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Arch Phys Med Rehabil. 2018 Apr;99(4):726-735. doi: 10.1016/j.apmr.2017.11.006. Epub 2017 Dec 15.

Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms.

Author information

1
Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden. Electronic address: harald.ekedahl@med.lu.se.
2
Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
3
Department of Radiology, Lund University Hospital, Lund, Sweden.

Abstract

OBJECTIVES:

To investigate the accuracy of 3 commonly used neurodynamic tests (slump test, straight-leg raise [SLR] test, femoral neurodynamic test) and 2 clinical assessments to determine radiculopathy (radiculopathy I, 1 neurologic sign; radiculopathy II, 2 neurologic signs corresponding to 1 specific nerve root) in detecting magnetic resonance imaging (MRI) findings (extrusion, subarticular nerve root compression, and foraminal nerve root compression).

DESIGN:

Validity study.

SETTING:

Secondary care.

PARTICIPANTS:

We included subjects (N=99; mean age, 58y; 54% women) referred for epidural steroid injection because of lumbar radicular symptoms who had positive clinical and MRI findings. Positive clinical findings included the slump test (n=67), SLR test (n=50), femoral neurodynamic test (n=7), radiculopathy I (n=70), and radiculopathy II (n=33). Positive MRI findings included extrusion (n=27), subarticular nerve compression (n=14), and foraminal nerve compression (n=25).

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Accuracy of clinical tests in detecting MRI findings was evaluated using sensitivity, specificity, and receiver operating characteristics analysis with area under the curve (AUC).

RESULTS:

The slump test had the highest sensitivity in detecting extrusion (.78) and subarticular nerve compression (1.00), but the respective specificity was low (.36 and .38). Radiculopathy I was most sensitive in detecting foraminal nerve compression (.80) but with low specificity (.34). Only 1 assessment had a concurrent high sensitivity and specificity (ie, radiculopathy II) in detecting subarticular nerve compression (.71 and .73, respectively). The AUC for all tests in detecting extrusion, subarticular nerve compression, and foraminal nerve compression showed ranges of .48 to .60, .63 to .82, and .33 to .57, respectively.

CONCLUSIONS:

In general, the investigated neurodynamic tests or assessments for radiculopathy lacked diagnostic accuracy. The slump test was the most sensitive test, while radiculopathy II was the most specific test. Most interestingly, no relationship was found between any neurodynamic test and foraminal nerve compression (foraminal stenosis) as visualized on MRI.

KEYWORDS:

Magnetic resonance imaging; Neurologic examination; Radiculopathy; Rehabilitation; Validity of results

PMID:
29253501
DOI:
10.1016/j.apmr.2017.11.006
[Indexed for MEDLINE]

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