10 terms

Orthopedics Lumbar Tests

Valsalva Maneuver
How to perform test:
-Ask patient to bear down as if straining on the stool for 2-3 seconds OR ask patient to put thumb in mouth and blow on it.

Positive Test:
-worsening symptoms or pain

Positive Test Implies:
-bulging disc
-disc herniation
-space occupying lesion (tumor, osteophyte) in spinal cord or IVF
Bechterew's Test
* Used to confirm suspicion of sciatic irritation or L4, L5, S1 root irritation when patient complains of leg pain, paresthesia, subjective numbness, or weakness

How to perform test:
-With back slumped and head tilted forward (flexed). Ask patient to extend one knee at a time

Positive Test:
-radicular pain
-recreation of low back or leg pain

Positive Test Implies:
-symptoms past the knee indicate:
+ L4, L5, or S1 radiculopathy due to:
~herniated disc
~ SOL (osteophytes, tumors)
~ infection
~ fracture
Slump Test
* used to determine if a patient's pain is due to stretching of neurological tissue

How to perform test:
1. Patient sits upright, arms behind back
2. patient slumps forward, flexing thoracic & lumbar spine while keeping cervical spine extended
3. patient tilts head forward (cervicals flexed)
4. You? extend one of patient's knees at a time and dorsiflex the ankle
* Also, in ghormley's version, press down on the patient's head to maximally flex the neck
*Book version: keep leg raised while the patient releases cervical flexion & notes any change in Sxs

Positive Test:
-spinal or leg pain occurs in the indicated position and then is relieved by releasing cervical flexion

Positive Test Implies:
-creation of radicular pain suggests:
+dynamic neurological component to the patient's pain
+ radicular pain reproduced with specific movements suggests involvement at the area being stretched.
Kemp's Test
* used to assess nerve root encroachment, disc herniation, muscle strain, ligamentous strain, facet irritation, capsular inflammation

How to perform test:
-Have patient laterally flex and rotate at the spine
-pull back/push down on lower shoulder
Ghormley: You rest your elbow on the patient's lower shoulder and hand on the higher shoulder
-You then push anteriorly at multiple places along the lumbar spine

Positive Test:
-pain the radiates down the leg
-low back pain

Positive Test Implies:
-If low back pain WITH radicular pain:
+ nerve root compression
-If low back pain WITHOUT radicular pain:
+ muscle strain/ligamentous strain/ facet irritation/ capsular inflammation
Lindner's Test
(=Soto Haul Test)

How to Perform:
-You Passively flex the patient's chin to chest
-Variation: You flex the head, cervical, thoracic, & lumbar spine to form a C shape -use your thigh to support their back in that position for a few seconds

Positive Test:
-Pain at the level of the lesion (low back) & radicular Sxs along nerve distribution down leg

Positive Test Indicates:
-nerve root compression
Brudzinski's Test
*Confirms suspicion of meningeal inflammation/irritation or sciatic nerve root irritation

How to Perform:
-Patient actively? Flexes neck (chin to chest)

Positive Test:
-low back and/or leg pain
-flexion of knees to relieve pain caused by traction of spinal cord and dural sac from neck flexion

Positive Findings Indicate:
-sciatic nerve root irritation
-classically associated with meningitis/meningeal irritation
-other possible causes:
+ cord tumors
+ cord inflammation
+ multiple sclerosis
+ subarachnoid hemorrhage
Straight Leg Raise (SLR)
* A nerve tension test used to rule out sciatica or L4-S1 nerve root irritation

How to Perform:
-You place one hand under the patient's heel and the other over the knee to keep the leg straight
-You passively raise the patient's leg from the table, holding the knee straight (extended) until the onset of pain
-You note the angle at which the onset of pain occurs as well as the location, quality, & magnitude of the pain

Positive Test:
1. sharp, burning, electrical pain radiating past the knee with hip flexion between 35 and 70 degrees (hard positive)
2. pain radiating into lower extremity but not past knee (soft positive)
3. no pain at all or only pain in back or to buttocks
4. focal point of pain in the leg or pelvis

Positive Test Indicates:
1. A "hard" positive test suggests
+ sciatic nerve irritation
+ L4-S1 nerve root radiculitis
-Other causes:
+ lumbar disc herniation
+ tumor
+ spinal canal stenosis
+ encroachment by spurring or osteophytes
2. A "soft" or "equivocal" positive suggests:
-considered meaningful if any other evidence suggests that nerve root or sciatic nerve is inflamed or compressed
-considered insignificant if no other evidence supports radicular syndrome
3. no pain at all or only pain in back or to buttocks suggests:
-NEGATIVE for nerve root involvement
-if pain, it is most likely sacroiliac or lumbar
4. focal point of pain in the leg or pelvis
-ALARM sign suggesting a tumor (soft tissue or bony) in location of pain

* pain between 0-35 degrees: lumbar strain, piriformis spasm, or sacroiliac
* pain between 35-70 degrees: disc and or nerve root involvement
* pain over 70 degrees: sacroiliac or lumbar joint pain
Well Leg Raise
How to Perform:
-Examiner performs straight leg raise on NON-SYMPTOMATIC LEG

Positive Test:
-Increased Symptoms in the SYMPTOMATIC LEG

Positive Test Indicates:
-strong evidence for lumbar disc herniation
-could also be nerve root irritation from encroachment by osteophytes
Bragard's Test
*Test should follow a positive straight leg raise test

How to Perform:
-You lower the patient's leg 5-10 degrees or to just below level that elicited pain
-You then dorsiflex the patient's foot

Positive Test:
-Duplication or increase of radicular leg pain

Positive Test Suggests:
-sciatic radiculopathy from:
+ disc herniation
+ intervertebral foramen encroachment
+ space occupying lesion
Kernig's Test
*Performed on patients with low back pain to rule out nerve root tension or meningeal irritation

How to Perform:
-Patient actively flexes hip and knee to 90 degrees
-Patient then attemps to actively extend the knee while maintaining hip flexion. (tractions on the sciatic nerve & meninges)

Positive Test:
-low back and leg pain relieved by knee flexion, worsened by extension

Positive Test Indicates:
-lumbar muscle strain
-radicular pain relieved: nerve root involvement
-resistance without pain: hamstring tightness
-fever & opposite knee flexion: meningeal irritation