Thoracic and Lumbar Spine Special Tests and Pathologies

Clinical Evaluation Spring Test: Test Positioning: Action: Subject is prone Examiner stands with thumbs or hypothenar eminence over the spinous process of a lumbar vertebrae Action: Apply a downward “springing” force through the spinous process of each vertebrae to assess anterior-posterior motion Positive Finding: Increases or decreases in motion at one vertebrae compared to another (hypermobility or hypomobility)

Clinical Evaluation Nerve Root Impingement: Narrowing of intervertebral foramen: Stenosis Facet joint degeneration Herniated intervertebral disc

Clinical Evaluation

Clinical Evaluation Nerve Root Impingement Tests: Milgram Test: Test Position: Patient supine, examiner at feet of the patient Action: Patient performs a bilateral straight leg raise to the height of 2 to 6 inches and is asked to hold the position for 30 seconds Positive Finding: Patient unable to hold position, cannot lift the leg, or has pain with test Implications: Intrathecal or extrathecal pressure causing an intervertebral disc to place pressure on a lumbar nerve root

Clinical Evaluation Nerve Root Impingement Tests: Kernig’s Test: Test Position: Patient supine, examiner at side of patient Action: Patient performs a unilateral active straight leg raise with the knee extended until pain occurs After pain occurs, the patient flexes the knee Positive Finding: Pain in the spine and possibly radiating into lower extremity Pain relieved when patient flexes the knee Implications: Nerve root impingement secondary to bulging of the intervertebral disc or bony entrapment; irritation of dural sheath; irritation of meninges

Clinical Evaluation Nerve Root Impingement Tests: Kernig/Brudzinski Test: Patient actively flexes the cervical spine (lifts the head) Hip unilaterally flexed (no more than 900) Knee than flexed to no more than 900 (+) ↑ pain with neck and hip flexion; pain relieved when knee is flexed

Clinical Evaluation Nerve Root Impingement Tests: Unilateral Straight Leg Raise Test (Lasegue Test): Test Position: Patient supine, examiner standing at tested side with the distal hand around the subject’s heel and proximal hand on subject’s distal thigh (anterior) – maintains knee extension Action: Examiner slowly raises the leg until pain/tightness noted or full ROM is obtained Slowly lower the leg until the pain or tightness resolves, at which point dorsiflex the ankle and have subject flex the neck

Clinical Evaluation Straight Leg Raise Test: Positive Findings: Leg and/or low back pain occurring with DF and or neck flexion is indicative of dural involvement and/or sciatic nerve irritation Lack of pain reproduction with DF and/or neck flexion is indicative of hamstring tightness or SI pathology

Clinical Evaluation Nerve Root Impingement Tests: Well Straight Leg Raising Test: Can be used to differentiate between sciatic nerve irritation or a herniated intervertebral disc that is irritating the nerve root Test Position: Patient supine, examiner standing at unaffected side; one hand grasps under the heel while other is placed on anterior thigh to stabilize the leg in extension

Clinical Evaluation Well Straight Leg Raise Test: Action: Examiner raises the leg by flexing the hip until discomfort is reported (knee kept in full extension) Positive Finding: Pain is experienced on the side opposite that being raised

Clinical Evaluation Nerve Root Impingement Tests: Slump Test: Test Position: Patient sits over edge of table; examiner is at side of patient Action: (1) Patient slumps forward along thoracolumbar spine, rounding the shoulders while keeping cervical spine neutral (2) Patient flexes cervical spine; Clinician holds patient in this position (3) Knee is actively extended (4) Ankle is actively dorsiflexed (5) Repeat on opposite side

Clinical Evaluation Slump Test: Positive Findings: Implications: Sciatic pain or reproduction of other neurological symptoms Implications: Impingement of the dural lining, spinal cord, or nerve roots Note: Patient performs ACTIVE knee extension and dorsiflexion

Clinical Evaluation Femoral Nerve Stretch Test: Tests for nerve root impingement at L2, L3, L4 Test position: Patient prone with a pillow under the abdomen; examiner at side of patient Action: Examiner passively extends hip while keeping knee flexed to 900 Positive test: Pain in anterior and lateral thigh

Clinical Evaluation Single Leg Stance Test: Test position: Action: Patient standing with body weight evenly distributed between the 2 feet; examiner stands behind pt. Action: Patient lifts one leg, then places the trunk in hyperextension; examiner may assist Positive test: Pain in lumbar spine or SI area

Clinical Evaluation Single Leg Stance Test: Implication: Comments: Shear forces are placed on pars interarticularis by iliopsoas pulling the vertebrae anteriorly Comments: Unilateral fracture – pain when opposite leg raised Bilateral fractures – pain with either leg being fractured

Clinical Evaluation Sacroiliac Joint Stress Test: Test position: Subject supine; examiner stands next to subject and with arms crossed, places heel of both hands on the subject’s ASISs Action: Examiner applies outward and downward pressure with the heels of both hands Positive finding: Unilateral pain at SI joint or in gluteal/leg region is indicative of anterior SI ligament sprain

Clinical Evaluation Sacroiliac Joint Stress Test: Test position: Subject side-lying; examiner stands next to patient and places both hands (one on top of the other) directly over the subject’s iliac crest Action: Apply downward pressure Positive finding: Increased pain indicative of SI pathology (possible involvement of posterior SI ligament)

Clinical Evaluation Sacroiliac Joint Stress Test: Test position: Subject lying supine; examiner places both hands on lateral aspect of subject’s iliac crests Action: Apply inward and downward pressure Positive finding: Increased pain indicative of SI pathology (possibly involving posterior SI ligaments)

Clinical Evaluation Patrick or FABER Test: Test position: Action: Subject supine Action: Examiner passively flexes, abducts, and externally rotates the involved leg until the foot rests on the top of the knee of uninvolved lower extremity; examiner slowly abducts the involved lower extremity towards the table Positive test: Involved lower extremity does not abduct below level of uninvolved side SI pathology, iliopsoas tightness