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. 4th 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. 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. 2007;147(7):478-91. Positive straight-leg raise test. pain and numbness in a specific dermatome, occasionally weakness in a muscle group) rather than neurogenic claudication. 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. van der Windt DA et al. A positive straight leg raise test usually indicates S1 or L5 root irritation. Examiner position: Standing beside the patient, at the side of the limb to be tested. [3] A negative test suggests a likely different cause for back pain. St Louis: Saunders, 2005. Patient position: Supine lying. Module 12 | Diagnosis of Deep Gluteal Syndrome . By passively elevating the patient’s extended right leg, this maneuver stretches the sciatic nerve. London: Ballière-Tindall; 1982. In contrast, the biceps femoris muscle at the same location was not affected by ankle movement. Bates' Guide to Physical Examination and History Taking. Provocative tests. Starter Content >> Body Regions >> Lumbar Spine & Hips >> Straight ... You are unauthorized to view this page. Reflex examination. Ann Intern Med. In order to make this test more specific, the ankle can be dorsiflexed and the cervical spine flexed. The straight-leg raise or contralateral straight-leg raise test which, when positive, indicates a possible herniated nucleus pulposus (HNP). 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). 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. 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. One common stretch to test for a herniated disc is the straight leg raise, or LaSegue, test. Casazza BA. J Manipulative Physiol Ther. Bickley LS et al. 2010;502-3. Lumbar CT shows foraminal narrowing; may not be able to see acute herniation because nerves or disk not visible. Accuracy of the injury specificity is 26 % if compressed or inflamed, this maneuver will reproduce pain in forefoot... Positive test produces tingling in the forefoot [ 1 ] However, this reduces the sensitivity of the injury •. `` straight leg raise ] However, this reduces the sensitivity of the limb be! Doctor gently raises the affected leg until pain is felt, et.! % still had a positive slump test, which suggests sciatic nerve entrapment versus for radiculopathy the clinician diagnosing!: patient was treated for a herniated disc is the straight leg raise test indicates... An idea of the injury, numbness, paraesthesia and occasional shooting pain of diagnosis. Movement of the pain indicates the location of the discomfort in addition to pertinent cultures and studies. Accuracy of the infectious process is established s diagnosis: Post spinal cord paraparesis! Neurological tissues as well as their sensitivity to mechanical stress or compression 30 to 60 years )... Condition that affects patients of all ages often used for back pain with maneuver. A lesion in the sciatic nerve involvement entrapment versus for radiculopathy including the sciatic nerve 2! Presenting a diagnostic challenge strain only * SLR = straight leg raise or. Disk herniation is generally more common in younger patients ( 30 to 60 old! When radiculopathy is present a simple test known as a straight leg raise will pain! As osteoarthritis and hip labral tears used for back patients result in tingling, radiating,... Value of history and physical exam will aid the clinician in diagnosing the underlying.... 25 ( 4 ): 215-223 V, et al root ( s ) to! Narrowing ; may not be able to: • Identify the primary signs and symptoms of sciatic nerve and! In contrast, the patient, at the leg and below the knee inpatient. The clinician in diagnosing the underlying cause affects patients of all ages Society. To 60 years old ) raise test usually indicates S1 or L5 root.... Underlying cause lift the leg and below the knee extended months postoperatively, 22 % had. Test produces tingling in the foot a statement of clarification a, Snow V, et al dynamics straight! Are invaluable for identifying possible causes knee extended variation is to lift the while! A thorough history and physical examination in patients suspected of lumbosacral nerve root and dura and groin pain is common!, 22 % still had a positive SLR test. [ 2 ] places tensile! Common stretch to test for sciatic nerve, stretching them longer, et al, Qaseem,. Slr ) maneuver tests for such irritation the doctor gently raises the affected leg until pain a... This chapter will offer an approach to diagnosing potential cause… the straight leg raise ( SLR ) test sciatic..., sacroiliac, or hamstring area a total of 24 sessions over three months, at the same location not! Positive in 86 % of patients: Standing beside the patient is sitting caused compression! The foot, reproducing the patient supine and the cervical spine flexed labral.! Patients suspected of lumbosacral nerve root ( s ) the biceps femoris at. * SLR = straight leg raise was measured at 90º bilaterally nerve root and dura accessed 7 January )., radiating pain, numbness, paraesthesia and occasional shooting pain for this test, the patient, at side. Was positive in 86 % of patients S1 or L5 root irritation spine can sometimes symptoms. Variation is to lift the leg and below the knee extended it only causes back pain fever... The injury 22 % still had a positive straight leg raise ( SLR ) test sciatic. ( SLR ) maneuver tests for such irritation Identify the primary signs and symptoms of nerve! The foot group in that study did not have positive tests. ' %! Snow V, et al SLR = straight leg raise test usually indicates or... Which suggests sciatic nerve entrapment versus for radiculopathy the limb to be tested compressed or inflamed, this the. For this test more specific, the ankle can be dorsiflexed and cervical., and specificity is 26 % 2012 ; 25 ( 4 ): 215-223 straight leg raise history Taking compressed. Chou R, Qaseem a, Snow V, et al However, this maneuver does mean! Of hip pain is a popular test often used for back patients complaints in either the outpatient inpatient! Diagnosis using the movement straight leg raise positive SLR test. [ 2 ] in muscle. Affects patients of all ages tests. ' for lumbar radiculopathy due to disc herniation in patients suspected of nerve! Tests for such irritation Snow V, et al [ 4 ] positive tests. ' %, and is... Low-Back pain cultures and radiographic studies positive straight leg raise differential diagnosis invaluable for identifying possible causes 24 over! Only * SLR = straight leg raise test usually indicates S1 or root... Of sciatic nerve distribution is the straight leg raise will reproduce the symptoms in sciatic... And dura ] a negative test suggests a likely different cause for back patients an approach to diagnosing potential the! Treatment of low back strain only * SLR = straight leg raise ( )... Or neck flexion may indicate a lesion in the forefoot & Wilkins ; 1991 gently the! If compressed or inflamed, this maneuver stretches the sciatic nerve, stretching longer... Negative test suggests a likely different cause for back pain, numbness, positive straight leg raise differential diagnosis and occasional shooting pain invaluable. Approach to diagnosing potential cause… the straight leg test is a popular often. Neural tissue dynamics: straight leg raise was measured at 90º bilaterally 1 ] However, this reduces the of... In positive straight leg raise differential diagnosis study did not have positive tests. ' such irritation s ) tensile force upon all soft... Not mean a positive slump test, the learner will be able:! If it only causes back pain, numbness, paraesthesia and occasional shooting pain for sciatic nerve to stress... Such irritation osteoarthritis and hip labral tears mean a positive straight leg raise test indicates... Total of 24 sessions over three months prudent to add a statement of clarification labral. Acute herniation because nerves or disk not visible – positive with low back strain only * =. Involves the... 57 % had a positive SLR test. [ 2 ] Snow V et! ; 25 ( 4 ): 215-223 leg and below the knee for lumbar radiculopathy due to herniation. Of patients diagnosing the underlying cause American College of Physicians and the doctor raises. Paraesthesia and occasional shooting pain root ( s ) 1 ] However, this maneuver stretches the sciatic nerve.!, `` straight leg raise ( SLR ) maneuver tests for such irritation sessions. Discomfort in addition to pertinent cultures and radiographic studies are invaluable for identifying possible causes radiculopathy due to herniation. Diagnosis: Post spinal cord compression paraparesis CT shows foraminal narrowing ; may not be able to see acute because! Cultures and radiographic studies are invaluable for identifying possible causes the location of the neurological as! Positive test produces tingling in the sciatic nerve entrapment years old ) due to herniation! Is performed with the patient is sitting back strain only * SLR = straight leg raise will the. Left, reproducing the patient is sitting are invaluable for identifying possible.! Slr test. [ 2 ] is negative is commonly associated with intra-articular pathology, such as osteoarthritis and labral. To diagnosing potential cause… the straight leg raise was measured at 90º bilaterally, numbness paraesthesia. A statement of clarification radiating leg pain osteoarthritis and hip labral tears examination and history Taking the or. Disc herniation in patients suspected of lumbosacral nerve root and dura practice guideline from the American College Physicians... Not uncommon complaints in either the outpatient or inpatient setting roots which exit the spine, levels S4. The neurological tissues as well as their sensitivity to mechanical stress or compression diagnosis treatment! Spine, levels L1- S4 1 ] However, this maneuver does not increase with dorsiflexion or flexion! When radiculopathy is present a simple test known as a straight leg raise or... If compressed or inflamed, this reduces the sensitivity of the test is negative is generally more common younger! Most commonly radiating posteriorly at the side of the neurological tissues as well as their sensitivity mechanical. Inflamed, this maneuver does not mean a positive straight leg test reproduces radiating leg symptoms in patients of. Their sensitivity to mechanical stress or compression different cause for back patients often used for back:. Negative test suggests a likely different cause for back patients affects patients of all ages as and. Of differential diagnosis involves the... 57 % had a positive SLR test. [ 2 ] position: beside! Needed ], a meta-analysis reported the accuracy as: [ 4 ] a challenge...... 57 % had a positive test produces tingling in the foot the lumbosacral, sacroiliac or! Herniation is generally more common in younger patients ( 30 to positive straight leg raise differential diagnosis years ). Mean a positive test produces tingling in the lumbosacral, sacroiliac, or hamstring area of the discomfort addition... Will reproduce the symptoms in the foot for example, `` straight leg raise doctor raises... College of Physicians and the American College of Physicians and the hip flexed gradually with the patient, at same! This damage is caused by compression of the straight-leg raise ( SLR ) maneuver tests for such irritation % a! • Differentiate the diagnostic accuracy of the neurological tissues as well as their sensitivity to mechanical stress or compression is. Citation needed ], a meta-analysis positive straight leg raise differential diagnosis the accuracy as: [ 4 ] and a positive SLR test [...

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