Purpose: To determine the possibility of non-musculoskeletal causes for the patient's symptoms.
Test Position: Supine.
Performing the Test: A straight leg raise is performed passively by the examiner (the patient cannot usually perform an active SLR). If the SLR is positive, the end-feel is usually spasm or capsular, but definitely painful. Return the patient to neutral. Passively flex the patient's hip, but this time with the ipsilateral knee flexed to end-range. Assess for if further hip flexion was achieved. If no change in range of motion, the pathology is within the hip or buttock, and not the hamstrings or sciatic nerve. The second part of the test usually has an empty end-feel and is more painful than the first part. To be positive, the Sign of the Buttock must have all present: restriction of SLR concurrently with limited hip flexion and a non-capsular pattern of restriction of hip joint ROM.
Diagnostic Accuracy: Unknown.
Importance of the Test: When performing a SLR, a pathology in the hamstrings, sciatic nerve, buttock, or hip may cause limitations. If the knee is flexed, the stress is taken off the hamstrings and sciatic nerve (because they cross the knee), so remaining limitation is due to pathology of the hip or buttock. With an empty end feel, we know that there is a potentially serious pathology involved in the patient's symptoms, which may include: osteomyelitis, chronic septic SI arthritis, ischiorectal abscess, septic bursitis, neoplasm of the upper femur, or fractured sacrum.
Note: these tests should only be used by properly trained health care practitioners.