Clinical tests for the musculo-skeletal system

Santoro's sign 1: Nodular structure ( counted as one or more for each side), spindle shaped and variable in dimensions ( from about 1 to 5 centimeter length; from 0,5 to 3 centimeters of width), which lays along the edge of the iliac crest (unilaterrally o bilaterrally), this condition dictates from the features of the ongoing alteration). When active ( rigid fibrotic tissue, voluminous and symptomatic), the patient complains symptoms caused by a low back pain, lumbar-sciatica (L4-L5, L5-S1), or lumbar-cruralgia (L2-L3, L3-L4) on going (acute or subacute phase). When asymptomatic (elastic fibrous tissue, less bulky and asymptomatic) indicates previous alterations already compensated, but not necessarily solved.

Santoro's sign 2: contracted pathological adesion of the fibrous-connective tissue, having the typical aspect of a sclerotic membrane covering the whole toraco-lumbar fascia into its portion lombo-sacral (extension related to the intensity and duration of the inflammatory process. In its presence (rigid and bulky fibrotic tissue), the patient complains symptoms caused by a low-back pain, lumbar-sciatica (L4-L5, L5-S1) or lumbar-cruralgia (L2-L3, L3-L4) by this time chronic.

Easily detectable with manual palpation, their origin is from a inflammatory lesion of fibrous structures of lumbar muscles, presumably determined from an functional alteration (irritation or inflammation) of nervous root, which is determined from a functional unbalance into the weight balance, where there is a persistent presence of a trauma or RSI (repetive strain injury): from the somatic dysfunction at misalligniment (chiropratic sublussation) with radicular compression (with or without disc estrusion), from an alteration of the fascial system (flogosis) with chronic contractures of dynaminc structure (antiversion or retroversion muscles), with a pathological distribution of weights on the low estremities, or misallignement of the sacrum and instability of the plantar support.

The objective examination emphasis:

• Ispection phase - sensible reduction of throphism (muscular mass), especially on the gluteal structure: common antalgic posture, with lumbar paravertebral muscle to a state of monolateral ipertonicity mainly in its acute stage of alteration: lumbar spine trending up to loose its physiologicl lordosis: sacrum with disallignement with difficulty on walking: lumbar pain (interested tract) accentuated by spine movements (chiefly opposite side-bending) and during defecation.
• Palpatory phasee - nodular structures present along the path of the iliac bone, which palpation provokes ipereastesia or pain, localized or irradiated at the lower limbs (path of the sciatic nerve): paravertebral muscles and gluteal contracted: deficiency of cutaneous sensitiveness or muscular function (obvious loss of strenght).

Translated by Daniele Truffa (Physiotherapist)