Kemp Test: Difference between revisions

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== Description  ==
== Description  ==
[[File:Facet-joints.png|alt=|right|frameless]]The Kemp test (also known as the quadrant test and extension-rotation test) is a provocative test useful for diagnosing pain related to [[Facet Joint Syndrome|facet joint pathology]], e.g. [[osteoarthritis]].


The lumbar quadrant or [[KEMP test|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.<ref name="1">Steve Jensen; back pain – clinical assessment; Australian Family Physician Vol. 33, No. 6, June 2004 (level of evidence:D)</ref>  
# The client performs combined extension and rotation of the spine (used for the [[Cervical Anatomy|cervical spine]] or the [[Lumbar|lumbar spine]]).  
# The test is considered positive when the patient reports [[Pain Assessment|pain]], numbness or tingling in the area concerned.<ref>Radiopedia Kemp Test Available:https://radiopaedia.org/articles/kemp-test?lang=gb (accessed 26.9.2022)</ref>


== Clinically Relevant Anatomy ==
== Purpose ==


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.<br>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.<br>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.<ref name="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</ref><br>  
The purpose of this test is to assess lumbar or cervical spine [[Facet Joints|facet joint]] pain. It 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 [http://www.physio-pedia.com/index.php/Facet_Joint_Syndrome facet syndrome], though it is nonspecific.<ref name="p4">Craig E. Morris; Low back syndromes; McGraw-hill professional; 2005 (Level of evidence: D)</ref>  It is a provocation test to detect pain. Local pain suggest a facet cause, whilst radiating pain into the leg/arm is more suggestive of nerve root irritation. Especially if the pain is below the knee/elbow.<ref name="p5">Souza TA. [https://books.google.com/books?hl=en&lr=&id=g8FEXRYkN2wC&oi=fnd&pg=PR1&dq=Thomas+A.+Souza%3B+differential+diagnosis+and+management+for+the+chiropractor%3B+Jones+%26+Bartlett+Learning%3B+2008+(Level+of+evidence:+D)&ots=WMksJjptOD&sig=s5MUc8GwPmwRKLYjbwl-S6 Differential diagnosis and management for the chiropractor: protocols and algorithms]. Jones & Bartlett Publishers; 2009 Oct 7.</ref>  


== Purpose<br> ==
== Technique ==


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 [http://www.physio-pedia.com/index.php/Facet_Joint_Syndrome facet syndrome], though it is nonspecific.<ref name="4">Craig E. Morris; Low back syndromes; McGraw-hill professional; 2005 (Level of evidence: D)</ref><sup>4 </sup>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.<ref name="5">Thomas A. Souza; differential diagnosis and management for the chiropractor; Jones &amp; Bartlett Learning; 2008 (Level of evidence: D)</ref><sup>5</sup><br>
The Kemp Test test may be performed with the patient either in the seated or standing position.  


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


The lumbar quadrant test may be performed with the patient either in the seated or standing position.<br>  
{{#ev:youtube|tBVhHpxF3ZQ|300}} <ref>Rocky Bains. Kemp's Test. Available from: https://www.youtube.com/watch?v=tBVhHpxF3ZQ [last accessed 22/10/2020]</ref>  


Standing position: <br>&nbsp;1. Patient is standing before the therapist.<br>&nbsp;2. The therapist fixes the opposite ilium from the side being tested with one hand.<br>&nbsp;3. The other hand grabs the shoulder from the patient and leads the patient to extension, ipsilateral sidebending and &nbsp; &nbsp; &nbsp; &nbsp;ipsilateral rotation (3D extension movement).<br>&nbsp;4. Hold this position for three seconds.<br>  
'''Seated position''':<br>&nbsp;1. The patient seated with arms crossed over the chest.<br>&nbsp;2. One hand of the therapist stabilize the patient’s lumbosacral region on the side to be tested.<br>&nbsp;3. The other arm controls the patient’s upper body movement.<br>&nbsp;4. The patient is passively directed into flexion, rotation, lateral flexion, and finally extension.<br>&nbsp;5. Depending on the patient’s response, axial compression may be applied in the fully extended and rotated position to &nbsp;increase stress on the posterior joints. <br>  


{{#ev:youtube|4GBjhAcwh90}}<ref>Physiotutors. Kemp Test / Kemps / Extension Quadrant | Lumbar Spinal Stenosis. Available from: https://www.youtube.com/watch?v=4GBjhAcwh90 </ref>
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.<ref name="p1">Steve Jensen; back pain – clinical assessment; Australian Family Physician Vol. 33, No. 6, June 2004 (level of evidence:D)</ref><ref name="p3">Lyle MA, Manes S, McGuinness M, Ziaei S, Iversen MD. [https://academic.oup.com/ptj/article-abstract/85/2/120/2804972 Relationship of physical examination findings and self-reported symptom severity and physical function in patients with degenerative lumbar conditions.] Physical therapy. 2005 Feb 1;85(2):120-33.</ref><ref name="p4" /><span style="font-size: 11px;">&nbsp;</span>Local pain suggests a facet cause, while radiating pain into the leg is more suggestive of [http://www.physio-pedia.com/index.php/Lumbar_Radiculopathy#top nerve root irritation]. Especially if the pain is below the knee.<sup><ref name="p5" /></sup><br>The seated position is more preferable because the therapist has more control over the patient’s positioning and there is less muscle activation.<sup><ref name="p4" /><ref name="p5" /></sup><sup></sup>  


Seated position:<br>&nbsp;1. The patient seated with arms crossed over the chest.<br>&nbsp;2. One hand of the therapist stabilize the patient’s lumbosacral region on the side to be tested.<br>&nbsp;3. The other arm controls the patient’s upper body movement.<br>&nbsp;4. The patient is passively directed into flexion, rotation, lateral flexion, and finally extension.<br>&nbsp;5. Depending on the patient’s response, axial compression may be applied in the fully extended and rotated position to &nbsp;increase stress on the posterior joints. <br>  
{{#ev:youtube|4wIFZmxiSTg|300}}<ref>Palmer Health Sciences Library. Kemp's Test. Available from: https://www.youtube.com/watch?v=75bVhJ-sBcI [last accessed 22/10/2020]</ref>  


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.<ref name="1" /><ref name="3">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)</ref><ref name="4" /><span style="font-size: 11px;">&nbsp;</span>Local pain suggests a facet cause, while radiating pain into the leg is more suggestive of [http://www.physio-pedia.com/index.php/Lumbar_Radiculopathy#top nerve root irritation]. Especially if the pain is below the knee.<sup><ref name="5" /></sup><br>The seated position is more preferable because the therapist has more control over the patient’s positioning and there is less muscle activation.<sup><ref name="4" /><ref name="5" /></sup>
The below video is of the Kemp test in the cervical spine (similar to [[Spurling's Test]]).
 
{{#ev:youtube|v=jNdBq3eR-eY|300}} <ref>Massage nerd. Orthopedic Test - C / SPINE KEMP'S TEST. Available from: https://www.youtube.com/watch?v=jNdBq3eR-eY [last accessed 26.9.2022]</ref>  
<sup></sup>
 
{{#ev:youtube|4wIFZmxiSTg|300}}


== Evidence  ==
== Evidence  ==
 
Kemp’s test is the most used diagnostic procedure for lumbar pain but has a poor diagnostic accuracy with a sensitivity of 50-70%<ref name="p3" /> and specificity of 67.3%<ref>Manchikanti L, Pampati V, Fellows B, Baha AG. [https://www.painphysicianjournal.com/current/pdf?article=MzMw&journal=3 The inability of the clinical picture to characterize pain from facet joints]. Pain Physician. 2000 Apr;3(2):158-66.</ref>.
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&nbsp;:<br>- The quadrant test was the strongest predictor of symptom severity<br>- The quadrant test distinguished those subjects with clinically meaningful low back symptom severity but was not predictive of impaired function.<br>- The quadrant test was the most common test that reproduced the patient’s symptoms.<br>- 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<sup><ref name="3" /></sup>.  


== Resources  ==
== Resources  ==


http://videos.rehabstudents.com/lumbar-quadrant-test/ <br>http://ptjournal.apta.org/content/85/2/120  
http://videos.rehabstudents.com/lumbar-quadrant-test/ <br>http://ptjournal.apta.org/content/85/2/120
 
== References  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References<br> ==


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[[Category:Assessment]][[Category:Lumbar]][[Category:Lumbar_Examination]][[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Assessment]]
[[Category:Lumbar Spine]]
[[Category:Lumbar Spine - Assessment and Examination]]
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]

Latest revision as of 23:29, 18 December 2023

Original Editor - Rachael Lowe

Top Contributors - Aminat Abolade, Admin, Rachael Lowe, Kim Jackson, Lucinda hampton, WikiSysop, Jess Bell, 127.0.0.1, Tony Lowe, Roel De Groef, Aarti Sareen, Oyemi Sillo, Kai A. Sigel and Wanda van Niekerk  

Description[edit | edit source]

The Kemp test (also known as the quadrant test and extension-rotation test) is a provocative test useful for diagnosing pain related to facet joint pathology, e.g. osteoarthritis.

  1. The client performs combined extension and rotation of the spine (used for the cervical spine or the lumbar spine).
  2. The test is considered positive when the patient reports pain, numbness or tingling in the area concerned.[1]

Purpose[edit | edit source]

The purpose of this test is to assess lumbar or cervical spine facet joint pain. It 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.[2] It is a provocation test to detect pain. Local pain suggest a facet cause, whilst radiating pain into the leg/arm is more suggestive of nerve root irritation. Especially if the pain is below the knee/elbow.[3]

Technique[edit | edit source]

The Kemp Test 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 side bending and ipsilateral rotation (3D extension movement).
 4. Hold this position for three seconds.

[4]

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.[5][6][2] 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.[3]
The seated position is more preferable because the therapist has more control over the patient’s positioning and there is less muscle activation.[2][3]

[7]

The below video is of the Kemp test in the cervical spine (similar to Spurling's Test).

[8]

Evidence[edit | edit source]

Kemp’s test is the most used diagnostic procedure for lumbar pain but has a poor diagnostic accuracy with a sensitivity of 50-70%[6] and specificity of 67.3%[9].

Resources[edit | edit source]

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

References[edit | edit source]

  1. ↑ Radiopedia Kemp Test Available:https://radiopaedia.org/articles/kemp-test?lang=gb (accessed 26.9.2022)
  2. ↑ 2.0 2.1 2.2 Craig E. Morris; Low back syndromes; McGraw-hill professional; 2005 (Level of evidence: D)
  3. ↑ 3.0 3.1 3.2 Souza TA. Differential diagnosis and management for the chiropractor: protocols and algorithms. Jones & Bartlett Publishers; 2009 Oct 7.
  4. ↑ Rocky Bains. Kemp's Test. Available from: https://www.youtube.com/watch?v=tBVhHpxF3ZQ [last accessed 22/10/2020]
  5. ↑ Steve Jensen; back pain – clinical assessment; Australian Family Physician Vol. 33, No. 6, June 2004 (level of evidence:D)
  6. ↑ 6.0 6.1 Lyle MA, Manes S, McGuinness M, Ziaei S, Iversen MD. Relationship of physical examination findings and self-reported symptom severity and physical function in patients with degenerative lumbar conditions. Physical therapy. 2005 Feb 1;85(2):120-33.
  7. ↑ Palmer Health Sciences Library. Kemp's Test. Available from: https://www.youtube.com/watch?v=75bVhJ-sBcI [last accessed 22/10/2020]
  8. ↑ Massage nerd. Orthopedic Test - C / SPINE KEMP'S TEST. Available from: https://www.youtube.com/watch?v=jNdBq3eR-eY [last accessed 26.9.2022]
  9. ↑ Manchikanti L, Pampati V, Fellows B, Baha AG. The inability of the clinical picture to characterize pain from facet joints. Pain Physician. 2000 Apr;3(2):158-66.


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