Lumbar Scan Flashcards
Give the 5 reasons you would perform a Lumbar scan.
1) Referred pain to the hip and LE; so anytime nerves that can refer pain may be involved.
2) Insidious onset of back, hip, knee, or foot pain
3) Symptoms with hints of a neuro component (weakness, parasthesias, sensory loss, coordination, and odd symptoms)
4) Observable muscle atrophy in any muscle with L/S innervation.
5) Symptoms are relieved by putting LE or spine in unusual positions.
What are the 4 parts of the observation portion of the scan?
1) Posture
2) Pelvis Symmetry
3) General Skeletal Alignment
4) Gait
When assessing posture what are some major things to look for?
FHP, Kyphosis, shoulder ht differences, increased lordosis, problems in LE and feet.
Remember biomechanically the inferior problem usually causes problem above, but not always*
What are you looking for with pelvic symmetry?
Height of PSIS and ASIS, iliac spine ht differences (could mean SI rotation), muscle wasting or changes?
What is the problem with iliac spines that are the same front to back, but not side to side?
Could indicate an upslip or downslip of the hemi pelvis.
A disc patient will present with a lateral shift which way?
Away from the side of the lesion.
Why do you perform AROM?
Looking for pain, restriction of movements, or deviations that may suggest a specific lesion.
When a patient flexes forward what do you want to see and where?
Roundedness in the lumbar spine. Don’t want to see a flat back (shows more flexing at hips than spine)
Where would you measure to see improvement in SB to the Left and Right and Flexion?
Measure from the fingertips to the floor.
True or False: You are less concerned about joints that don’t move than you are about joints that do move.
False, you are JUST as concerned,
Where do you apply your overpressure in lumbar extension?
The clavicle and Lumbar spine.
Where would you expect the “crease” seen in extension to be found?
L4-L5
When performing a rotation AROM check what do you want to make sure is actually moving? How do you optimize it’s movement?
Want to see Lumbar spine moving; optimize movement by having them sit on the corner of the bed with a leg on each side of the corner.
How do you test the S1-S2 dermatome?
10-15 unilateral toe raises- gastrocnemius testing
Don’t let the patient do what when you are testing their gastroc?
Don’t let them lean forward instead of going up on their toes
What does the patellar tendon reflex test?
L3-L4
What is an alternate way to test the S1-S2 reflex?
Pt sitting with foot relaxed. Move into slight DF and tap Achilles’ tendon
How do you put more stretch on the nerves in a SLR test?
Add in DF and then neck flexion
If you have a positive SLR do you need to to the Slump test?
Not necessarily. Only do the Slump if you get a negative SLR, but you are still concerned.
What is a non-therapy way to use the SLR and Slump Test?
Can be a good way to pick out malingerers.
Name the 5 myotomal tests you can do in supine.
L2- hip flexors L3- Quads L4- Anterior Tibialis L5- EHL L5-S1- Fibulars
What are the 3 tests for UMNL Pathologic Reflexes?
Clonus: DF stretch to ankle
Babinski: Noxious stim to sole of pt foot, + = ext of big toe & ABD of rest
Hoffmans: flicking middle phalange, + = flexion of thumb & index
What are the two prone myotomal tests?
S1- Hamstrings
S2- Gluts
How would you test the lumbar plexus of nerve roots L1-L4?
Flex knee and extend hip slightly. Positive test is back or anterior thigh pain
