Physical Exam Helps Diagnose Source of Lumbar Pain

Physical exam tests can accurately predict lumbar nerve impingement presence and location

FRIDAY, Jan. 21 (HealthDay News) Physical examination tests can help diagnose the presence of nerve root impingement in the low lumbar and midlumbar regions as well as pinpoint level specific impingement in the low lumbar region, according to a study published in the Jan. 1 issue of Spine.

Pradeep Suri, M.D., of New England Baptist Hospital in Boston, and colleagues calculated the likelihood ratios (LRs) that individual tests and test combinations would yield useful diagnostic information regarding the presence and level of lumbar nerve root impingement. Fifty-four patients with lumbosacral radicular pain underwent a series of physical exam tests, and the results were compared to findings from magnetic resonance imaging.

For midlumbar impingement, the researchers found moderate to large changes from pre-test to post-test probability (LRs ≥ 5.0) using the femoral stretch test (FST), crossed-FST, medial ankle pinprick sensation, and patellar reflex testing as well as the combination of the FST and either patellar reflex testing or the sit-to-stand test. For diagnosing lower lumbar impingement, the Achilles reflex test had a LR of ≥ 5.0. The anterior thigh sensation test was diagnostic of a nerve impingement at L2; patellar reflex testing, medial ankle sensation, or crossed FST at L4; and hip abductor strength at L5. LRs were increased using test combinations for L4 impingement only.

"Optimizing the accuracy of the physical examination is a goal worthy of further study, to improve the array of cost-effective diagnostic tools available in specialty spine care," the authors write.

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