Spinal Orthopedic Exam Final

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For Minor's Sign, what is the... - Procedure - Positive Findings - Significance: Procedure: Observe the patientt while he/she rises from a seated position.

Positive Findings: Pain and difficulty when rising from seated position. Patient may support their weight on unaffected leg, keeping affected leg flexed.

Significance: Non-specific. May be present with a radiculopathy, but also may be present with non-radicular lumber or SI disorders.
What is the purpose of Goldthwaite's Test?: It helps differentiate pain between lumbar and SI disorders.
Goldthwaite's Test - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Suppine
DP: On side of affected leg
Proc: Dr. places superior hand below lumbar spine, and raises patient's leg (beneath ankle) with inferior hand. Dr. is feeling for the point at which the lumbar spine moves.
Positive Find: If low back pain occurs before lumbar spine movement, there is an SI joint lesion. If low back pain occurs when the Dr. feels the lumbar spine begin to move, there is a lumbar lesion.
What is the purpose of the Fabere Patrick Test?: To stress the SI joint via the hip joint.
Fabere Patrick Test - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: supine
DP: On the side being tested
Proc: Dr. takes patient leg, flexes, abducts, externally rotates it while patients foot rests on knee of opposite leg.
Pos. find: Pain in SI region indicates SI disorder. Restricted motion of hip, or pain in hip or inquinal region may indicate hip disorder.
What is the purpose of the Laguerre Test?: To stess the SI joint via the hip joint.
What is the mnemonic for remembering how to perform the Laguerre test?: "Laguerre is Fabere in the air!"
Laguerre Test - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Supin
DP: Standing on side being examined
Proc: Dr. flexes patient hip, abducts and externally rotates it. Dr's inferior arm goes beneath patients leg and supports the opposite ASIS. Patients leg rests on Dr's arm. Dr. superior arm pushes down on leg being tested.
Pos. find: Pain in the SI joint
Signif: Determines if there is an SI joint disorder.
Both the Fabere and Laguerre tests are to find disorders in what areas?: In the SI joint and/or in the hip.
Gaenslen's Test: - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Supine
DP: On affected side
Proc: Move patient close to edge of table on affected side. Patient grabs unaffected leg and flexes it toward chest. Dr. lowers patient's affected leg over edge of table. Dr. pushes down (over edge of table) on affected leg, while pushing the patients knee toward their chest.
Pos. find: Pain in region of SI joint on affected side
Signif: Indicates an SI lesion
Lewin-Gaenslen Test - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Laying on side of unaffected leg.
DP: Behind patient
Proc: Similar to standard Gaenslen's Test, however, with patient on side, patient flexes unaffected knee, Dr. stabilizes patient sacrum with superior hand, while pulling back (extending) affected leg.
Nachlas Test: - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Prone
DP: On side of leg being tested
Proc: Apply pressure to sacrum and flex heal to ipsilateral buttock.
Pos. Find: Pain in SI joint region indicates SI joint problem. Pain in lumbar spine indicates lumbar problem.
In the Nachlas Test, in addition to testing for SI joint or lumbar problems, what other incidental finding may be observed?: This test also stretches the quadriceps muscles and the femoral nerve.

Aching and pulling in anterior thigh indicates tight quads.

A "sciatic-like" sensation down the anterior thigh indicates femoral neuropathy or upper lumbar radiculopathy.
Eli's Test: - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Prone
DP: On side of leg being tested
Proc: Dr. flexes patient's leg toward opposite buttock.
Pos. find: Pain in SI joint indicates SI joint disorder. Pain in lumbar region indicates lumbar disorder.

This test also stretches the quads and can identify tight quads. It also stretches the femoral nerve and can immitate a "sciatic-like" sensation, which may indicate femoral neuropathy or upper lumbar radiculopathy.
What is the purpose of Yeoman's test?: It is a test for sprain of the anterior SI joint ligaments
Yeoman's Test: - Patient Position - Doctor Position - Procedure - Positive Findings - Significance: PP: Prone
DP: On side of affected SI joint
Proc: Dr. applies pressure to the affected SI joint. Dr. flexes the heal to the ipsilateral buttock, and extends the hip by lifting the knee off the table.
Pos. find: Pain in SI joint region
Signif: If pain, indicates sprain of the anterior SI joint ligaments.
During Yeoman's test, besides checking for anterior SI joint ligament sprain, what other indidental findings may result?: Tight anterior thigh muscles may be found.

A sciatic-like sensation down the front of the thigh may indicate femoral neuropathy or upper lumbar radiculopathy.
Hibbs Test: - Patient Position - Dr. Position - Procedure - Positive Findings - Significance: PP: prone
DP: On side opposite that being tested
Proc: Stabilize pelvis by placing hand on sacrum. Flex the knee to 90'. Rotate the foot outward.
Pos. find: pain in SI joint
Signif: SI joint disorder
During the Hibb's test, what could cause spasm of the Piriformis muscle?: The action of externally rotating the lower leg causes internal rotation of the hip and pulls on the piriformis. This may induce spasm.
In the Hibb's test, besides SI joint pain, where might other pain be elicited?: In the hip. This indicates a hip disorder.
Belt Test (supported forward bending test): What are the two parts to this test?: 1. Unsupported lumbar flexion
2. Supported lumbar flexion
What is the procedure for the unsupported Belt Test?: While patient is standing, ask patient to bend forward at the waist.
While a patient is performing the unsupported Belt Test, where might pain be felt?: Either in the lumbar region or the SI region.
What is the procedure for the supported Belt Test?: While patient is standing, stabilize the patient's sacrum with your hip, and support the ilia with your hands. Ask patient to bend forward.
What is a positive finding for the supported Belt Test?: pain in the lumbar or SI region.
What is a positive finding for the unsupported belt test?: If pain is elicited upon unsupported flexion, but there is reduced pain upon supported flexion, this indicates an SI joint lesion.
Iliac Compression Test: - Patient Position - Dr. Position - Procedure - Positive Findings - Significance: PP: Lying on side, with SI joint being tested, up.
DP: behind patient
Proc: Dr. exerts a strong downward pressure on the ilium
Pos. find: Pain in SI joint
Signif: SI joint lesion
Sacroiliac Compression Test (Gapping Test): - Patient Position - Dr. Position - Procedure - Positive Findings - Significance: PP: Supine
DP: On either side of patient
Proc: Dr. crosses arms and applies downward and lateral pressure to the ASIS
Pos. find: Pain in the SI joint
Signif: SI joint lesion (sprain of anterior SI ligaments)
Sacroiliac Resisted Abduction Test: - Patient Position - Dr. Position - Procedure - Positive Findings - Significance: PP: Lying on side, with leg being tested up
DP: Behind patient
Proc: With superior arm, Dr. supports patient at hip. With inferior arm, Dr. applies resistence to the patients leg as the patient abducts the leg.
Pos. find: Pain in SI joint
Signif: Identifies SI ligament sprain/lesion
Thomas Test: - Patient Position - Dr. Position - Procedure - Positive Findings - Significance: PP: Supine
DP: On side opposite of leg being tested
Proc: Dr. flexes patient knee toward chest.
Pos. find: The leg being tested will lift off of the table.
Signif: The leg lifting off the table indicates tight hip flexors. If the hip flexors were not tight, the thigh and knee would remain on the table.
Trendelenburg's Test: - Patient Position - Dr. Position - Procedure - Positive Findings - Significance: PP: Standing, facing a wall with hands on wall supporting themselves
DP: Observing from behind
Proc: Patient is instructed to flex one knee and stand on one leg.
Pos. find: If the level of the iliac crests remains the same or drops.
Signif: This indicates weakness or non-function of the gluteus medius m. Can also indicate possible hip joint pathology: coxa vara, congenital hip dislocation, etc.)
Leg Length Assessment: What is this test for?: It tests for a true leg length discrepency.
Leg Length Assessment: - Patient Position - Dr. Position - Procedure - Positive Finding - Significance: PP: Supine, with legs pependicular to a line drawn through the ASIS. Legs should be about 15-20cm apart and parallel to each other.
DP: To either side of patient
Proc: Dr. places a tape measure at the ASIS and measures the distance from the ASIS to the medial malleolus.
Pos. find: Unequal distance between both sides indicates one lower extremity is shorter than the other.
If you did a Leg Length Assessment test, and you found that one leg was shorter than the other, what other test might you do to further verify your findings?: You would do Allis Test. It enables the Dr. to determine if the length length inequality is present in the femur or tibia.

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