Kemp’s Test | Extension Quadrant | Lumbar Stenosis

Kemp’s Test is a common orthopedic test to assess neurogenic claudication due to lumbar spinal stenosis as well as facet joint irritation. In lumbar spinal stenosis, the intervertebral foramen narrows due to degenerative changes in lumbar spine anatomy. Symptoms are usually pooled under the term neurogenic claudication. It involves pain in the back, buttock, and thigh, reduced strength and feeling as well as heaviness and weakness of the leg. Symptoms are provoked in lumbar spine extension occurring during standing and walking for example.

Kemp’s test, which is also referred to as quadrant test or extension quadrant is designed to recreate this narrowing. Furthermore, it puts maximal stress on the facet joints. It has a  reported sensitivity of 70% as reported by Lyle et al. (2005).

To conduct the test, the patient is standing. Assist the patient in extending the spine maximally by holding their shoulders.

Then, the patient should rotate and lateral flex to the site of pain.

A positive test will show in the reproduction of the patient’s symptoms. If symptoms are more concordant with those of neurogenic claudication lumbar spinal stenosis is likely. If pain is predominant, degenerative joint disease of the facet joints can be at play.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other common tests for lumbar spinal stenosis are :

• Clinical prediction rule of Cook
• Modified Romberg Sign
• Two-Stage Treadmill test.

Lyle MA, Manes S, McGuinness M, Ziaei S, Iversen MD. Relationship of physical examination findings and self-reported symptom severity and physical function in patients with degenerative lumbar conditions. Physical therapy. 2005 Feb 1;85(2):120-33.