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Modified straight leg test results
Pt sitting, raise leg to straight from 90degrees
- If no pain: functional problem
- If pain: see "tripod sign" = structural problem
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CVA tenderness
pyelonephritis
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Straight leg test
- Pt supine, Raise leg 80 degrees
- If <80degrees, lower slightly, if can dorsiflex=hamstrings tight
- If <80degrees and cannot dorsiflex= sciatica
- Pain radiating down post/lat thigh and past knee=herniated disk impinging L5/S1
- Pain in opp leg in SLT= central disk herniation
- If pain before 30degrees=malingering
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Crossed Straight leg test
- Asx leg raised with Sx leg crossed over it
- Pain in Sx leg is diagnostic of central disk herniation
- no pain does no rule out (.25 sens, .90 spec)
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FABER test
- Flex knee, abduct hip, and externally rotate thigh
- (place affected foot on opp knee) and press down on tested knee while stabilizing opp hip.
- Pain or cannot lower to parralel =sacroilitis or hip joint path
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Pelvic compression test
Pain = sacroilitis
-
Classic disk herniation sx
- Pain worse with sitting or bending
- inc pain with coughing or sneezing
- pain radiating down leg or foot
- paresthesia
- muscle weakness (foot drop)
-
back pain + urinary retention
Cauda equina syndrome
-
Back pain cancer red flags
- Hx cancer
- Unexplained weight loss >10 kg within 6 months
- >50 years old or <17 years old
- Failure to improve with therapy
- Pain persists for more than 4 to 6 weeks
- Night pain or pain at rest
-
Back pain infection red flags
- Persistent fever (temperature over 100.4 F)
- Hx IV drug abuse
- Recent bacterial infection, esp bacteremia (UTI, cellulitis, pneumonia)
- Immunocompromised
-
back pain cauda equina syndrome red flag
- Urinary incontinence or retention
- Saddle anesthesia
- Anal sphincter tone decreased or fecal incontinence Bilateral lower extremity weakness or numbness Progressive neurologic deficits
-
Back pain significant herniated nucleus pulposis red flags
- Major muscle weakness (strength 3 of 5 or less)
- Foot drop
-
back pain vertebral fracture red flags
- Prolonged use of corticosteroids
- Mild trauma over age 50 years
- Age greater than 70 years
- Hx osteoporosis
- Recent significant trauma at any age
- Previous vertebral fracture
-
Tx for back pain without redflags
- NSAIDS
- muscle relaxant
- continue activity level as tolerated, avoid strenuous activity
- moist heat
- PT can help
- revisit in 4-6 weeks if not improving
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