lumbar ans si ortho lab 2 s 7, Orthopedic Tests
Hibb's Test
*Pt is prone* ___Examiner flexes pt's knee fully ___*Examiner internally rotates the hip while maintaining full knee flexion* ___Bilaterally performed ___Positive findings: pain in SI or hip joint ___Indications: sprain of SI {SI Joint Syndrome}; hip joint arthritis, capsulitis, etc.
Trendelenburg's Test
+= weak glut medius, hip lesion/path, S/I lesion on stance side L.P.
Mennell's Test
+Exacerbation of SI pain Myofascial involvement of gluteal muscles SI subluxation or sprain.
Laguerre's Test is also referred to as _____________
-FABER in the air
What is the purpose of clinical prediction rules?
-If both tests provoke familiar pain, no further testing is indicated
Is age a red flag? Yes or No?
-No
What does FAIR stand for? (hint: FADIR)
-flexion, adduction and internal rotation
In the SLR if patient has pain between 0-35 degrees, it indicates what? (3)
-hamstring tightness, SI or Hip problem (piriformis syndrome)
psoas muscle
FLEX AND LAT ROTATE HIpp
Sartorius
Flexes, abducts, and laterally rotates thigh at the hip; flexes knee
gastrocnemius muscle
Function: Plantar flexes ankle, Insertion: Calcaneus (heel), Origin: Femur
Kemp's Test
The patient seated/standing and supported by the doctor. The doctor rotates the patient's trunk from the original position and circumducts the trunk toward the affected side and then away from the affected side. Positive sign is sciatic pain down the involved side, indicating posteromedial disc involvement if the positive is away from pain, if the positive is into pain indicates posterolateral disc involvement
kemps test
The patient seated/standing and supported by the doctor. The doctor rotates the patient's trunk from the original position and circumducts the trunk toward the affected side and then away from the affected side. Positive sign is sciatic pain down the involved side, indicating posteromedial disc involvement if the positive is away from pain, if the positive is into pain indicates posterolateral disc involvement
Trendelenburg test
The patient stands and rises one foot and then the other while the doctor observes the buttocks. Positive sign is when the buttock drops on the side that the foot is elevated indicating hip abductor weakness on the stance leg side.
Femoral nerve traction test
This test may also cause contralateral pain, indicating a nerve root compression or irritation on the opposite side. -Extension of the hip and flexion of the knee place traction pressure on the femoral nerve and nerve roots of L2 to L4.
piriformis muscle
a flat, pyramidal muscle arising from the anterior sacrum, passing through the greater sciatic notch to insert into the superior aspect of the greater trochanter of the femur; serves to rotate and abduct the thigh
Quadriceps
a muscle group consisting of four muscles that is located along the front of the thigh
gluteus maximus
extends hip
Valsalva's meneuver
hold breath and bear down INC intrathecal pressure
Slump Test
identifies dysfunction of neurological structures supplying the lower limb
psoas muscle
originates from the anterior surface of the transverse processes and lateral surface of the vertebral bodies L1-L5 It serves to flex the hip and also somewhat to lateral rotation and abduction of the thigh. It can becomes infected with abscess espeically in a patient with HIV
Drop Heel Test
pain from shockwave indicates disc, facet or nerve root pathology
Braggard's Test
pain on dorsiflexion = disc lesion or sciatica
Adductors of the hip joint
pectineus, adductor brevis, adductor longus, adductor magnus
Thomas' Test
positive if opposite thigh flexes off table
C Compression
root/disk injury
Leg Length - Supine
use medial maleoli may indicate S/I lesion
Trendelenburg test is positive as a result of what 4 things?
-(1) gluteal paralysis or weakness of the hip abductors (gluteus medius/minimus) from polio -(2) gluteal inhibition (from pain arising in the hip joint) -(3) gluteal insufficiency from coxa vara -(4) congenital dislocation of the hip. Nevertheless, false-positive results have been recorded in approximately 10% of the patients with hip pain
Sacroiliac joint involvement produces local pain over the joint, or pain that is referred to what 3 areas?
-(1) the groin on the same side -(2) the posterior thigh on the same side -(3) down the leg, which is less often
If Gaenslen's test is negative what is suspected?
-A lumbosacral lesion is suspected
-Bechterew's Test -If no positive response is elicited, instruct the patient to do what?
-Bechterew's Test -Sciatica -Pain radiating down the leg (radicular pain) -Raise both legs together
Belt test / Supported Adam's test
-Belt Test -Lumbar vs. Sacroiliac Pain -If the lesion is of a pelvic nature, flexing the spine with the pelvis immobilized will not reproduce the discomfort. If the lesion is of a spinal nature, the pain will be aggravated in both instances.
Bowstring Sign - lumbar sexy over knee press on hamstrings
-Bowstring Sign -Lumbar Nerve Root Compression or sciatica -Pain in the lumbar region or radiculopathy is a positive sign for nerve root compression supine position, the examiner moves the patient's leg until it is above the examiner's shoulder. At this point, firm pressure should be exerted on the hamstring muscles
-Bragard sign slr dorsiflex
-Bragard sign -Sciatica -The sign is present if pain is increased. the sign is a finding associated with sciatic -If the Lasègue test or the straight-leg-raising test is positive, the leg is lowered below the point of discomfort, and the foot is sharply dorsiflexed.
-Buttock Test
-Buttock Test -Assessment for Gluteal Bursitis, Tumor, or Abscess -If the lumbar spine is the source of complaint, hip flexion will increase. A positive sign of the buttock occurs when hip flexion does not increase with knee flexion. -A passive unilateral straight-leg-raising test is performed on a supine patient. When unilateral restriction is encountered, the knee is flexed to determine if hip flexion increases
Bowel or bladder incontinence or retention is the first sign of what?
-Cauda Equina Syndrome
Dejerine's Triad
-Dejerine's triad -Space-Occupying Lesion -Increase in intrathecal pressure
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Ely Sign AKA Ely Heel-to-Buttock Test -Assessment for Lumbar Radicular or Femoral Nerve Inflammation -Reproduction of femoral radicular pain -The patient is prone, with the toes hanging over the edge of the table and legs relaxed. One or the other heel is approximated to the opposite buttock. After flexion of the knee, the thigh is hyperextended.
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-FAIR Test -Assessment for Piriformis Syndrome -Pain in the area or the piriformis muscle and/or radicular pain is indicative of piriformis syndrome -With the patient laying on the unaffected side, the examiner stands behind the patient holding the patient's knee (Fig. 12-18). The examiner then brings the extremity into hip flexion, adduction and internal rotation
-Fajersztajn Test AKA Well Leg Raise Test
-Fajersztajn Test AKA Well Leg Raise Test -Sciatica Caused by Disc Herniation or Dural Sleeve Adhesions -When this test causes pain on the symptomatic side, Fajersztajn sign is present, which indicates sciatic nerve root involvement due to as medial disc protrusion syndrome or dural root sleeve adhesions. -Straight-leg-raising and dorsiflexion of the foot are performed on the asymptomatic side of a sciatic patient
Femoral nerve traction test
-Femoral Nerve Traction Test -Assessment for Radicular Symptoms Caused By Space-Occupying Lesion -Pain extending to the mid tibia indicates a L4 nerve root problem. This test may also cause contralateral pain, indicating a nerve root compression or irritation on the opposite side. -Extension of the hip and flexion of the knee place traction pressure on the femoral nerve and nerve roots of L2 to L4.
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Gaenslen's Test -Assessment for Sacroiliac Lesions -pain is felt in the sacroiliac area or referred down the thigh -The patient is lying supine. The examiner acutely flexes the knee and thigh of the patient's unaffected leg to the abdomen
-Goldthwait's Test
-Goldthwait's Test -Assessment for Sacroiliac Joint Sprain VS. a Lumbosacral Spine Abnormality -If pain is brought on before the lumbar spine begins to move, a sacroiliac lesion is probably present. If pain does not come on until after the lumbar spine begins to move, the disorder is more likely to have its origin in the lumbosacral area or, less. commonly, in the sacroiliac area. -The patient's affected leg is raised slowly, while one of the examiner's hands is under the lumbar portion of the patient's spine.
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Hibb's Test -Assessment for Sacroiliac Disease -The production of pelvic pain is a positive finding -From this position, the examiner slowly pushes the patient's leg laterally, causing strong internal rotation of the femoral head
-Lindner's Sign-Assment for Lumbar Nerve Root Irritation or Inflammation
-If pain occurs in the lumbar spine and along the sciatic n erve distribution, the test is positive and, according to Lindner, is an indication of root sciatica -Passive flexion of the patient's head onto the chest can be accomplished in a supine, seated, or standing position
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Iliac Compression Test -Assessment for Sacroiliac Lesions/Sprain -Increased pressure in the SI-joint suggests a sacroiliac lesion. This pressure may also indicate a sprain of the posterior sacroiliac ligaments. -The patient is in a side-lying position. The examiner compresses the patient's superior ilium toward the floor
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Iliac Distraction Test AKA Gapping Test (per Magee) -Assessment for Sprain of Anterior Sacroiliac Ligaments -The examiner's hands pushing against the ASIS can elicit pain -The patient lies supine while the examiner applies crossed-arm pressure to the ASIS
\-Kemp's Test
-Kemp's Test -Assessment for Radicular Pain, Muscular Strain, Ligamentous Sprain, or Pericapsular Inflammation -If this compression causes or aggravates a pattern of radicular pain in the thigh and leg, the test is positive and indicates nerve root compression -While in a seated position, the patient is supported by the examiner, who reaches around the patient's shoulders and upper chest from behind. The patient is directed to lean forward to one side and then around until the patient is eventually bending obliquely backward.
In the SLR which level of spinal nerve roots along with the sciatic nerve are being tested? (3)
-L5, S1 and S2
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Laguerre's Test -Assessment for SI Dysfunction -Pain in the sacroiliac joint on the affected side constitutes a positive test. -The examiner laterally rotates the hip, applying an overpressure at the end of the range of motion. The contralateral pelvis is stabilized by holding the anterosuperior iliac spine down.
Which SI test cluster has the highest specificity?
-Laslett 2
In the SLR if patient has pain between 70-90 degrees, it indicates what? (1)
-Lumbar joint pain
-Minor's Sign
-Minor's Sign -Assessment for Sacroiliac Lesions, Lumbosacral Strains and Sprains, Lumbopelvic Fractures, Intervertebral Disc Syndrome, Muscular Dystrophy, and Dystonia -Sciatic radiculitis is suggested by how a patient with this condition rises from a seated position -The patient supports the body with the uninvolved side by balancing on the healthy leg, placing one hand on the back, and flexing the knee and hip of the affected limb
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Nachlas Test -Assessment for Sacroiliac or Lumbosacral Disorder -The test is positive if pain is noted in the sacroiliac area or lumbosacral area or if pain radiates down the thigh or leg. - The knee is fully flexed, approximating the heel to the ipsilateral buttock.
-Neri's Sign
-Neri's Sign -Assessment for Lumbar Intervertebral Disc Syndrome -The sign is present if the patient flexes the knee on the affected side and if trunk flexion causes pain in the leg. The sign is present for lower lumbar disc involvement, as well as lumbosacral and sacroiliac strains -While in a standing posture, the patient is directed to bow forward The sign is present when the patient flexes the knee on the affected side
Gaenslen's test is usually contraindicated in what age group?
-Older patients
-One Leg Standing Lumbar Extension Test
-One Leg Standing Lumbar Extension Test -Assessment for Spondylolysis or Spondylolisthesis -If the pars interarticularis is fractured, lumbar pain will be produced or increased -Instruct the patient to stand on one leg and extend the lumbar spine. Be close to the patient to provide support if the patient loses balance
If a patient presents with deep achy pain in the buttock and trouble sitting for a long time. What do they most likely have?
-Piriformis Syndrome
Trendelenburg Test is done for people with what? (2)
-Poliomyelitis -Muscular Dystrophy
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Sacral Thrust Test AKA Prone Springing -Assessment for Sacroiliac Disorders -If pain is produced over the joint -Pressure is then applied to the apex of the sacrum, causing a shear of the sacrum on the ilium
-Sicard's Test
-Sicard's Test -Assessment for Sciatic Radiculopathy -When the sign is present, dorsiflexion of the great toe reproduces sciatic pain -While the patient is supine, the extended leg is raised to a point just short of that which produces pain
In a Kemp's test what does sitting do?
-Sitting increases intradiscal pressure and therefore maximizes stress on the disc
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Slump Test -Assessment for Sciatica -Symptoms of sciatic pain or reproduction of the patient's symptoms indicates a positive test -The patient sits on the examining table with hands resting behind the back and is asked to "slump" so that the spine flexes and the shoulders sag forward while the examiner holds the chin and head erect. Then they flex the head. Then they ask patient to stick one leg out. Then they dorsiflex the foot.
--Straight Leg Raise Test
-Straight Leg Raise Test -Assessment for Sciatica -At 35-70, reproduction of sciatic pain will occur, and pain below the knee -Raise patient's leg between 35-70 degrees.
A __________________ is a combination or group of special tests which are developed to facilitate clinical decision making by improving the diagnostic utility.
-Test Item Cluster
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Thigh Thrust Test -Assessment for Sacroiliac Disorders -Pain in the sacroiliac joint on thrusting is a positive test -The patient lies supine while the examiner passively flexes the hip on the test side to 90°. Using one hand to palpate the sacroiliac joint, the examiner thrusts down through the knee and hip on the affected side.
--Lasegue's Test -Assessment For Sciatic Radiculopath
-This test is positive for sciatic radiculopathy when (a) no pain is elicited when the hip is flexed and the leg is flexed or (b) pain is present when the hip is flexed and the leg is extended -With the patient supine, flex the patient's hip with the leg flexed Keeping the hip flexed, extend the leg.
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Trendelenburg Test -Assessment for Insufficiency of the Hip Abductor System -The iliac crest will be high on the standing side and low on the side of the elevated leg. -The patient stands and is instructed to raise the foot of the unaffected leg off the floor. If normal, the iliac crest may be low on the standing side and high on the side of the elevated leg.
What is another name for the Slump test?
-Triple flexion test
In Gaenslen's test Pain is often increased by lying on the affected side. True or False?
-True
The second, third, and fourth nerve roots do not have an increase in tension during straight leg raising, but they do undergo an increase in tension during the femoral stretch tests. True or False?
-True
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Valsalva Maneuver -Assessment for Space-Occupying Lesion Tumor, Disc Herniation, or Osteophytes -A positive test is indicated by increased pain caused by increased intrathecal pressure. -The patient takes a deep breath and holds it while bearing down abdominally
Belt test / Supported Adam's test
-While positioned behind the patient, the examiner grasps the patient's iliac crests and braces a hip against the patient's sacrum (Fig. 9-21). The patient flexes the spine again as the examiner immobilizes the patient's pelvis
-What test is this? -What is it an assessment for? -What will elicit a positive sign? -How do we perform this test?
-Yeoman's Test -Assessment for Anterior Sacroiliac Ligament Injury -If pain is increased in the sacroiliac area, this increase in pain indicates a sacroiliac lesion or anterior sacroiliac ligaments. -The patient is lying prone. With one hand, the examiner applies firm pressure over the patient's suspect SI-joint, fixing the pelvis to the table. With the other hand, the examiner flexes the patient's leg on the affected side and hyperextends the thigh by lifting the knee off the examining table.
Milgram's Test
6" off table, hold 30 sec. R.P. = space occupying lesion (disc, mass, spur)
Abductors / Adductors
Abductors-draw a limb away from the midline Adductors-return the limb back toward the body
Piriformis
Abducts and laterally rotates thigh at the hip
Minor's Sign
Ask patient to rise from a seated position. Positive if the patient supports their body with the uninvolved side balancing on good side, indicating sciatica
Yeoman's Test
Doctor stabilizes SI joint testing, with the other hand doctor flexes leg of affected side and hyperextends the thigh by lifting knee off the table. Positive sign is pain in the SI joints indicating an SI lesion.
Hibb's Test
Doctor stabilizes the pelvis on the side they are standing, with the other hand the doctor grasps the ankle of opposite leg and flexes knee to 90 degrees. The doctor slowly pushes the leg away laterally producing internal rotation of the hip. Positive sign is pain in the SI joints indicating SI lesion
Hibb's Test - hip and pelvis
INSTRUCT: pt prone, ex stabilizes pelvis on near side while grasping the opposite ankle and flexing the knee to 90 degrees; the ex maximally flexes the knee and then slowly internally rotates the thigh (pushing lateral on the leg); compare bilaterally POSITIVE: 1. pain in the hip region 2. pain in the buttock/pelvic region INDICATES: hip jt pathology 2. SI jt lesion
Bilateral Leg Lowering
L.P. = L, L/S S/S R.P. = disc lesion
Ely's Test
L.P. = L/S or S/I S/S
Hibb's Test (Int. Rotation)
L.P. = hip or S/I S/S or lesion, or piriformis spasm
Lasegues Test (SLR)
L.P. @ 0-35 deg = S/I, S/S, piriformis spasm R.P. @ 35-70 deg = (L5,S1,S2) disc lesion L.P. @ 70-90 deg = L/S, S/S
Patrick /FABERE Sign
L.P.=hip, S/I, or groin lesion
Burn's Bench Test
Patient is instructed to kneel on a table 18 inches from floor, bend forward at the trunk, and touch the floor. Doctor holds the patient's ankles. Positive sign is if the patient refuses to perform the test indicating malingering
Lewin-Gaenslen's Test
Patient lie on unaffected side and pulls /table contacting, lower knee to chest. Doctor stabilizes pelvis and hyperextends top thigh. Positive: SI pain -> SI lesion
Kemp's Test
Patient seated. Doctor rotates patient's trunk and laterally bends towards and then away from affected side. Positive: Sciatica pain in involved side -> Disc Local pain -> Facet
Kemp's Test
Patient seated. Doctor rotates patient's trunk and laterally bends towards and then away from affected side. Positive: Sciatica pain in the involved side -> Disc Local pain -> Facet
Piriformis test
Patient side lying near edge of table. Patient flexes upper hip and knee to 90 degrees. Stabilize hip with one hand, press on knee with other. + pain in the buttock or radicular pain down leg: piriformis syndrome
Ober Test
Patient side lying. Grasp ankle and flex knee to 90 degrees, slightly extend hip. Slightly abduct hip + leg remains abducted (fails to adduct): tight IT band
Gaenslen's Test
Patient sidelying at edge of table while holding bottom leg in maximal hip and knee flexion (knee to chest). Stand behind the patient and passively extend hip of upper most limb. This places stress on SIJ associated with upper most limb. (+) TEST: pain in SIJ
Trendelburg test
Patient standing with back to examiner. Place thumbs on PSIS. Patient flexes hip one leg at at time + pelvis (on standing leg) falls or fails to rise when other leg is flexed: weak gluteus medius muscle, hip joint pathology of standing leg
Lasegue's test or Straight leg raising test
Patient supine with legs resting on table. Passively flex hip of one leg with knee extended until patient complains of shootingpain into lower limb. Slowly lower limb until pain subsides then passively dorsiflex foot (+) TEST: reproduction of pathological, neurological symptoms when foot is dorsiflexed
Kernig sign
Patient supine, actively flex hip and knee to 90 degrees. Patient extends knee + inability to strengthen the leg or pain with knee extension, meningeal irritation, sciatica
FABER test
Patient supine, cross one ankle above other knee. Stabilize opposite hip, while pressing crossed knee down + pain at the hip: inflammation or trauma of the hip joint
Brudzinski sign
Patient supine, passively flex patient's neck to chest + flexion of knees, meningeal irritation
Straight leg test
Patient supine, passively raise patient's leg to point of pain or 90 degrees + pain from 0-35: piriformis syndrome, SI joint lesion + pain from 35-70: herniated disc + pain from 70-90: lumbar joint problem
Laguerre's Test FAbere in the air 4 in the air
Positive: Pain in hip Indicates: Hip joint lesion (mainly for SI joint)
Nachlas Test /prone knee flexion
Positive: Pain in the buttock and/or pain in the lumbar region. Indicates: Sacroiliac joint lesion, or Lumbar pathology.
Kernig's Test
R.P. = disc or sciatic lesion
Nachla's Test
R.P. to ant. thigh=disc or n.r. lesion L2,L3,L4 L.P. = S/I or L/S S/S
Well-Leg-Raiser aka Fajerstazn's
SLR w/ dorsiflexion of the foot is performed on the Asymptomatic side of sciatic pt. Positive: pain down the symptomatic side Indicates: medial disc lesion
Hamstrings
The Biceps Femoris, Semitendinosus, & Semimembranosus muscles all make up the _______________.
Lasegue test
[straight leg raising] helps confirm the presence of herniated nucleus pulposus. Lifting affected leg to see if sciatic pain is reproduced
Fabere's figure 4 pressure on oppisite hip and lower knee
___Examiner passively flexes pt's hip & knee, external rotates & abducts hip so ankle is placed above knee on opposite thigh sign of 4 ___*Stabilize opposite ASIS* & gently lowers pt knee down towards table ___Use a two finger contact to apply slight pressure down & in on the knee ___Bilaterally performed ___Positive finding: pain in groin, inferior gluteal fold or SI Joint ___Indication: hip capsulitis, arthritis, fracture; SI joint syndrome also called *Patricks* and *Sign of 4*
Gluteus Medius
abducts and medially rotates thigh
Gluteus Medius
abducts and medially rotates thigh; steadies pelvis during walking
Tensor Fascia Latae (TFL)
abducts hip, flexes hip superior gluteal nerve
Gracilis
adducts thigh, flexes and medially rotates leg
Anterior Tibialis
dorsiflexion and inversion of ankle
Gluteus Maximus
extends thigh
L'Hermitte's Sign
flex C and T spine shooting pain=disc lesion, cord disease, meningitis local pain=S/S
Gaenslen's Test
identifies sacroiliac joint dysfunction
Ely's Test prone oppisite buttcheek
identifies tightness of rectus femoris, he lies to the opposite side
Ober's Test
identifies tightness of tensor fascia latae and/or iliotibial band tightness
Hoover's Test
if patient is not malingering Dr. will feel opposite leg pushing down, unless patient has well developed abdominals
Rust's Sign
indicates severe injury: muscle, ligament, disc, vertebral fracture/dislocation
Neri's Bowing Test
involved side flexes leg to avoid sciatic nerve stretch
If pain decreases on the affected side when the unaffected leg is raised, suspect a _______ disc protrusion, because the nerve root is being pulled away from the disc
lateral disc protrusion
Spinal Percussion
local pain=fracture/sprain radiating=disc lesion pain w/ tapping=strain
popliteus muscle
medially rotates the tibia (or laterally rotates the femur) to unlock the knee joint.
Iliac compression test aka Approximation test
pt is side-lying •contact lateral pelvis (halfway b/w top of crest and trochanters) •press down toward table •bilateral (+) pain in SI IND: SIJ syndrome, infection, sprain
Kernig's Test
pt supine dr passively flexes hip to 90 knee to 90 then extends leg observes opposite leg for kicking
Goldthwaite's Test
pt supine, dr w palm under lumbar spine, lifts leg off table and asks pt when symptoms occur
Minor's Sign
sciatica severe S/S
Dejerine's Triad
strain/cough/sneeze
Lindner's Sign
stretches dura and nerve roots local=S/S radiating=disc lesion
Bechterew's Test
stretches sciatic and lumbar n.r.'s leaning back w/or radiating pain= dic, sciatic nerve, nerve root
Tensor Fascia Lata
superior gluteal nerve
