Flashcards in Lumbar Orthopedics Deck (51):
What is Antalgia Sign?
Patient will maintain a certain posture to alleviate pain
What are findings of Antalgia Sign?
If patient leans away from the side of pain, that is indicative of a posterolateral herniated disc
If a patient leans towards the side of pain, that is indicative of a posteromedial herniated disc
A forward antalgic lean is consistent with a posterocentral (rhizal) herniated disc
What is the procedure for Straight Leg Raiser?
Patient is supine. Doctor raises symptomatic leg, with knee straight, off the table until pain is reproduced or pain increases. Note angle at which pain occurred and location of pain.
What is the purpose of SLR?
Testing for SOL, IVD lesion, Sacro-Iliac or Lumbosacral problem
What are positive findings of SLR?
Pain may suggest sciatica from lumbosacral lesion or SOL (causing dural tension or irritation of nerve root)
What is the procedure for Bragards Sign?
Perform after a +SLR by lowering the affected leg 5 degrees and dorsiflexing the foot.
What anatomy is being tractioned during Bragards Sign?
What is a positive Bragards Sign?
Reproduction or increase in leg pain
What is the procedure for Sicard's Sign?
Perform after a +Bragards Sign. Dorsiflex the big toe to reproduce pain.
What are positive findings for Sicard's Sign?
Irritation of L5 nerve root is most common
L4 and S1 can also be involved
How do we perform Bechterew's Test (seated SLR)?
Patient is seated on table with back straight (or so their back is against the wall) and extends the leg at the knee. If no pain, doctor applies downward pressure just above the knee and patient attempts to lift leg off the table.
What are positive findings for a Seated SLR?
This test will be positive if SLR is positive. Pain location and quality will correlate.
What is the procedure for Slump Test?
Patient is seated with their back maximally slumped. Starting with the knee at 90 degrees and maximal ankle dorsiflexion, the knee is extended.
What are positive findings for Slump Test?
Pain should correlate with SLR findings. If positive, suspect disc bulge or herniation.
What is the procedure for Crossed Straight Leg Raiser?
Perform CSLR on asymptomatic side with patient supine. Raise extended leg until pain is reproduced & note angle.
What is the purpose of the CSLR?
This test will reproduce pain on the symptomatic side, even though we're testing the asymptomatic side.
What are positive findings of the CSRL?
If symptoms occur at same level of SLR, there may be a posteromedial IVD bulge or herniation.
If symptoms occur at an increased angle compared to SLR, there may be a posterolateral IVD bulge or herniation BUT THINK POSTEROMEDIAL FIRST.
How do we perform Fajersztajn's Test?
Doctor performs CSLR, then lowers the leg 5 degrees and dorsiflexes the foot.
What are positive findings of Fajersztajn's Test?
If there is pain at the same angle as Braggards, there may be a posteromedial IVD bulge or herniation.
If there is pain at a greater angle than Braggards, there may be a posterolateral IVD bulge/herniation, but THINK POSTEROMEDIAL FIRST.
How do we perform Cox sign?
This will occur during the SLR if present. Patient will raise the ipsilateral hip to alleviate pain.
What are positive findings of Cox sign?
How do we perform Ely's Test?
Patient is prone. Doctor will touch the heel of one foot to the contralateral buttock.
What is the purpose of Ely's Test?
Perform this test to produce pain in the anterior thigh and/or groin area (DDX: prostate problem in males)
What are positive findings of Ely's Test?
Radiating pain due to femoral nerve or upper lumbar spinal NR compression
Localized pain is due to quadriceps muscle contracture
How do we perform Femoral Nerve Traction Test?
Patient rests on unaffected side with bottom leg straight and the top leg bent at the knee. Doctor extends the thigh back on the affected side to traction the Femoral nerve.
What are positive findings for the FNTT?
Radiating pain to groin - L1 NR
Radiating pain to anterior mid-thigh - L3 NR
What is the procedure for the Heel/Toe Walking Test?
Patient walks on heels only, testing dorsiflexion. Patient then walks on toes only, testing plantar flexion.
What are positive findings for the Heel/Toe Walking Test?
If patient can't walk on heels: L5 problem (L4 IVD)
If patient can't walk on toes (MC): S1 problem (L5 IVD)
What is the procedure for Kemps Test?
Patient is seated. Doctor stabilizes lumbar spine with one hand and supports shoulder with other hand. Patient is laterally flexed away from doctor, then flexed forward and laterally toward doctor, then brought into extension with compression of shoulder on the side being tested. This is performed as circumduction in one smooth motion.
What are potential findings for Kemps Test?
Local pain - facet problem or capsulitis
Pain at waist - sprain/strain
-Radiating leg pain - IVD lesion
Always note location and quality of pain to help categorize patient.
What is the procedure for Kernig's Sign?
Patient is supine. Doctor flexes patient's hip and knee to 90 degrees, then extends the leg.
What is the purpose of Kernig's Sign?
To elicit pain in head or spine or involuntary flexion of the opposite knee/hip.
**Pain with fever = meningitis**
What is the procedure to test for Brudzinski sign?
Patient is supine. Doctor flexes the head towards the xiphoid process.
What is the purpose of Brudzinski sign?
To elicit pain in head or spine or involuntary hip and nee flexion.
Pain with fever = meningitis
What is the procedure for Lasegue Test?
Patient is supine. Doctor flexes the hip and knee to 90 degrees, then extends the leg.
What are positive findings for Lasegue Test?
Hip pain: hip pathology
Thigh/leg pain: Radiculopathy
Bilateral pain: Tight hamstrings
What is the procedure for Lindner's Sign?
Patient can be seated or supine. Doctor passively flexes the patients chin to their chest.
What is the purpose of Lindner's Sign?
Tractions the meninges and nerve roots
What are positive findings for Lindner's Sign?
Supine: Same as Brudzinski's Sign - meningitis
Seated: Same as Lhermitte's - meningitis or cervical myelopathy
If pain is elicited in low back and Sciatic Nerve, NR irritation or inflammation are likely
What is the procedure for Milgram's Test?
Patient is supine and lifts feet 6" off table with knees in extension. Hold for 30 seconds (or as long as they can)
What are positive findings for Milgram's Test?
No pain but unable to hold position - weak core muscles
Low back pain - Herniation or lumbar strain/sprain
What is Minor's Sign?
Patient uses upper body strength to stand from a seated position. They may have a hand on the hip of the affected side.
Why would someone exhibit Minor's Sign?
SI Joint lesion
How do we perform Nachlas' Test?
Patient is prone. Doctor touches the heel of one foot to the ipsilateral buttock.
What are possible findings for Nachlas' Test?
Radiating pain: Femoral nerve or lumbar spine NR compression
Localized pain: Quadriceps muscle contracture
How do we perform Quick test?
Patient supports themselves with hand on wall or table for balance, then does 5 deep squats with a bounce at the bottom.
What is the purpose of Quick test?
Look for pain, locking, or crepitus in the low back, hips, knees, or ankles.
When should we avoid using Quick test?
On pregnant and elderly patients
How do we perform Bilateral Leg Lowering Test?
Patient is supine. Doctor flexes hips to 90 degrees with legs extended. Patient lowers the legs until the Doctor tells them to stop (around 45 degrees)
What is the purpose of Bilateral Leg Lowering Test?
Check for IVD lesion, facet syndrome, or lumbosacral sprain/strain