Episode Summary
Learn how to assess suspected lumbar spinal stenosis with a focused neurological screen, movement testing, and key provocation maneuvers. You’ll also see how to spot red flags, distinguish spinal from vascular claudication, and decide when urgent referral is needed.
A thorough assessment for suspected lumbar spinal stenosis should go beyond pain location and imaging findings. The examination begins with a full neurological screen, including myotomes, dermatomes, reflexes, gait, and movement testing, to identify radicular claudication, weakness, sensory change, or signs such as foot drop and compensatory gait patterns. Learners are shown how to assess posture, preference for flexion, and symptom response during walking, forward bending, standing extension, the 30-second extension test, and the Kemp test.
The transcript also explains exertional testing with cycling and treadmill walking to help distinguish lumbar claudication from vascular claudication, especially when symptoms are not relieved by flexion. It emphasizes comparing findings left to right, testing ankle function in sitting, lying, and standing, and using light touch sensory screening across the whole leg and foot.
Additional sections cover nerve mechanosensitivity tests such as straight leg raise and slump, urgent referral indicators for radiculopathy, screening for possible myelopathy using upper limb reflexes and pathological signs, and key vascular assessment features including pulses, ankle-brachial index, and Buergers test.
