ch22: lumbar spinal cond Flashcards
(20 cards)
spinal cord end
ends around L1-L2
lumbar plaxus
- supplying the ant and medial muscle of the thigh region
- T12-L5 nerve roots
slump test
- potential lumbar nerve root irritation
- one step at a time
1-slump
2- head flex
3- kn ext
4- fot DF
5- extend neck
SLR
lasègue test
- used to differentiate pain: SI jnt, iiritation of sciatic, disk herniation, tight h/s
SLR1:sciatic + tibial
SLR2: tibial nerve (added EV)
SLR3: surl nerve (added INV)
SLR4: coomon peroneal (PF, INV, medial rot)
SLR5: nerve root disc prolapse (same as #1) just no add
well SLR
unaffected leg is raised
- if pain on the opposing side being raised = space occupying lesion
bowstring test
tension or popliteal pressure sign
- passive hip flexion with kn ext
- until pain felt by pt
- kn bent 20deg should releive pain
- AT then applies pressure to tibial portion of sciatic nerve in popliteal fossa
+ for sciatic nerve irritation if pressure recreates symptoms
brudzinski test
pt supine with hands behond head
- pt tries to flex neck off table
+ve= pt bends kn to releive pressure when flexing neck = possible dural irritation
kernig
buldging disk, nerve root impingement, inflammmation of dural sheat or irritation of the meninges
- pt supine, they flex hip and extend kn
- +ve = pain in head, neck or lower back
- inc pain with extend kn and releived with kn flex = meningeal irritation, nerve root involvment or dural irritation
milgram test
- inc intrathecal pressure
- inc bulge of the nucleus pulposus
- pt supine and hold legs up 2-6inc off table for 30s
+ve if affected limb or limbs canot be held for 30s or if symptoms reproduce
FAIR
- felxion, add, int rot
- recreation of symptoms = pace sign
- pace sign = pain may be caused by piriformis syndrome
piriformis sign
- indicats piriformes and other lat rotators are excessively tight
- sign is seen when pt lies supine and AT at feet of pt
- the presence of external rot of the lower limb present only on the involved leg in a relax pt = +ve sign
femoral nerve stretch test
- assess nerve root lesion at L2-L3-L4 level
PKB test
single leg stance test
assessment of spondylolysis, spondylolisthesis, and SI jn irritation
- stork test
+ve sign and indication
- pain elicite when opposing leg up = unilateral lesion of pars interarticularis
- pain when either leg is lifted = bil pars intercularis fx
- Rot + ext pain = facet implication to side of rot
-
quadrant test
- standing behind pt
- pt extends spine
- AT supports pt sh to stabilise and control ext
- OP on ext while pt side bend and rot towards pain
- causes max narrowing of intervertebral foramen and stresses facet
+ve: with radicular sign = impingement of the lumbar nerve roots
+ve: localised pain = facet jnt patholofy
+ve: pain around PSIS = SI jnt pathology
hoover test
test for liars
classification of sciatica
- sciatica only: no sensory or m. weakness
- Sciatica with soft signs: some sensory changes, mild or no reflex change, normal muscle strength, normal bowel,
- Sciatica with hard signs: sensory and reflex change, muscle weakness,
- sciatica w/ severe signs: sensory and reflex change, m. weakness, altered bladder func
prolapsed disk
eccentric nucleus produces a definite deformity as it works its way through the fibers of the annulus
extruded disk
material moves into the spinal canal, where it runs the risk of impinging on adjacent nerve roots
sequestrated disk
material has separated from the disk itself and potentially, can migrate
spondylolysis vs spondylolisthesis
spondylolysis = stress fx of the pars intercularis
Spondylolisthesis= bilateral fx of the pars interarticularis w/ and slippage of involved vertebra
