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NMS > Lumbar and Pelvis Ortho Tests > Flashcards

Lumbar and Pelvis Ortho Tests Flashcards

1
Q

Heel walking - Screen test procedure:

A
  • Patient stands with heads in neutral position and arms at sides
  • Demonstrate and/or instruct the patient to walk towards doctor while balancing on their heels
  • Observe for ability to balance all body weight on the patient’s heels, one foot at a time
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2
Q

Heel walking - screening test interpretations:

A
  • Inability to maintain dorsiflexion (balancing on heels) indicates foot drop
  • L5 radiculopathy, L4-L5 disc problem, common peroneal nerve injury, weak anterior tibialis
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3
Q

Toe walking - screening test procedure:

A
  • Patient stands with head in neutral position and arms at their sides.
  • Demonstrate and/or instruct the patient to walk away from doctor while balancing on their toes
  • Observe patients ability to balance all body weight on their toes, one foot at a time
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4
Q

Toe walking - screening test interpretation:

A
  • Inability to maintain plantar flexion (balancing to toes) indicated heel drop
  • S1 radiculopathy, L5-S1 disc problem, tibial nerve injury or weak calf muscles
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5
Q

Straight leg raise procedure:

A
  • Patient is supine with arms at sides
  • Doctor stands to the side of the patient facing cephalad
  • Doctor contacts distal femur and calcaneus to maintain knee extension
  • Doctor passively flexes the hip to 90 degrees or to the point of pain
  • Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present
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6
Q

Straight leg raise interpretations:

A
  • Local pain with radiculopathy at 0 to 30 degrees
    = Suspect SI lesion or piriformis syndrome
  • Local pain with radiculopathy at 30 to 70 degrees
    = suspect sciatic nerve root irritation by intervertebral disc pathology or intradural lesion
  • Local pain at 70 degrees or more
    = suspect lumbar joint involvement
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7
Q

Bragards test procedure:

A

THIS IS ONLY PERFORMED FOLLOWING A + SLR TEST. IT IS A FOLLOW UP PROCEDURE
- Doctor lowers the leg 5 degrees from the point of pain
- Doctor passively dorsiflexes the affected foot
- Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present

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8
Q

Bragards test interpretations:

A

THIS IS ONLY PERFORMED FOLLOWING A + SLR TEST. IT IS A FOLLOW UP PROCEDURE
- If dorsiflexion produces pain at 0 to 30 degrees
= suspect extradural sciatic nerve irritation
- If dorsiflexion produces pain at 30 to 70 degrees
= suspect intradural problem such as an intervertebral disc pathology causing sciatic nerve root irritation
- Dull posterior lower leg or thigh pain
= indicates tight muscles

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9
Q

Sicard’s test procedure:

A

FOLLOW UP TEST TO SLR AND BRAGARDS
- Lower 5 degrees from the positive Bragards position and extend the great toe

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10
Q

Sicard’s test interpretations:

A

FOLLOW UP TEST TO SLR AND BRAGARDS
- Pain indicates stretching of the dura mater in the spinal cord or a lesion within the spinal cord
—– Disc herniation, tumor, meningitis

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11
Q

Well leg raise/ Crossover test procedure:

A
  • Patient is supine and arms at their sides
  • Doctor stands on the unaffected side of the patient facing cephalad
  • Doctor passively flexes the unaffected hip to 90 degrees or to the point of pain, maintaining knee extension
  • Doctor asks patient if there is pain, verifying the location, severity, radiation and quality of pain if present.
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12
Q

Well leg raise/ Crossover test interpretation:

A

Reproduction of pain with radiculopathy on the affected side is indicative of a central or medial disc herniation.

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13
Q

Fajersztajn’s sign procedure:

A
  • Similar to Bragards, except it is performed on the unaffected side after receiving a positive Well Leg Raise test.
  • Lower the unaffected leg 5 degrees and DF the ankle.
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14
Q

Fajersztajn’s sign interpretations:

A

Positive test= recreation of pain on the affected side.

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15
Q

Smith-Peterson Test or Goldthwaits test procedure:

A
  • Patient is supine, arms at their sides
  • Doctor stands to the side of the patient facing cephalad
  • Doctor places one hand under the lumbar spine with each finger contracting an interspinous space while passively flexing the leg with other hand
  • Doctor asks if there is pain present (WWRR) and notes if the pain occurs before or during lumbar spinous fanning occurs
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16
Q

Smith-Peterson Test or Goldthwaits test interpretations:

A
  • Pain produced before spinouses fan (o-30 degrees) suspect SI lesion
  • Radicular pain during lumbar fanning (30-70 degrees) indicates an intradural lesion – Disc defect, osteophyte, mass
  • Local pain after lumbar fanning (70+) indicates a posterior lumbar joint disorder
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17
Q

Lasegue Test procedure:

A
  • Patient is supine with arms at sides
  • Doctor stands square to the patient, on either side
  • Doctor passively flexes the patients hip and keeps the knee flexed.
  • Doctor then keeps the hip flexed and extends the knee then asks if there is pain (WWRR)
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18
Q

Lasegue Test interpretations:

A

If there is no pain with hip and knee flexion, but pain is elicited when the knee is extended the test is positive for sciatic radiculolopathy

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19
Q

Bechterew’s test procedure:

A
  • Patient is seated with legs hanging off table, head in neutral and arms at sides.
  • Doctor stands in front of patient and instructs them to extend one knee. Pain? (WWRR) then bring knee back down.
  • Doctor instructs patient to extend other knee. Pain? (WWRR) Then bring back down.
  • If no pain in unilateral leg extension, doctor instructs patient to extend both legs at the same time. Pain? (WWRR)
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20
Q

Bechterew’s Test interpretations:

A
  • Extending the leg tractions the sciatic nerve
  • Radicular pain or if the patient must lean back due to pain indicates compression of the sciatic nerve or lumbar nerve roots often due to lumbar disc protrusion.
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21
Q

Knee Flexion test (Neri’s sign) procedure:

A
  • Patient is standing
  • Doctor stands to one side of the patient and instructs them to bend forward and touch their toes
  • Doctor observes for knee flexion on either side
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22
Q

Knee Flexion test (Neri’s sign) interpretations:

A
  • Knee flexes on affected side = lumbar disc, lumbosacral or SI problem
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23
Q

Bowstring Sign procedure:

A
  • Patient is supine with arms at sides
  • Doctor is seated on the side being tested, facing cephalad and places affected leg on their inside shoulder
  • Doctor places firm pressure on the hamstring muscle using bilateral thumbs
  • If pain is not elicited then apply pressure into the popliteal fossa
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24
Q

Bowstring sign interpretations:

A
  • Applying pressure to the hamstring or popliteal fossa increases sciatic nerve tension
  • Pain in the lumbar region or radiculopathy is a positive sign of sciatic nerve compression
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25
Q

Slump Test procedure:

A

AFTER EVERY STEP ASK IF THERE IS PAIN AND WWRR IF SO
- Doctor instructs patient to slump forward while the doctor hold the patients chin to prevent cervical flexion
- Doctor releases chin and further flexes the torso by pressing on the shoulder and advises the patient to further flex their chin forward
- Doctor further flexes the cervical spine by pushing on the occiput
- Doctor maintains the cervical overpressure and instruct and dorsiflexes the foot while the patient remains in leg extension
- Doctor release the cervical overpressure and advises the patient to extend their neck while maintaining leg extension and foot dorsiflexion

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26
Q

Slump test interpretations:

A
  • Each phase of the test induces motion induced spinal traction that increases with each phase
  • Pain during any portion of the phase indicates meningeal tract irritation usually caused by a disc defect
  • If symptoms are produced with any phase the test should be stopped to prevent further pain
  • Pain lessened with cervical extension is also confirmation of meningeal irritation
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27
Q

Thomas test procedure:

A
  • Patient is supine, legs extended
  • Doctor has patient pull hip into flexion by pulling on their flexed knee
  • Doctor observes if the contralateral femur flexes as the patient flexes the hip
  • Doctor performs the test bilaterally
  • Doctor asks patient is there is pain (WWRR)
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28
Q

Thomas test interpretations:

A

If the patients contralateral leg is unable to lay flat on the table and lumbar spine stays in lordosis as they pull their knee to their chest. This indicates a flexion contracture of the iliopsoas muscle

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29
Q

Lewin Supine procedure:

A
  • Patient is supine
  • Doctor stands on either side by patients feet
  • Doctor stabilizes patients ankles to the table
  • Doctor asks patient to sit up and ask about pain (WWRR)
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30
Q

Lewin Supine interpretation:

A
  • Inability to sit up is associated with lumbar arthritis, lumbar fibrosis/ankylosis, lumbar disc protrusion, or sciatica
  • Patients with weak abdominals will experience difficulty with this test
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31
Q

Milgrams test procedure:

A
  • Patient is supine with arms at sides
  • Doctor instructs patient to raise both legs 2-3 inches off the table
  • Doctor instructs the patient to maintain this position for 30 seconds and asks if there is pain (WWRR)
32
Q

Milgrams test interpretations:

A
  • This test increases intrathecal pressure
  • If pain is present suspect a space occupying lesion inside or outside of the spinal cord – Disc protrusions usually produce positive tests
  • Patients with weak abdominals would have a hard time with this test
33
Q

Beevor sign procedure:

A
  • Patient lies supine
  • Doctor anchors ankles????? UNSURE WHAT DOCTOR DOES
  • Patient flexes their head against resistance and attempts to sit up with their hands resting behind the head or across the chest
34
Q

Beevor sign interpretations:

A
  • The sign is positive if the umbilical does not remain in a straight line when the abdominals contract, indicating neurological pathologic conditions
35
Q

Prone Knee Bending test (Nachlas test)

A
  • Patient is lying prone
  • Doctor stands on either side of the table facing cephalad or square
  • Doctor passively brings patients heal to the same side buttcheek and asks if there is pain (WWRR)
36
Q

Prone Knee Bending test (Nachlas test) Interpretation

A
  • Radicular anterior thigh pain may indicate L2-L4 compression or irritation by an intradural lesion (disc defect, spur, mass), a lumbar plexus or femoral nerve compression from iliopsoas hypertrophy
  • Pain in the butt may indicate an SI lesion
  • Pain in the lumbosacral joint may indicate a lumbosacral lesion
37
Q

Kemps test procedure:

A
  • Patient is seated (increases intradiscal pressure) or standing (maximizes stress on facets) with head in neutral position and arms across chest
  • Doctor stands behind the patient
  • Doctor reaches across the chest to grab the contralateral shoulder or arm
  • Doctor stabilizes the PSIS with other hand (palm or fist)
  • Doctor passively extends the patient obliquely over contact and ask if there is pain (WWRR)
  • Repeat on other side
38
Q

Kemps test interpretations:

A
  • Local lumbar pain with radiation indicates disc herniation
  • Local lumbar pain with no radicular pain indicates lumbar muscle spasm or facet capsulitis
39
Q

Pheasants Test procedure:

A
  • Patient is prone
  • Doctor stands on either side of the table facing cephalad or square
  • Doctor passively brings both of the patients heels to the patients butt.
  • Doctor applies P-A pressure over individual lumbar vertebrae and asks if there is pain (WWRR)
40
Q

Pheasants Test interpretations:

A

Spinal instability (i.e. Spondylisthesis)

41
Q

Prone Segmental Instability Test prodecure:

A
  • Patient is lying prone halfway off the end of the table
  • Doctor applies specific pressure to the posterior aspect of the lumbar spine or SIJ while the patient rest in this position
  • The patient then lifts their legs off the floor
  • Doctor again applies posterior compression to the lumbar spine or SIJ
42
Q

Prone Segmental Instability Test interpretation:

A

If pain is elicited in the resting position only, the test is positive because the muscle contraction masks the instability by stabilizing the segment.

43
Q

Apprehension Sign procedure:

A

The patient is asked if within the past week they had experienced any sensation of lower back collapse or giving-way due to sudden onset of LBP during transitional movements like standing up or sitting down.

44
Q

Apprehension Sign interpretation:

A

This test shows high specificity, but low sensitivity for spinal instability

45
Q

Catch Sign

A
  • The patient performs standing flexion and returns to upright, while the clinician evaluates for an aberrant movement pattern
  • SPECIFICALLY, the doctor should assess for: Pain, catching, sudden acceleration or deceleration, or any disruption of normal rhythm, including the use of arms to return upright
  • The patient is then asked to perform an abdominal brace and repeat the forward flexion maneuver
  • Dissipation or elimination of pain when performing flexion in the braced position is a positive test suggesting spinal instability
46
Q

SIJ Gapping/SIJ Distraction/Anterior Iliac Stretch Test procedure:

A
  • Patient is lying supine
  • Doctor stands on either side of the table facing cephalad
  • Examiner contacts both ASIS and stresses A-P and M-L then asks patient is there is pain (WWRR)
47
Q

SIJ Gapping/ SIJ Distraction/ Anterior Iliac Stretch Test interpretations:

A
  • Local pain over the ASIS is attributed to compression of soft tissue structures and is NOT considered a positive test
  • Unilateral sacroiliac or gluteal pain signifies a positive test for anterior SIJ ligament sprain
48
Q

Iliac Compression (Approximation test) procedure:

A
  • Patient is in side lying position with hips and knees stacked and slightly flexed
  • Doctor stands behind patient
  • Doctor contacts superior ilium and applies downward compression and then asks if there is pain (WWRR)
49
Q

Iliac Compression (Approximation test) interpretations:

A
  • Pain within either sacroiliac joint indicates sprain of posterior sacroiliac ligaments
  • Pain on lateral surface of either ilia could indicate contusion or compression of soft tissue
50
Q

Gaenslen’s Test procedure:

A
  • Patient is supine towards one side of the table
  • Doctor stands on side of the table closest to patient, facing cephalad or square
  • Doctor flexes the knee and hip of the patients contralateral leg to their abdomen
  • Doctor hyperextends the affected leg OFF THE TABLE and asks patient if there is pain (WWRR)
51
Q

Gaenslen’s Test interpretations:

A
  • Positive test reproduces pain in the SI area
  • Dull anterior thigh pain could indicate tight hip flexors
  • Radiating symptoms down the thigh could indicate lumbar disc involvement
  • If the test is negative, a lumbosacral lesion is suspected
52
Q

Thigh Thrust Test procedure:

A
  • Patient is lying supine
  • Doctor contacts opposite side leg from where they are standing and flexes the patients hip 90 degrees with the knees flexed
  • The doctors caudal hand is placed beneath the sacrum to provide a supportive and opposing force and maintains their elbow on the table
  • Using the cephalad hand, contact the distal femur and apply A-P pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly
53
Q

Thigh Thrust Test interpretation:

A

A positive test reproduces the patient’s complaint of pain in the SI joint

54
Q

Sacral Thrust Test procedure:

A
  • Patient is lying prone
  • Doctor takes a reinforced contact OVER THE MIDLINE OF THE SACRUM and pushes P-A, producing a shearing force at both SI joints
55
Q

Sacral Thrust Test interpretation:

A
  • A positive test will produce pain in the affected SI joint, reproducing the patients symptoms
56
Q

The Drop Test procedure:

A
  • Patient stands facing wall or table for support
  • The patient raises their heels from the floor
  • Keeping one knee in extension the patient uses their bodyweight and drops the test side heel to the ground with force producing shear force at the SI joint
57
Q

The Drop Test interpretation:

A

Produced pain in the SI joint is a positive test

58
Q

Cluster of Laslette

A

In chronic back pain populations, patients who have 3 or more positive provocation SI joint tests and whose symptoms cannot be made to centralize have a probability of having SI joint pain of 77%, and in pregnant populations with back pain, a probability of 89%
- SI joint distraction
- Thigh thrust
- Sacral thrust
- The drop test
- Gaenslen’s
- Iliac compression

59
Q

Erichsen Sign procedure:

A
  • Patient is lying prone
  • Doctor stands on either side of the table facing cephalad
  • Doctor contacts bilateral ilia and thrusts towards the midline and then asks if there is pain (WWRR)
60
Q

Erichsen Sign interpretation:

A
  • Test should reproduce pain if SI is the source of pain
  • Test will not reproduce pain if iliofemoral joint is the source of pain
61
Q

Lewin-Gaenslen’s Test procedure:

A
  • Patient is lying on their side and the side being tested will be the top leg
  • Doctor stands behind the patient and instructs them to hug the bottom leg toward their chest
  • Doctor stabilizes the patient’s pelvis and grasps the top leg to hyperextend it and ask if there is pain (WWRR)
62
Q

Lewin-Gaenslen’s Test interpretations:

A
  • A positive test produces pain within the SI joint
  • Dull ache along the anterior thigh of the extended leg indicates tight hip flexors
63
Q

Yeoman’s Test procedure:

A
  • Patient is prone
  • Doctor takes a thenar contact over the ipsilateral PSIS and applies firm downward pressure over the affected SI, fixing the pelvis to the table
  • Doctor grasps anterior aspect of the knee and lifts the thigh, extending the patients hip and then asks if there is pain (WWRR)
64
Q

Yeoman’s Test interpretation:

A
  • Pain within the SI indicates SI dysfunction
  • Dull achy pain along the anterior thigh indicates right hip flexors
65
Q

Hibb’s test (Prone Gapping Test) procedure:

A
  • Patient is prone
  • Doctor stands on the ipsilateral side of the table facing cephalad or square and palpates the medial side of the PSIS
  • Doctor flexes ipsilateral knee 90 degrees without extending the hip and internally rotates the hip (foot will move away from midline) then asks is there is pain (WWRR)
66
Q

Hibbs Test (Prone Gapping Test) interpretation:

A
  • Pain experienced within the SI joint indicates a positive test
  • Pain within the iliofemoral joint indicates hip pathology
67
Q

Ely’s Test procedure:

A
  • Patient is prone
  • Doctor stands on either side of the table facing cephalad or square and passively brings the patients heels to the CONTRALATERAL buttcheek and asks if there is pain (WWRR)
68
Q

Ely’s Test interpretations:

A
  • Femoral radicular pain indicates lumbar nerve root inflammation
  • Upper lumbar discomfort indicates lumbar nerve root irritation
  • Significant hip lesions will make performing the test difficult
  • Iliopsoas muscle irritation will make performing the leg extension portion difficult
69
Q

Patrick Test/ FABER (Flexion, Abduction, External Rotation) procedure:

A
  • Patient is supine
  • Doctor stands on either side of the table and maneuvers the patients leg into a figure 4
  • Doctor stabilizes contralateral pelvis and extends hip with downward pressure on ipsilateral knee and then asks if there is pain (WWRR)
70
Q

Patrick Test/ FABER (Flexion, Abduction, External Rotation) interpretations:

A
  • Pain in the hip indicates iliofemoral pathology
  • Pain in the SI joint indicates SI joint pathology
71
Q

Laguere’s Sign (Patricks in the air) procedure:

A
  • Patient is supine
  • Doctor stands on either side of the table facing cephalad and flexes, abducts and externally rotates involved leg
  • Doctor stabilizes opposite ASIS and overpressures involved leg and asks if there is pain (WWRR)
72
Q

Laguere’s Sign (Patricks in the air) interpretations:

A
  • Positive test produces pain within SI joint
  • Pain felt within the iliofemoral joint indicates possible hip pathology
73
Q

Bonnet’s Test/FAIR (Flexion, Adduction, Internal Rotation) procedure:

A
  • Patient is supine with arms at their sides
  • Doctor stands near the foot of the table facing cephalad
  • Doctor passively flexes the hip while keeping the knee extended while also internally rotating and adducting the leg, then asks if there is pain (WWRR)
74
Q

Bonnet’s Test/FAIR (Flexion, Adduction, Internal Rotation) interpretation:

A

Radicular pain is indicative of sciatic nerve entrapment due to piriformis involvement

75
Q

Belt Test (Supported Adams test) procedure:

A
  • Patient with low back pain is standing
  • Doctor stands in front of patient and instructs them to do a toe touch and asks if there is pain (WWRR)
  • Patient returns to standing
  • Doctor then explains the procedure of supported adams infront of the patient
  • Doctor stands behind the patient and uses the lateral surface of their thigh/hip to brace the patients sacrum while holding onto the patients ASIS
  • Doctor then asks the patient to bend forward and asks if there is pain (WWRR)
76
Q

Belt test (supported adams test) interpretations:

A
  • If lesion if lumbar in origin, pain will be produced with or without pelvic bracing
  • If the lesion is pelvic in origin, pain will be produced without pelvic bracing but lessened or eliminated with pelvic bracing.

NMS (5 decks)

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