ASSESSMENT | tandlspine

When assessing a possible spinal cord injury, it is extemely important to take note of the patients position when you reach them. Do not try to move the patient before you have done an initial assessment. Start by checking ABC's, then move into a HOPS format for further, off-field evaluation.

ASSESSMENT OF A LUMBAR SPINE INJURY

ABC's, Spineboarding, Subjectives, Objectives and Palpation of the lumbar spine are similar to the thoracic spine.

SPECIAL TESTS

VALSALVA MANEUVER

A postive finding is increased pain due to increased intrathecal pressure, that can be secondary to a space-occupying lesion, herniated disk, tumor or osteophyte.

STOOPS TEST

Positive finding is pain in the buttocks an lower limb areas brought on by brisk walking that is soon relieved with forward flexing of the trunk may relate to the neurogenic intermittent claudication, posture and walking.

HOOVER TEST

Positive finding would be the inability to lift leg which may reflect a neuromuscular weakness. The examinar should also note if he or she does not feel an increased pressure in the palm that underlies the resting leg, the patient may not be telling the truth.

KERNIG/BRUDZINSKI SIGN

Positive finding is when there is an increased pain, which can be localized or radiates into the lower extremities, when the neck and hip are in flexion. The pain is relieved when the knee is flexed. The pain is indicative of meningeal irritation, nerve root impingement, or dural irritation that is exaggerated by elongating the spinal cord.

BOWSTRING TEST

Positive finding painful radicular reproduction following popliteal compression indicates tension on the sciatic nerve.

SITTING ROOT TEST

Positive finding when the subject arches backward and complains of pain in the regions of the buttocks, posterior thigh and calf during knee extension demonstrates a positive for sciatic nerve pain.

UNILATERAL STRAIGHT LEG RAISE

Positive finding when leg and lower back pain occures with dorsiflexion and/or neck flexion is indicative of dural involvement. A lack of pain reproduction with dorsiflexion and or neck flexion is indicative or either hamstring tightness or possible lumbar spine or sacroiliac joint involvement.

SLUMP TEST

A complaint of sciatic-type pain or any reproduction of symptoms is a postive test.

SPRING TEST

Positive finding is an increase or decrease in motion at one vertebra compared to another are indicative of hypermobility or hypomobility.

TRENDELENBURG TEST

Positive finding is seen when the pelvis on the unsupported side drops noticeably lower than the pelvis on the supported side. This indicates a weakness of the gluteus medius muslces on the supported side.

WELLS STRAIGHT LEG RAISE

The examiner raises the leg by flexing the hip until discomfort is reported. Positive test is if the patient experiences pain on the opposite side

STORK STANDING TEST

Positive finding when the patient complains of pain in the lumbar region may be related to the pars interarticularis region, which at times associates with spondylolysis.

BABINSKI TEST

A positive test is indicated if the great toe extends and the other toes splay, indicating an upper motor neuron lesion

OPPENHEIM TEST

A positive test is indicated if the great toe extends and the other toes splay, indicating an upper motor neuron lesion

SEGMENTAL INSTABILITY TEST

If the pain is relieved upon back extension, the back extensor muscles are stabilizing the spine

LEG LENGTH DISCREPANCY

Limb length discrepancy can be measured by a physician during a physical examination and through X-rays.
Typical causes are: previous injury to the bone of the leg, bone infection or bone diseases

RANGE OF MOTION

Flexion: Normal ROM for back flexion is about 90 degrees or greater depending on the individual being assest.

Extension: Normal ROM for back extension is 15-25 degrees.

Lateral Flexion: Normal ROM for lateral flexion is about 30-40 degrees

Rotation: Normal ROM for rotation of the spine is about 20 degrees or more.

MANUAL MUSCLE TESTING

GLUTEUS MAXIMUS

Patient prone with knee flexed to 90 degrees or more. Patient will be asked to extend the hip, keeping the knee flexed. Pressure is applied against the lower part of the posterior thigh in the direction of hip flexion.

GLUTEUS MEDIUS

Patient side lying on untested side while the under leg is flexed at the hip and knee. Patient is asked to abduct, slightly extend and slightly externally rotate the leg to be tested. The examiner stabilizes the hip and applies pressure against the leg, near the ankle in the direction of adduction and slight flexion.

GLUTEUS MINIMUS

Patient is side lying on side not being tested and asked to abduct the hip. Pressure is applied against the leg in the direction of adduction.

TENSOR FASCIA LATA

Patient is side lying on untested side and asked to abduct the hip. Pressure is applied against the leg in the direction of adduction.

BICEPS FEMORIS

Patient is prone and asked to flex the knee 50 to 70 degrees with the toes pointed to the lateral side. Stabilize the thigh and apply pressure against the leg proximal to the ankle in the direction of the knee extension.

SEMITENDENOSIS/SEMIMEMBRANOSIS

Patient is prone and asked to flex the knee between 50 to 70 degrees with the toes pointed to the medial side. Stabilize the thigh and apply pressure against the leg proximal to the ankle in the direction of knee extension. Do not apply pressure against the rotational component.

ILIOPSOAS

Patient is supine and asked to flex, slightly abduct and slightly externally rotate the hip. The examiner stabilizes the opposite hip and applies pressure against the anteromedial aspect of the leg in the direction of extension.

PARASPINAL MUSCLES

Patient is prone with hands clasped behind the head. The examinar stabilizes the legs firmly on the table. The patient is then asked to extend the trunk to the individuals full ROM. If the test is performed with the hands behind the head, no pressure needs to be added. The ability to complete the movement and hold the position with hands behind the head, may be considered normal. The low back muscles are seldom weak. The inability to hold will indicate weakness. Weakness is best described as slight, moderate, or marked, for purpose of grading, based on the judgement of the examiner.