03 Thoracic and Lumbar 1 Flashcards Preview

7232 Ortho > 03 Thoracic and Lumbar 1 > Flashcards

Flashcards in 03 Thoracic and Lumbar 1 Deck (47):
1

What are the lower quarter neurodynamic tests used for?

radicular symptoms

2

What is the primary nerve on the posterior thigh?

sciatic

3

What is the primary nerve on the anterior thigh?

femoral

4

indications for SLR test

distal radicular symptoms and LBP

5

SLR test implications - reproduction of symptoms between 0-30˚

either:
- highly irritated sciatic nerve
- hip dysfunction

6

SLR test implications - reproduction of symptoms between 30-50˚

most likely sciatic or other nerve involvement

7

SLR test implications - reproduction of symptoms 50˚ and up

either:
- sciatic nerve
- hamstrings

8

What is the sensitizing maneuver of the SLR test?

lower the leg to level of no symptoms and pull foot upward in dorsiflexion

9

When you do the SLR sensitizing maneuver, how do you know if it's hamstring and not sciatic nerve?

symptoms will not return because you aren't adding a stretch to the hamstrings when you dorsiflex the foot

10

When you do the SLR sensitizing maneuver, how do you know if it's sciatic nerve and not hamstring?

You will get symptoms because the sciatic nerve connects all the way down the posterior leg

11

What does the slump test do?

sequentially adds tension to the sciatic nerve

12

When doing the slump test, where should the PT be sitting?

on the side you're testing

13

slump test procedure

- hands behind back
- flex neck and slump down
- straighten leg that has symptoms

14

What should you have the patient do during slump test to see if it's sciatic or hamstrings?

If they have symptoms when the leg is straightened, have them hold it and lift their chin up

15

During the slump test, how do you know it's hamstring vs. sciatic involvement

- hamstrings: lifting the chin won't change symptoms because it doesn't impact hamstrings
- sciatic: lift the chin and symptoms are decreased

16

What does lifting the chin do to the nerve in the slump test?

reduces tension on the dura

17

When would you do the prone knee bend test?

anterior symptoms

18

prone knee bend test procedure for right anterior symptoms

- patient prone, flex right knee
- ask if they feel symptoms (where and what type of pain)

19

For the prone knee bend test, what could pain indicate?

- quad tightness
- femoral nerve irritation

20

How do you differentiate if the prone knee bend test is nerve or muscular?

- must rely on the quality of pain
- no sensitizing maneuver

21

Why are femoral nerve symptoms less common than sciatic nerve?

most common lumbar levels with issues are L4-5 and L5-S1, which is where the sciatic nerve comes out

22

Where does the femoral nerve exit?

higher up in the lumbar spine than the sciatic nerve

23

Out of all of the neurodynamic tests, this one is the least common. Why?

- crossed straight leg raise
- low sensitivity and specificity

24

crossed straight leg raise test procedure

similar to SLR, but raise leg that doesn't have symptoms

25

What is a positive crossed SLR test?

pain increased in symptomatic LE

26

What is a negative crossed SLR test?

pain is unchanged in symptomatic LE

27

What does a true positive crossed SLR test indicate?

suggests that a disc herniation is causing the nerve root irritation

28

Determining which of the neurodynamic tests are indicated for a patient

posterior symptoms: SLR and slump test
anterior symptoms: prone knee bend test

29

Why is it important to determine if neural tension is significant for the patient?

- may have positive test and be asymptomatic, so it's not an issue
- test doesn't tell you if it's clinically relevant

30

indications for prone instability test

central lumbar pain with or without radicular symptoms

31

In the prone instability test, what are you testing for?

muscular instability

32

Step 1 of prone instability test

- prone with hips and LEs off end of table
- perform CPA and assess pain response

33

Step 2 of prone instability test

- prone with hips and LEs off end of table
- have pt lift both legs off floor and repeat CPA
- assess pain response

34

In the prone instability test, where do you perform the CPA?

on the level of pain with ttp

35

positive prone instability test

- compare pain between steps 1 and 2
- decreased pain = positive test

36

negative prone instability test

- compare pain between steps 1 and 2
- equal or increased pain = negative test

37

What does decreased pain during step 2 of the prone instability test suggest?

- lumbar instability is contributing to symptoms
- strengthening should help with symptoms

38

What do you need to make sure you do for the prone instability test?

- palpate to confirm level of pain
- have them rate pain so you know if it changes

39

Would you do part 2 of the prone instability test if there's no pain in part 1?

no

40

lumbar quadrant test indications

- can be used as a general clearing test to see if pain is coming from lumbar spine OR
- as a specific part of the lumbar spine exam to differentiate facet DJD from lateral stenosis

41

lumbar quadrant test procedure

- standing
- passive sequential extension, lateral flexion, and rotation

42

What is happening in the lumbar quadrant test?

- pressure on facets and nerve roots

43

positive lumbar quadrant test

reproduction of s/s on ipsilateral side

44

implications of a positive lumbar quadrant test as part of a lumbar screen

lumbar spine should be investigated further

45

implications of lumbar quadrant test

What would cause you to think facet DJD?

positive test with diffuse local pain

46

implications of lumbar quadrant test

What would cause you to think lateral stenosis?

positive with radicular pain

47

During the lumbar quadrant test, where should you stabilize the patient?

sacrum and sternum