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Peripheral nerve assessment and treatment is an important component of a lumbar spine or lower quarter examination. To the right, is a complimentary video from our insider access library on lower extremity peripheral nerve testing.
There are only a few professions that look at peripheral nerves. BE AN EXPERT AT ASSESSING THEM!
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Straight Leg Raise Test
Purpose of Test: To test for the presence of a disc herniation.
Test Position: Supine.
Performing the Test: The examiner will passively flex the patient’s hip while maintaining the knee in full extension. A positive test is considered when the patient reports reproduction of pain at 40 degrees of hip flexion or less. The examiner should make note of the degree of hip flexion where the patient reported pain or reproduction of symptoms.
Diagnostic Accuracy: Sensitivity: .91, Specificity: .26, +LR: .35, -LR: 1.2 ("The test of Lasegue. Systematic review of the accuracy in diagnosing herniated discs"). Sensitivity: .52, Specificity: .89 (“The sensitivity and specificity of the SLUMP and straight leg raised tests in patients with lumbar disc herniation”).
Importance of Test: Disc herniations are a common problem in patient’s with low back pain. During this test the examiner is placing a traction force on the involved nerve root, reproducing the pain the patient presented with. Normally, patients can reach 70-90 degrees of hip flexion before a sensation of tightness occurs in the posterior thigh. If pain is felt significantly earlier, the patient could potentially be suffering from a disc herniation.
(Interesting fact: The SLR primarily puts a stretch on the L5-S1 nerve root segment). It should be noted that a painful, stretching, or other neurological symptom may be produced by this test as a result of neural tension due to adhesions while travelling throughout the body. Compare the results of the test with the pain for which the patient sought treatment. Also, utilize the angle at which symptoms were produced to help differentiate the source of the patient's pain.
Note: tests should only be performed by a properly trained health care practitioner.
Test Position: Supine.
Performing the Test: The examiner will passively flex the patient’s hip while maintaining the knee in full extension. A positive test is considered when the patient reports reproduction of pain at 40 degrees of hip flexion or less. The examiner should make note of the degree of hip flexion where the patient reported pain or reproduction of symptoms.
Diagnostic Accuracy: Sensitivity: .91, Specificity: .26, +LR: .35, -LR: 1.2 ("The test of Lasegue. Systematic review of the accuracy in diagnosing herniated discs"). Sensitivity: .52, Specificity: .89 (“The sensitivity and specificity of the SLUMP and straight leg raised tests in patients with lumbar disc herniation”).
Importance of Test: Disc herniations are a common problem in patient’s with low back pain. During this test the examiner is placing a traction force on the involved nerve root, reproducing the pain the patient presented with. Normally, patients can reach 70-90 degrees of hip flexion before a sensation of tightness occurs in the posterior thigh. If pain is felt significantly earlier, the patient could potentially be suffering from a disc herniation.
(Interesting fact: The SLR primarily puts a stretch on the L5-S1 nerve root segment). It should be noted that a painful, stretching, or other neurological symptom may be produced by this test as a result of neural tension due to adhesions while travelling throughout the body. Compare the results of the test with the pain for which the patient sought treatment. Also, utilize the angle at which symptoms were produced to help differentiate the source of the patient's pain.
Note: tests should only be performed by a properly trained health care practitioner.
References:
Deville W, van der Windt D, Dzaferagic A, et al. "The test of Lasegue. Systematic review of the accuracy in diagnosing herniated discs." Spine 200; 25: 1140-1147.
Majlesi J, Togay H, Unalan H, Toprak S. "The sensitivity and specificity of the SLUMP and straight leg raised tests in patients with lumbar disc herniation." J Clin Rheumatol. 2008 Apr. Web. 08/18/2012.
Deville W, van der Windt D, Dzaferagic A, et al. "The test of Lasegue. Systematic review of the accuracy in diagnosing herniated discs." Spine 200; 25: 1140-1147.
Majlesi J, Togay H, Unalan H, Toprak S. "The sensitivity and specificity of the SLUMP and straight leg raised tests in patients with lumbar disc herniation." J Clin Rheumatol. 2008 Apr. Web. 08/18/2012.
