Bend patient and assess space of line between l5 spinous and 10 cm above. The straight leg raise test also called the Lasegue test, is a fundamental neurological maneuver during the physical examination of the patient with lower back pain aimed to assess the sciatic compromise due to lumbosacral nerve root irritation. Is this sciatica? The straight leg raise (SLR) or Lasegue's sign is a widely used test to assess the sciatic nerve in cases of back pain. The straight leg raise (SLR) maneuver tests for such irritation. 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.  |  Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Increased sciatica on raising the opposite or "well" leg, the crossed straight leg raising (XSLR) sign, is associated with a herniated lumbar disc in 97% of patients. 44. van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, & Aertgeerts B. About Us Our Team Annual Report Our Culture Contact Disclosures, ALiEMU ALiEM Cards Chief Resident Incubator Faculty Incubator Wellness Think Tank, ACEP Annals of Emergency Medicine EBSCO Health-DynaMed Plus Essentials of Emergency Medicine SAEM The Teaching CoOp US Acute Care Solutions Western Journal of Emergency Medicine. By passively elevating the patient’s extended right leg, this maneuver stretches the sciatic nerve. crossed straight leg raise test is. NLM We aim to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education. crossed straight leg raise test is a topic covered in the Taber's Medical Dictionary. Because most disk herniations occur at the L4-L5 and L5-S1 level, you should test for irritation of the L4-S1 nerve roots. It is possible for patients with this sign to have a normal myelogram, but 90% of them will prove nevertheless to have a herniated disc. To view the entire topic, please sign in or purchase a subscription. If elevating their LEFT leg passively reproduces pain down his/her affected RIGHT leg, this is highly predictive of a sciatic radiculopathy and disk herniation. Straight Leg Raise. Is there a more specific test? Neurosurg Clin N Am. ALiEM Founder, Bridge to EM: Senior Medical Student Curriculum, GroundED in EM: A Third-Year Student Curriculum. In a 2010 Cochrane review, the SLR test yielded a high sensitivity (92%) and low specificity (28%). Patient position: Supine lying. A randomized clinical trial of the effectiveness of mechanical traction for sub-groups of patients with low back pain: study methods and rationale. Please enable it to take advantage of the complete set of features! 1981 Apr 1;124(7):879-82. Clipboard, Search History, and several other advanced features are temporarily unavailable. This site needs JavaScript to work properly. Additional Notes: In the cadaveric study, Fajersztajn showed that the crossed straight leg raise test can increase strain in the dura and contralateral lumbosacral nerve roots (3, 4). Can Med Assoc J. Although widely used, the test has limited diagnostic accuracy when diagnosing herniated discs. ALiEM is not endorsed by, sponsored by, or affiliated with the University of California San Francisco or any institution. Your account has been temporarily locked. Referencevan der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, & Aertgeerts B. [Electromyographical study of the straight leg raising test in lumbar disc herniation]. The crossed straight leg raise is used to evaluate lumbar disc herniation. Test Sensitivity: 80-98%; Test Specificity: 40-60%; Positive Likelihood Ratio: 2.0; Negative Likelihood Ratio: 0.2 to 0.5 (high Negative Predictive Value) Crossed Straight Leg Raise. It has also been shown that approximately one-thrid of the patients with confirmed disc protrusions have a positive crossed straight leg raise test (1). Modified straight leg raising test: a hypothetical clinical adjunct to distinguish two types of lumbar disc herniation preoperatively. Epub 2009 Mar 10. 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. 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