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. Capra F et al. St Louis: Saunders, 2005. 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. Localization of the discomfort in addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes. [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. Sapira's Art and Science of Bedside Diagnosis. The Straight Leg Raise (SLR) test is a neurodynamic test. MR – Positive with low back strain only *SLR = Straight Leg Raise *MR = Manual Resistance . After completing module 12, the learner will be able to: • Identify the primary signs and symptoms of sciatic nerve entrapment. London: Ballière-Tindall; 1982. NS. "[citation needed], A meta-analysis reported the accuracy as:[4]. For this test, the patient lies down flat on the back and the doctor gently raises the affected leg until pain is felt. Disk herniations generally cause unilateral radiculopathy (i.e. 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 test reproduces radiating leg pain. 4th ed. Starter Content >> Body Regions >> Lumbar Spine & Hips >> Straight ... You are unauthorized to view this page. 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. Lumbar CT shows foraminal narrowing; may not be able to see acute herniation because nerves or disk not visible. •Straight leg raise test –SN 97%, SP 57%, QUADAS 10 (VroomenP, de Krom M, WilminkJ, Kester A, Knottnerus J. Orient, JM. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. 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. •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 … At 4 months postoperatively, 22% still had a positive SLR test. Neural tissue dynamics: Straight leg raise was measured at 90º bilaterally. Back pain and fever are not uncommon complaints in either the outpatient or inpatient setting. 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. The SLR test is a popular test often used for back patients. 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. • Differentiate the diagnostic accuracy of the straight-leg raise (SLR) test for sciatic nerve entrapment versus for radiculopathy. Examination of Low Back Pain Technique. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. 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. The injury-free control group in that study did not have positive tests.'" 2007;147(7):478-91. Casazza BA. Leg sensation abnormal. Module 12 | Diagnosis of Deep Gluteal Syndrome . Sandella BJ et al. This chapter will offer an approach to diagnosing potential cause… Baltimore, MD: Williams & Wilkins; 1991. 89. ... Straight Leg Raise test (SLR), as described by KendalLY Ankle jerk may be decreased Journal of Back and Musculoskeletal Rehabilitation 2012; 25(4): 215-223. Pain that does not increase with dorsiflexion or neck flexion may indicate a lesion in the lumbosacral, sacroiliac, or hamstring area. Reflex examination. Positive straight-leg raise test. (Last accessed 7 January 2014) http://emedicine.medscape.com/article/2092651-technique#aw2aab6b4b6. Intervention: Patient was treated for a total of 24 sessions over three months. Philadelphia, PA: Lippincott Williams & Wilkins. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Bickley LS et al. [5] In 1864 Lasègue described the signs of developing low back pain while straightening the knee when the leg has already been lifted. A straight-leg raise is performed with the patient supine and the hip flexed gradually with the knee extended. pain and numbness in a specific dermatome, occasionally weakness in a muscle group) rather than neurogenic claudication. Pain most commonly radiating posteriorly at the leg and below the knee. Preoperatively, the SLR test was positive in 86% of patients. 48. In order to make this test more specific, the ankle can be dorsiflexed and the cervical spine flexed. If you're a member, please login. Radiculopathy can occur in any part of the spine, but it is most common in the lower bac… 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. The straight-leg raise or contralateral straight-leg raise test which, when positive, indicates a possible herniated nucleus pulposus (HNP). See this video. Disk herniation is generally more common in younger patients (30 to 60 years old). J Neurol Neurosurg Psyciatry. If it only causes back pain, then the test is negative. 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 … Am Fam Physician. If compressed or inflamed, this maneuver will reproduce pain in the sciatic nerve distribution. 2nd ed. J Manipulative Physiol Ther. Positive neural tension test with provocation of pain in the affected leg (straight leg raise test/femoral nerve test/slump test) If raising the opposite leg causes pain (cross or contralateral straight leg raising): Lasègue's sign was named after Charles Lasègue (1816-1883). 0.2. 0.6. Numbness and/or paraesthesia in the involved lower leg. 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. By passively elevating the patient’s extended right leg, this maneuver stretches the sciatic nerve. 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. Williams & Wilkins ; 1991 such as osteoarthritis and hip labral tears straight. 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