Lumbar Spine Evaluation

history (6)

• survey the scene

• MOI

• acute, subacute, or chronic

• type of pain (radiating)

• location of pain

• previous injury (duration and necessary habit changes)

observation (5)

• deformity/swelling

• disrobing/gait

• skin (redness, scars)

• overall posture (accommodations due to pain)

• leg length discrepancy

palpation (10)

• spinous process

• PSIS

• iliac crest

• greater trochanter

• sciatic nerve

• ischial tuberosity

• supra and interspinous ligaments

• erector spinae

• abdominal muscles

• for pain, spasm, crepitus, point tenderness

dermatome, myotome, and reflex of L1

• ant. thigh

• hip flexion

• none

dermatome, myotome, and reflex of L2

• middle, ant. thigh

• hip flexion

• none

dermatome, myotome, and reflex of L3

• medial lower leg

• knee extension

• patellar

dermatome, myotome, and reflex of L4

• great toe

• ankle dorsiflexion

• patellar

dermatome, myotome, and reflex of L5

• dorsum of foot

• toe extension

• hamstring, tib posterior

dermatome, myotome, and reflex of S1

• lateral malleolus

• plantar flexion and eversion

• achilles

special tests for neurological dysfunction (9)

• slump test (passive) - disc, impingement

• sitting root test (active) - disc, impingement

• straight leg raise - same side pain

  • 0-30: muscular pain

  • 30-75: nerve root, disc

  • >75: upper lumbar spine

• well-leg raise - opposite side pain; disc nerve root

• prone knee bending - femoral nerve pathology

• femoral nerve traction test - femoral nerve pathology

• bowstring - sciatic nerve

• Kernig/Brudinski - nerve root

• valsalva - space-occupying lesion, stenosis, could be disc

special tests for lumbar instability (2)

• passive lumbar extension - fracture, instability of back

• prone segmental instability test - lumbar instability

  • if pt can do both parts well, probably a good candidate for rehab

special tests for muscle tightness and joint dysfunction (6)

• 90-90 SLR test - hamstrings

• Thomas test - rectus femoris contracture

• rectus femoris contracture test - rectus femoris contracture

• ober test - IT band

• Milgram’s test - muscular injury

• Hoover’s test/sign - malingering

other special tests (1)

bicycle test of van Gelderen - intermittent claudication

• if leaning forward hurts = vascular

• if leaning forward feels better = spinal stenosis

other things to remember (4)

• compare bilaterally

• reflexes

• x-ray, CT scan, myelogram

• referral

babinski reflex

run sharp object up bottom of foot, toes should curl

oppenheim reflex

run sharp object down tibial crest, toes should curl

cremasteric reflex

run sharp object along inner thigh, testicle on that side should elevate: only in males

superficial abdominal reflex

use very sharp object, diamond shape around umbilicus, belly button should track with lines drawn