Dr. Jeff Mollins, Brooklyn’s premier accident specialist, has been diagnosing, treating, and documenting injuries sustained by individuals involved in accidents (automobile, work, construction, and slip and falls) for close to thirty years. When Dr. Mollins evaluates an individual involved in an accident, he initially takes a concise history which typically includes the mechanism of the accident (how the accident occurred) and if there were any pre-existing conditions (i.e. a previous accident). The next step is to perform a comprehensive physical examination. Orthopedic testing is an essential part of the physical examination. Orthopedic tests are performed by placing the patient into specific positions to enable Dr. Mollins to determine a working diagnosis. Pain or inability to perform a specific movement is usually considered to be a positive sign (the orthopedic test is positive for that particular diagnosis).
In the lumbar spine, orthopedic testing is especially crucial in making a differential diagnosis. Quite often lower back pain (resulting from an accident) can be due to disc injury, pinching a nerve (known as radicular pain) or simply a sprain/strain. Both conditions may have similar symptomatology but must be differentially diagnosed because a sprain is a relatively mild condition yet disc involvement (pinching a nerve) can be much more dire. The following is a list of orthopedic tests for the lumbar spine which enable Dr. Mollins obtain an accurate diagnosis.
- Becterews Test – When performing this test the patient is sitting on the examining table with legs hanging over. Dr. Mollins will extend each leg. If the patient is unable to extend the legs all the way (to full extension) due to pain, then this test is positive. A positive test can indicate disc protrusion/herniation compressing nerves leaving the lumbar spine and thus a radiculopathy.
- Kemps Test – This test can be performed sitting or standing. In both cases Dr. Mollins will place his hand over the lower back on the right side. He will then grab the opposite shoulder and extend the patient over his right hand. He will then repeat the test on the other side. If the patient is unable to perform the extension due to pain, this is a positive. Once again, a positive Kemps Test may be indicative of disc injury in the lumbar spine resulting in radiculopathy.
- Straight Leg Raise Test – This time Dr. Mollins’ patient is lying on his back on the examination table. Legs are fully extended. Dr. Mollins will bring up each straight leg as far as possible. If the patient is unable to perform this due to pain, then this test is positive. A positive straight leg raise may very well be an indication of a disc injury resulting in radicular pain.
- Milgrams Test – The patient is lying on their back on the examining table. The patient is asked to raise both legs a few inches off the table and hold. If the patient is unable to hold this position due to back pain, then we have a positive test. Once again, the possibility of disc involvement with radiculopathy exists.
Other than orthopedic tests a comprehensive physical examination also consists of careful observation of the patient (both gait and their ability to get off and on the examination table), palpation, reflexes, range of motion testing, sensation testing, and measurement of muscles to determine atrophy. However, orthopedic testing still remains a vital part of the physical examination.
To accurately obtain a concise diagnosis once Dr. Mollins completes his physical examination he will typically refer his patients for radiographic testing (general radiology and/or MRI). Neurologic testing (such as EMG and Nerve Conduction Study) may be required as well.
Once a concise, accurate diagnosis is determined, Dr. Mollins can then place his patient on a comprehensive treatment regimen so that his patients may achieve wellness as expeditiously as possible.