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Lumbar Quadrant Test

From Physiopedia

Original Editor - Rachael Lowe

Top Contributors -

Rachael Lowe, Roel De Groef, Oyemi Sillo and Aarti Sareen  

Contents

Description

The lumbar quadrant or Kemp’s test is a test to assess the lumbar spine facet joints. It is a provocative test to detect pain, which can be local, referred or radiculair.[1]

Clinically Relevant Anatomy

The facet joints (FJ) or zygapophyseal joints play an important role in load transmission. The purpose of these FJ is to stabilize the motion segment in flexion, extension and also restricting axial rotation. They also provide a posterior load-bearing helper.
The lumbar FJ are paired, true synovial joint that comprise the posterolateral articulation between vertebral levels. The orientation of the FJ in a transverse plane varies from the upper level of the lumbar spine to the lower one.
Lumbar FJ contain hyaline cartilage, synovial membrane, fibrous capsule, and a joint space with a potential capacity of 1 to 2 mL. The existence of menisci in the lumbar FJ has been emphasized in numerous publications.[2]

Purpose

The purpose of this test is to assess the lumbar spine facet joints. Lumbar quadrant test uses the patient’s trunk both as a lever to induce tension and as a compressive force. This test is used in differentiation and diagnosis of a lumbar posterior facet syndrome, though it is nonspecific.[3]4 The Lumbar quadrant test is a provocation test to detect pain. Local pain suggest a facet cause, while radiating pain into the leg is more suggestive of nerve root irritation. Especially if the pain is below the knee.[4]5

Technique

The lumbar quadrant test may be performed with the patient either in the seated or standing position.

Standing position:
 1. Patient is standing before the therapist.
 2. The therapist fixes the opposite ilium from the side being tested with one hand.
 3. The other hand grabs the shoulder from the patient and leads the patient to extension, ipsilateral sidebending and        ipsilateral rotation (3D extension movement).
 4. Hold this position for three seconds.


Seated position:
 1. The patient seated with arms crossed over the chest.
 2. One hand of the therapist stabilize the patient’s lumbosacral region on the side to be tested.
 3. The other arm controls the patient’s upper body movement.
 4. The patient is passively directed into flexion, rotation, lateral flexion, and finally extension.
 5. Depending on the patient’s response, axial compression may be applied in the fully extended and rotated position to  increase stress on the posterior joints.

The test is positive when the patient reports pain, numbness or tingling in the area of the back or lower extremities. The pain is located on the side being tested.[1][5][3] Local pain suggests a facet cause, while radiating pain into the leg is more suggestive of nerve root irritation. Especially if the pain is below the knee.[4]
The seated position is more preferable because the therapist has more control over the patient’s positioning and there is less muscle activation.[3][4]

Evidence

Results showed for Lumbar quadrant test in following article: ‘Relationship of Physical Examination findings and Self-reported symptom severity and physical function in patients with degenerative lumbar conditions; Mark A Lyle, Sarah Manes, Michael McGuinness, Sarah Ziaei and Maura D Iversen; PHYS THER. 2005; 85:120-133.’ The purpose of this study was to examine the relationships of symptom provocation during physical examination procedures and self-report of symptom severity and function in patients with degenerative lumbar conditions :
- The quadrant test was the strongest predictor of symptom severity
- The quadrant test distinguished those subjects with clinically meaningful low back symptom severity but was not predictive of impaired function.
- The quadrant test was the most common test that reproduced the patient’s symptoms.
- Patients who reported symptoms during the quadrant test had higher self-reported Lumbar Spinal Stenosis symptom severity scores compared with those who did not report symptoms during the quadrant test[5].

Resources

http://videos.rehabstudents.com/lumbar-quadrant-test/
http://ptjournal.apta.org/content/85/2/120

Recent Related Research (from Pubmed)

References

  1. 1.0 1.1 Steve Jensen; back pain – clinical assessment; Australian Family Physician Vol. 33, No. 6, June 2004 (level of evidence:D)
  2. Leonid Kalichman, BPT, PhD, and David J. Hunter, MBBS, Phd; Lumbar facet joint osteoarthritis: A review; 2007; Elsevier Inc; Semin Arthritis Rheum 37:69-80
  3. 3.0 3.1 3.2 Craig E. Morris; Low back syndromes; McGraw-hill professional; 2005 (Level of evidence: D)
  4. 4.0 4.1 4.2 Thomas A. Souza; differential diagnosis and management for the chiropractor; Jones & Bartlett Learning; 2008 (Level of evidence: D)
  5. 5.0 5.1 Mark A Lyle, Sarah Manes, Michael McGuinness, Sarah fckLRZiaei and Maura D Iversen; Relationship of Physical Examination Findings and Self-Reported Symptom Severity and Physical Function in Patients With Degenerative Lumbar Conditions; PHYS THER. 2005; 85:120-133. (level of evidence: A)


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