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Cited by 89Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationPeripheral Nerve Disorders

The accuracy of the physical examination for the diagnosis of midlumbar and low lumbar nerve root impingement

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Suri, Pradeep, Rainville, James, Katz, Jeffrey N., Jouve, Cristin, Hartigan, Carol, Limke, Janet, Pena, Enrique, Li, Ling +2 more·2011·Spine
DOI 10.1097/brs.0b013e3181c953ccPMC PMC2978791
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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.

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  1. [16]O'Brien MD Brain. Introduction Aids to the Examination of the Peripheral Nervous System 2000 4 ed London WB Saunders for The Guarantors of Brain 1 2
  2. [35]Dawson B Trapp RG Methods of Evidence-Based Medicine and Decision Analysis Basic & Clinical Biostatistics 2004 4 ed New York Lange Medical Books/McGraw-Hill 326

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Authors
Suri, P., Rainville, J., Katz, J. N., Jouve, C., Hartigan, C., Limke, J., Pena, E., Li, L., Swaim, B., & Hunter, D. J.
Affiliations
  • New England Baptist Hospital (US)
  • Brigham and Women's Hospital (US)
Corresponding author
  • Suri, Pradeep
  • Rainville, James
  • Jouve, Cristin
  • Hartigan, Carol
  • Limke, Janet
  • Li, Ling
  • Swaim, Bryan
  • Hunter, David J.
ORCID
Venue
Spine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-01
Volume
36
Issue
1
Pages
63-73
ISSN
0362-2436 (ISSN-L)
DOI
10.1097/brs.0b013e3181c953cc
PMC
PMC2978791
OpenAlex
W1986597153
Cited by
89
References
34
Citations by year
2026: 4 · 2025: 8 · 2024: 11 · 2023: 5 · 2022: 2 · 2021: 7 · 2020: 7 · 2019: 1 · 2018: 12 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 7 · 2013: 2 · 2012: 8
FWCI
3.46
Type
journal article
Language
en
Open access
Locations
  • Spine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (acceptedVersion)
Funders
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR002123, K24-AR02123)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD001097, K12HD01097)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Peripheral Nerve Disorders
Keywords
nerve root compression, lumbar radiculopathy, physical examination, diagnostic accuracy, patellar reflex, Achilles tendon reflex, sit-to-stand test, hip abductor strength, likelihood ratios, sensitivity and specificity, magnetic resonance imaging comparison, low back pain, sciatica, lumbar nerve roots
MeSH terms
Adult, Aged, Boston, Cross-Sectional Studies, Disability Evaluation, Female, Humans, Lumbar Vertebrae, Magnetic Resonance Imaging, Male, Middle Aged, Nerve Compression Syndromes, Neurologic Examination, Pain Measurement, Physical Examination, Predictive Value of Tests, Prospective Studies, Surveys and Questionnaires, Reflex, Sensation, Sensitivity and Specificity, Spinal Nerve Roots, Likelihood Functions, Low Back Pain, Lower Extremity, Muscle Strength

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