Springing Test

Springing Test is used for localization of functional impairments in the lumbar spine, it’s also used to examine posterior longitudinal ligament.

How do yo do Springing Test?

• The patient is in prone position.
• The examiner palpates the articular processes or laminae of the vertebrae in question with his or her index and middle fingers.
• With the ulnar edge of the other hand, which is held perpendicularly over the palpating fingers, the examiner repeatedly presses lightly in a posteroanterior direction.
• The palpating fingers conduct this light springing pressure to the articular processes or laminae of the vertebrae in question.

See Also: Lasegue Test

What does a positive Springing Test mean?

• Where joint function is intact, the articular processes or laminae will be resilient.
• Lack of resiliency or excessive resiliency is a sign of abnormal segmental mobility, in the former case a blockade and in the latter case hypermobility.

Notes

Springing test is also a provocation test for the posterior longitudinal ligament in particular and will result in an increase in the deep, dull low back pain that is typical of this structure and is difficult to localize.

Springing test can also be used to differentiate between a cervical rib tip and a supraclavicular lymph node, the examiner applies intermittent pressure on a point corresponding to the surface marking of a cervical rib shaft and checks for transmission of the springing movement to the swelling. The tip of a cervical rib will move but a supraclavicular lymph node will not.

See Also: Thoracic Outlet Syndrome

Posterior Longitudinal Ligament

Lying on the anterior aspect of the vertebral canal, the Posterior Longitudinal Ligament extends from the sacrum to the body of the axis (C2), where it is continuous with the tectorial membrane.

The Posterior Longitudinal Ligament travels over the posterior aspect of the centrum, attaching to the superior and inferior margins of the body, but is separated from the waist of the body by a fat pad and the basivertebral veins.

In addition, this ligament attaches firmly to the posterior aspect of the Inter vertebral disks, laminae of hyaline cartilage, and adjacent margins of vertebral bodies.

The Posterior Longitudinal Ligament is broader and considerably thicker in the cervical region than in the thoracic and lumbar regions.

The Posterior Longitudinal Ligament functions to prevent disk protrusions and also acts as a restraint to segmental flexion of the vertebral column. The dura mater is strongly adherent to the Posterior Longitudinal Ligament at the level of C3 and higher, but this attachment diminishes at lower levels.

Sacroiliac Joint Spring Test

There is also a Spring Test that can be used to assess facet hyper mobility in the sacroiliac joint.

The examiner places the index finger of one hand first on the superior margin of the sacroiliac joint and then on its inferior margin (S1 – S3) in such a manner that the fingertip lies on the sacrum and the volar aspect of the distal phalanx lies on the medial margin of the ilium. The examiner’s other hand grasps the index finger and exerts posteroanterior pressure, which the palpating finger transmits to the sacrum .

A normal sacroiliac joint will be resilient: palpating pressure will slightly increase the distance between the posterior margin of the ilium and the sacrum. This resiliency is not present in a motion restricted sacroiliac joint. A relatively long range of motion with a hard end point suggests hyper-mobility in the sacroiliac joint. Pain during the examination can occur in both a motion-restricted and a strained hyper mobile joint (painful hyper mobility).

The sensitivity and specificity of spring test are 66% and 42% respectively.

Reference

• Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142-52. doi: 10.1179/jmt.2008.16.3.142. PMID: 19119403; PMCID: PMC2582421.
• Venkatesh Rao PS. Springing test for differentiating a cervical rib tip from a supraclavicular lymph node. Jpn J Surg. 1988 Sep;18(5):606-7. doi: 10.1007/BF02471498. PMID: 3230732.
• Dreyfuss P, Michaelsen M, Pauza K, et al. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine. 1996;21: 2594-2602.
• Clinical Tests for the Musculoskeletal 3rd Ed. Book.
• Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.