Orthopedic Diagnosis Lab (Lumbar Spine)

6 Written Questions

1. Positive: Pain in the lumbar region or radiculopathy
   
   Indicates: Sciatic erve root compression. Helps to rule out tight hamstrings.
2. Positive: Lack of counter-pressure on healthy side
   
   Indicates: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg.
3. Positive:
   Inability to bend at the waist more than 45 degrees, because of either/or:
   
   1) Radiating pain along Sciatic nerve, either unilateral or bilateral
   Indicates: Sciatic neuralgia or radiculopathy, etc. possibly due to a lumbar disc pathology
   
   2) Low back pain (lumbar or pelvic regions)
   Indicates: Anterior (rotational) displacement of the Ilium relative to Sacrum
4. Positive: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side.
   
   Indicates: Positive with a variety of low back pathologies. Hamstring tension on pelvis may trigger the response.
5. Paraspinal Muscles (Superficial Layer)
   Spinalis
   Longissimus
   Iliocostalis
   Sciatic Nerve
   Gluteus Maximus
   Gluteus Medius
   Hamstrings
   Biceps Femoris
   Semitendinosus
   Semimembranosus
   Anterior Abdominal Muscles
6. Flexion: 25
   Extension: 30
   Left Lateral Bending: 25
   Right Lateral Bending: 25
   Left Rotation: 30
   Right Rotation: 30

6 Multiple Choice Questions

1. Positive: Inability to perform test
   
   Indicates: L4-L5 disc problem (L5 nerve root)
   1. Heel Walk
   2. Lasegue Test
   3. Toe Walk
   4. Bowstring Sign
2. Positive: Radiating pain and/or posterior thigh pain
   
   Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees = possible discogenic sciatic radiculopathy (Cipriano).
   1. Buckling Sign (Cipriano)
   2. Bragard's Sign
   3. Straight Leg Raiser (SLR)
   4. Heel Walk
3. Positive: Reproduction of radicular pain or inability to perform correctly due to Tripod Sign.
   
   Indicates: Sciatic Radiculopathy
   
   *KEEP HANDS IN LAP
   1. Bechterew's Test
   2. Bragard's Sign
   3. Hoover's Sign
   4. Millgram's Test
4. Positive: Radiating pain down the leg causing flexion of the patient's knee or knees
   
   Indicates: Gluteal, lumbosacral or sacroiliac pathologies.
   1. Lewin Standing Test
   2. Bowstring Sign
   3. Lumbar Spine ROM
   4. Lasegue Test
5. Positive: Reproduction of Sciatic pain BEFORE 60 DEGREES
   
   Indicates: Sciatica
   
   *PANTY HOSE DISPLAY
   1. Toe Walk
   2. Heel Walk
   3. Lasegue Test
   4. Bowstring Sign
6. Lumbar Spinous Processes
   
   Sacral Tubercles
   
   Iliac Crest
   
   PSIS
   1. Lumbar Spine Bony Palpation
   2. Lewin Standing Test
   3. Lumbar Spine ROM
   4. Lumbar Spine Soft Tissue Palpation

6 True/False Questions

1. Bragard's Sign → Positive: Lack of counter-pressure on healthy side
   
   Indicates: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg.

   True        False

2. Goldthwait'a Sign → Positive: Radiating pain in posterior thigh.
   
   Indicates: Sciatic Radiculopathy

   True        False

3. Buckling Sign (Cipriano) → Positive: Pain in the lumbar region or radiculopathy
   
   Indicates: Sciatic erve root compression. Helps to rule out tight hamstrings.

   True        False

4. Ely's Heel to Buttock Test (Ely's Sign) → Positive: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side.
   
   Indicates: Positive with a variety of low back pathologies. Hamstring tension on pelvis may trigger the response.

   True        False

5. Toe Walk → Positive: Inability to perform test
   
   Indicates: L5-S1 disc problem (S1 nerve root)

   True        False

6. Millgram's Test → Positive: Inability to perform test and/or low back pain
   
   Indicates: Weak abdominal muscles or space occupying lesion
   
   *YOU RAISE LEGS 2-3 inches)
   Instruct the to hold for 30 SECONDS
   SPOT THEM

   True        False