Physical Examination of Back Pain
o
Straight leg raise (Lasegue's sign) Straight-leg raising test
(Lasegue test)
o
Leg
slowly raised while keeping knee straight
o
Positive
test if it reproduces the patient’s typical radicular pain and paresthesias
o
A
response to < 10° or > 60° is likely not root compression
o hands against wall and stand on toes (each
foot at a time) then heels
·
Cervical
Regions
o hold thumb and pointer finger together and
try to pull away (tests C6)
o hold thumb and pinky together and try to
pull away (tests C8)
o Hoffman’s – indicates UMN lesion
o Lhermette's sign
§
pain down the back and into the
extremities upon neck flexion
§
seen with
Arnold-Chiari
o Spurling Test
§
Tilt head to
side and push down – will impinge nerve
§
reproduces
cervical radicular symptoms)
· Biceps, gastrocnemius are
antigravity muscles with lots of innervation and remain very strong even with
nerve compression
· Reflexes may be diminished because
they involve a nerve arc with more neurons involved
· Crossed straight-leg raising test
o
Elevating
the asymptomatic leg causes typical symptoms in the symptomatic leg
o
90%
specificity for lumbosacral nerve root compression
· Percussion of the spine
o
Pain
may indicate metastatic disease, epidural abscess, osteomyelitis or other
disorders of the vertebral bones
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