Case 2 | Examination

Inspection

  1. General - Moderate Build / Appears uncomfortable attempting to stand up.
  2. Posterior - Slight list to RIGHT side (i.e. pelvis shifted to right, shoulder to the left).
  3. Lateral - Loss of lumbar lordosis.
  4. Gait - The patient walks with their shift still apparent (pelvis shifted to left, shoulder to the right).

 

Palpation

No bony tenderness but has a lot of pain down the right lateral paraspinal muscles.  They feel tense.

 

Movement

Modified Schobers Test:

Patient unable to comply due to right leg pain. 

Extension:

Again very limited due to pain.

Lateral movements

Right leg pain exacerbated by lateral flexion to the right side.

 

Neurological examination

Motor power

Power (Lower Limb)

RIGHT

LEFT

Hip flexion

5

5

Knee flexion

5

5

Knee extension

5

5

Ankle dorsiflexion

5

5

Ankle plantarflexion

5

5

Great toe dorsiflexion

4

5

Great toe plantarflexion

5

5

     

 

Sensory

Altered sensation lateral aspect of right lower leg and dorsum of foot, particularly over first web space. 

 

Co-ordination

Normal

 

Reflexes

Ankle – normal

Knee – normal

 

Nerve tension tests

Straight leg raising

Pain at 10 degrees radiating up posterior aspect of right leg

Lasegue’s test

Positive

Bowstring test

Positive

Femoral nerve stretch test

Not indicated

 

Other Relevant Examinations

Screening for hip problems - Full range of rotation, painless.

 Peripheral vascular  -  Intact