Baastrups Disease

Baastrup's disease is a radiographic finding more often than a clinical syndrome. Best seen on a lateral x-ray,

Table 37.2 Examination outline and rationale.

Criteria for assessment

General assessment Global level of comfort

General quality of movement Assess pain location

Standing

Standing posture

Gait

Gross motor examination Spine range of motion Palpation

Simulation tests (of Waddell) Sitting

Muscle stretch reflex examination

Upper motor neuron signs Manual muscle testing

Vascular examination Sensory examination

Distraction (W) Supine

Straight leg raising

Hip provocative maneuvers and range of motion Knee joint examination

Side lying

Repeat palpatory examination

Rectal examination and perineal sensory examination

Assess how disabling the pain is or signs of pain behaviors suggesting chronic pain syndrome grimacing vocalizations, rubbing, over-reacting (Waddell's signs (W))34 Look for guarding, posturing suggesting muscle spasm, or fear of movement Regionalization (W) of pain complaints or sensory changes

Look for guarding, off-weighting a limb or atrophy; scoliosis may suggest mass lesion, iliac crest height asymmetry suggests a functional or anatomic leg length discrepancy Antalgic, Trendelenberg; suggests hip disease or weak hip girdle weakness, steppage; compensating for foot drop, spastic; suggests central nervous system problem Walking on heels and on toes; an extension of the muscle testing examination looking for L5 orS1 weakness, respectively

Look for quality and quantity of movement; Schober test can measure amount of flexion. Extension, stork, and quadrant test load the posterior elements (i.e. facet joints or spondylolysis if present) Look for muscular tenderness, possible bursitis (ischial or greater trochanteric), spinous process tenderness may suggest level of facet or disk pain Simulated hip rotation, axial loading; nonanatomic tenderness (W); superficial skin rolling (W)

Look for symmetry; heel jerk tests S1, internal hamstring test L5 and knee jerk tests L4, relaxation is important

Babinski, clonus, hypertonicity, hyper-reflexia

Must have 30-40% of strength loss to be able to see it on this part of the examination; L2, hip flexion; L3, knee extension; L4, ankle dorsiflexion; L5, great toe extension, foot inversion, and hip abduction; S1, ankle plantar flexion or foot eversion and hip extension; S2, knee flexion

Screening for vascular disease, especially if claudication is suspected

Pin examination discriminates best between dermatomes: look for dermatomal sensory loss if radiculopathy is suspected

Seated straight leg raise, while performing Babinski testing

Look for reproduction of leg complaints if present below the knee up to 70° of hip flexion. Must have leg relaxed

Look to reproduce pain complaints in the area of the hip and compare to well side (Faber's, Stinchfield's tests)

Look to reproduce pain complaints with joint line palpation, meniscal testing, full flexion or extension

Look for reproducibility of tenderness found standing. Look for a potential muscular target for focal pain treatments If cauda equine syndrome is suspected generously sized adjacent spinous processes make contact creating degenerative changes and occasionally a pseudo bursa. Focal pain in the interspinous process region with tenderness would make this a potential clinical issue.49

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