FIU - Thoracic and Lumbar Spine Special Tests and Pathologies

7/26/2019 FIU - Thoracic and Lumbar Spine Special Tests and Pathologies

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Thoracic and LumbarThoracic and Lumbar

Spine Special TestsSpine Special Testsand Pathologiesand Pathologies

Orthopedic Assessment IIIOrthopedic Assessment III Head, Spine, and Trunk Head, Spine, and Trunk

with Labwith Lab

PET !"#$PET !"#$
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Clinical EvaluationClinical Evaluation

Spring Test%Spring Test% Test Positioning:Test Positioning:

Subject is proneSubject is prone

Examiner stands with thumbs or hypothenarExaminer stands with thumbs or hypothenar

eminence over the spinous process of a lumbareminence over the spinous process of a lumbarvertebraevertebrae

Action:Action:Apply a downward springing! force through theApply a downward springing! force through the

spinous process of each vertebrae to assess anterior"spinous process of each vertebrae to assess anterior"

posterior motionposterior motion Positive #inding:Positive #inding:

$ncreases or decreases in motion at one vertebrae$ncreases or decreases in motion at one vertebrae

compared to another %hypermobility or hypomobility&compared to another %hypermobility or hypomobility&


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'erve (oot'erve (oot

$mpingement:$mpingement: 'arrowing of'arrowing of

intervertebralintervertebralforamen:foramen: StenosisStenosis

#acet joint#acet joint

degenerationdegeneration

)erniated)erniated

intervertebral discintervertebral disc


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests: &alsal'a Test%&alsal'a Test%

Test Position:Test Position: Patient seated* examiner standing next to patientPatient seated* examiner standing next to patient

Action:Action: Subject ta+es a deep breath and holds while bearingSubject ta+es a deep breath and holds while bearing

down as if having a bowel movementdown as if having a bowel movement

Positive #inding:Positive #inding: $ncreased spinal or radicular pain due to$ncreased spinal or radicular pain due to intrathecalintrathecal

pressurepressure

,ay be secondary to a space"occupying lesion %i-e-,ay be secondary to a space"occupying lesion %i-e-herniated disc* tumor* osteophyte in lumbar canal&herniated disc* tumor* osteophyte in lumbar canal&

Comments:Comments: $ncrease in intrathecal pressure may result in$ncrease in intrathecal pressure may result in pulse* .pulse* .venous return* / venous pressure %di00iness and1orvenous return* / venous pressure %di00iness and1orfainting&fainting&


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests:(ilgram Test%(ilgram Test%

Test Position:Test Position: Patient supine* examiner at feet of the patientPatient supine* examiner at feet of the patient

Action:Action: Patient performs a bilateral straight leg raise to thePatient performs a bilateral straight leg raise to the

height of 2 to 3 inches and is as+ed to hold theheight of 2 to 3 inches and is as+ed to hold theposition for 45 secondsposition for 45 seconds

Positive #inding:Positive #inding: Patient unable to hold position* cannot lift the leg*Patient unable to hold position* cannot lift the leg*

or has pain with testor has pain with test $mplications:$mplications:

$ntrathecal or extrathecal pressure causing an$ntrathecal or extrathecal pressure causing anintervertebral disc to place pressure on a lumbarintervertebral disc to place pressure on a lumbarnerve rootnerve root


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests:)ernig*s Test%)ernig*s Test%

Test Position:Test Position: Patient supine* examiner at side of patientPatient supine* examiner at side of patient

Action:Action: Patient performs a unilateral active straight legPatient performs a unilateral active straight leg

raise with the +nee extended until pain occursraise with the +nee extended until pain occurs After pain occurs* the patient 6exes the +neeAfter pain occurs* the patient 6exes the +nee

Positive #inding:Positive #inding: Pain in the spine and possibly radiating into lowerPain in the spine and possibly radiating into lower

extremityextremity

Pain relieved when patient 6exes the +neePain relieved when patient 6exes the +nee $mplications:$mplications:

'erve root impingement secondary to bulging of'erve root impingement secondary to bulging ofthe intervertebral disc or bony entrapment7the intervertebral disc or bony entrapment7irritation of dural sheath7 irritation of meningesirritation of dural sheath7 irritation of meninges


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'erve (oot'erve (oot$mpingement Tests:$mpingement Tests:)ernig+rud-inski)ernig+rud-inski

Test%Test%

Patient actively 6exesPatient actively 6exesthe cervical spine %liftsthe cervical spine %liftsthe head&the head&

)ip unilaterally 6exed)ip unilaterally 6exed%no more than 85%no more than 8555&&

9nee than 6exed to no9nee than 6exed to no

more than 85more than 8555 %& / pain with nec+%& / pain with nec+

and hip 6exion7 painand hip 6exion7 painrelieved when +nee isrelieved when +nee is6exed6exed


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests: .nilateral Straight Leg /aise Test.nilateral Straight Leg /aise Test

0Lasegue Test1%0Lasegue Test1%

Test Position:Test Position: Patient supine* examiner standing at testedPatient supine* examiner standing at tested

side with the distal hand around the subject;sside with the distal hand around the subject;sheel and proximal hand on subject;s distalheel and proximal hand on subject;s distalthigh %anterior& < maintains +nee extensionthigh %anterior& < maintains +nee extension

Action:Action: Examiner slowly raises the leg untilExaminer slowly raises the leg until

pain1tightness noted or full (=, is obtainedpain1tightness noted or full (=, is obtained Slowly lower the leg until the pain orSlowly lower the leg until the pain or

tightness resolves* at which point dorsi6extightness resolves* at which point dorsi6exthe an+le and have subject 6ex the nec+the an+le and have subject 6ex the nec+


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Straight Leg /aiseStraight Leg /aiseTest%Test% Positive #indings:Positive #indings:

>eg and1or low bac+>eg and1or low bac+

pain occurring withpain occurring with?# and or nec+?# and or nec+6exion is indicative6exion is indicativeof dural involvementof dural involvementand1or sciatic nerveand1or sciatic nerveirritationirritation

>ac+ of pain>ac+ of painreproduction with ?#reproduction with ?#and1or nec+ 6exion isand1or nec+ 6exion isindicative ofindicative ofhamstring tightnesshamstring tightnessor S$ pathologyor S$ pathology


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests: 2ell Straight Leg /aising Test%2ell Straight Leg /aising Test%

Can be used to di@erentiate betweenCan be used to di@erentiate between

sciatic nerve irritation or a herniatedsciatic nerve irritation or a herniatedintervertebral disc that is irritating theintervertebral disc that is irritating the

nerve rootnerve root

Test Position:Test Position: Patient supine* examiner standing atPatient supine* examiner standing at

una@ected side7 one hand grasps under theuna@ected side7 one hand grasps under the

heel while other is placed on anterior thighheel while other is placed on anterior thigh

to stabili0e the leg in extensionto stabili0e the leg in extension


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2ell Straight Leg2ell Straight Leg

/aise Test%/aise Test%Action:Action:

Examiner raises theExaminer raises the

leg by 6exing the hipleg by 6exing the hip

until discomfort isuntil discomfort is

reported %+nee +eptreported %+nee +ept

in full extension&in full extension&

Positive #inding:Positive #inding: Pain is experiencedPain is experienced

on the side oppositeon the side opposite

that being raisedthat being raised


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests: 3uadrant Test%3uadrant Test%

Test Position:Test Position:

Patient standing with feet shoulder widthPatient standing with feet shoulder widthapartapart

Examiner stands behind the patient* graspingExaminer stands behind the patient* grasping

the patient;s shouldersthe patient;s shoulders

Action:Action: Patient extends the spine as far as possible*Patient extends the spine as far as possible*

than sidebends and rotates to a@ected sidethan sidebends and rotates to a@ected side

Examiner provides overpressure through theExaminer provides overpressure through the

shoulders* supporting the patient as neededshoulders* supporting the patient as needed


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests: 3uadrant Test%3uadrant Test%

Positive #indings:Positive #indings:

(eproduction of patient;s symptoms(eproduction of patient;s symptoms $mplications:$mplications:

(adicular pain indicates compression of the(adicular pain indicates compression of the

intervertebral foramina that impinges on theintervertebral foramina that impinges on the

lumbar nerve rootslumbar nerve roots

>ocal pain %not radiating& indicates facet joint>ocal pain %not radiating& indicates facet joint

pathologypathology

Symptoms isolated to the area of the PS$S maySymptoms isolated to the area of the PS$S may

indicate S$ joint dysfunctionindicate S$ joint dysfunction


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'erve (oot $mpingement Tests:'erve (oot $mpingement Tests: Slump Test%Slump Test%

Test Position:Test Position: Patient sits over edge of table7 examiner is at sidePatient sits over edge of table7 examiner is at side

of patientof patientAction:Action:

%& Patient slumps forward along thoracolumbar%& Patient slumps forward along thoracolumbarspine* rounding the shoulders while +eepingspine* rounding the shoulders while +eepingcervical spine neutralcervical spine neutral

%2& Patient 6exes cervical spine7 Clinician holds%2& Patient 6exes cervical spine7 Clinician holdspatient in this positionpatient in this position %4& 9nee is actively extended%4& 9nee is actively extended %B& An+le is actively dorsi6exed%B& An+le is actively dorsi6exed %& (epeat on opposite side%& (epeat on opposite side


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Slump Test%Slump Test% Positive #indings:Positive #indings:

Sciatic pain orSciatic pain or

reproduction ofreproduction of

other neurologicalother neurological

symptomssymptoms

$mplications:$mplications: $mpingement of$mpingement of

the dural lining*the dural lining*spinal cord* orspinal cord* or

nerve rootsnerve roots

4ote% Patient per5ormsA$TI&E knee e6tension and


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Test for PatientTest for Patient

,alingering:,alingering: ,alingering < medical,alingering < medical

and psychological termsand psychological terms

that refers to anthat refers to an

individualindividual

fabricating1exaggeratinfabricating1exaggeratin

g their level ofg their level of

symptomssymptoms #inancial compensation#inancial compensation

%fraud&%fraud&

Avoiding wor+Avoiding wor+

=btaining drugs=btaining drugs

Attract attention orAttract attention or

sympathysympathy


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Test for Patient ,alingering:Test for Patient ,alingering:Hoo'er Test%Hoo'er Test%

Test Position:Test Position: Patient supinePatient supine Examiner at feet of patient with hands cuppingExaminer at feet of patient with hands cupping

the calcaneous of each legthe calcaneous of each leg

Action:Action: Patient attempts to actively straight leg raise onPatient attempts to actively straight leg raise on

the involved sidethe involved side

Positive #indings:Positive #indings: Patient does not attempt to lift the leg andPatient does not attempt to lift the leg and

examiner does '=T sense pressure from theexaminer does '=T sense pressure from theuninvolved leg pressing down on the handuninvolved leg pressing down on the hand

Patient is not attempting to perform the testPatient is not attempting to perform the test


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Test 4ote% E6aminer should be standing at 5eet o5patient with their hands cupping the heels o5 each


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'erve'erve

(oot(oot

>evel>evel

Sensory TestingSensory Testing

>> $nguinal area %just below inguinal$nguinal area %just below inguinalligamentligament

>2>2 ,id"thigh %medial&,id"thigh %medial&

>4>4 ,edial +nee %just above superior,edial +nee %just above superiorpole of patella&pole of patella&

>B>B ,edial aspect of lower leg* medial,edial aspect of lower leg* medialan+le* big toean+le* big toe

>> Top of foot %an1or blow head ofTop of foot %an1or blow head of

Lower 3uarter 4eurological ScreenLower 3uarter 4eurological Screen


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'erve (oot'erve (oot

>evel>evel,otor Testing,otor Testing

>> )ip 6exion)ip 6exion

>2>2 )ip 6exion)ip 6exion

>4>4 9nee extension9nee extension

>B>B ?orsi6exion?orsi6exion>> reat toe extensionreat toe extension

SS Plantar6exionPlantar6exion

S2S2 'A'A



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'erve'erve

(oot(oot>evel>evel

(e6ex(e6ex

TestingTesting

>B>B PatellarPatellarTendonTendon

>> PatellarPatellar

TendonTendon

SS AchillesAchilles

TendonTendon

S2S2 AchillesAchilles

TendonTendon



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abinkski*s Test%abinkski*s Test% Test Position: athlete supineTest Position: athlete supine Athletic Trainer Position: AtAthletic Trainer Position: At

the foot of the athlete holdingthe foot of the athlete holdinga blunt tool %re6ex hammer&a blunt tool %re6ex hammer&

Procedure: (ub the tool upProcedure: (ub the tool up

bottom of athlete;s footbottom of athlete;s footstarting at the calcaneus andstarting at the calcaneus andending at the great toe-ending at the great toe-

Positive test: reat toePositive test: reat toeextends while other toesextends while other toessplay-splay-

$mplications: >esion of upper$mplications: >esion of upper

motor neurons* may bemotor neurons* may becaused by trauma to the braincaused by trauma to the brain

Comments: This re6ex occursComments: This re6ex occursnaturally in newborns-naturally in newborns-)owever* this re6ex should)owever* this re6ex shouldcease Guic+ly after birth-cease Guic+ly after birth-


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Erector SpinaeErector Spinae

(uscle Strain%(uscle Strain% Common low bac+Common low bac+

pathologypathology

,=$:,=$: )istory of heavy or)istory of heavy or

repetitive liftingrepetitive lifting

Signs1Symptoms:Signs1Symptoms: Aching bac+Aching bac+

PainPain with passive andwith passive andactive 6exion* resistedactive 6exion* resisted

extensionextension

'eurological Evaluation:'eurological Evaluation: 'egative results'egative results


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8acet 9oint :;s5unction%8acet 9oint :;s5unction% Pathology of facet joints < B5H of all chronicPathology of facet joints < B5H of all chronic

low bac+ painlow bac+ pain Iague signs1symptoms:Iague signs1symptoms:

=ften resemble other low bac+ pathologies %i-e-=ften resemble other low bac+ pathologies %i-e-strain1spasm of paraspinal muscles* nerve rootstrain1spasm of paraspinal muscles* nerve rootimpingement* disc degeneration&impingement* disc degeneration&

$nvolvement:$nvolvement: ?islocation1sublocation of facet:?islocation1sublocation of facet:

Tends to loc+! the involved spinal segmentTends to loc+! the involved spinal segment%hypomobile vertebrae&%hypomobile vertebrae&

#acet joint syndrome: %in6ammationacet joint syndrome: %in6ammation& Causes: repetitive stress through movement or loadingCauses: repetitive stress through movement or loading

?egeneration: %arthritis&?egeneration: %arthritis& Causes: undeDned historyCauses: undeDned history .. intervertebral foramen si0e %nerve root impingement&intervertebral foramen si0e %nerve root impingement&


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8acet 9oint :;s5unction%8acet 9oint :;s5unction% )istory:)istory:

=nset < insidious=nset < insidious

Pain characteristics < locali0edPain characteristics < locali0ed

,=$ < extension* rotation* lateral bending of,=$ < extension* rotation* lateral bending ofvertebraevertebrae

Predisposing conditions < repeated motions of spinalPredisposing conditions < repeated motions of spinal

extension* rotation* lateral bendingextension* rotation* lateral bending

$nspection:$nspection: Patient may assume posture that . pressure onPatient may assume posture that . pressure on

a@ected facetsa@ected facets

Palpation:Palpation: Possible local muscle spasm %paravertebral muscles&Possible local muscle spasm %paravertebral muscles&


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8acet 9oint8acet 9oint:;s5unction%:;s5unction% >igamentous Tests:>igamentous Tests:

Spring Test < pain* .Spring Test < pain* .

motionmotion 'eurological Tests:'eurological Tests:

'ot applicable'ot applicableunless secondaryunless secondarynerve rootnerve rootimpingement occursimpingement occurs

Special Tests:Special Tests: Juadrant Test %&Juadrant Test %& $ntervertebral disc$ntervertebral disc

lesions %"&lesions %"&
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8acet 9oint :;s5unction%8acet 9oint :;s5unction% $nitial Treatment:$nitial Treatment:

'SA$?s'SA$?s

$nstruct patient to avoid$nstruct patient to avoidpostures1movements that irritate facetspostures1movements that irritate facets

,odalities < moist heat* e"stim* ice to .,odalities < moist heat* e"stim* ice to .muscle spasmmuscle spasm

Therapeutic Exercises:Therapeutic Exercises: Stretching and strengthening:Stretching and strengthening: >ow bac+>ow bac+AbdominalsAbdominals )ip 6exors* hip extensors* hamstrings)ip 6exors* hip extensors* hamstrings


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Inter'ertebral :iscInter'ertebral :iscLesions%Lesions%:isc :egeneration%:isc :egeneration%

>oss of water from>oss of water from

nucleus pulposusnucleus pulposus .. cushioning abilitycushioning ability

// stress load onstress load onannulus Dbrosusannulus Dbrosus Small tears occur toSmall tears occur to

annulus %scar tissueannulus %scar tissue

formation < not asformation < not asstrong as normalstrong as normaltissue&tissue&

Kulging of nucleusKulging of nucleuspulposuspulposus


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Inter'ertebral :iscInter'ertebral :isc

Herniation%Herniation% Extrusion ofExtrusion of

nucleus pulposusnucleus pulposus

through annulusthrough annulusDbrosusDbrosus $mpingement1pressur$mpingement1pressur

e on nerve root belowe on nerve root below

a@ected disca@ected disc

SeGuestrated


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(/I lumbar image%

L+S< disc has su=ered a

#mm disc e6trusion 0redarrow1 that is not contained b;the PLL

L>+ disc has su=ered asmaller >mm disc protrusion0green arrow1 that is

contained b; the PLL

L?+> 0blue arrow1 iscompletel; normal and has nodisc material pro@ectingposteriorl; into the epiduralspace

4ote% L?+> disc is white incolor, which indicates it isnondegenerated 0iBeB, 5ull o5water and health;proteogl;can1

Herniated discs0L>+ C L+S


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Lumbar :isc :egeneration%Lumbar :isc :egeneration% )istory:)istory:

=nset < insidious or may be related to single=nset < insidious or may be related to singleepisodeepisode Krea+down of disc is related to repetitive stress7 >astKrea+down of disc is related to repetitive stress7 >ast

episode < Dnal failure an annulus Dbrosus to containepisode < Dnal failure an annulus Dbrosus to containnucleus pulposusnucleus pulposus

Pain characteristics < a@ected vertebrae7Pain characteristics < a@ected vertebrae7compression of spinal nerve root leads to paincompression of spinal nerve root leads to painin low bac+* buttoc+s* radiating into thigh*in low bac+* buttoc+s* radiating into thigh*

calf* heel* footcalf* heel* foot ,=$ < repetitive loading of disc,=$ < repetitive loading of disc Predisposing condition < history of lumbarPredisposing condition < history of lumbar

spine traumaspine trauma


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Lumbar :isc :egeneration%Lumbar :isc :egeneration% $nspection:$nspection:

Slow A$TSlow A$T

#lattened lumbar spine#lattened lumbar spine Changes in body position < guarded andChanges in body position < guarded andpainfulpainful Sitting L standing 1 sitting L lyingSitting L standing 1 sitting L lying

Changes in disc pressureChanges in disc pressure

Standing position:Standing position: >ateral shift away from side of leg pain>ateral shift away from side of leg pain

Palpation:Palpation: ,usculature spasm,usculature spasm


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Lumbar :isc :egeneration%Lumbar :isc :egeneration% #unctional Tests:#unctional Tests:

>imited (=, in all directions>imited (=, in all directions

,ovement in one direction may relieve or .,ovement in one direction may relieve or .

symptomssymptoms 'eurological Tests:'eurological Tests:

>ower Guarter screen>ower Guarter screen

Special Tests:Special Tests:

Straight leg raising* Mell straight leg raising*Straight leg raising* Mell straight leg raising*,ilgram* Sciatic and femoral nerve tension tests,ilgram* Sciatic and femoral nerve tension tests

?iagnostic Tests:?iagnostic Tests: ,($,($


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Inter'ertebral :isc :egeneration%Inter'ertebral :isc :egeneration%Surger;Surger; Spinal 8usion%Spinal 8usion%

Melding 2 or more vertebrae togetherMelding 2 or more vertebrae together Cause of bac+ pain %motion betweenCause of bac+ pain %motion betweenvertebral segments& spinal fusion may be avertebral segments& spinal fusion may be away to prevent motion and stop the painway to prevent motion and stop the pain TechniGue %basics&:TechniGue %basics&:

Small pieces of extra bone Dlls space between twoSmall pieces of extra bone Dlls space between twovertebrae %pelvic bone* allograft bone&vertebrae %pelvic bone* allograft bone& ?isc removed?isc removedMires* rods* screws* metal cages or plates may beMires* rods* screws* metal cages or plates may be

usedused


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Articial disc replacement% :isc is placed in the disc space throughArticial disc replacement% :isc is placed in the disc space through

an abdominal incisionF the articial disc then maintains mobilit; inan abdominal incisionF the articial disc then maintains mobilit; in

the spine and as such protects the ad@acent disc 5rom acceleratedthe spine and as such protects the ad@acent disc 5rom accelerateddegeneration and 5urther surger;degeneration and 5urther surger;



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$auda EGuina S;ndrome%$auda EGuina S;ndrome% Anatomy: spinal cord ends at the lower edge ofAnatomy: spinal cord ends at the lower edge of

the st lumbar vertebrathe st lumbar vertebra >umbar and sacral nerve roots form a bundle>umbar and sacral nerve roots form a bundlewithin the spinal canal below the conus medullariswithin the spinal canal below the conus medullaris

CES < nerves within the spinal canal have beenCES < nerves within the spinal canal have beendamaged7 nerves supplying muscles of legs*damaged7 nerves supplying muscles of legs*bladder* bowel and genitals do not functionbladder* bowel and genitals do not functionproperlyproperly

'umbness* loss of sensation %damage usually'umbness* loss of sensation %damage usuallypermanent&permanent&

Congenital causes:Congenital causes: Spina biDda %abnormality in closure of spinal canal&Spina biDda %abnormality in closure of spinal canal& Tumors of the cauda eGuinaTumors of the cauda eGuina

AcGuired causes of Cauda EGuina Syndrome:AcGuired causes of Cauda EGuina Syndrome: $njury %spinal fractures&$njury %spinal fractures& Secondary to medical proceduresSecondary to medical procedures


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8emoral 4er'e Stretch8emoral 4er'e Stretch

Test%Test% Tests for nerve rootTests for nerve root

impingement at >2* >4* >Bimpingement at >2* >4* >B

Test position:Test position: Patient prone with a pillowPatient prone with a pillow

under the abdomen7under the abdomen7

examiner at side of patientexaminer at side of patient

Action:Action: Examiner passively extendsExaminer passively extends

hip while +eeping +neehip while +eeping +nee

6exed to 856exed to 8555

Positive test:Positive test: Pain in anterior and lateralPain in anterior and lateral

thighthigh


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Sciatica%Sciatica% eneral term for anyeneral term for any

in6ammation involvingin6ammation involvingsciatic nervesciatic nerve

Causes:Causes: >umbar disc herniation>umbar disc herniation S$ joint dysfunctionS$ joint dysfunction Scar tissue around nerveScar tissue around nerve

rootroot

'erve root in6ammation'erve root in6ammation Spinal stenosisSpinal stenosis Synovial cystsSynovial cysts Cancerous orCancerous or

noncancerous tumorsnoncancerous tumors


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Sciatica%Sciatica% Signs and Symptoms:Signs and Symptoms:

(adiating pain(adiating pain

,uscular wea+ness,uscular wea+ness

Special Tests:Special Tests: Straight leg raise testStraight leg raise test

Tension signTension sign

Treatment and (ehab:Treatment and (ehab: (esolve pathology that(esolve pathology that

is irritating nerveis irritating nerve =ral anti"in6ammatory=ral anti"in6ammatory

meds 1 corticosteroidsmeds 1 corticosteroids

Exercises for strength 1Exercises for strength 1

(=,(=,


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Tension Sign%Tension Sign% Tests for sciatic nerve irritationTests for sciatic nerve irritation Test position:Test position:

Patient supine7 examiner;s one hand grasps thePatient supine7 examiner;s one hand grasps the

heel while other grasps the thighheel while other grasps the thighAction:Action:

)ip and +nee 6exed to 85)ip and +nee 6exed to 8555

9nee is then extended as far as possible with the9nee is then extended as far as possible with theexaminer palpating the tibial portion of theexaminer palpating the tibial portion of the

sciatic nerve as it passes behind popliteal spacesciatic nerve as it passes behind popliteal space Positive Dnding:Positive Dnding:

Tenderness and reproduction of sciaticaTenderness and reproduction of sciaticasymptomssymptoms


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owstring Test% 0$ram Test1owstring Test% 0$ram Test1 Test position:Test position:

Patient supinePatient supine

Action:Action:

Examiner performs a passive straight leg raise onExaminer performs a passive straight leg raise oninvolved sideinvolved side $f subjects reports radiating pain* examiner 6exes the$f subjects reports radiating pain* examiner 6exes the

subject;s +nee to approximately 25subject;s +nee to approximately 2555in attempt toin attempt toreduce painreduce pain

Pressure than applied to popliteal area to reproducePressure than applied to popliteal area to reproduce

radicular painradicular pain Positive Dnding:Positive Dnding:

Painful radicular reproduction with poplitealPainful radicular reproduction with poplitealcompressioncompression $ndicates sciatic nerve tension$ndicates sciatic nerve tension


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Spond;lol;sis%Spond;lol;sis% ?efect in pars interarticularis?efect in pars interarticularis

%area between inferior and%area between inferior and

superior articular facets&superior articular facets&

,=$ < repetitive stress,=$ < repetitive stress Nnilateral or bilateral defectsNnilateral or bilateral defects

>isthesis:>isthesis: Posterior portion of thePosterior portion of the

vertebrae* laminae* inferiorvertebrae* laminae* inferior

articular surfaces* spinousarticular surfaces* spinous

process separates fromprocess separates fromvertebral bodyvertebral body

Collared Scotty dog! deformityCollared Scotty dog! deformity

Symptoms:Symptoms:

>ocali0ed mow bac+ pain %/>ocali0ed mow bac+ pain %/

during1after activity&during1after activity&

Pain with extensionPain with extension


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Spond;lolisthesis%Spond;lolisthesis% Progression of spondylolysis LProgression of spondylolysis L

separation of vertebrae %superiorseparation of vertebrae %superiorvertebrae slides anteriorly on the onevertebrae slides anteriorly on the onebelow it&below it& ?ecapitated Scotty dog! deformity:?ecapitated Scotty dog! deformity:

)ead of the dog %anterior element of vertebrae&)ead of the dog %anterior element of vertebrae&has become detached from body %posteriorhas become detached from body %posteriorelement&element&

Severity < amount of anterior displacementSeverity < amount of anterior displacement Epidemiology:Epidemiology:

,ost prevalent in women and adolescents,ost prevalent in women and adolescentsOoung gymnastsOoung gymnasts


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Lateral 'iew o5 thelumbar spine% ilateral

break in the parsinterarticularis0spond;lol;sis blackarrow1L 'ertebral bod; 0redarrow1 has slipped

5orward on the S


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Spond;lol;sis and Spond;lolisthesis%Spond;lol;sis and Spond;lolisthesis% )istory:)istory:

=nset of pain:=nset of pain: $nsidious7 pain begins as an ache* / to constant$nsidious7 pain begins as an ache* / to constant

painpain Characteristics:Characteristics:

>umbar pain* radiating into buttoc+s and upper>umbar pain* radiating into buttoc+s and upperposterolateral thighposterolateral thigh

,=$:,=$: (epetitive stress %extension&(epetitive stress %extension&

Predisposing conditions:Predisposing conditions: ,uscular imbalances,uscular imbalances (epetitive hyperextension activities(epetitive hyperextension activities

$nspection:$nspection: // lordotic curvelordotic curveAltered A$TAltered A$T


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Spond;lol;sis and Spond;lolisthesis%Spond;lol;sis and Spond;lolisthesis% Palpation:Palpation:

Step"o@ deformity may be feltStep"o@ deformity may be felt Spasm of paraspinal musclesSpasm of paraspinal muscles

#unctional Tests:#unctional Tests:A(=,:A(=,:

#lexion < restricted* pain free#lexion < restricted* pain free Extension < painExtension < pain (otation and bending " pain(otation and bending " pain

P(=,:P(=,: )ip 6exion < hamstring tightness)ip 6exion < hamstring tightness

((=,:((=,: Mea+ness of spinal erectorsMea+ness of spinal erectors


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Spond;lol;sis and Spond;lolisthesis%Spond;lol;sis and Spond;lolisthesis% Special Tests:Special Tests:

Pain with Spring testPain with Spring test

S> stance test7 straight leg raises mayS> stance test7 straight leg raises mayproduce painproduce pain

'eurological Exam:'eurological Exam: >ower Guarter screen %results typically>ower Guarter screen %results typically

negative&negative&

Comments:Comments: "ray* CT* ,($ %will di@erentiate between"ray* CT* ,($ %will di@erentiate between

spondylolysis and spondylolisthesis&spondylolysis and spondylolisthesis&


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Single Leg Stance Test%Single Leg Stance Test% Test position:Test position:

Patient standing with body weight evenlyPatient standing with body weight evenly

distributed between the 2 feet7 examinerdistributed between the 2 feet7 examinerstands behind pt-stands behind pt-

Action:Action: Patient lifts one leg* then places the trun+Patient lifts one leg* then places the trun+

in hyperextension7 examiner may assistin hyperextension7 examiner may assist Positive test:Positive test:

Pain in lumbar spine or S$ areaPain in lumbar spine or S$ area


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Single Leg StanceSingle Leg Stance

Test%Test% $mplication:$mplication:

Shear forces are placedShear forces are placed

on pars interarticularison pars interarticularisby iliopsoas pulling theby iliopsoas pulling the

vertebrae anteriorlyvertebrae anteriorly

Comments:Comments: Nnilateral fracture


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Sacroiliac :;s5unction%Sacroiliac :;s5unction% )istory:)istory:

=nset:=nset: Acute or insidiousAcute or insidious

Pain characteristics:Pain characteristics: =ne or both S$ joints7=ne or both S$ joints7

possibly radiating painpossibly radiating painin buttoc+s* groin* thighin buttoc+s* groin* thigh

,echanism:,echanism: Prolonged stressProlonged stress

Predisposing conditions:Predisposing conditions: Postpartum womenPostpartum women

%relaxin levels&%relaxin levels& )ormonal levels during)ormonal levels during

menstruationmenstruation


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Sacroiliac 9oint :;s5unction%Sacroiliac 9oint :;s5unction% $nspection:$nspection:

>evels of iliac crests* AS$S* PS$S>evels of iliac crests* AS$S* PS$S Palpation:Palpation:

Pain over S$ joints and PS$SPain over S$ joints and PS$S #unctional tests:#unctional tests:

Trun+ 6exion %with +nees extended& will causeTrun+ 6exion %with +nees extended& will causemovement of the sacrum on the ilia %pain&movement of the sacrum on the ilia %pain&

'eurological testing:'eurological testing:

>ower Guarter screen>ower Guarter screen Special tests:Special tests:

>ong sit7 S$ compression and distraction7>ong sit7 S$ compression and distraction7straight leg raising7 fabre7 gaenslen;s7 Guadrantstraight leg raising7 fabre7 gaenslen;s7 Guadrant


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Sacroiliac 9oint StressSacroiliac 9oint Stress

Test%Test% Test position:Test position:

Subject supine7 examinerSubject supine7 examiner

stands next to subject andstands next to subject and

with arms crossed* placeswith arms crossed* placesheel of both hands on theheel of both hands on the

subject;s AS$Sssubject;s AS$Ss

Action:Action: Examiner applies outwardExaminer applies outward

and downward pressure withand downward pressure with

the heels of both handsthe heels of both hands Positive Dnding:Positive Dnding:

Nnilateral pain at S$ joint orNnilateral pain at S$ joint or

in gluteal1leg region isin gluteal1leg region is

indicative of anterior S$indicative of anterior S$

ligament sprainligament sprain


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Subject side"lying7Subject side"lying7

examiner stands next toexaminer stands next to

patient and places bothpatient and places both

hands %one on top of thehands %one on top of the

other& directly over theother& directly over the

subject;s iliac crestsubject;s iliac crest

Action:Action:

Apply downward pressureApply downward pressure Positive Dnding:Positive Dnding:

$ncreased pain indicative$ncreased pain indicative

of S$ pathology %possibleof S$ pathology %possible

involvement of posterior S$involvement of posterior S$

ligament&ligament&


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Subject lying supine7Subject lying supine7

examiner places bothexaminer places bothhands on lateral aspecthands on lateral aspect

of subject;s iliac crestsof subject;s iliac crests

Action:Action:Apply inward andApply inward and

downward pressuredownward pressure

Positive Dnding:Positive Dnding: $ncreased pain indicative$ncreased pain indicative

of S$ pathology %possiblyof S$ pathology %possibly

involving posterior S$involving posterior S$

ligaments&ligaments&


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Sacroiliac 9oint Stress Test%Sacroiliac 9oint Stress Test% Test position:Test position:

Subject lying prone7 examiner placesSubject lying prone7 examiner places

both hands %one on top of the other&both hands %one on top of the other&over subject;s sacrumover subject;s sacrum

Action:Action:Apply downward pressure on sacrumApply downward pressure on sacrum

Positive Dnding:Positive Dnding: $ncreased pain indicative of S$ pathology$ncreased pain indicative of S$ pathology


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Patrick or 8AE/ Test%Patrick or 8AE/ Test% Test position:Test position:

Subject supineSubject supine

Action:Action: Examiner passively 6exes*Examiner passively 6exes*

abducts* and externallyabducts* and externallyrotates the involved leg untilrotates the involved leg untilthe foot rests on the top ofthe foot rests on the top ofthe +nee of uninvolved lowerthe +nee of uninvolved lowerextremity7 examiner slowlyextremity7 examiner slowlyabducts the involved lowerabducts the involved lowerextremity towards the tableextremity towards the table

Positive test:Positive test: $nvolved lower extremity$nvolved lower extremity

does not abduct below leveldoes not abduct below levelof uninvolved sideof uninvolved side

S$ pathology* iliopsoasS$ pathology* iliopsoastightnesstightness


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aenslen*s Test%aenslen*s Test% Test position:Test position:

Subject supine* lying closeSubject supine* lying closeto edge of table7 examinerto edge of table7 examinerstands at sidestands at side

Action:Action: Slide patient to edge ofSlide patient to edge of

table7 patient pulls far +neetable7 patient pulls far +neeup to the chest7 near legup to the chest7 near legallowed to hang over edgeallowed to hang over edgeof tableof table

Examiner applies downwardExaminer applies downward

pressure on near leg*pressure on near leg*forcing it intoforcing it intohyperextensionhyperextension

Positive Dnding:Positive Dnding: Pain in S$ region indicatingPain in S$ region indicating

S$ joint dysfunctionS$ joint dysfunction


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LongSitting Test%LongSitting Test% Test position:Test position:

Subject supine* both hips and +nees extended7 examinerSubject supine* both hips and +nees extended7 examinerstanding with thumbs on subject;s medial malleolistanding with thumbs on subject;s medial malleoli

Action:Action:

Examiner passively 6exes both hips and +nees and thenExaminer passively 6exes both hips and +nees and thenfully extends and compares position of medial malleolifully extends and compares position of medial malleolirelative to eachotherrelative to eachother

Subject slowly assumes the long"sitting position andSubject slowly assumes the long"sitting position andmalleolar position is re"assessedmalleolar position is re"assessed

Positive Dnding:Positive Dnding: >eg appears longer in supine but shorter in long"sitting>eg appears longer in supine but shorter in long"sitting

is indicative of an ipsilateral anteriorly rotated iliumis indicative of an ipsilateral anteriorly rotated ilium >eg appears shorter in supine but longer in long"sitting>eg appears shorter in supine but longer in long"sitting

is indicative of an ipsilateral posteriorly rotated iliumis indicative of an ipsilateral posteriorly rotated ilium


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=n"#ield Evaluation=n"#ield Evaluation

)istory:)istory: >ocation of pain:>ocation of pain:

>ocali0ed in vertebral column < disc rupture*>ocali0ed in vertebral column < disc rupture*

sprain* facet pathologysprain* facet pathology

(adiating pain into extremities < spinal nerve root(adiating pain into extremities < spinal nerve rootpathologypathology

Pain parallel to vertebral column < muscle spasmPain parallel to vertebral column < muscle spasm

Peripheral symptoms:Peripheral symptoms: 'erve root impingement'erve root impingement

,=$:,=$: (otational forces* hyperextension* repetitive stress(otational forces* hyperextension* repetitive stress


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=n"#ield Evaluation=n"#ield Evaluation

$nspection:$nspection: Position of athlete:Position of athlete:

Supine < if spinal cord involvement suspected*Supine < if spinal cord involvement suspected*manage accordingly %spine board&manage accordingly %spine board&

PosturePostureMillingness to moveMillingness to move 'eurological tests:'eurological tests:

SensorySensory ,otor tests,otor tests

Palpation:Palpation: Kony palpationKony palpation ParaspinalsParaspinals

Date post:	02-Mar-2018
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FIU - Thoracic and Lumbar Spine Special Tests and Pathologies

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