Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France.
Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France.
Joint Bone Spine. 2021 Jan;88(1):105030. doi: 10.1016/j.jbspin.2020.06.004. Epub 2020 Jun 16.
Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasègue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasègue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasègue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.
坐骨神经痛的诊断主要依赖于腰椎神经根拉伸时的疼痛再现,因为神经系统检查和病史通常不足以保证诊断。直腿抬高试验(SLR)是最常用的方法,但它并不完美,并且并不总是能得到很好的执行或解释。SLR 结束时的被动踝关节背屈(Bragard 试验)更敏感,但在某些坐骨神经痛病例中也可能正常。其他拉伸试验可以帮助识别下肢疼痛定义不明确的患者的腰椎神经根损伤:首先是 Christodoulides 试验,即通过股神经拉伸试验再现 L5 坐骨神经痛;其次是 Slump 试验,让患者坐在座位上,缓慢伸展疼痛的腿,然后被动弯曲颈部(或相反);最后是弓弦试验,在 Lasègue 试验结束时,一旦膝关节稍微弯曲,就在腘窝内按压腓总神经和/或胫神经的走行,以尝试再现患者感觉到的确切疼痛。所有这些测试结合起来不到 2 分钟,可提高物理检查诊断坐骨神经痛的敏感性和特异性。本文综述了 Lasègue/SLR 试验的局限性以及这些其他拉伸腰椎神经根试验的效果。
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