These tests are indicated with lower back complaints and/or exaggerated lordosis and/or sacral kyphosis.
Is a prominent lumbar spinous process palpable?
Procedure
- The patient lies completely flat in a prone position on the examination table with arms along the torso. With a thumb, palpate the lower thoracic and lumbar spinous processes. Conclude whether a prominent spinous process is present in the lumbar region (irregular alignment palpable) [Figure 59] (see palpation with patient in prone position).
Figure 59
Interpretation
A prominent spinous process (often at the L5 level) may indicate slipping of the matching vertebra (spondylolisthesis). This leads to the spinous process, located cranially from the prominent spinous processes, to lie in a relatively ventral position.
Recent evidence based research shows that the sensitivity and/or specificity of many classic specific tests is limited. A dependable diagnosis can rarely be made or discarded exclusively based on a specific test. An in-depth medical history, combined with physical examination and laboratory/radiographic examination, is always necessary.
Specific tests will continue to be incorporated in the physical-diagnostic examination considering the following reasons:
- Practically: They are still being practiced in various medical centres.
- Didactically: They may help in giving more insight into the pathology being examined.
- Necessity: In areas where sophisticated diagnostic techniques are not available.