Table 1 Descriptions of Physical Examination Tests and Involved Nerve Roots
From: Bias in the physical examination of patients with lumbar radiculopathy
Physical Examination Test | Description Of Test | Involved Nerve Roots |
|---|---|---|
1. Provocative testing | ||
Straight Leg Raise (SLR) | With the patient supine, the examiner grasps the patient's heel on the symptomatic (ipsilateral) side while maintaining the knee extended. The straight leg is slowly raised until pain occurs; reproduction of radicular pain constitutes a positive test1. | L5, S1 |
Crossed Straight Leg Raise (CSLR) | The straight leg raise test is performed as above, but is performed instead on the patient's well leg. Reproduction of radicular pain in the symptomatic limb constitutes a positive test1. | L5, S1 |
Femoral Stretch Test (FST) | With the patient prone, the examiner grasps the patient's ankle on the symptomatic (ipsilateral) side and facilitates ipsilateral knee flexion; reproduction of typical lower extremity pain constitutes a positive test. | L2, L3, L4 |
Crossed Femoral Stretch Test (CFST) | With the patient prone, the examiner grasps the patient's ankle on the asymptomatic (contralateral) side and facilitates contralateral knee flexion; reproduction of typical lower extremity pain constitutes a positive test. | L2, L3, L4 |
2. Motor testing | ||
Hip flexion test | The patient lies supine and flexes the ipsilateral hip while the examiner applies an extension force; inability to resist examiner is a positive test result. | L2 |
Sit-to-stand test | The test begins with the patient sitting and the examiner standing facing the patient. The patient rises to standing using only the strength of one supporting limb, holding the examiner's hands for balance; inability to do so is a positive test2. | L3 |
Heel walk test | The patient walks on heels only while avoiding contacting the floor with the forefoot, using the examiner's for balance as needed; inability to maintain the forefoot off the ground is a positive result. | L4 |
Great toe extensor strength | The patient fully dorsiflexes the great toe and maintains this position as the examiner applies a plantarflexion force; inability to do so is a positive result. | L5 |
Heel raise test | The patient stands on one foot while flexing the contralateral knee, and then plantarflexes the ankle, raising the heel of the supporting limb off the floor to maximal plantarflexion. Inability to perform 10 successive heel raises is a positive result. | S1 |
3. Sensory testing | ||
Anterior thigh sensation | Sensation is assessed by pinprick testing at the mid-anterior thigh using a standard 3 point grading scale3; any sensory impairment is a positive result. | L2 |
Medial knee sensation | Sensation is assessed by pinprick testing at the medial aspect of the knee; any sensory impairment is a positive result. | L3 |
Medial ankle sensation | Sensation is assessed by pinprick testing at the medial aspect of the ankle; any sensory impairment is a positive result. | L4 |
Great toe sensation | Sensation is assessed by pinprick testing at the dorsal aspect of the great toe; any sensory impairment is a positive result. | L5 |
Lateral foot sensation | Sensation is assessed by pinprick testing at the lateral border of the foot; any sensory impairment is a positive result. | S1 |
4. Reflex testing | ||
Patella reflex | Achilles deep tendon reflex is assessed using a standard 5 point grading scale4; diminished grade as compared to the contralateral limb is a positive result. | L4 |
Achilles reflex | Patellar deep tendon reflex is assessed and graded as above; diminished grade as compared to the contralateral limb is a positive result. | S1 |