Spine Provocative Test

Question 1

Cervical provocative test (4)

Answer 1

1. Spurling
2. Shoulder abduction test (Bakody Sign)
3. Elvey upper limb tension test
4. Lhermitte’s Sign

Question 2

Lumbar provacative tests (10)

Answer 2

1. Straight leg raise
2. Crossed straight leg raise
3. Lasegue test: SLR + Dorsiflexion
4. Bowstring test
5. Slumpt test
6. Femoral nerve stretch test: (L2-L4) Prone + Knee passively flexed + Hip extended
7. Milgram Test: Supine + Raise both legs 2-6 in + Hold for 30 sec
8. Kernig/Brudzinski
9. Valsvalva
10. Schober

Question 3

SI joint provocative tests (8)

Answer 3

1. FABEr
2. Gaenslen’s
3. Yeoman’s
4. Iliac compression/distraction
5. Gillet’s Test
6. Sacral Thrust Test
7. Active Straight Leg Raise Test
8. Posterior pelvic pain provocation test

Question 4

Normal cervical ROM

Answer 4

• Rotation: 90
• SB: 45
• Flex: 60
• Ext: 75

Question 5

When to avoid spurling’s test

Answer 5

RA

Unstable c-spine

Metastatic disease

Question 6

How do you improve sensitivity w/ spulrings?

Answer 6

Hold for 30 sec-1 min (at baseline only 30% sensitive, 93% specific)

Question 7

Bakody’s sign

Answer 7

improvement of symptoms w/ hand of affected extremity raised to the top of head

Pts w/ cervical radic often state they need to sleep w/ arm abducted over head

Question 8

Lhermittes sign

Answer 8

Pt flexes chin to touch chest

• Shooting pain/paresthesias down cervical/thoracic spine
• Considered RED FLAG for neck symptoms
• Can indicate cervical myelopathy or MS

Question 9

Percentage of low back pain that improves w/in 3 months w/o intervention

Answer 9

90%

Question 10

Williams PT program

Answer 10

Flexion based (facet mediated pain)

Question 11

Mckenzie PT program

Answer 11

Extension based (discogenic pain)

Question 12

Bowstring sign test

Answer 12

Sciatic nerve irritation

• After SLR flex knee to 20 degrees + apply pressure to popliteal fossa

Question 13

Migram test

Answer 13

Pt raises both legs 2-6 inch off table and holds for 30 sec

• Unable to hold affected leg up= Positive
  
  • Can be falsely positive w/ weak abdominal muscles

Question 14

Kernig/Brudzinksi test

Answer 14

Supine + C-spine flexed= active flexion of hips on affected side

Question 15

Schober’s Test

Answer 15

Ankylosing spondylitis= Iliac crests mark spot 5 cm inferior and 10 cm superior and have pt flex

• <5 cm change or <20 cm total distance= Positive test

Question 16

SI mediate pain diagnosis criteria

Answer 16

2-3 positive SI tests

Question 17

SI Provocative Tests: FABER

Answer 17

(+)= reproduction of pain on contralateral SI joint

Question 18

SI Provocative Tests: Gaenslens

Answer 18

Supine + Flex one leg to chest + Hang one leg off table

• Stresses both SI joints

Question 19

SI Provocative Tests: Yeoman’s

Answer 19

Prone + Rotate Illeum + Extend hip w/ knee extended

• Stresses ipsilateral SI

Question 20

SI Provocative Tests: Gillet’s Test

Answer 20

Pt standing place thumbs over PSIS + Pt alternates flexing each hip

• (+)= No movment and/or superior movement

Question 21

Special Tests: Piriformis Syndrome

Answer 21

• FAIR test
• PACE: Resisted abduction and external rotation w/ hip flexed
• Freiberg: reproduction on pain w/ forced internal rotation w/ hip

Question 22

Differentiation of posterior pelvic pain form lumbar pain in pregnant women

Answer 22

4P test (Posterior Pelvic Pain Provocation)

• Axial load to hip and knee 90 flexed
• Pain in pubic symphysis vs SI joint

Question 23

Special Tests: Facet joints

Answer 23

Single leg hyperextention test

Quadrants test: Extend lumbar spine w/ rotation and sidebending to side w/ physician applying downward force

GOLD STANDARD: Improved pai nw/ nerve block

Question 23

Special Tests: Facet joints

Answer 23

Single leg hyperextention test

Quadrants test: Extend lumbar spine w/ rotation and sidebending to side w/ physician applying downward force

GOLD STANDARD: Improved pai nw/ nerve block