straight leg raising test

straight leg raising test  SLRT

LASEGUE SIGN (SLRT)

• slowly raise the leg -knee extended – till patient reports pain
• intense pain in sacrum and leg – nerve root irritation (disk extrusion or tumor) – extra cranial compression of nerve root
• positive sign when shooting pain into leg along the course corresponding to motor or sensory dermatome of affected nerve root
• angle at which pain starts in degrees measured – indicates severity of nerve root irritation
• patient attempts to avoid pain by raising the pelvis on the side examined
• sacral or lumbar pain, increases slowly as leg raised or pain in posterior thigh in -pseudo radicular pain (pseudo Lasegue sign) [against true sciatica]
• degenerative joint disease ( facet syndrome)
• pelvic ligament irritation ( tendinitis)
• increased tension in hamstring
• 

LASEGUE SIGN (with patient seated)

• sitting at edge of examining table – flex hip with extended knee
• tries to avoid pain by leaning forward – using arms for support – FLIP or tripod sign

CONTRALATERAL LASEGUE SIGN (LASEGUE – MOUTAUD – MARTIN SIGN)

• non painful leg raise – knee extended
• movement of lifting the other leg referred to affected segment – cause sciatica at affected leg – in case of disk extrusion with nerve root irritation

BRAGARD TEST

• for differentiating genuine from pseudo Lasegue sign
• supine – heel in one hand – other hand over anterior knee – leg raised with knee extended - at onset of pain stop raising – lowered to the point of painlessness – passively dorsiflex into extreme position – typical pain elicited – d/t stretching of sciatic nerve
• positive Bragrad – nerve root compression – L4S1
• sensation of tension in calf – thrombosis – thrombophlebitis – contracture of gastrocnemius
• usually negative in malingerers

REVERSE LASEGUE TEST ( FEMORAL NERVE LASEGUE TEST)

• prone – passively raises leg – with flexion at knee
• hyper extension hip with knee flexed – traction of femoral nerve
• u/l or b/l radicular pain in sacrum or anterior thigh or leg – L3- L4 nerve root irritation

Stages of SLRT

• negative
• small protrusion
  • painful not limiting motion
  • painful arc
• painful – limited – no neurological deficit
• painful – limited – neurological deficit
• no motion with neurological deficit

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