OD1 Lumbar Exam History ** Red Flags NSLBP Screening Tests MS Screen by far most important part of assessment - alerted to possible problems #, OP, tumour, infection, disc, AS, cauda equina NOTE: account for 1-2% of people presenting with LBP 90% When radicular or myopathic P (muscle pathologies: weakness, stiffness, cramps, tetany) SLR, Valsalva's (1ff-Step Screen) History Onset mechanism Aggravating specific movements/postures Relieving specific movements/postures Outcome measure Review Anatomy Oswestry (LBP questionnaire) PSFS - patient specific functional scale (an activity pt specifically finds difficult) Lumbar facet orientation 0 A B 0 L1 C D 0 / 1 E 0 0 F 1 - L5 - Figure 9-4 The varieties of orientation and curvature of the lumbar zygapophyseal joints. A, Flat joints oriented close to 90° to the sagittal plane. B, Flat joints orientated at 60° to the sagittal plane. C, Flat joints orientated parallel (0°) to the sagittal plane. D, Slightly curved joints with an average orientation close to 90° to the sagittal plane. E, "C"- shaped joints orientated at 45° to the sagittal plane. F, "J"-shaped joints orientated at 30° to the sagittal plane. (Redrawn from Bogduk N, Twomey LT: Clinical anatomy of the lumbar spine, New York, 1987, Churchill Livingstone, p. 26.) FSU Posterior portion Anterior portion Figure 9-7 Functional segmental unit (three-joint complex) in the lumbar spine. Such a complex may also be seen in the cervical and thoracic spines.
Functionally Increase in pressure at Lff (compared to standing) · Forward bend 150% · Lift 20kg with knees straight, back bent 169% · Lift 20kg with knees bent, back straight 7ff% Greatest motion in Lumbar spine . Is at L4-S1 · Considerable variability in ROM General Principles · Observe . Look · Feel (palpate) . Move . Test Observe General features height weight Appearance grooming, well / unwell Posture antalgia, energetic / lethargic, slouched Gait rhythm, stride Other comfortable to sit & stand Look Men shirt off, Women in gown Skin scars, color changes, oedema, erythema Shape swelling, wasting, deformity Positionprevious injury, congenital abnormality Scars Posture surgery, accidents more specific assessment Key Features of Interest LATERAL plumb line: Hyper / hypo lordosis / kyphosis knees hyperextended EAM, hum head, gr troch, slightly ant to knee/ankle genu recurvatum - when 1 lordosis, knees extend to maintain COG AP crest & PSIS height, gluteal folds asymmetries scoliosis (Adams Test - see below) muscle bulk / wasting: ES and areas T & Normal spine Deformity from scoliosis *ADAM Adams Test Classic antalgic posture of disc
Feel Move General scan to assess swelling, deformity, temperature Start active ROM, then passive Painful movements last Full comfortable ROM - record · Flex & side-bending · Rotation how far down leg how much shoulder rotation Stiffness, laxity Crepitis Consider ROM End-feel P provocation Active Flex: normal, even flex or L's flatter (flexing from hips) Ext: limited, excessive SB: look for asymmetry in movement - break in continuity, angulation at a specific level Rot: arms across chest - some but limited Look for lack