positive straight leg raise differential diagnosis

positive straight leg raise differential diagnosis

11 to 61. A variation is to lift the leg while the patient is sitting. 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. [5] In 1864 Lasègue described the signs of developing low back pain while straightening the knee when the leg has already been lifted. If pain occurs when the leg is raised at a 30- to 70 … Unilateral leg pain more severe than low back pain . Leg sensation abnormal. Lumbar CT shows foraminal narrowing; may not be able to see acute herniation because nerves or disk not visible. The process of differential diagnosis involves the ... 57% had a positive slump test, which suggests sciatic nerve involvement. Onset is generally acute. 2011;34(4):231-8. Capra F et al. Am Fam Physician. London: Ballière-Tindall; 1982. Localization of the discomfort in addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes. These findings show differential … Ann Intern Med. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Because this is often misunderstood, it is prudent to add a statement of clarification. 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 … 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. ... Straight Leg Raise test (SLR), as described by KendalLY 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 … Diagnosis and treatment of acute low back pain. 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. [3] A negative test suggests a likely different cause for back pain. Neural tissue dynamics: Straight leg raise was measured at 90º bilaterally. Vol. ... spine can sometimes cause symptoms in the foot. Sandella BJ et al. A straight-leg raise is performed with the patient supine and the hip flexed gradually with the knee extended. If you're a member, please login. Textbook of Orthopaedic Medicine. Abnormal ankle reflex. 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. (Last accessed 7 January 2014) http://emedicine.medscape.com/article/2092651-technique#aw2aab6b4b6. Orient, JM. The straight leg raise (SLR) maneuver tests for such irritation. Philadelphia, PA: Lippincott Williams & Wilkins. Leg raise test. This increases the stretching of the nerve root and dura. One common stretch to test for a herniated disc is the straight leg raise, or LaSegue, test. 4.3. Jul 2012. St Louis: Saunders, 2005. 2010;CD007431. For example, "Straight leg test is positive on the left, reproducing the patient's radiating leg symptoms. 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). Neurodynamic tests check the mechanical movement of the neurological tissues as well as their sensitivity to mechanical stress or compression. This damage is caused by compression of the nerve roots which exit the spine, levels L1- S4. The compression can result in tingling, radiating pain, numbness, paraesthesia and occasional shooting pain. Bates' Guide to Physical Examination and History Taking. Ankle jerk may be decreased Intervention: Patient was treated for a total of 24 sessions over three months. Philadelphia, PA: Lippincott Williams & Wilkins. Pain that does not increase with dorsiflexion or neck flexion may indicate a lesion in the lumbosacral, sacroiliac, or hamstring area. By passively elevating the patient’s extended right leg, this maneuver stretches the sciatic nerve. "[citation needed], A meta-analysis reported the accuracy as:[4]. Cyriax J. Disk herniation is generally more common in younger patients (30 to 60 years old). 2012;85(4):343-50. At 4 months postoperatively, 22% still had a positive SLR test. 11th ed. 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. 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). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. 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. 2nd ed. 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. •Slump test –SN 83%, spec 55%, QUADAS 11 If you have a lumbar herniated disc, it should press on the stretched nerve root as your leg is … pain and numbness in a specific dermatome, occasionally weakness in a muscle group) rather than neurogenic claudication. For this test, the patient lies down flat on the back and the doctor gently raises the affected leg until pain is felt. 4th ed. 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. When safe to do so, it is advisable to avoid starting antimicrobial therapy until an idea of the infectious process is established. 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. Preoperatively, the SLR test was positive in 86% of patients. Posterior hip pain is associated with piriformis syndrome, sacroiliac j… Disk herniations generally cause unilateral radiculopathy (i.e. Often when radiculopathy is present a simple test known as a straight leg raise will reproduce the symptoms in the foot. 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. Bickley LS et al. Straight leg raise is often positive. Baltimore, MD: Williams & Wilkins; 1991. 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. •Straight leg raise test –SN 97%, SP 57%, QUADAS 10 (VroomenP, de Krom M, WilminkJ, Kester A, Knottnerus J. 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 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 … 89. A thorough history and physical exam will aid the clinician in diagnosing the underlying cause. The location of the pain indicates the location of the injury. 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. 2002;72:630-634.) After completing module 12, the learner will be able to: • Identify the primary signs and symptoms of sciatic nerve entrapment. • Differentiate the diagnostic accuracy of the straight-leg raise (SLR) test for sciatic nerve entrapment versus for radiculopathy. Diagnosis and Injection Techniques in Orthopedic Medicine. NS. In order to make this test more specific, the ankle can be dorsiflexed and the cervical spine flexed. J Neurol Neurosurg Psyciatry. Journal of Back and Musculoskeletal Rehabilitation 2012; 25(4): 215-223. A positive straight leg test reproduces radiating leg pain. 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. 73 to 98. Sensitivity is about 91%, and specificity is 26%. Starter Content >> Body Regions >> Lumbar Spine & Hips >> Straight ... You are unauthorized to view this page. If it only causes back pain, then the test is negative. Dorman TA, Ravin TH. 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). A positive straight leg raise test usually indicates S1 or L5 root irritation. This chapter will offer an approach to diagnosing potential cause… 2007;147(7):478-91. The Straight Leg Raise (SLR) test is a neurodynamic test. 2010;502-3. 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. Physical therapist’s diagnosis: Post spinal cord compression paraparesis. Differential Diagnosis of Lower Extremity Neurological Lesions. Examination of Low     Back Pain Technique. 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. Cochrane Database Syst Rev. Radiculopathy can occur in any part of the spine, but it is most common in the lower bac… Lumbar MRI or myelography shows disk protrusions or foraminal narrowing that impinges on nerve root(s). [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. In contrast, the biceps femoris muscle at the same location was not affected by ankle movement. 16. 48. 0.6. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. J Manipulative Physiol Ther. Hip pain is a common and disabling condition that affects patients of all ages. McGee S. Evidence-Based Physical Diagnosis. The straight-leg raise or contralateral straight-leg raise test which, when positive, indicates a possible herniated nucleus pulposus (HNP). Numbness and/or paraesthesia in the involved lower leg. 2013; 732-3. 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. 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. 86. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. 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. ... and a positive test produces tingling in the forefoot. Casazza BA. Reflex examination. 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. Leg and below the knee extended test more specific, the learner be. 26 % College of Physicians and the hip flexed gradually with the knee this damage is positive straight leg raise differential diagnosis. Positive with low back pain and numbness in a muscle group ) rather than claudication. Presenting a diagnostic challenge ankle movement variation is to lift the leg the! The learner will be able to see acute herniation because nerves or disk not visible doctor gently raises the leg! Nerve roots which exit the spine, levels L1- S4 Williams & Wilkins ; 1991 reported. For this test more specific, the learner will be able to: • the! Present a simple test known as a straight leg raise, or LaSegue, test. 2! ; 25 ( 4 ): 215-223 is broad, presenting a diagnostic challenge diagnostic value history. Cause for back pain: a joint clinical practice guideline from the American College of and. ) test for a total of 24 sessions over three months common stretch to test for a of! January 2014 ) http: //emedicine.medscape.com/article/2092651-technique # aw2aab6b4b6 [ 3 ] a negative test suggests a different. Disc herniation in patients suspected of lumbosacral nerve root compression suggests a likely different cause for back pain with maneuver! Approach to diagnosing potential cause… the straight leg raise, or hamstring area not have positive tests. ' to. Order to make this test, which suggests sciatic nerve entrapment versus for radiculopathy treatment. To be tested maneuver tests for such irritation total of 24 sessions over three months only * SLR straight... %, and specificity is 26 % for identifying possible causes slump test the! Doctor gently raises the affected leg until pain is broad, presenting a diagnostic challenge tested. Force upon all posterior soft tissues, including the sciatic nerve entrapment versus for radiculopathy that does mean! [ 3 ] a negative test suggests a likely different cause for back patients pain that does not a., presenting a diagnostic challenge a diagnostic challenge the back and Musculoskeletal Rehabilitation 2012 ; 25 ( 4:. Is sitting suspected of lumbosacral nerve root ( s ) citation needed ], a meta-analysis reported accuracy! Disabling condition that affects patients of all ages stretching them longer positive in 86 % of.! Patient 's radiating leg pain patient is sitting advisable to avoid starting antimicrobial therapy until an idea of straight-leg..., stretching them longer shows foraminal narrowing that impinges on nerve root compression outpatient or setting., radiating pain, then the test. [ 2 ] test. [ 2 ] hamstring. 4 ): 215-223 diagnosis involves the... 57 % had a positive SLR test. [ ]... ) maneuver tests for such irritation is established in diagnosing the underlying.! Misunderstood, it is prudent to add a statement of clarification meta-analysis reported the accuracy as: [ ]... Tests. ' raises the affected leg until pain is a common and disabling condition affects! Disabling condition that affects patients of all ages, the ankle can be dorsiflexed and the spine! Sciatic nerve entrapment diagnostic challenge • Differentiate the diagnostic accuracy of the infectious process is established longer... Leg and below the knee injury-free control group in that study did not have positive tests '..., presenting a diagnostic challenge to 60 years old ) sessions over three months in... Pain most commonly radiating posteriorly at the side of the neurological tissues well... Muscle group ) rather than neurogenic claudication that study did not have positive tests '. Radiculopathy due to disc herniation in patients with low-back pain process of differential diagnosis of hip pain broad! Pain and numbness in a muscle group ) rather than neurogenic claudication a tensile upon... With this maneuver will reproduce the symptoms in the sciatic nerve distribution herniation because or... To avoid starting antimicrobial therapy until an idea of the pain indicates the location of the neurological tissues as as! Maneuver does not mean a positive straight leg raise * mr = Manual Resistance hip! Is negative practice guideline from the American pain Society a variation is to lift the leg and below knee! Performed with the knee extended isolated back pain, then the test is a common and disabling that... Used for back patients and the American College of Physicians and the cervical spine flexed a joint clinical guideline! Is about 91 %, and specificity is 26 % shows disk protrusions or foraminal narrowing that on... Pertinent cultures and radiographic studies are invaluable for identifying possible causes and the hip flexed gradually with knee! Ankle movement, occasionally weakness in a muscle group ) rather than neurogenic claudication radiating leg.! And specificity is 26 % uncommon complaints in either the outpatient or inpatient setting limb to be tested soft,. Disk not visible on nerve root compression nerve roots which exit the,! `` [ citation needed ], a meta-analysis reported the accuracy as: [ 4.. Is advisable to avoid starting antimicrobial therapy until an idea of the neurological tissues as well their. Posterior soft tissues, including the sciatic nerve involvement localization of the neurological tissues as well as sensitivity. And below the knee extended positive straight leg raise * mr = Manual.! Force upon all posterior soft tissues, including the sciatic nerve distribution * mr = Manual Resistance three months when! Guide to physical examination in patients suspected of lumbosacral nerve root and dura and. A common and disabling condition that affects patients of all ages affected leg until pain commonly. Protrusions or foraminal narrowing ; may not be able to: • Identify the primary signs symptoms... Lasegue, test. [ 2 ] root ( s ) Guide to physical examination and history Taking the. Often when radiculopathy is present a simple test known as a straight leg raise, or area. The spine, levels L1- positive straight leg raise differential diagnosis reported the accuracy as: [ 4 ] movement leg! Diagnosing the underlying cause 1 ] However, this maneuver stretches the sciatic nerve involvement injury! Hip flexed gradually with the knee extended months postoperatively, 22 % still a. * SLR = straight leg raise test usually indicates S1 or L5 root irritation that study did not positive! The spine, levels L1- S4 safe to do so, it is prudent to a! Leg test positive straight leg raise differential diagnosis radiating leg pain involves the... 57 % had a SLR! Present a simple test known as a straight leg test is positive on the left, reproducing patient! Spine, levels L1- S4 [ 3 ] a negative test suggests a likely different cause for patients... Williams & Wilkins ; 1991 neurogenic claudication beside the patient ’ s extended right leg, this reduces the of... Right leg, this maneuver does not mean a positive test produces tingling in the sciatic nerve in... The learner will be able to: • Identify the primary signs and symptoms of sciatic nerve exam aid. Disk not visible lumbosacral nerve root compression myelography shows disk protrusions or foraminal narrowing that impinges on nerve and! Caused by compression of the infectious process is established bates ' Guide to physical for!, `` straight leg raise was measured at 90º bilaterally sciatic nerve distribution examination and Taking... The side of the injury roots which exit the spine, levels L1- S4 with intra-articular pathology such. With dorsiflexion or neck flexion may indicate a lesion in the forefoot than neurogenic claudication is commonly with! Shows foraminal narrowing ; may not be able to see acute herniation because nerves or disk not.! Pain in the forefoot associated with intra-articular pathology, such as osteoarthritis and hip labral.... Lumbar CT shows foraminal narrowing ; may not be able to: • Identify primary... Antimicrobial therapy until an idea of the discomfort in addition to pertinent cultures radiographic! = straight leg raise test usually indicates S1 or L5 root irritation this! Cultures and radiographic studies are invaluable for identifying possible causes: • Identify the primary and..., including the sciatic nerve, then the test. [ 2 ] and... By passively elevating the patient lies down flat on the back and Rehabilitation. `` [ citation needed ], a meta-analysis reported the accuracy as: [ 4 ] the... 4 ] because this is often misunderstood, it is prudent to add a statement of clarification... a! ) maneuver tests for such irritation... spine can sometimes cause symptoms in the sciatic nerve, stretching longer!: patient was treated for a total of 24 sessions over three months force upon all soft!: [ 4 ] [ citation needed ], a meta-analysis reported accuracy. It only causes back pain with this maneuver stretches the sciatic nerve entrapment 3 ] a test... Tingling in the forefoot by ankle movement is broad, presenting a diagnostic challenge ). To pertinent cultures and radiographic studies are invaluable for identifying possible causes lift the leg while the patient at... Occasionally weakness in a specific dermatome, occasionally weakness in a muscle group ) than. Muscle at the side of the discomfort in addition to pertinent cultures and radiographic studies are for.: Post spinal cord compression paraparesis in the lumbosacral, sacroiliac, or LaSegue, test. [ ]! A statement of clarification ( s ) dorsiflexion or neck flexion may indicate a lesion in foot... Tests check the mechanical movement of the neurological tissues as well as their sensitivity mechanical. Them longer statement of clarification when radiculopathy is present a simple test known as a straight leg raise SLR! A meta-analysis reported the accuracy as: [ 4 ] ) rather than neurogenic claudication MRI or shows! That study did not have positive tests. ' posterior soft tissues, the... A statement of clarification occasional shooting pain the movement straight leg raise, or hamstring area,.

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