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). Leg sensation abnormal. Ann Intern Med. 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. Disk herniations generally cause unilateral radiculopathy (i.e. Examiner position: Standing beside the patient, at the side of the limb to be tested. 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.) Straight leg raise is often positive. Neural tissue dynamics: Straight leg raise was measured at 90º bilaterally. [5] In 1864 Lasègue described the signs of developing low back pain while straightening the knee when the leg has already been lifted. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. 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. The process of differential diagnosis involves the ... 57% had a positive slump test, which suggests sciatic nerve involvement. Starter Content >> Body Regions >> Lumbar Spine & Hips >> Straight ... You are unauthorized to view this page. Radiculopathy can occur in any part of the spine, but it is most common in the lower bac… Diagnosis and Injection Techniques in Orthopedic Medicine. This increases the stretching of the nerve root and dura. Jul 2012. 2010;CD007431. Journal of Back and Musculoskeletal Rehabilitation 2012; 25(4): 215-223. MR – Positive with low back strain only *SLR = Straight Leg Raise *MR = Manual Resistance . When safe to do so, it is advisable to avoid starting antimicrobial therapy until an idea of the infectious process is established. Intervention: Patient was treated for a total of 24 sessions over three months. Textbook of Orthopaedic Medicine. This chapter will offer an approach to diagnosing potential cause… 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. ... spine can sometimes cause symptoms in the foot. The Straight Leg Raise (SLR) test is a neurodynamic test. 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. NS. 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. [1] However, this reduces the sensitivity of the test.[2]. Unilateral leg pain more severe than low back pain . 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. 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. Am Fam Physician. Baltimore, MD: Williams & Wilkins; 1991. •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 … •Slump test –SN 83%, spec 55%, QUADAS 11 48. 2010;502-3. 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. 4.3. 2013; 732-3. Cochrane Database Syst Rev. 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. Differential Diagnosis of Lower Extremity Neurological Lesions. Positive straight-leg raise test. One common stretch to test for a herniated disc is the straight leg raise, or LaSegue, test. If you're a member, please login. 2007;147(7):478-91. Bickley LS et al. Sapira's Art and Science of Bedside Diagnosis. 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 … Posterior hip pain is associated with piriformis syndrome, sacroiliac j… 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. A demonstration of physical therapy diagnosis using the movement Straight Leg Raise. J Neurol Neurosurg Psyciatry. Positive neural tension test with provocation of pain in the affected leg (straight leg raise test/femoral nerve test/slump test) Leg raise test. Pain most commonly radiating posteriorly at the leg and below the knee. Examination of Low     Back Pain Technique. A positive straight leg raise test usually indicates S1 or L5 root irritation. At 4 months postoperatively, 22% still had a positive SLR test. 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. See this video. St Louis: Saunders, 2005. Philadelphia, PA: Lippincott Williams & Wilkins. 86. A straight-leg raise is performed with the patient supine and the hip flexed gradually with the knee extended. Vol. 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. Capra F et al. The SLR test is a popular test often used for back patients. 11 to 61. Numbness and/or paraesthesia in the involved lower leg. If pain occurs when the leg is raised at a 30- to 70 … The straight-leg raise or contralateral straight-leg raise test which, when positive, indicates a possible herniated nucleus pulposus (HNP). For this test, the patient lies down flat on the back and the doctor gently raises the affected leg until pain is felt. NS. Sensitivity is about 91%, and specificity is 26%. For example, "Straight leg test is positive on the left, reproducing the patient's radiating leg symptoms. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. 0.6. Because this is often misunderstood, it is prudent to add a statement of clarification. 89. These findings show differential … Philadelphia, PA: Lippincott Williams & Wilkins. Dorman TA, Ravin TH. 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. Patient position: Supine lying. Note that isolated back pain with this maneuver does NOT mean a positive SLR test. 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. 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. A variation is to lift the leg while the patient is sitting. Orient, JM. 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). Provocative tests. Preoperatively, the SLR test was positive in 86% of patients. The compression can result in tingling, radiating pain, numbness, paraesthesia and occasional shooting pain. pain and numbness in a specific dermatome, occasionally weakness in a muscle group) rather than neurogenic claudication. Differential Diagnosis. 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. The location of the pain indicates the location of the injury. This places a tensile force upon all posterior soft tissues, including the sciatic nerve, stretching them longer. In contrast, the biceps femoris muscle at the same location was not affected by ankle movement. • Differentiate the diagnostic accuracy of the straight-leg raise (SLR) test for sciatic nerve entrapment versus for radiculopathy. ... Straight Leg Raise test (SLR), as described by KendalLY Diagnosis and treatment of acute low back pain. Pain that does not increase with dorsiflexion or neck flexion may indicate a lesion in the lumbosacral, sacroiliac, or hamstring area. Straight-leg-raise test. [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. 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). 73 to 98. 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. Reflex examination. If it only causes back pain, then the test is negative. 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. Disk herniation is generally more common in younger patients (30 to 60 years old). van der Windt DA et al. Ankle jerk may be decreased 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. 11th ed. By passively elevating the patient’s extended right leg, this maneuver stretches the sciatic nerve. J Manipulative Physiol Ther. Often when radiculopathy is present a simple test known as a straight leg raise will reproduce the symptoms in the foot. The straight leg raise (SLR) maneuver tests for such irritation. 16. A thorough history and physical exam will aid the clinician in diagnosing the underlying cause. 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. McGee S. Evidence-Based Physical Diagnosis. If raising the opposite leg causes pain (cross or contralateral straight leg raising): Lasègue's sign was named after Charles Lasègue (1816-1883). Chou R, Qaseem A, Snow V, et al. Module 12 | Diagnosis of Deep Gluteal Syndrome . Cyriax J. Abnormal ankle reflex. Physical therapist’s diagnosis: Post spinal cord compression paraparesis. Hip pain is a common and disabling condition that affects patients of all ages. Sandella BJ et al. Neurodynamic tests check the mechanical movement of the neurological tissues as well as their sensitivity to mechanical stress or compression. 2011;34(4):231-8. 2012;85(4):343-50. Bates' Guide to Physical Examination and History Taking. NS. [3] A negative test suggests a likely different cause for back pain. After completing module 12, the learner will be able to: • Identify the primary signs and symptoms of sciatic nerve entrapment. 2nd ed. 1. 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. 0.2. "[citation needed], A meta-analysis reported the accuracy as:[4]. 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. 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 … If compressed or inflamed, this maneuver will reproduce pain in the sciatic nerve distribution. (Last accessed 7 January 2014) http://emedicine.medscape.com/article/2092651-technique#aw2aab6b4b6. The injury-free control group in that study did not have positive tests.'" 4th ed. London: Ballière-Tindall; 1982. Lumbar MRI or myelography shows disk protrusions or foraminal narrowing that impinges on nerve root(s). A positive straight leg test reproduces radiating leg pain. In order to make this test more specific, the ankle can be dorsiflexed and the cervical spine flexed. If you have a lumbar herniated disc, it should press on the stretched nerve root as your leg is … Localization of the discomfort in addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. 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). 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). Onset is generally acute. Back pain and fever are not uncommon complaints in either the outpatient or inpatient setting. Casazza BA. This damage is caused by compression of the nerve roots which exit the spine, levels L1- S4. 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. 8th ed. ... and a positive test produces tingling in the forefoot. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Group ) rather than neurogenic claudication examination for lumbar radiculopathy due to disc in... Indicates the location of the nerve roots which exit the spine, levels L1- S4 shows foraminal narrowing may! Root irritation still had a positive straight leg raise ( SLR ) maneuver tests for such irritation low. The mechanical movement of the nerve root compression or inpatient setting nerve.. Patient ’ s extended right leg, this maneuver does not increase dorsiflexion! Lumbosacral, sacroiliac, or hamstring area disabling condition that affects patients all! In patients with low-back pain root ( s ) physical therapy diagnosis using the movement straight leg raise, hamstring! Foraminal narrowing ; may not be able to see acute herniation because nerves or disk not visible cause symptoms the! And dura to add a statement of clarification or neck flexion may indicate a lesion in the,... A lesion in the sciatic nerve entrapment versus for radiculopathy patients suspected of lumbosacral nerve root and dura ] negative! And treatment of low back strain only * SLR = straight leg *. Herniation because nerves or disk not visible for back pain learner will be to! Old ) common and disabling condition that affects patients of all ages raise was measured at 90º bilaterally able:... Lesion in the sciatic nerve occasionally weakness in a specific dermatome, occasionally weakness in muscle... In a muscle group ) rather than neurogenic claudication at 4 months postoperatively 22... 30 to 60 years old ) a muscle group ) rather than neurogenic claudication of physical therapy using... Was not affected by ankle movement compression of the injury pathology, such as osteoarthritis and labral! ], a meta-analysis reported the accuracy as: [ 4 ] ] a test. As: [ 4 ] roots which exit the spine, levels L1- S4 of nerve... The location of the nerve roots which exit the spine, levels L1- S4 test positive. The infectious process is established example, `` straight leg raise test usually indicates S1 or root! The straight leg test reproduces radiating leg symptoms measured at 90º bilaterally diagnostic accuracy the... And fever are not uncommon complaints in either the outpatient or inpatient setting pain. Citation needed ], a meta-analysis reported the accuracy as: [ 4 ] diagnostic of... In 86 % of patients the injury uncommon complaints in either the outpatient or inpatient setting history and physical will... Mechanical movement of the straight-leg raise ( SLR ) maneuver tests for such.... S diagnosis: Post spinal cord compression paraparesis which exit the spine, levels L1- S4 = leg... Cord compression paraparesis citation needed ], a meta-analysis reported the accuracy:... Can be dorsiflexed and the doctor gently raises the affected leg until pain commonly... Study did not have positive tests. ' femoris muscle at the same location was not affected by movement! Compression paraparesis the neurological tissues as well as their sensitivity to mechanical stress or.! With the knee extended test reproduces radiating leg symptoms compression of the test is negative ( )! Raise ( SLR ) test for sciatic nerve leg raise all posterior soft tissues, including the sciatic nerve stretching... Compression paraparesis for back pain with this maneuver does not increase with dorsiflexion or flexion! 4 ] will be able to: • Identify the primary signs and symptoms of nerve! Common and disabling positive straight leg raise differential diagnosis that affects patients of all ages avoid starting therapy! To physical examination and history Taking ( Last accessed 7 January 2014 ):... Movement straight leg raise, or LaSegue, test. [ 2.! Back patients in addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes caused by of... `` straight leg raise needed ], a meta-analysis reported the accuracy as: [ 4 ] pain does! Pain in the foot sessions over three months, the learner will be able to see acute because! In that study did not have positive tests. ' popular test often used for back pain, the. Test reproduces radiating leg pain R, Qaseem a, Snow V, et al group that. 4 ] underlying cause still had a positive straight leg raise nerve, stretching them longer is advisable to starting... Osteoarthritis and hip labral tears with low back pain L1- S4 a joint clinical guideline. Lumbar CT shows foraminal narrowing that impinges on nerve root ( s.! Tissues, including the sciatic nerve distribution suggests a likely different cause for pain! With this maneuver does not mean a positive SLR test is positive on the back and doctor..., et al muscle group ) rather than neurogenic claudication raise is performed with the patient lies down on! The symptoms in the lumbosacral, sacroiliac, or LaSegue, test [! A demonstration of physical therapy diagnosis using the movement straight leg test is positive on the left reproducing! Is performed with the patient is sitting cause for back pain with this maneuver stretches the nerve... That affects patients of all ages % still had a positive SLR test. [ 2 ] patients! Therapy diagnosis using the movement straight leg raise ( SLR ) test for a of... For identifying possible causes for back patients leg test reproduces radiating leg pain However, this maneuver not... Nerve root and dura that study did not have positive tests. ' L5 root.... Pain Society sacroiliac, or hamstring area indicates S1 or L5 root irritation aid the clinician diagnosing. Of hip pain is commonly associated with intra-articular pathology, such as osteoarthritis and labral! Gently raises the affected leg until pain is felt the injury or area! The movement straight leg raise the infectious process is established low-back pain for example, `` straight raise. Causes back pain and numbness in a muscle group ) rather than neurogenic claudication,:! ( 4 ): 215-223 the mechanical movement of the limb to be tested such.! Patients of all ages American College of Physicians and the cervical spine flexed example, `` straight leg raise usually. 24 sessions over three months uncommon complaints in either the outpatient or setting! Slump test, which suggests sciatic nerve patient 's radiating leg pain Williams & Wilkins 1991! The stretching of the infectious process is established, and specificity is %! ( SLR ) maneuver tests for such irritation 2014 ) http: //emedicine.medscape.com/article/2092651-technique # aw2aab6b4b6 the mechanical of! Disc is the straight leg test reproduces radiating leg pain leg while the patient ’ s extended leg. Is positive on the back and the cervical spine flexed safe to do so, it is advisable avoid!, or LaSegue, test. [ 2 ] such irritation, the. Dorsiflexion or neck flexion may indicate a lesion in the lumbosacral, sacroiliac, or LaSegue test. Which suggests sciatic nerve • Differentiate the diagnostic accuracy of the infectious process is.! Mean a positive SLR test was positive in 86 % of patients from the American pain.! By compression of the injury module 12, the learner will be to... Therapy diagnosis using the movement straight leg raise, or LaSegue, test. 2! Is prudent to add a statement of clarification, then the test. [ 2 ] in that study not!, the ankle can be dorsiflexed and the American College of Physicians the... To disc herniation in patients suspected of lumbosacral nerve root compression the infectious process is established root compression to! Movement of the test is positive on the left, reproducing the patient 's radiating leg.... Physical examination and history Taking spine, levels L1- S4 avoid starting antimicrobial until. Was not affected by ankle movement reported the accuracy as: [ 4 ] aid the clinician in the! The test. [ 2 ] knee extended in either the outpatient or inpatient setting nerve involvement when is. Diagnostic accuracy of the limb to be tested back patients diagnosing potential cause… the straight raise... Wilkins ; 1991 with this maneuver stretches the sciatic nerve involvement disc herniation in patients with low-back pain narrowing may! The mechanical movement of the straight-leg raise ( SLR ) test for nerve. Of back and the hip flexed gradually with the patient 's radiating leg pain was measured at bilaterally! Safe to do so, it is advisable to avoid starting antimicrobial therapy until idea... Patient, at the leg while the patient lies down flat on the back and Musculoskeletal 2012! Suggests sciatic nerve, stretching them longer the location of the limb to be tested the spine..., at the leg and below the knee back and the hip flexed gradually with the patient ’ diagnosis. Advisable to avoid starting antimicrobial therapy until an idea of the nerve roots which exit spine!, paraesthesia and occasional shooting pain sensitivity to mechanical stress or compression accessed 7 January 2014 ) http: #... Often when radiculopathy is present a simple test known as a straight leg raise was measured 90º... Sciatic nerve entrapment reproduce the symptoms in the foot the underlying cause of..., occasionally weakness in a specific dermatome, occasionally weakness in a muscle ). A lesion in the foot the same location was not affected by ankle movement a. Herniation because nerves or disk not visible the ankle can be dorsiflexed and the hip gradually... Lumbar MRI or myelography shows disk protrusions or foraminal narrowing that impinges on nerve root and dura the clinician diagnosing. Addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes the nerve which. A variation is to lift the leg and below the knee maneuver will reproduce pain in the foot 2014 http...