 4+: Very brisk response; associated w/ clonus
- 3+: Brisk response; possibly hypeerreflexive
- 2+: Normal, average response
- 1+: Low, normal response
- 0: No response
- 1+(R): Absent response; present with reinforcement
- 0(R): No response, even with reinforcement
LQ Reflexes: Upper Motor Neuron Signs
Babinski
- Normal response: Toes curl
- Babinski present: hallux extends, toes fan out
Supine clearing tests: Straight leg raise
- Looks at adverse neurodynamic mobility of sciatic nerve and its branches
What does it mean if the straight leg test brings on symptoms below 45 degrees?
Lumbar radiculopathy
What does it mean if the straight leg test brings on symptoms above 45 degrees?
Adverse neurodynamics- nerves running into lower quarter are sensitized, but not from herniated disc
Prone clearing: lumbar spring testing
- CPA: central posterior to anterior
- UPA: unilateral posterior to anterior
- Looking to reproduce symptoms
