Straight-leg-raising test

Straight-leg-raising test (SLR), also known as Lasègue's sign, is a medical test used to diagnose suspected lumbar nerve root impingement, commonly known as sciatica. This test is often performed during a physical examination when a patient presents with lower back pain or symptoms of sciatic nerve compression.

Procedure

The straight-leg-raising test is conducted with the patient lying down on their back on an examination table. The healthcare provider lifts the patient's leg while keeping the knee straight. This action stretches the sciatic nerve and compresses the lumbar nerve roots. The test is considered positive if it reproduces the patient's sciatic pain or lower back pain. The angle at which the pain begins provides an indication of the severity of the nerve impingement. Typically, an angle between 30 and 70 degrees is considered indicative of sciatica.

Interpretation

A positive SLR test suggests lumbar disc herniation or other conditions causing nerve root impingement. However, a negative test does not rule out lumbar disc pathology. The test's sensitivity and specificity vary, but it is a valuable tool in the clinical assessment of patients with lower back pain.

Variations

Several variations of the straight-leg-raising test exist, including the crossed straight-leg-raising test, also known as the Fajersztajn's test, where raising the unaffected leg provokes pain in the affected leg. This variation is considered more specific but less sensitive than the standard SLR test.

Clinical Significance

The straight-leg-raising test is a fundamental component of the neurological examination for patients with lower back pain. It helps in identifying the presence of lumbar radiculopathy and guiding further diagnostic testing and treatment options. Despite its utility, the SLR test should be interpreted in the context of a comprehensive clinical assessment.

Limitations

The accuracy of the SLR test can be affected by the examiner's technique, the patient's pain tolerance, and the presence of other medical conditions. It is also important to note that the test can produce false positives in patients with tight hamstring muscles or other non-spinal causes of leg pain.

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