The Accuracy of the Physical Examination for the Diagnosis of Midlumbar and Low Lumbar Nerve Root Impingement
- 1 January 2011
- journal article
- diagnostics
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 36 (1), 63-73
- https://doi.org/10.1097/brs.0b013e3181c953cc
Abstract
Study Design. Cross-sectional study with prospective recruitment. Objective. To determine the accuracy of the physical examination for the diagnosis of midlumbar nerve root impingement (L2, L3, or L4), low lumbar nerve root impingement (L5 or S1) and level-specific lumbar nerve root impingement on magnetic resonance imaging, using individual tests and combinations of tests. Summary of Background Data. The sensitivity and specificity of the physical examination for the localization of nerve root impingement has not been previously studied. Methods. Sensitivities, specificities, and likelihood ratios (LRs) were calculated for the ability of individual tests and test combinations to predict the presence or absence of nerve root impingement at midlumbar, low lumbar, and specific nerve root levels. Results. LRs ≥5.0 indicate moderate to large changes from pre-test probability of nerve root impingement to post-test probability. For the diagnosis of midlumbar impingement, the femoral stretch test (FST), crossed FST, medial ankle pinprick sensation, and patellar reflex testing demonstrated LRs ≥5.0 (LR ∞). LRs ≥5.0 were observed with the combinations of FST and either patellar reflex testing (LR 7.0; 95% confidence interval [CI] 2.3–21) or the sit-to-stand test (LR ∞). For the diagnosis of low lumbar impingement, the Achilles reflex test demonstrated an LR ≥5.0 (LR 7.1; 95% CI 0.96–53); test combinations did not increase LRs. For the diagnosis of level-specific impingement, LRs ≥5.0 were observed for anterior thigh sensation at L2 (LR 13; 95% CI 1.8–87); FST at L3 (LR 5.7; 95% CI 2.3–4.4); patellar reflex testing (LR 7.7; 95% CI 1.7–35), medial ankle sensation (LR ∞), or crossed FST (LR 13; 95% CI 1.8–87) at L4; and hip abductor strength at L5 (LR 11; 95% CI 1.3–84). Test combinations increased LRs for level-specific root impingement at the L4 level only. Conclusion. Individual physical examination tests may provide clinical information that substantially alters the likelihood that midlumbar impingement, low lumbar impingement, or level-specific impingement is present. Test combinations improve diagnostic accuracy for midlum-bar impingement.Keywords
This publication has 37 references indexed in Scilit:
- Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back painCochrane Database of Systematic Reviews, 2010
- The STARD Statement for Reporting Diagnostic Accuracy Studies: Application to the History and Physical ExaminationJournal of General Internal Medicine, 2008
- SPORT Lumbar Intervertebral Disk Herniation and Back PainSpine, 2008
- Surgical vs Nonoperative Treatment for Lumbar Disk HerniationJAMA, 2006
- Surgical vs Nonoperative Treatment for Lumbar Disk HerniationJAMA, 2006
- Muscle Mass, Muscle Strength, and Muscle Fat Infiltration as Predictors of Incident Mobility Limitations in Well-Functioning Older PersonsThe Journals of Gerontology: Series A, 2005
- Lumbar Disc DegenerationSpine, 2004
- Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compressionJournal of Neurology, Neurosurgery & Psychiatry, 2002
- Extreme lateral lumbar disc herniation: Clinical presentation in 178 patientsActa Neurochirurgica, 1994
- Neurologic Patterns in Unilateral SciaticaSpine, 1981