### Date : 2024-06-16 11:18 ### Topic : Lumbar Spine Specific Physical Examination Tests #medicine #orthopedic ---- ### Lumbar Spine Physical Examination Tests #### 1. Standing Modified Schober Test Here is the [[Reasons for using the Modified Schober Test instead of the original test]] The **Modified Schober Test** is a clinical test used to measure the flexibility and mobility of the lumbar spine, particularly in the context of [[Ankylosing spondylitis (강직성 척추염)]]. It is an adaptation of the original Schober test, designed to provide a more accurate assessment of lumbar spine flexibility. <iframe title="Schober Test for Lumbar Spine Flexion" src="https://www.youtube.com/embed/eYOUA9asDu8?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> **Positioning:** - Have the patient stand upright with their feet shoulder-width apart, and ask them to keep their back straight. **Procedure:** 1. **Marking Points:** - (First mark) Identify and mark the midpoint of the line connecting the posterior superior iliac spines (PSIS). This point is generally at the level of the L5 vertebra. - (Second mark) Measure and make a second mark 5 cm below this point. - (Third mark) Measure and make a third mark 10 cm above the original midpoint mark. 2. **Measuring Movement:** - Ask the patient to bend forward as far as possible, keeping their knees straight. - Measure the distance between the upper and lower marks while the patient is in the flexed position. **Interpretation:** - In a healthy individual, the distance between the marks should increase by more than 5 cm when the patient bends forward. - A lesser increase in distance suggests reduced lumbar spine flexibility, which can be indicative of conditions such as ankylosing spondylitis. #### 2. Supine Straight Leg Raise (SLR) Test The Straight Leg Raise test is used to assess for lumbar nerve root irritation, often due to a herniated disc. <iframe title="Straight Leg Raise or Lasègue's Test for Lumbar Radiculopathy" src="https://www.youtube.com/embed/LdAD9GNv8FI?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> **Positioning:** - Have the patient lie supine (on their back) with their legs extended. **Procedure:** 1. **Initial Leg Raise:** - The examiner lifts one of the patient’s legs while keeping the knee straight. - Lift the leg until the patient experiences pain or reaches full hip flexion. - Note the angle at which pain occurs, typically between 30 to 70 degrees of hip flexion. 2. **Lower the Leg:** - Lower the leg slightly until the pain subsides. 3. **Dorsiflexion of the Foot (Bragard’s Sign):** - While maintaining the leg’s position, dorsiflex the foot (flex the ankle so the toes move toward the shin). - Observe if this maneuver reproduces or intensifies the pain. **Interpretation:** - **Positive Bragard’s Sign:** Reproduction or intensification of pain during foot dorsiflexion supports the diagnosis of sciatic nerve irritation or lumbar nerve root compression. - Pain radiating down the leg at an angle between 30 to 70 degrees suggests lumbar nerve root irritation, often due to a herniated disc (sciatica). - Pain primarily in the back and not radiating down the leg may indicate other lumbar spine issues. #### 3. Patrick (FABER) Test The **Patrick (FABER) Test** is a physical examination maneuver used to assess the hip joint or sacroiliac (SI) joint for pathology. The acronym FABER stands for Flexion, ABduction, and External Rotation, which are the movements involved in the test. <iframe title="Patrick's / Faber / Figure Four Test" src="https://www.youtube.com/embed/89Qiht82zmg?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> **Positioning:** - Have the patient lie supine (on their back) on the examination table. **Procedure:** 1. **Flexion:** Place the patient's leg in a figure-four position by flexing the hip and knee of the tested leg and placing the ankle on the opposite knee. 2. **Abduction and External Rotation:** Stabilize the opposite hip by placing one hand on the anterior superior iliac spine (ASIS) of the non-tested side. 3. **Apply Pressure:** Gently press down on the knee of the bent leg, moving it toward the examination table. ##### Interpretation **Pain Localization:** - **Groin Pain:** Pain in the groin area suggests hip joint pathology, such as hip arthritis, labral tear, or other intra-articular hip disorders.  <Photo from: https://www.medindia.net/health/symptoms/groin-pain.htm> - **Lower Back/Buttock Pain:** Pain in the sacroiliac region (lower back or buttock area) suggests SI joint dysfunction or pathology.  <Photo from: https://en.wikipedia.org/wiki/Sacroiliac_joint> #### 4. Chest Expansion Test Overview The **chest expansion test** is a clinical assessment used to evaluate the movement of the thoracic cage during respiration. It is particularly useful in diagnosing conditions that limit chest expansion, such as ankylosing spondylitis (AS). ##### Purpose The chest expansion test helps to identify reduced chest wall mobility, which is a characteristic feature of ankylosing spondylitis. It can also be used to assess respiratory function in other conditions that affect chest wall movement.  <Photo from: https://www.jaypeedigital.com/book/9788184482058/chapter/ch12> ##### Procedure **Positioning:** - The patient should be standing or sitting comfortably. **Steps:** 1. **Find Reference Points:** Identify the fourth intercostal space (just below the nipple line) or the xiphisternum (the lower part of the sternum). 2. **Place Measuring Tape:** Wrap a flexible measuring tape around the patient's chest at the level of the fourth intercostal space or xiphisternum. 3. **Exhale Measurement:** Ask the patient to fully exhale and measure the chest circumference at the end of exhalation. 4. **Inhale Measurement:** Ask the patient to take a deep breath in (inhale fully) and measure the chest circumference at the end of inhalation. 5. **Calculate Expansion:** Subtract the exhalation measurement from the inhalation measurement to determine the chest expansion. **Normal Values:** - Normal chest expansion is typically greater than 5 cm in healthy adults. ##### Interpretation - **Reduced Chest Expansion:** Less than 2.5 cm difference between inhalation and exhalation measurements may indicate conditions such as ankylosing spondylitis, where chest wall expansion is limited due to fusion of the costovertebral joints. - **Normal Chest Expansion:** Greater than 5 cm difference suggests normal chest wall mobility. ### Summary of Tests - **Standing Schober Test:** Measures lumbar spine flexibility; reduced flexibility suggests conditions like ankylosing spondylitis. - **Supine Straight Leg Raise (SLR) Test:** Assesses for lumbar nerve root irritation; pain radiating down the leg suggests sciatica. - **Patrick (FABER) Test:** Evaluates hip and sacroiliac joint pathology; pain location indicates the affected joint.