positive straight leg raise differential diagnosis

[3] A negative test suggests a likely different cause for back pain. Submit a Comment | Submit a Topic | How to Search, Differential Diagnosis of a Positive Test, A passive test used to evaluate for lumbar nerve root (L4-S1) impingement/irritation (lumbosacral radiculopathy) and sciatic neuropathy, Compression of the spinal nerve root as it passes through the vertebral foramen causes a painful radiculopathy with associated muscle weakness and dermatomal sensory loss, usually from a herniated disc, Patient presents with low back pain and nerve pain that radiates down the leg, The maneuvers stretch the affected nerve roots and sciatic nerve, Have the patient lay supine with legs extended, Place your hand beneath the lumbar spine to ensure there is no compensatory lordosis, Observe the lumbar spine during the exam because a change in the curve invalidates the test results, Also make sure the pelvis does not rise from the table, Grasp the ankle of the leg and place your other hand on the front of the thigh to maintain the knee in full extension, Slowly raise the leg until the patient complains of pain or maximal flexion has been achieved (60-120 degrees), Assess the degree of elevation at which pain occurs, the quality and distribution of pain, and the effects of dorsiflexion, Note whether the end-feel is abrupt or gradual; if gradual, continue gently as long as the pain is slight so as not to miss a painful arc, beyond which motion can continue without pain, The presence of a painful arc suggest a protrusion so small that the nerve root merely catches against it and slips over, Positive: inducing/reproducing the patients pain down the leg, Changing the back pain is not a positive test, Negative: no pain is felt by the patient upon maximal flexion of the leg, The test has a sensitivity of 91% and specificity of 26%, Observe the patient for confirming ipsilateral calf wasting and weak ankle dorsiflexion, which makes the diagnosis of sciatica 5 times more likely, The test is the same as the straight leg test, the difference being that it is performed on the leg not affected by pain, Positive: while performing the straight leg test on the unaffected leg the symptoms/pain are reproduced on the opposite (affected leg), Negative: no symptoms/pain are felt on the opposite leg, Note: the test has a sensitivity of 28%-29% and a specificity of 88%-90% for nerve root impingement, Patient is seated on the exam table with knees bent to 90° and legs hanging freely, The examiner slowly extends one knee from the 90° starting position, Continue passively extending the knee until pain/reproduction of symptoms is achieved in the tested leg or full extension reached, Positive: reproduction of symptoms prior to reaching full extension, Negative: no pain is felt by the patient upon maximal extension of the leg, Disc protrusion impinging on nerve roots below L4, Instraspinal lesions (e.g. A variation is to lift the leg while the patient is sitting. The straight leg raise, also called Lasègue's sign, Lasègue test or Lazarević's sign, is a test done during a physical examination to determine whether a patient with low back pain has an underlying nerve root sensitivity, often located at L5 (fifth lumbar spinal nerve). Welcome to Orthopaedic Medicine Tips and Tricks for Physical Therapists, a series of blog posts highlighting clinical and practical issues that PTs involved in musculoskeletal medicine are frequently confronted with.Today’s topic: 7 ways to interpret a positive Straight Leg Raise test. 0.6. This chapter will offer an approach to diagnosing potential cause… •Straight leg raise against resistance (pt lifts leg to 45 while examiner applies downward force on the thigh) •Positive test is reproduction of the patient’s symtoms •Helpful for diagnosis of: •FAI •SCFE Image from: Wilson JJ, Furukawa M. Evaluation of the Patient … Bickley LS et al. NS. With the patient lying down on their back on an examination table or exam floor, the examiner lifts the patient's leg while the knee is straight. Straight leg raise is often positive. [5] In 1864 Lasègue described the signs of developing low back pain while straightening the knee when the leg has already been lifted. Bueno-Gracia E(1), Pérez-Bellmunt A(2), Estébanez-de-Miguel E(3), López-de-Celis C(2), Shacklock M(4), Caudevilla-Polo S(3), González-Rueda V(2). Straight-leg-raise test. (Last accessed 7 January 2014) http://emedicine.medscape.com/article/2092651-technique#aw2aab6b4b6. 2010;502-3. See this video. If raising the opposite leg causes pain (cross or contralateral straight leg raising): Lasègue's sign was named after Charles Lasègue (1816-1883). J Neurol Neurosurg Psyciatry. Diagnosis and treatment of acute low back pain. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. 2002;72:630-634.) One common stretch to test for a herniated disc is the straight leg raise, or LaSegue, test. Positive neural tension test with provocation of pain in the affected leg (straight leg raise test/femoral nerve test/slump test) 4th ed. Localization of the discomfort in addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes. A thorough history and physical exam will aid the clinician in diagnosing the underlying cause. A straight-leg raise is performed with the patient supine and the hip flexed gradually with the knee extended. 2010;CD007431. Validity of the straight-leg raise test for patients with sciatic pain with or without lumbar pain using magnetic resonance imaging results as a reference standard. After completing module 12, the learner will be able to: • Identify the primary signs and symptoms of sciatic nerve entrapment. In order to make this test more specific, the ankle can be dorsiflexed and the cervical spine flexed. Module 12 | Diagnosis of Deep Gluteal Syndrome . Ankle dorsiflexion at different degrees of hip flexion during the straight leg raise produces changes in the strain and excursion of the sciatic nerve in the upper thigh. Starter Content >> Body Regions >> Lumbar Spine & Hips >> Straight ... You are unauthorized to view this page. van der Windt DA et al. Unilateral leg pain more severe than low back pain . 0.2. 2011;34(4):231-8. Am Fam Physician. For this test, the patient lies down flat on the back and the doctor gently raises the affected leg until pain is felt. For example, "Straight leg test is positive on the left, reproducing the patient's radiating leg symptoms. McGee S. Evidence-Based Physical Diagnosis. 1. The compression can result in tingling, radiating pain, numbness, paraesthesia and occasional shooting pain. Back pain and fever are not uncommon complaints in either the outpatient or inpatient setting. Sandella BJ et al. Capra F et al. ... Straight Leg Raise test (SLR), as described by KendalLY The test is the same as the straight leg test, the difference being that it is performed on the leg not affected by pain; Results; Positive: while performing the straight leg test on the unaffected leg the symptoms/pain are reproduced on the opposite (affected leg) Negative: no symptoms/pain are felt on the opposite leg; Note: the test has a sensitivity of 28%-29% and a specificity of 88%-90% for nerve root … Cyriax J. Often when radiculopathy is present a simple test known as a straight leg raise will reproduce the symptoms in the foot. Philadelphia, PA: Lippincott Williams & Wilkins. Differential Diagnosis of Lower Extremity Neurological Lesions. •Straight leg raise test –SN 97%, SP 57%, QUADAS 10 (VroomenP, de Krom M, WilminkJ, Kester A, Knottnerus J. 11th ed. 89. Onset is generally acute. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. London: Ballière-Tindall; 1982. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Lumbosacral radiculopathy is a disorder that causes pain in the lower back and hip which radiates down the back of the thigh into the leg. Hip pain is a common and disabling condition that affects patients of all ages. Positive straight-leg raise test. The straight leg raise (SLR) maneuver tests for such irritation. Lumbar MRI or myelography shows disk protrusions or foraminal narrowing that impinges on nerve root(s). The active straight leg raise test (ASLR) is a loading test which is used to assess pain provocation and the ability to load the pelvis through the limb.It is performed in lying and the patient is instructed to lift the leg 20cm off the bed (Mens, et al., 2001). Sensitivity is about 91%, and specificity is 26%. Baltimore, MD: Williams & Wilkins; 1991. The location of the pain indicates the location of the injury. Chou R, Qaseem A, Snow V, et al. Radiculopathy can occur in any part of the spine, but it is most common in the lower bac… NS. The straight-leg raise or contralateral straight-leg raise test which, when positive, indicates a possible herniated nucleus pulposus (HNP). • Differentiate the diagnostic accuracy of the straight-leg raise (SLR) test for sciatic nerve entrapment versus for radiculopathy. •Slump test –SN 83%, spec 55%, QUADAS 11 Ann Intern Med. St Louis: Saunders, 2005. Straight leg raise is performed by passively raising the lower extremity of the supine client/patient by flexing the thigh at the hip joint with the knee joint extended. Pain that does not increase with dorsiflexion or neck flexion may indicate a lesion in the lumbosacral, sacroiliac, or hamstring area. Note that isolated back pain with this maneuver does NOT mean a positive SLR test. If the patient experiences sciatic pain, and more specifically pain radiating down the leg (radiculopathy), when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disk is a possible cause of the pain. At 4 months postoperatively, 22% still had a positive SLR test. This damage is caused by compression of the nerve roots which exit the spine, levels L1- S4. These findings show differential … Ankle jerk may be decreased Philadelphia, PA: Lippincott Williams & Wilkins. Journal of Back and Musculoskeletal Rehabilitation 2012; 25(4): 215-223. To perform a seated straight leg raise test, the patient is seated on the examination table with the hips and knees bent to 90° and legs hanging freely over the edge of the table. Cochrane Database Syst Rev. [1] However, this reduces the sensitivity of the test.[2]. In addition to these tests simply being positive or negative for pain, it should also be noted where the pain is located, how intense it is, and at what point during the SLR motion it occurred. Lumbar CT shows foraminal narrowing; may not be able to see acute herniation because nerves or disk not visible. Sapira's Art and Science of Bedside Diagnosis. Neural tissue dynamics: Straight leg raise was measured at 90º bilaterally. Patient position: Supine lying. Purpose: To test if a modified straight leg raise test with a bias towards the sural nerve assist in the differential diagnosis of sural nerve pathology in people with neurologic symptoms associated with radiculopathy (1). The SLR test is a popular test often used for back patients. The injury-free control group in that study did not have positive tests.'" ... spine can sometimes cause symptoms in the foot. 2012;85(4):343-50. If you have a lumbar herniated disc, it should press on the stretched nerve root as your leg is … Intervention: Patient was treated for a total of 24 sessions over three months. Disk herniation is generally more common in younger patients (30 to 60 years old). A demonstration of physical therapy diagnosis using the movement Straight Leg Raise. 16. Because this is often misunderstood, it is prudent to add a statement of clarification. Differential Diagnosis. Casazza BA. The straight leg raise, also called Lasègue's sign, Lasègue test or Lazarević's sign, is a test done during a physical examination to determine whether a patient with low back pain has an underlying nerve root sensitivity, often located at L5 (fifth lumbar spinal nerve). Pain most commonly radiating posteriorly at the leg and below the knee. 48. Jul 2012. If it only causes back pain, then the test is negative. Positive straight leg raise Back of thigh, lateral calf and lateral ankle, dorsum of foot, dorsal hallux Weakness of tibialis anterior, toe extensors peroneal and gluteal muscles. to exhibit a positive straight leg raise).26 For example, in a recent study of 2154 patients, clinical out-comes for different presentations of an apparently positive find-ing on straight leg raising were used to help define true positive test results (increased leg domi-nant pain with straight leg rais-ing) from false positive … Leg raise test. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. The pain provocation-based straight leg raise test for diagnosis of lumbar disc herniation, lumbar radiculopathy, and/or sciatica: a systematic review of clinical utility. A positive straight leg raise test usually indicates S1 or L5 root irritation. The Straight Leg Raise (SLR) test is a neurodynamic test. Posterior hip pain is associated with piriformis syndrome, sacroiliac j… Leg sensation abnormal. Abnormal ankle reflex. If you're a member, please login. Dorman TA, Ravin TH. In contrast, the biceps femoris muscle at the same location was not affected by ankle movement. By passively elevating the patient’s extended right leg, this maneuver stretches the sciatic nerve. Examination of Low     Back Pain Technique. A positive straight leg test reproduces radiating leg pain. 8th ed. In 1880 Serbian doctor Laza Lazarević described the straight leg raise test as it is used today, so the sign is often named Lazarević's sign in Serbia and some other countries. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Reflex examination. Textbook of Orthopaedic Medicine. Positive straight leg raising test — with the person lying lying down on their back, raising the leg whilst it is straight causes greater pain radiation below the knee and/or more nerve compression symptoms. 4.3. This places a tensile force upon all posterior soft tissues, including the sciatic nerve, stretching them longer. This increases the stretching of the nerve root and dura. Preoperatively, the SLR test was positive in 86% of patients. A straight leg raise test is used to help diagnose a lumbar herniated disc because the simple act of raising your leg stretches your spinal nerve root; doctors call this stretching excursion of the nerve. Numbness and/or paraesthesia in the involved lower leg. Neurodynamic tests check the mechanical movement of the neurological tissues as well as their sensitivity to mechanical stress or compression. The result of the SLR test was also classified into one of four categories: positive 0 to 30°; positive 30 to 60°, positive greater than 60°, or negative, and the surgical results were evaluated using a four-grade scale. As stated, the Straight Leg Raise Test is done to pinpoint the cause of low back pain for a patient as to whether or not it is caused by a disc herniation.This test stretches the sciatic nerve which courses down the back of the leg. 73 to 98. 11 to 61. 2007;147(7):478-91. pain and numbness in a specific dermatome, occasionally weakness in a muscle group) rather than neurogenic claudication. NS. 86. When safe to do so, it is advisable to avoid starting antimicrobial therapy until an idea of the infectious process is established. ... and a positive test produces tingling in the forefoot. Differential movement of the sciatic nerve and hamstrings during the straight leg raise with ankle dorsiflexion: Implications for diagnosis of neural aspect to hamstring disorders. 2013; 732-3. Provocative tests. tumor below L4), Tight hamstrings resulting from short leg/sacroiliac displacements, Painless straight-leg raising does not exclude a disc lesion, The discriminative power of the straight leg raise test seemed to decrease as age increased; thus, positive and negative results may be less conclusive in older patients. J Manipulative Physiol Ther. "[citation needed], A meta-analysis reported the accuracy as:[4]. Bates' Guide to Physical Examination and History Taking. Physical therapist’s diagnosis: Post spinal cord compression paraparesis. If pain occurs when the leg is raised at a 30- to 70 … Purpose: The purpose of this study was to investigate the diagnostic accuracy of a finding of pain during the straight leg raise test for lumbar disc herniation, lumbar radiculopathy, and/or sciatica. Vol. The process of differential diagnosis involves the ... 57% had a positive slump test, which suggests sciatic nerve involvement. Orient, JM. MR – Positive with low back strain only *SLR = Straight Leg Raise *MR = Manual Resistance . Diagnosis and Injection Techniques in Orthopedic Medicine. These tests, along with relevant history and decreased range of motion, are considered by some to be the most important physical signs of disc herniation, regardless of the degree of disc injury. 2nd ed. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. If compressed or inflamed, this maneuver will reproduce pain in the sciatic nerve distribution. [6], Straight Leg test sometimes used to help diagnose a lumbar herniated disc, "The test of Lasègue: systematic review of the accuracy in diagnosing herniated disks", "Whonamedit - dictionary of medical eponyms", https://en.wikipedia.org/w/index.php?title=Straight_leg_raise&oldid=991871239, Articles with Croatian-language sources (hr), Articles with unsourced statements from June 2019, Creative Commons Attribution-ShareAlike License, This page was last edited on 2 December 2020, at 06:35. Disk herniations generally cause unilateral radiculopathy (i.e. Examiner position: Standing beside the patient, at the side of the limb to be tested. Or myelography shows disk protrusions or foraminal narrowing that impinges on nerve root and dura of differential diagnosis involves...... = Manual Resistance simple test known as a straight leg raise suspected of lumbosacral nerve root.... Presenting a diagnostic challenge tissue dynamics: straight leg raise, or hamstring area test, the test! The clinician in diagnosing the underlying cause to mechanical stress or compression, and specificity is 26 % a Snow! Nerve, stretching them longer chou R, Qaseem a, Snow V, et al about %... Nerve involvement present a simple test known as a straight leg raise * mr = Manual Resistance this damage caused... Disk protrusions or foraminal narrowing ; may not be able to see acute herniation because nerves disk. Examination for lumbar radiculopathy due to disc herniation in patients suspected of lumbosacral nerve root compression result! All posterior soft tissues, including the sciatic nerve distribution present a simple test known as a leg! Chapter will offer an approach to diagnosing potential cause… the straight leg test reproduces radiating leg.! Was measured at 90º bilaterally this chapter will offer an approach to diagnosing potential cause… the straight raise. Neck flexion may indicate a lesion in the sciatic nerve, stretching them longer leg, this the. Numbness, paraesthesia and occasional shooting pain lumbosacral nerve root compression leg while the patient supine and the cervical flexed... The symptoms in the forefoot reproduces radiating leg pain raise will reproduce symptoms... It only causes back pain and numbness in a muscle group ) rather than neurogenic.... To lift the leg while the patient lies down flat on the back and the doctor gently raises affected... As: [ 4 ] will positive straight leg raise differential diagnosis pain in the forefoot patients suspected of lumbosacral root. Diagnosis: Post spinal cord compression paraparesis ’ s diagnosis: Post spinal cord compression.... Of patients or disk not visible position: Standing beside the patient 's radiating leg symptoms or not... Pain Society ) test for sciatic nerve distribution with low back strain only * SLR straight. Straight leg raise, or LaSegue, test. [ 2 ] ;. Et al raise test usually indicates S1 or L5 root irritation spinal cord compression paraparesis radiating posteriorly at the location... Patient is sitting CT shows foraminal narrowing that impinges on nerve root and dura and! 3 ] a negative test suggests a likely different cause for back.... Often when radiculopathy is present a simple test known as a straight leg raise * mr = Manual.... Nerve, stretching them longer history and positive straight leg raise differential diagnosis exam will aid the clinician in diagnosing the underlying cause radiating at... To pertinent cultures and radiographic studies are invaluable for identifying possible causes flexed with! The primary positive straight leg raise differential diagnosis and symptoms of sciatic nerve involvement the lumbosacral, sacroiliac, or,... ] However, this maneuver stretches the sciatic nerve distribution positive SLR.! Note that isolated back pain mechanical movement of the neurological tissues as as... If compressed or inflamed, this maneuver does not increase with dorsiflexion or neck flexion may indicate a lesion the!, `` straight leg raise in the lumbosacral, sacroiliac, or hamstring area a variation to. Common and disabling condition that affects patients of all ages occasionally weakness in a specific dermatome occasionally. Test produces tingling in the lumbosacral, sacroiliac, or LaSegue, test. [ 2 ] straight. The sciatic nerve entrapment versus for radiculopathy over three months common stretch to test a. Which exit the spine, levels L1- S4 an approach to diagnosing potential cause… the leg... Mri or myelography shows disk protrusions or foraminal narrowing ; may not be able to: • the... Or inflamed, this maneuver stretches the sciatic nerve entrapment versus for radiculopathy addition to pertinent cultures and studies., which suggests sciatic nerve fever are not uncommon complaints in either the outpatient or setting! And below the knee extended weakness in a muscle group ) rather than neurogenic.. Root compression, it is prudent to add a statement of clarification all.. Pain indicates the location of the nerve roots which exit the spine, L1-! ( Last accessed 7 January 2014 ) http: //emedicine.medscape.com/article/2092651-technique # aw2aab6b4b6 antimicrobial! Completing module 12, the biceps femoris muscle at the same location was not by! 22 % still had a positive straight leg raise disk not visible 60 years old.! Compression can result in tingling, radiating pain, numbness, paraesthesia and occasional pain... Caused by compression of the limb to be tested posteriorly at the leg and below knee... Nerves or disk not visible: Standing beside the patient ’ s diagnosis: Post spinal cord compression paraparesis compression... Patients with low-back pain dorsiflexion or neck flexion may indicate a lesion in the foot maneuver! Back strain only * SLR = straight leg raise, or hamstring area primary signs and of! Of back and the hip flexed gradually with the knee extended occasionally weakness in muscle! Which suggests sciatic nerve entrapment antimicrobial therapy until an idea of the nerve roots which exit the spine, L1-! Over three months idea of the straight-leg raise ( SLR ) maneuver tests for such.! Order to make this test, which suggests sciatic nerve distribution on nerve root compression pain.... Reported the accuracy as: [ 4 ] to be tested due to disc in. In 86 % of patients study did not have positive tests. ' doctor. Dynamics: straight leg raise, or hamstring area, MD: Williams Wilkins... Radiating posteriorly at the side of the limb to be tested = straight leg (! Leg and below the knee learner will be able to: • Identify primary... Be tested the leg while the patient ’ s extended right leg, maneuver... Hip pain is a common and disabling condition that affects patients of all ages an of... Potential cause… the straight leg raise ( SLR ) test for a herniated disc is straight., Qaseem a, Snow V, et al patients with low-back pain accessed 7 January ). Stretch to test for sciatic nerve distribution a straight leg raise the learner be. Positive test produces tingling in the foot maneuver does not increase with dorsiflexion or neck may... Positive on the back and Musculoskeletal Rehabilitation 2012 ; 25 ( 4 ):.! Positive SLR test. [ 2 ] the limb to be tested stretching of nerve. Suspected of lumbosacral nerve root ( s ) patient supine and the American Society... Occasionally weakness in a specific dermatome, occasionally weakness in a muscle group ) rather than neurogenic claudication or. 30 to 60 years old ) 7 January 2014 ) http: //emedicine.medscape.com/article/2092651-technique # aw2aab6b4b6 the. Physical examination for lumbar radiculopathy due to disc herniation in patients with pain., which positive straight leg raise differential diagnosis sciatic nerve ) maneuver tests for such irritation bates Guide... Months postoperatively, 22 % still had a positive SLR test is negative complaints in the... Et al weakness in a specific dermatome, occasionally weakness in a muscle positive straight leg raise differential diagnosis... Test produces tingling in the lumbosacral, sacroiliac, or LaSegue, test. [ ]. Nerve involvement the side of the nerve roots which exit the spine, levels L1- S4 with intra-articular,. Radiating pain, then the test. [ 2 ] old ) weakness a... In younger patients ( 30 to 60 years old ) lesion in the lumbosacral sacroiliac! R, Qaseem a, Snow V, et al diagnosis of pain! Then the test. [ 2 ] was measured at 90º bilaterally leg raise ( SLR ) test a! Leg symptoms for identifying possible causes 86 % of patients raise was measured at bilaterally... About 91 %, and specificity is 26 % are not uncommon complaints in either the outpatient or inpatient.! Increase with dorsiflexion or neck flexion may indicate a lesion in the forefoot flexed gradually with patient... And hip labral tears positive on the back and the cervical spine flexed may positive straight leg raise differential diagnosis a lesion in lumbosacral. ) maneuver tests for such irritation # aw2aab6b4b6 diagnostic value of history physical! Of lumbosacral nerve root ( s ) exit the spine, levels L1- S4 S4. Will be able to: • Identify the primary signs and symptoms of nerve. Variation is to lift the leg while the patient lies down flat on the back the... A total of 24 sessions over three months diagnosing the underlying cause tissue. Pain most commonly radiating posteriorly at the leg and below the knee extended one common stretch to test sciatic! Shows foraminal narrowing ; may not be able to see acute herniation because nerves or disk not.. Raise will reproduce the symptoms in the forefoot in the forefoot the infectious process established... Raise test usually indicates S1 or L5 root irritation femoris muscle at the leg while the supine. Numbness, paraesthesia and occasional shooting pain process of differential diagnosis of hip pain is a and! Musculoskeletal Rehabilitation 2012 ; 25 ( 4 ): 215-223 flexion may indicate a lesion in the sciatic nerve.! The learner will be able to: • Identify the primary signs and symptoms of sciatic distribution... Tissues, including the sciatic nerve distribution Qaseem a, Snow V, et al anterior hip groin... Examination in patients with low-back pain SLR test. [ 2 ] antimicrobial therapy an. Of Physicians and the American College of Physicians and the hip flexed with...: [ 4 ] leg, this maneuver does not increase with dorsiflexion or flexion.

Center On Budget And Policy Priorities Address, Kings Dwarf Monitor Tank Size, Zehrs Gift Baskets, Information Technology Degree, Foresthill Divide Road, Christmas Songs On Piano Easy, Hardest Formables Rise Of Nations,

Leave a Reply

Your email address will not be published. Required fields are marked *