LQ Neuro Exam
When should you do a full neuro exam on a patient?
- Radiating pain distal to the gluteal fold
- (+) numbness, tingling or weakness
- Symptoms are present bilaterally (include UMN elements)
- If you are going to do any neurosensitivity tests
What are the bias's for the SLR test?
TED: Tibial (Eversion & DF)
PIP: Peroneal (Inversion & PF)
SID: Sural (Inversion & DF)
Which muscles help anteriorly tilt and increase lumbar lordosis? What about posterior tilt and flexing the lumbar spine?
Hip flexors and lumbar extensors
Abdominals and hip extensors
A 56 year old patient presents with back pain, has a history of DM and smoking, what is one pathology you should rule out?
A. Cauda Equina Syndrome
B. Osteomyelitis of Vertebrae
C. Abdominal Aortic Aneurysm
D. Fracture of lumbar vertebrae
C. Abdominal Aortic Aneurysm
An 85 year old patient presents with low back pain after falling in their home. They have increased pain with weight bearing and it is painful to touch. Which pathology might you suspect?
A. Fracture of Lumbar Vertebrae
B. Abdominal Aortic Aneurysm
C. Lumbar Instability
D. Lumbar Disc Disorder
A. Fracture of Lumbar Vertebrae
Name the landmarks for the LQ dermatome test.
L1- upper anterior thigh
L2- Mid anterior thigh
L3- Medial femoral condyle
L4- Medial malleolus
L5- dorsum of great toe
S1- lateral malleolus
S2- popliteal fossa
What nerve is the prone knee bend test assessing?
Femoral nerve
What happens to the lumbar spine and pelvis when you bend forward? What about coming back up from bending forward?
Bending forward: 1st the lumbar spine flexes--> then the pelvis anteriorly tilts
Coming back up from bending forward: pelvic posteriorly tilts --> then the lumbar spine extends
A 40 year old patient presents with low back pain and has pain and difficulty with urination. They state they had a UTI a month ago but it cleared up. What pathology might you be suspecting?
A. Osteomyelitis of Vertebrae
B. Cystic Kidney Disease
C. Cauda Equina Syndrome
D: Spinal Cord Tumor
B. Cystic Kidney Disease
What is it called when there is a stress fracture of the pars interarticularis of the lumbar vertebrae?
Spondylolysis
Name to movements and the correlating nerve root levels for LQ myotome test.
L1-L2: Hip flexion
L3: Knee extension
L4: Dorsiflexion
L5: Great toe extension
L5-S1: Plantar flexion
S1-2: Plantar Flexion and Eversion
Between what angles is a disc pathology more likely to be causing a patient pain during the SLR? Where would the patient report pain during the SLR if they had disc pathology
35-70 degrees
They would report pain on the opposite side of the leg that is being raised
What is the most common diagnosis treated in outpatient ortho PT?
Low back pain
A patient presents with diminished sensation around the ankle and foot area along with weakness in the lower extremities. They also complain of bowel and bladder incontinence. What pathology would this most likely be?
A. Abdominal Aortic Aneurysm
B. Spinal Cord Tumor
C. Fracture of Lumbar Vertebrae
D. Cauda Equina Syndrome
D. Cauda Equina Syndrome
What is is called when there is inflammation of the vertebrae discs to fuse together?
Ankylosing Spondylitis
Patellar- L3
Achilles- S1
What nerve is the slump test and the SLR assessing?
Sciatic nerve
What is a good/bad score on the Oswestry Disability Index?
Good: lower score
Bad: higher score
A patient presents to us with deep constant pain that is worse when they are standing. A few weeks ago they had a UTI but it has cleared up since then. What pathology might we suspect?
A. Lumbar Instability
B. Osteomyelitis of Vertebrae
C. Cystic Kidney Disease
D. Fracture of Lumbar Vertebrae
B. Osteomyelitis of Vertebrae
What happens to the vertebrae in Spondylolisthesis? Which spinal level is the most common to see this at?
The superior vertebra slips forwards on the inferior vertebra
L5/S1 most common
What maneuver can be used to help enhance a muscle reflex?
Jendrassik Maneuver
How would you bias the lateral femoral cutaneous nerve in the prone knee bend test?
You can adduct the knee to bias the lateral femoral cutaneous nerve
What is the FABQ scale? What is a good/bad score?
Fear avoidance back questionnaire
Higher score means there is a greater chance fear will affect PT treatment (BAD)
>34 : increased risk of not returning to work
A 60 year old patient comes in with back pain. They state it is not relieved by rest and gets worse when they are standing. Their past medical history shows they are in remission from skin cancer. What pathology might you suspect?
A. Cauda Equina Syndrome
B. Vascular Claudication
C. Spondylosis
D. Spinal Cord Tumor
D. Spinal Cord Tumor
What is an example for a yellow flag?
Someone who has a psychological risk factor like fears and unhelpful beliefs
Ex. depression, catastrophizing