Schober Test

Purpose

The Schober test checks the lumbar flexion range of motion.

Suppose the spine is straight. If it bends forward, like in lumbar flexion, the posterior surface of the back should stretch out to accommodate the movement.

For example, if you have a circle drawn with a thick line, the circumference of the outer side of the line is greater than the circumference of the inner side of the line.

If the posterior back doesn’t stretch out all that much, it means the range of lumbar flexion is limited.

Steps

  • Patient has back facing you
  • Find the level of the posterior superior iliac spine
    • PSIS is roughly at L5-S1 level
  • Make a mark 10cm above that and another mark 5cm below it
    • Memory aid: the higher number is higher up
    • The distance between the points is 15cm
  • Tell patient to touch toes
    • Patient bends over, which is lumbar flexion
  • If the distance between the points is <20cm, there is limited lumbar flexion
    • Alternatively, means the increase in distance from the lumbar flexion movement is <5cm

References

  1. Physiopedia. (n.d.). Schober test. [online] Available at: https://www.physio-pedia.com/Schober_test [Accessed 2 Feb. 2018].
  2. General Practice Notebook. (n.d.). Schober’s test. [online] Available at: https://www.gpnotebook.co.uk/simplepage.cfm?ID=1422917656 [Accessed 2 Feb. 2018].
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Thomas Test

Purpose

The Thomas test looks for hip pathology, namely of issues with hip flexor tightness. This is called a fixed flexion deformity.

For example, there could be a problem with the iliopsoas muscle.

Steps

  • Patient is supine on bed
  • Tell patient to bring knees to chest
    • Patient flexes both knees and hips
    • But not excessively so, otherwise it could give a false positive result
  • Lower one leg straight onto the bed
    • If the thigh is on the bed, it is a normal result
    • If the thigh is off the bed, the patient has a fixed flexion deformity of that side

References

  1. Patel, M. (2011). Thomas test. [online] OrthopaedicsOne. Available at: https://www.orthopaedicsone.com/display/Main/Thomas+test [Accessed 31 Jan. 2018].
  2. Physical Therapy Haven. (2018). Thomas Test. [online] Available at: http://www.pthaven.com/page/show/157779-thomas-test [Accessed 31 Jan. 2018].
  3. General Practice Notebook. (n.d.). Thomas’ test. [online] Available at: https://www.gpnotebook.co.uk/simplepage.cfm?ID=120913935 [Accessed 31 Jan. 2018].

Regulators Of Bone Formation

Stimulates bone formation

Wnt: Wow! Let’s have bone formation!

Wnt proteins bind to LRP5 receptors on osteoblasts, triggering bone formation.

Inhibits bone formation

Sclerostin: Stop! No bone formation here!

Sclerostin is a factor produced by osteocytes. It inhibits the above Wnt process.

References

  1. Walker, B. R., Colledge, N. R., Ralston, S., & Penman, I. D. (2014;2013;). Davidson’s principles and practice of medicine (22nd ed.). Edinburgh: Churchill Livingstone/Elsevier.