Lumbar Assessment

Question 1

Assessment Skills: Lumbar Assessment

Thoracolumbar
* ROM = ?
* End Feel = ?
* Loose pack = ?
* Close pack = ?
* Capsular pattern = ?

Answer 1

Thoracolumbar Snapshot

Question 2

Assessment Skills: Lumbar Assessment

Pelvic Surface Anatomy

Answer 2

• Iliac Crest: Standing, supine or prone; corresponds to L4-L5 interspace.
• Posterior Superior Iliac Spine (PSIS): From iliac crest medially to inderiorly. [Helper Line: S2 locasted between PSIS].
• Ischial Tubersity: Side lying; start gluteal fold until you feel a bony prominence.

Question 3

Assessment Skills: Lumbar Assessment

Lumbar Surface Anatomy (Prone)

Answer 3

• Sacral Sulcus: From PSIS, move superiorly and medially.
• Inferior Lateral Angle (ILA): Inferior to PSIS.
• Coccyx: Top of gluteal cleft.
• Sacrotuberous Ligaments: From ILA to ischial tubersoty.

Question 4

Assessment Skills: Lumbar Assessment

Lumbar Surface Anatomy (Prone / Processes)

Answer 4

• Spinous Processes: L5: Start at PSIS, move medially and superiorly at a 30-45 degree angle L1-L4: Count superiorly from L5.
• Transverse Processes: Move laterally from spinous process. Most easily felt in the trough between spinalis and longissimus. Note the orientation of transverse processes relative to spinous processes

Question 5

Assessment Skills: Lumbar Assessment

Lumbar Surface Anatomy (Prone / T12)

Answer 5

• T12 Spinous Process: Locate L5 spinous process and count superiorly; will be smaller than L1.
• 12 Ribs: Move laterally from T12 spinous process.
• Quadratus Lumborum: In the quadrant (yellow lines) created by the lumbar spinous processes, 12th rib and iliac crests.

Question 6

Assessment Skills: Lumbar Assessment

Pelvic Surface Anatomy (Supine)

Answer 6

• Anterior Superior Iliac Spine (ASIS): From iliac crests move distally and medially.
• Psoas: From midpoint between ASIS and umbilicus, apply direct pressure toward the spine.
• Iliacus: From ASIS move medially, and apply pressure downward to ilium.
• Pubic Tubercles: Patient places thumbs on abdomen and slides down to pelvis. Examiner places thumbs on top of patient’s thumbs.
• Greater Trochanter: Supine; have patient ER/IR hip to assist in locating.

Question 7

Assessment Skills: Lumbar Assessment

Lumbar Surface Anatomy (Prone - Glute)

Answer 7

• Helper line for Piriformis: PSIS to greater trochanter; divide lines into thirds.
• Piriformis: Piriformis will be 1 – 2 cm inferior to middle 1/3 of helper line.
• Helper line for Sciatic Nerve: Ischial tuberosity to greater trochanter.
• Sciatic Nerve: Medial 1/3 to halfway between ischial tuberosity and greater trochanter.

Question 8

Assessment Skills: Lumbar Assessment

Lumbar Surface Anatomy (Prone - Erectors)

Answer 8

• Spinalis: Most medial
• Longissimus: Middle
• Iliocostalis: Most lateral

Question 9

Assessment Skills: Lumbar Assessment

Thoracolumbar Flexion and Extension: Goniometer

Answer 9

Question 10

Assessment Skills: Lumbar Assessment

Thoracolumbar Lateral Flexion: Goniometer

Answer 10

Question 11

Assessment Skills: Lumbar Assessment

Thoracolumbar Rotation

Answer 11

Question 12

Assessment Skills: Lumbar Assessment

Thoracolumbar Flexion and Extension: Inclinometer

Assessing ROM

Answer 12

Question 13

Assessment Skills: Lumbar Assessment

Lumbar Lateral Flexion: Inclinometers

Assessing ROM

Answer 13

Question 14

Assessment Skills: Lumbar Assessment

Assessing Strength

Question 15

Assessment Skills: Lumbar Assessment

Assessing Strength

Question 16

Assessment Skills: Lumbar Assessment

Assessing Strength

Question 17

Assessment Skills: Lumbar Assessment

Trunk Flexion (0 – 5)

Assessing Strength

Answer 17

Question 18

Assessment Skills: Lumbar Assessment

Trunk Extension (0 – 5)

Assessing Strength

Answer 18

Question 19

Assessment Skills: Lumbar Assessment

Trunk Rotation (0 – 5)

Assessing Strength

Answer 19

Question 20

Assessment Skills: Lumbar Assessment

Lower Abdominals

Assessing Strength

Answer 20

Question 21

Assessment Skills: Lumbar Assessment

Sensation protocal

Assessing M.R.S.

Answer 21

• Use cotton ball or brush
• Show patient what it feels like in an area that is not compromised.
• Have the patient close his/her eyes
• Using equal pressure L and R, gently touch the area one side at a time.
• Use consistent cues and questions (“Does this feel the same on both sides?”).

“testing nervous systems ability to communicate w/other parts of the bod

“symmetry, quality, provocation”

Question 22

Assessment Skills: Lumbar Assessment

L2 Myotome

Assessing M.R.S.

Answer 22

L2 = hip flexion

“symmetry, quality, provocation”

Question 23

Assessment Skills: Lumbar Assessment

L3 Myotome

Assessing M.R.S.

Answer 23

L3 = Knee extension

“symmetry, quality, provocation”

Question 24

Assessment Skills: Lumbar Assessment

L4 Myotome

Assessing M.R.S.

Answer 24

L4 = Ankle dorsi flexion

“symmetry, quality, provocation”

Question 25

# Assessment Skills: Lumbar Assessment L5 Myotome ## Footnote Assessing M.R.S.

Answer 25

L5 = Great toe extension ## Footnote "symmetry, quality, provocation"

Question 26

# Assessment Skills: Lumbar Assessment S1 Myotome ## Footnote Assessing M.R.S.

Answer 26

S1 = plantar flexion ## Footnote "symmetry, quality, provocation"

Question 27

# Assessment Skills: Lumbar Assessment S2 Myotome ## Footnote Assessing M.R.S.

Answer 27

S2 = knee flexion ## Footnote "symmetry, quality, provocation"

Question 28

# Assessment Skills: Lumbar Assessment L4 Reflex Grading Scale? ## Footnote Assessing M.R.S.

Answer 28

L4 Reflex = Pateller

Question 29

# Assessment Skills: Lumbar Assessment S1 Reflex Grading Scale? ## Footnote Assessing M.R.S.

Answer 29

S1 Reflex = Achilles

Question 30

# Assessment Skills: Lumbar Assessment L1 Dermatome ## Footnote Assessing M.R.S.

Answer 30

L1 Dermatome = Upper anterior thigh

Question 31

# Assessment Skills: Lumbar Assessment L2 Dermatome ## Footnote Assessing M.R.S.

Answer 31

L2 Dermatome = Mid anterior thigh

Question 32

# Assessment Skills: Lumbar Assessment L3 Dermatome ## Footnote Assessing M.R.S.

Answer 32

L3 Dermatome = Medial anterior thigh

Question 33

# Assessment Skills: Lumbar Assessment L4 Dermatome ## Footnote Assessing M.R.S.

Answer 33

L4 Dermatome = Medial malleolus

Question 34

# Assessment Skills: Lumbar Assessment L5 Dermatome ## Footnote Assessing M.R.S.

Answer 34

L5 Dermatome = Dorsum of great toe

Question 35

# Assessment Skills: Lumbar Assessment S1 Dermatome ## Footnote Assessing M.R.S.

Answer 35

S1 Dermatome = Lateral malleolus or heel

Question 36

# Assessment Skills: Lumbar Assessment S2 Dermatome ## Footnote Assessing M.R.S.

Answer 36

S2 Dermatome = Popliteal fossa

Question 37

# Assessment Skills: Lumbar Assessment Central Posterior to Anterior Glides (Spring Test) Grading? ## Footnote Assessing Joint Play

Answer 37

Question 38

# Assessment Skills: Lumbar Assessment Unilateral Posterior to Anterior Glides ## Footnote Assessing Joint Play

Answer 38

Question 39

# Assessment Skills: Lumbar Assessment ## Footnote Special Tests

Question 40

# Assessment Skills: Lumbar Assessment Straight Leg Raise – Tension ## Footnote Special Tests

Answer 40

Question 41

# Assessment Skills: Lumbar Assessment Slump Test ## Footnote Assessing Joint Play

Answer 41

## Footnote sciatic neural tension

Question 42

# Assessment Skills: Lumbar Assessment Prone Instability Test ## Footnote Assessing Joint Play

Answer 42

Question 43

# Assessment Skills: Lumbar Assessment ## Footnote Assessing Joint Play