Flashcards in Lumbar Tests Deck (22):
Segmental Instability Test
Check for spondylolisthesis, segmental instability in joint
Prone on table, feet on floor
Pressure applied to lumbar spine
Positive if pain reproduced while relaxes, but disappears when legs lifted of floor.
Tests for intrathecal pressure (usually due to space-occupying lesion. -- tumour, herniated disc, osteophyte).
Possible sciatic nerve involvement.
Sit down. Bear down.
Positive if pain reproduced.
Patient extends spine, laterally flexes, and rotates toward pain. Apply over pressure into shoulders.
Positive: reproduces pain
[narrowing foramen, stress facet joint]
Dural Slump Test
Tests for tension in neuromeningeal tract.
Sit up, hands behind back
Slump with chin in neutral
Apply over pressure to shoulders
over pressure to cervical, thoracic and lumbar spine
Knee extension (possibly passive)
Hold with max knee extension
Overpressure to c-spine
Positive if symptoms REproduced (not just produced), if knee extension increases or symptoms decrease with neck extension.
Neural tissue tends to adhere more at what points?
C6 T6 L4 Knee
Straight Leg Raising Test
AKA Lasegue's test
Tests for disc herniation, PN involvement, disc
Unilateral. Unaffected side first.
Supine. Hip medially rotated, adducted, knee extended.
Passive flexion of hip until patient complains of back or hamstring
Lower leg until symptoms disappear.
Can flex neck to make more provocative
SLR: at what point in hip flexion is the sciatic nerve tensioned
Sciatic nerve tense over IVD
Range of deformation decreases as angle increases
No further deformation of nerve root. Pain is probably joint pain.
Unilateral SLR: sequence of tension
Greater sciatic foramen
Ala of sacrum
Where nerve crosses pedicle
SLR: nerves tractioned
Lumbosacral nerve roots
L5-S2 nerve roots
SLR: pain in back
Likely smaller and more central if back pain only
SLR: pain in posterior leg
Periphery nerve involvement
SLR: pain in back and posterior leg
Disc herniation and peripheral nerve
SLR: increase in pain
Dura mater or spinal cord involvement
Pain when unaffected leg tested.
Large disc protrusion medial to nerve root
SLR: tibial nerve bias
SLR: sural nerve bias
SLR: common fibularis bias
Pelvis not stabilized, rotates more on flexion,decreasing stress
Pain before 70°: SI joint
Pain after 70°: lumbar spine lesion
After positive SLR
Tests for pressure on sciatic nerve
Knee slightly flexed (20°)
Ankle resting on shoulder
Apply pressure to popliteal area
Positive if radicular symptoms reproduced.