Week 4 (parts 1 and 2)

Question 1

Part 1

Answer 1

Lumbar Spine Assessment

Question 2

what are the stages of Lumbar Spine objective assessment

Answer 2

• Observation
• AROM
• Neuro integrity – dermatomes, myotomes and reflexes
• Neuro sensitivity – SLR etc
• Palpation
• PROM
• Special tests to area (e.g SU)
• Clearing other joints (hip)
• Muscle strength and stability testing
• Functional testing
• Outcome Measures

Question 3

what is part of observation

Answer 3

Sitting and standing posture
◦ Spinal posture – lordosis, kyphosis, scoliosis?
Muscle tone & bulk
Observed function, movement & pain behaviors.

Question 4

what is part of AROM

Answer 4

• Lx Flexion, Extension, Side Flexion
• Quantity and Quality – observe
• Depending on SIN – repeated or combined movements

Question 5

Neurological/ Neurointegrity assessment

Answer 5

As a GENERAL rule a neurological examination is indicated if the patient has symptoms (pain / weakness / altered sensation) BELOW the level of the buttock crease/shoulder
Neural integrity (classic neurology examination)
1. Dermatomes – variability from person to person
2. Myotomes – lesion can be located anywhere between spinal cord to terminal branches
3. Reflexes

Question 6

what are the 2 upper motor neurone Lesion tests

Answer 6

clonus
Babinski

Question 7

how do you test someones dermatomes

Answer 7

cotton wool/ tissue on both sides of the body ** KNOW WHERE SENSES WHAT**

Dermatomes:
Ensure even touch throughout the test.
Use tissue to remove variation in pressure.
Gently stroke the skin over the dermatome checking both sides.
You are looking for any difference in sensation that is dermatomal and has no other explanation (scars/surgery etc).
Compare both sides.
Try to find out the % of sensation reduction or some degree of quantification.
Document sensation changes – reduction or increases / hypersensitivity.

Question 8

what do myotomes assess/ why do we assess myotomes

Answer 8

Assessing for WEAKNESS (not pain)
Significant weakness is classed as <3/5 Oxford in a myotomal pattern, ie NOT generalised weakness or pain inhibition.
◦ L2- Hip Flexion
◦ L3- Knee Extension
◦ L4- Ankle Dorsiflexion
◦ L5 – Hallux Extension
◦ S1- Calf Plantarflexion (calf raise)
◦ S2-Knee Flexion
Compare both sides.
Sn – 31% Sp – 71% for localising spinal levels

Question 9

what are reflexes

Answer 9

An involuntary muscular contraction following percussion of a tendon or muscle
Patient needs to be relaxed and comfortably supported
A tendon reflex is elicited by briskly striking the tendon of a muscle which is on a slight stretch
In LL: Quads tendon / knee jerk = L3/4
Achilles tendon / ankle jerk = L5/S1
Brisk / hyperactive reflexes = UMN pathology
Diminished / absent reflexes = LMN pathology
◦ Eg CES, disk prolapse
‘Reinforcement’ (the Jendrassik manoeuvre) can help if reflexes are difficult to elicit
Sn – 27% Sp – 77% for localising spinal levels

Question 10

what is the Babinski test

Answer 10

running sharper end of neurone tester along sole of foot
Negative – down going plantar response
Positive – up going/ extension plantar response

Question 11

what is the Clonus test

Answer 11

Confident / brisk DF and hold (in slight knee flexion)

Negative/ normal - <4 beats of the ankle
Positive - >5 beats of the ankle

Question 12

what does PAIVM stand for

Answer 12

PAIVM = Passive accessory inter-vertebral movement.

Question 13

palpation of the Lx

Answer 13

The top of the iliac crest is roughly between L4 and L5
◦ HOWEVER – we can’t accurately locate exact levels (more of an art form than a science).
◦ SAYING THAT – we need some distinction for documentation.
Symbols assist in documentation and the G1-4 classification is used.
Mobilisations can be ‘central’ (over the spinus process) or ‘unilateral’ (roughly over the facet joints)
They are most useful when comparing stiffness over several levels or assessing for pain.
PA (Posterior-anterior) mobilisations centrally
PA unilateral mobilisations
Palpate your plinth partner(s) L5-T8
Check consent
Patient comfort
Uncover the area if possible but you can palpate through thin clothes if necessary.
Assess for pain and any differences in the ‘give’ of each level
Document what you have done and your findings using the correct symbols and levels.

Question 14

part 2

Answer 14

lumbar spine pathologies

Question 15

epidemiology of lumbar spine pathologies

Answer 15

• Low back pain (LBP) is ranked globally as the leading cause of disability that emerges during adolescence, and adulthood.
• According to a survey published in 2000 it was estimated that almost half of the UK adult population (49%) report LBP lasting for 24 hours at some time in the year.
• It is also estimated that 4 out of every five adults will experience back pain at some stage in their life.