Orthopedic Tests: Lumbar And Pelvic Evaluation

Front 1

Turyn's Test
(Nerve Root Traction Test)

Back 1

Dorsiflex the great toe while the leg is at rest (no elevation)

(+): sharp shooting pain down back of leg or exacerbation of LE complaint

Indication: sciatic nerve/root traction/irritation

Front 2

Straight Leg Raise
(Nerve Root Traction Test)

Back 2

Doctor elevates the patient's symptomatic leg with the knee extended. (One had on top of the knee ensures extension). Elevate the leg until the patient reports pain, or flexion of the knee occurs. Note the approximate angle at which leg pain is provoked. Ask patient to point to site of pain

(+): sharp shooting pain down back of leg or exacerbation of LE complaint

Indication: traction of the sciatic nerve/nerve roots, or hamstring dysfunction

Note: Other tests must be performed to ascertain which tissue is responsible

Front 3

Sicard's Test
(Nerve Root Traction Test)

Back 3

Perform the SLR, lower the leg below the angle of pain and dorsiflex the great toe

(+): sharp shooting pain down back of leg or exacerbation of LE complaint

Indication: sciatic nerve/root traction/irritation

Front 4

Braggard's Test
(Nerve Root Traction Test)

Back 4

Following a positive SLR, lower the leg until the pain eases, then dorsiflex the foot
(Note: a positive finding rules out hamstring, SI or hip as tissue of causation)

(+): sharp shooting pain down back of leg or exacerbation of LE complaint

Indication:sciatic nerve/root traction/irritation

Front 5

Well Leg Raise
(Nerve Root Traction Test)

Back 5

Raise the NON-symptomatic leg as per SLR. The leg is then lowered below the point of pain and foot is DORSIflexed

(+): exacerbation of pain in the posterior aspect of the symptomatic leg at any point in this test

Indication" nerve root lesion suggesting MEDIAL disc herniation

Front 6

Lindner's Sign
(Nerve Root Traction Test)

Back 6

The examiner flexes the patient's cervical and thoracic spine into flexion. Note exacerbation of low back and radiating pain

Present: exacerbation of pain in the posterior aspect of the symptomatic leg upon cervical flexion, or exacerbation of LE complaint

Indication: sciatic radiculopathy, particularly indication of LATERAL disc herniation

Front 7

Bowstring Sign
(Differential Diagnosis of Radiculopathy from Other Conditions)

Back 7

1. SLR that is (+)
2. While maintaining the symptomatic angle, the leg is flexed at the knee with the ankle resting on the examiner's shoulder
3. If the pain is reported to reduce with this move, the Dr exerts firm pressure at the tendons of each of the HS individually, then to the popliteal fossa to compress the sciatic nerve

Present: Pain
- Popliteal Fossa: pain in the lumbar region suggests radiculopathy
- Along sciatic distribution suggests sciatic neuritis
- HS tendon: assists in confirmation of hamstrings as source of leg pain in reproduced with tendon palpation (If this is performed seated, it is known as Deyerle's sign)

Front 8

Piriformis Stretch Test
(Piriformis Evaluation)

Back 8

Perform as per Hibb's test, but with stabilization of the contralateral SI joint and additional pressure upon internal rotation of the hip (may be performed side-lying)

(+): exacerbation of sciatic symptoms (classic positive- patient presents with shootin pain down leg or tight feeling in gluts)

Indication: piriformis entrapment of the sciatic nerve

Front 9

Bonnet's Test
(Piriformis Evaluation)

Back 9

1. Doctor performs SLR- at onset of pain
2. The doctor then externally rotates the patient's hip
3. Then the doctor internally rotates the patient's hip and slightly adducts the lower extremity

(+): decrease in sciatic pain upon EXTERNAL rotation, increase in sciatic pain upon INTERNAL rotation and adduction

Indication: piriformis entrapment of sciatic nerve

Front 10

Godthwaite Test
(Differentiating Lumbar from SI Joint Involvement)

Back 10

Patient is supine, the examiner performs an SLR while palpating the L5-S1 junction
(Order: Ipsilateral FA > ipsilateral SI > LS > contralateral SI > contralateral FA)

(+): pain before the LS junction opens or pain when the LS junction moves

Indication: sacroiliac lesion or LS lesion respectively

Front 11

Smith-Petersen
(Differentiating Lumbar from SI Joint Involvement)

Back 11

Following a positive Goldthwaite test, a SLR is performed on the asymptomatic side. (No palpation of the LS junction). The angle of SLR is compared to the positive Goldthwaite test

Indication: the well leg must be elevated higher than the symptomatic side in Goldthwaite, to confirm contralateral SI joint lesion. If raised to the same height, suggests LS lesion

Front 12

Double Leg Raise (Bilateral Straight Leg Raise)
(Differentiating Lumbar from SI Joint Involvement)

Back 12

Patient is supine. Perform a SLR on one leg and then on the other, note the angles at which the pain begins. Next, left both legs simultaneously and note the angle at which the pain begins. (Follows Goldthwaite test)

(+): reproduction of LS pain at a lesser angle than with individual SLRs

Indication: lumbosacral joint involvement (sprain, disc disease)

Front 13

Minor's Sign
(Seated Tests)

Back 13

Observe the patient while rising form a seated position

Present: the use of patient's arms while rising (pushing off chair arms, their own knees) and maintenance of the affected leg in flexion by leaning forward

Indication: non-specific indicator of the presence of pain of low back or lumbopelvic origin

Front 14

Bechterew's Test
(Seated Tests)

Back 14

Instruct the patient to extend the symptomatic leg (symptomatic leg first!), lower it, then repeat with the opposite leg. If no exacerbation of pain is elicited then instruct the patient to extend both knees simultaneously.

(+) may be
1. Same as SLR
2. Same as WLR
3. Assumption of tripod position with patient leaning back on the hands

Indication: interpreted as per SLR and WLR

Front 15

Kemp's Test
(Seated Tests)

Back 15

Note antalgic position first. With the patient seated, contact the low back at the site of pain. Bring the patient's upper body into extension, ipsilateral lateral flexion and rotation simultaneously. Note any exacerbation of pain in the low back or leg

(+)
- Increase or recurrence of radiating pain into LE extremity confirms radiculopathy
- In the seated position, preload on the disc is increased

Facet Syndrome: local pain may indicate facet syndrome (dull, boring, achy pain). In standing position, weight bearing by the facet is increased

Front 16

Adam's Test
(Standing Tests)

Back 16

1. Observe patient with structural scoliosis standing (look for scapular winging, rib humping, iliac crest higher)
2. Then patient is asked to flex forward at the waist. Dr. observes patient's back for signs of structural change

(+): 1. Resolution of structural findings, 2. No resolution of structural findings

Indication: 1. Resolution of functional scoliosis, 2. Non-resolution = structural scoliosis

Front 17

Belt Test
(Standing Tests)

Back 17

Instruct the patient to bend fully forward toward their toes and note when the onset of pain begins. Repeat the maneuver again while the examiner stands behind the patient and blocks SI joint motion by supporting the sacrum with their thigh or hip and pulling backward on the patient's ASIS bilaterally. This prevents flexion below the level of the LS junction

(+): decrease in pain upon supported flexion

Indication: decrease in pain indicates the source of pain in the unsupported motion was sacroiliac

Front 18

Neri's Sign (Bowing Sign)
(Standing Tests)

Back 18

The patient stands and bends forward from the waist (bowing)

Present: occurs when the patient's affected leg flexes at the knee and patient reports a reproduction of the LE complaint in this position

Indication: sciatic radiculopathy or hamstring spasm

Front 19

Lewin's Standing Test
(Standing Tests)

Back 19

If the patient's knee is flexed when standing normally, or with performance of Neri's test, the examiner stabilizes the patient's pelvis then attempts to pull the flexed knee back into extension

(+): increase in posterior leg pain or inability to keep leg straight

Indication: sciatic radiculopathy hamstring spasm

Front 20

Advancement Test
(Standing Tests)

Back 20

The patient bends forward to elicit pain into the leg. The patient is then asked to advance the SYMPTOMATIC leg one step and bend forward again

(+): reproduction of the radiating pain with less trunk flexion than before

Indication: sciatic radiculopathy (neuropathy/hamstring)

Front 21

Nachlas Test
(Prone Tests)

Back 21

Approximate the patient's heel to the IPSILATERAL buttock. Ask the patient to localize the site of pain

(+): pain localized by patient

Indication: the area the pain points indicates the site of involvement (SI vs. Lumbar). Pain radiating down the anterior thigh indicates femoral nerve/root irritation. Pain in LB may be facet syndrome

Front 22

Ely's Sign
(Prone Tests)

Back 22

Upon performance of the Nachlas test, "hunching of the pelvis occurs)

Present: hunching of the pelvis

Indication: tightness of the 2-joint hip flexors (rectus femoris and TFL)

Front 23

Ely's Heel to Buttock Test
(Prone Tests)

Back 23

The examiner approximates the patient's heel to the OPPOSITE buttock

(+): inability to perform the movement or pain upon approximation

Indication: hip joint lesion, SI, lumbar, iliopsoas (if Ely's sign is present) or femoral nerve root irritation (adding external rotation stresses the hip joint)

Front 24

Gaenslen's Test
(SI Tests)

Back 24

With the patient's side close to the edge of the examining table, instruct the patient to grasp the opposite knee (contact underneath is preferred) and approximate it to the chest. The examiner then gently lowers the affected side off the edge of the table

(+): SI joint pain

Indication: SI joint lesion

Front 25

Lewin-Gaenslen Test
(SI Tests)

Back 25

The identical test performed with the patient in the side lying position while the Dr stabilizes the pelvis. It has the additional advantage of allowing the examiner to palpate the SI joints

(+): SI joint pain

Indication: same as Gaenslen (SI joint lesion)

Front 26

Erichsen's Sign
(SI Tests)

Back 26

With the patient prone, firm pressure is applied toward the midline (Dr. uses soft contact lateral to the PSIS)

Present: SI joint pain

Indication: SI joint lesion

Front 27

Hibb's Test
(SI Tests)

Back 27

With the patient prone, flex the knee and use the lower leg as a lever to internally rotate the hip. NO stabilization

(+): SI joint pain or hip pain

Indication: lesion of hip or SI joint
* Differential between femoroacetabular and SI problem

Front 28

Yeoman's Test
(SI Tests)

Back 28

With the patient prone, flex the knee and lift the distal femur to create hip extension. Add downward pressure on the ipsilateral SI

(+): SI joint pain

Indication: SI sprain

Front 29

Mennell's Test

* Only test checking for SI flexion *

Back 29

1. With the patient prone, the examiner applies pressure with thumbs from the PSIS's outward into the soft tissue. Note any report of pain at the SI
2. The examiner then slides the thumbs toward the midline (Erichsen's)
3 & 4. If this 2nd maneuver elicits pain, the ilium is rocked forward (superior hand on the SI joint, inferior hand on the femur), and then pulled posteriorly (superior hand on the ASIS, inferior hand on ischial tuberosity). Note any exacerbation of pain

(+): exacerbation of SI pain

Indication: 1) myofascial involvement of gluteal muscles; 2, 3, 4) SI subluxation or sprain