Lumbar Spine Exam Flashcards
(25 cards)
Establishing an outcome/asterisk
“Where is your pain?”
“is that the same pain you are here to see me about today?”
Medical screening
BP, HR, RR, O2 level sat, Well’s criteria for PE/DVT
What is the Well’s criteria for DVT?
Active cancer
Paralysis, paresis, or immobilization of LE
Recently bedridden >3 days or major surgery within 4 weeks.
Localized tenderness in deep venous system
Entire LE swelling
Calf swelling by >3cm
Putting edema
Collateral superficial veins
Anything 3 or greater is a 75% of DVT
What is the Well’s criteria for PE?
Clinical symptoms of DVT Other diagnosis than PE Pule rate >100 BPM Immobilization greater than 3 days in last 4 weeks DVT/PE previous Hemoptysis Malignancy
Greater than 4, likely
Sensation on LE
L1: Inguinal area L2: Mid anterior thigh L3: Medial Knee L4: Medial Malleolus L5: Distal medial dorsum of foot S1: Lateral border of foot S2: Medial / Posterior calcaneus
Lower Quarter Scanning Exam:
Hip Flexion: L2-L3 Knee Extension: L3-L4 Ankle dorsi: L4-L5 Walk on toes L5-S1 Great Toe Extension: L5 Ankle Eversion S1-S2
Deep Tendon Reflex: Quadriceps
L2-L4 @ patellar tendon - knee extension
Deep Tendon Reflex: Achilles
L5-S1 @ achilles tendon - ankle plantarflexion
Cutaneous reflexes to assess UMN Lesion that are above anterior horn or motor nuclei cranial nerve
Abdominal Reflex
Babinski
Hoffman
Hoffman’s sign
Flick distal end of middle finger to illicit flex of thumb and index finger
Lumbar Spine Radiculopathy can cause:
Myotomal strength changes
Reflex Changes
Sensory Changes
Radiating pain along nerve
If there is an UMN lesion observed, what should happen?. What about a LMN lesion?
Upper= referred Lower= referred but can proceed with treatment
To determine leg length discrepancy? What is the most reliable?
Standing is most reliable. Have them stand and have knees extended. See if pelvis @ ASIS is level.
When most a LLD be taken?
After hip fracture, ORIF, THA.
What is a non-weight bearing method for LLD?
Supine, ASIS to medial malleolus
What is a meaningful LLD?
Less than 5 mm is hard to clinically detect . Supine method is very unreliable. Less Reliability in obese individuals.
What is a lateral shift?
Acute visible frontal plane deviation where there is low back and leg pain.
Named by the side the shoulders are shifted to.
What can cause a lateral shift?
Disc herniation or other multiple etiologies.
Scoliosis is named how?
Name for the side of the convexity.
Thoracic: apex between t2-t11; often t9
Thoracolumbar t12-l1 ; often t11/12
Lumbar: apex between l2 and l4 ; often l2/l3
During a movement analysis; the functional tests of: squats, step down, heel walk and toe walk are for which spinal root levels?
Functional Squat and Step Down L3-L4
Heel Walk: L4-L5
Toe Walk: L5-S1
What tests can be ran for a movement analysis?
Functional Squat, Step down, Heel Walk, Toe Walk, LQ scan, Gait analysis, Muscle Length Tests
Which hip tests should be ran?
FADIR (99 sensitivity; hip pain in groin)
FABER- Passive Flexion with ABduction and External Rotation (pain in groin)
What are the muscle length tests?
Modified Thomas Test
Ely’s Test
Ober’s Test
Popliteal Angle Test
What is normal lumbar AROM?
Flexion- 60
Extension 25
Side Bending- 25
Rotation -45
