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+ Hip and Lumbar Spine

Physical Examination Findings


in People Presenting With Low
Back Pain, With or Without
Lower Extremity Pain

Pembimbing:
dr. Untung Gunarto, Sp.S

Disusun oleh :
Lavenia Quinta Saraswati 1810221046
Low back pain is pain, muscle tension, or stiffness localized below the
+
costal margin and above the inferior gluteal folds, with or without
sciatica, and is defined as chronic when it persists for 12 weeks or more
More than 70 percent of persons in developed countries will experience
low back pain at some time in their lives. Each year, between 15 and 45
percent of adults have low back pain, and 5 percent of persons present to
the hospital with a new episode
Etiologi : ~85 % of low back pain is mechanical
Despite the many possible causes, making a specific diagnosis is
usually impossible (~85% of the time)

DIAGNOSE TRIAGE
“RED FLAG”
unilateral : Signs
, worse thanand
non
Called
symptoms
specific mechanical
LBP LBPserious
indicating :
1. Non Specific LBP -spinal
pain ispathology
worsened e.g. with: fracture,
movement
cancer,
Spreading infection
to lower and cauda
limb or toe
2. Nerve root pain ( -Parasthesia
pain is improved with
Radiculopathy ) equina syndrome
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rest tes +
Lasegue
-Localized
Non specific
nervepain
root
3. Serious spinal pathology distribution
compression
Physical
+examination
Inspection

Standing : The physician starts at the low back and examines down to the feet. Any
exaggerated or flattened normal spinal curves, asymmetries in skin folds or
deformities or abnormal curvatures in spine, muscle atrophy, or abnormal hair
patterns should be noted.

Seated : patient seated with knees and hips bent to 90° . The physician evaluates for
asymmetries of the pelvis

Lying : to check out leg-length discrepancy, assessed by comparing the distance on


either side between the umbilicus and a distal landmark such as the tibial tuberosity
or medial malleoli.

Gait
To complete the gait inspection, the patient’s gait should be evaluated from the front,
side, and posterior aspects
Palpation
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Attempt to localize the pain
Palpate the vertebrae for possible
fractures or bone infections or mass
Palpate the paraspinal muscles for
tenderness
Check for muscle spasms – compare one
side to the other

Percussion
Ask patient to bend forward
Lightly percuss spine from neck to
sacrum
Significant pain is a feature of
infections fractures and neoplasms
Beware exaggerated response – may be
a non organic problem
Palpable steps may indicate
spondylolisthesis
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MOTION TESTING (ROM)

Active range of motion of the lumbar spine is


evaluated with the patient standing

Hip range of motion needs to be


Motion of the
evaluated lumbar
with spine
a hand on the
occurs to
pelvis in 3 positions
detect any and
motion that
includes
may give4adirections, as owing
false value follows:to
tilting of the pelvis. Starting on
- Forward
one side, flexion: 40-60°
- Extension:
the 20-35° flexes the
physician
- Lateral flexion/side
patient’s hip and knee bending
both to
(left and right): 15-20°
90°.
- Rotationrotation
Internal (left and(30-40°)
right): 3-18°
external rotation (40-60°)
Tests for Neurological
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Dysfunction

Laseque test
Femoral nerve traction test
Patient supine
The
Hold thesetup
ankle andbegins in affected
gently lift a non-
leg
hyperextended
up to 70 position. While the
patient’s
used to neck is slightly
evaluate lumbarflexed,nerve
the
examiner
impingementpassively
or extends the hip
irritation. Oncewhile
a
standing
complaintbehind
of pain the patient. Finally,
or tightness the
is reached,
examiner
the leg is flexes
slowlythe knee, putting
lowered tension
until radicular
on the femoral
symptoms vanish.nerve. Reproduction of
radicular symptoms down the anterior
thigh demonstrates a positive test result.

Slumpt test
1 . Slump forward
2. Neck flexion
3. Leg extension
4. Passive dorsoflexion of the ankle
+Tests for Joint
Dysfunction

One leg standing test (stork stand)


The patient is instructed to flex one leg at the
hip and knee as if taking a marching step

Patrick-FABER test
The patient lies supine on the examination table
and is asked to place one foot on the opposite
knee. While supporting the pelvis with one hand,
the physician presses firmly down on the flexed
knee while supporting the pelvis at the opposite
anterior superior iliac spine.
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Muscle Stabilization
Testing

Trendelenburg test

It begins with the patient in a neutral stance.


The physician is seated behind the patient
with his or her hands placed behind the
patient’s hips with the thumbs resting on the
posterior superior iliac spine. The patient is
instructed to flex at the hip, raising the knee
as if taking a marching step. With the patient
in this stance, the physician evaluates for
pelvic drop
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Neurological Examination
Neurological Examination- Neurological Examination-
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sensation Reflex

Pinprick Sensation Testing Achilles Reflex Patella Reflex


L5 S1 L4
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TERIMA KASIH