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Exam of the Lumbar Spine



- See:
      - PE of C-Spine:
      - Neuro Exam


- Inspection: (scoliosis, thoracic kyphosis, lumbar lordosis, zoster ect.)


- ROM:
    - extension: Phalen's test (lumbar stenosis)
    - flexion:
          - frequently assessed by patient's ability to touch the floor;
          - ability to lean forward, however, has more to do with hip flexion than lumbar spine flexion;
          - w/ forward flexion there should be a reversal of the normal lumbar lordosis;


- Palpation:
     - cva tenderness (pyelonephritis ect.)
     - paraspinal tenderness (osteoporotic kyphosis vs. tumor)
     - Waddel criteria


- Provocative Tests:
    - SLR (HNP vs. Diskitis)
    - Femoral Nerve Stretch Test (L3-4) HNP



- Reflexes:
    - Biceps................C-6
    - Tricep................C-7
    - Knee..................L-4
    - Ankle.................S-1
    - Babinski
    - Bulbocavernosus


- Motor:
    - Psoas......................L-2
    - Quadriceps.................L-3    L2-L3 disk
    - Tibialis Anterior..........L-4    L3-L4 disk
    - Ext. Hallucis..............L-5    L4-L5 disk
    - Gastrocnemius..............S-1    L5-S1 disk
    - Blad Sphincter.............S-2
    - Anal Sphincter.............S-3   (sacral sparing & cauda equina):


- Misc:
    - Instability and Wt Relief Flexion Test
    - Hoover Test


- Sacroiliac Joint Pain:
    - elicited with the patient lying on the affected side without support (Gaenslen's test), direct compression,
            or Flexion, Abduction and External Rotation (FABER test)