bowstring, bowstring test, crams, crams test, disk herniation, dural adhesion, follow up, lumbar spine, popliteal fossa, SLR, special test, tibial nerve

Purpose

Cram’s test is a usual follow up to a positive SLR.  It can help differentiate between dural adhesion and acute disk herniations.

Technique

Patient is in supine with the hip in neutral

Clinician flexes the hip until symptoms are reproduced, once symptoms are reproduced, the clinician then slowly lowers the leg, stopping once the symptoms have gone away.

Next, (patients hip is still flexed) the clinician flexes the knee  about 20°, while internally rotating the hip.

The clinician rubs the popliteal fossa  across the posterior tibial nerve attempting to reproduce symptoms

Positive

The test is considered positive if it produces pain or reproduction of other symptoms.

Indication

A positive Cram’s is a strong indicator for surgery.

References

1. Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York, NY: The McGraw-Hill Companies, Inc.

Related videos:

1. Straight Leg Raise (SLR) Test
2. Femoral Nerve Test (in prone)
3. Femoral Nerve Test (in side lying)
4. Lumbar Shear Test
5. Godfrey’s Sign / Posterior Sag