Lumbar Special Tests Flashcards Preview

PHTH 7232 Ortho > Lumbar Special Tests > Flashcards

Flashcards in Lumbar Special Tests Deck (57):
1

What is a test that can be used as part of a detailed examination for suspected facet DJD or lateral stenosis?

lumbar Quadrant Test

2

Prone Knee Bend: Indications for performing test

Radicular pain or signs of peripheral neural tension in the femoral nerve or upper  lumbar spine

3

Prone Bridge: how to perform

Prone (plank) position propped on elbows spaced shoulder width apart; feet narrowly spaced. Stop when pt is unable to hold position.

Norms:

Males: asymptomatic - > 92.9s; symptomatic ->33.4s.

Females: asymptomatic -> 51.2s; symptomatic -> 24.3s

4

What special test assesses lumbar lateral flexor endurance?

Side Bridge (side plank)

5

Supine Bridge: how to perform

 

Supine in a hookline position w/hands positioned by ears. Raise pelvis up so that shoulders, hips, and knees are in straight line. Hold the position. If can hold for 2 min, dominant leg can be extended. Stop when pt is unable to hold position.

Norms:

Males: asymptomatic - > 188s; symptomatic ->77.9s.

Females: asymptomatic -> 152s; symptomatic -> 75.7s

6

What is a screeing test for lumbar problems?

 

Lumbar Quadrant Test

7

Straight Leg Raise: Response & Implications

Response: reproduction of s/s, usually at

Impl: Nerve root impinge or neural tension any LE periph nerves

  • local pain reproduced in the 0-30º range may indicate hip dysfunction; pain in the 0-30º range may indicate a highly irritated nerve root
  • Pain reproduced in the 30-50º range may indicate sciatic or other nerve involvement
  • Posterior thigh pain reproduced in the 50-70ºrange may indicate hamstring involvement or neural tension

7

What special test assesses lumbar flexor endurance?

Prone Bridge (plank)

8

Lumbar Quadrant Test: Indications for performing test

Screening test for lumbar problems or part of a detailed examination for suspected facet DJD or lateral stenosis

8

Prone Bridge: Indications

To assess lumbar flexor endurance

8

Sorensen: How to perform

 

pt prone with the superior margin of iliac crests aligned with the ridge of the table.

Stablize the pelvis, knees, and ankles

Extend upper body to the horizontal position and hold until pt is unable to maintain the testing position one time

Norms:

Males: asymptomatic - > 198s; symptomatic ->163s.

Females: asymptomatic -> 197s; symptomatic -> 177s

9

4 Lower Quarter Neurodynamic Tests

  1. Straight Leg Raise
  2. Crossed Straight Leg Raise
  3. Slump Test
  4. Prone Knee Bend

10

Repeated Extension in Standing: How to perform

If first step in series, check flexion ROM before starting

Keep knees straight and extend actively and repeatedly (up to 10 times)

May help if patient puts hands on bottom and slides them down back of legs

11

What tests are indicated if pt presents with radicular pain or signs of peripheral neural tension in the femoral nerve or upper lumbar spine?

Prone Knee Bend

12

Prone Knee Bend: How to perform test

pt prone

passivly flex knee until pt feels pain, tightness, or reproduction of symptoms. There is no sensitizing manuver, so PT must ask about quality of sensation to differentiate between nerve and musclular pain/tightness

Response: Reproduction of s/s

12

Lumbar Quadrant Test: how to perform

 

pt standing

Passive (assisted) sequential combined extension, LF and rotation (both towards side of pain)

12

Sorensen: Response & Implications

Response: Stop when pt is unable to hold position.

Norms:

Males: asymptomatic - > 198s; symptomatic ->163s.

Females: asymptomatic -> 5197s; symptomatic -> 177s

Implications: To assess the endurance of the lumbar extensors and determine whether lumbar extensor strengthening is warranted in a treatment program

12

What tests are indicated if pt has radicular s/s in one LE?

 

Crossed Straight Leg Raise

13

Repeated Flexion in Testing: Response & Implications

Response:

  • (+) if local or distal sumptoms peripheralize
  • if symptoms centralize, it suggests and anterior disc derangemnt but this should be correlated with repeated extension
  • If (+) then extension mobility will often be reduced afterward

Implications:

  • If symptoms peripheraize (+), suspect a posterior disc derangement
  • If symptoms centralize, suspect an anterior derangement

15

2 General Lumbar Special Tests

  1. Prone Instability Test
  2. Lumbar Quadrant Test

16

What special test is indicated if pt has redicular s/s in one LE?

 

Crossed Straight Leg Raise

18

Prone Instability Test: Indications for performing test

 

Central lumbar pain with or without radicular s/s

19

What tests are approprate if pt presents with radicular s/s ?

 

The Lower Quarter Nerodynamic Tests

  1. Straight Leg Raise
  2. Crossed Straight Leg raise (in one LE)
  3. Slump Test
  4. Prone Knee Bend (s/s in femoral nerve or upper lumbar spine).

Prone Instability Test (Central Lumbar pain with radicular s/s)

20

What UE Special Tests are analogous with the Lower Quarter Neurodynamic Tests?

 

ULTT

(upper limb tension tests)

20

4 Lumbar Endurance Tests

 

  1. Sorensen
  2. Supine Bridge
  3. Prone Bridge
  4. Side Bridge

22

Prone Knee Bend: Response & Implications

Response: Reproduction of s/s

Implications: Nerve root impingement at an upper lumbar level or nearual tension along pathway of femoral nerve

23

Repeated Flexion in Standing: How to perform

 

If first step in series, check extension ROM before starting

Keep knees straight and flex actively and repeatedly (up to 10 times)

 

 

24

Lumbar Quadrant Test: Response & Implications

 

Response: Reproduction of s/s on the ipsilateral side

Implications:

  1. If done as a lumbar screen, then (+) means that lumbar spine should be investigated further
  2. If done as part of a specific lumbar spine examination:
  • (+) with diffuse local pain suggests fecet DJD
  • (+) with radicular pain suggests lateral stenosis

25

Which two tests are indicated if pt has radicular pain or signs of neural tension?

Straight Leg Raise

Slump Test

26

What test is indicated when there is central lumbar pain with or without radicular s/s?

Prone Instability Test

27

What tests are indicated if pt has signs of neural tension?

 

Straight Leg Raise

Slump Test

Prone Knee Bend (if it is in femoral nerve distribution or upper lumbar spine)

28

Slump Test: How to perform test

 

pt sits in dependant postion with back of knees against the plinth.

Ask pt to slump forward into full back flexion. Passively straighten leg until pt reports pain or reproduction of symptoms. Perform sensitizing manuver: lower leg just enough for symptoms to subside. Ask pt to lift head. If pain/symptoms return, then it implicates nerve tension problem.

Response: reproduction of s/s within dermatomal pattern

29

Prone Instability Test: Response and Implication

Response: Compare pain during step 2 to step 1:

  • If pain decreases, then test is (+)
  • If pain = or increases, then test is (-)

Implications: Decreased pain during ste 2 compared to step 1 suggests lumbar instability is contributing to symptoms

30

Repeated Flexion in Lying: Response and Implications

Response:

(+) if local or distal symptoms change (either centralize or peripheralize)

Implications:

If symptoms peripheraize (+), suspect a posterior disc derangement
If symptoms centralize, suspect an anterior disc derangement

31

Prone Instability Test: How to perform test

pt prone with hips and LE's off end of table (basically standing on floor bent over table with edge of table hitting hip crease).

  1. Perform CPA (at any lumbar level) & assess pain response.
  2. have pt lift both legs slightly off floor and repeate CPA & assess pain response.

Pain MUST DECREASE in part 2 to have positive test (like O'Brien's test in shoulder)

32

Straight Leg Raise: How To Perform Test

Patient in Supine WITH NO PILLOW! & opposite knee stabilized.

Gradually and passively flex hip until pt reports pain. Perform sensitizing manuver to differentiate between nerve and  muscle tension (lower leg just until symptoms resolve, then passively dorsiflex foot). If symptoms return with dorsiflexion, then it is most likely neural pain.

+ response is reproduction of s/s; usually at

 

33

Side Bridge: How to perform

Sidelying (side plank) position propped on elbow &  feet. Top foot in front of bottom foot. Uninvoved arm placed acrosss the chest and resting on contalateral shoulder (we learned it with that arm placed along the side) Stop when pt is unable to hold position.

Norms:

Males: Right - > 94s; Left ->97s.

Females: Right -> 72s; Left -> 77s

35

Supine Bridge: Implications for performing test

To assess lumbar extensor endurance

36

Repeated Flexion in Lying: how to perform test

If first step in series, check extension ROM before starting

pt supine in hooklying position

use arms to pull knees to chest repeatedly (up to 10 times - stop if reproduction of symptoms or symptoms worsten - peripheralize)

37

Crossed Straitght leg raise: How To Perform Test

 

Patient in Supine WITH NO PILLOW! & opposite knee stabilized?

Perform Straight Leg Raise on contralateral LE:

Gradually and passively flex hip until pt reports pain. Maybe Perform sensitizing manuver to differentiate between nerve and  muscle tension (lower leg just until symptoms resolve, then passively dorsiflex foot). If symptoms return with dorsiflexion, then it is most likely neural pain. I'm not sure if this test has a sensitizing manuver

Response: if (P) increases in contralateral symptomactic LE (not the one being lifted) in dermatomal pattern, test is (+)

38

What lumbar special tests assess for lumbar disc derangement?

 

Repeated Movement Tests (4)

  1. Repeated Flexion in standing
  2. Repeated Extension in standing
  3. Repeated Flexion in lying
  4. Repeated Extension in lying

 

40

Crossed Straight Leg Raise: Response & Implications

Response

  • If pain increases in contralateral symptomatic LE (not the one being lifted) in the dermatomal pattern, test is (+)
  • If pain in symptomatic LE (not the one being lifted) is unchanged, test is (-)

Implications: Suggestest that a disk herniation is causing the nerve root irritation

42

Slump Test: Response & Implications

 

Response: Reproduction of s/s within a dermatomal pattern

Implications: Nerve root impingement or neural tension anywhere in LE peripheral nerves

43

Sorensen: Implications for performing test

To assess lumbar extensor endurance

43

Which two tests assess lumbar extensor endurance

 

  1. Sorensen
  2. Supine Bridge

46

Side Bridge: Response & Implications

Response: Stop when pt is unable to hold position.

Norms:

Males: Right - > 94s; Left ->97s.

Females: Right -> 72s; Left -> 77s

Implications: To assess the enduracne of the lumbar lateral flexors and determine whether lumbar lateral flexor strengthening is warranted in a treatment program

47

Straight Leg Raise: Indications for performing test

 

Radicular pain or signs of neural tension

48

4 Repeated Motion Tests

  1. Repeated Flexion in Standing
  2. Repeated Extension in Standing
  3. Repeated Fexion in Lying
  4. Repeated Extension in Lying

49

Side Bridge: Indications

To assess lumbar lateral flexor endurance

50

Prone Bridge: Response & IMplications

Response: Stop when pt is unable to hold position.

Norms:

Males: asymptomatic - > 92.9s; symptomatic ->33.4s.

Females: asymptomatic -> 51.2s; symptomatic -> 24.3s

Implications: To assess the endurance of the lumbar flexors and determine whether lumbar flexor strengthening is warranted in a treatment program

51

Supine Bridge: Response & Implications

Response: Stop when pt is unable to hold position.

Norms:

Males: asymptomatic - > 188s; symptomatic ->77.9s.

Females: asymptomatic -> 152s; symptomatic -> 75.7s

Implications: To assess the endurance of the lumbar extensors and determine whether lumbar extensor strengthening is warranted in a treatment program

52

Indications for Repeated Motion Tests (any of them)

Assesses for lumbar disc derangement

 

53

Crossed Straight Leg Raise: Indications for performing test

Radicular s/s in one LE

54

Repeated Extension in Standing: Response & Implications

Response:

(+) if local or distal symptoms peripheralize
if symptoms centralize, it suggests a posterior disc derangement but this should be correlated with repeated flexion
If (+) then flexion mobility will often be reduced afterward

Implications:

If symptoms peripheraize (+), suspect an anterior disc derangement
If symptoms centralize, suspect a posterior derangement

55

Repeated Extension in Lying: Response & Implications

Response:

(+) if local or distal symptoms change (either centralize or peripheralize)

Implications:

If symptoms peripheraize (+), suspect an anterior disc derangement
If symptoms centralize, suspect a posterior derangement

56

Slump Test: Indications for performing test

Radicular pain or signs of neural tension

57

Repeated extension in lying: how to perform

 

If first step in series, check flexion ROM before starting

pt prone with hands under shoulders

extend elbows repeatedly to extend lumbar spine but keep trunk relaxed (up to 10 times - stop if reproduction of symptoms or symptoms worsten - peripheralize)