Neurological Examination : Specific Test

Question 1

What is the purpose of lumbar radiculopathy test ?

Answer 1

Find clues to the presence of radiculaire irritation in a patient complaining of radiating pain in the leg.

Question 2

What do you inspect in case of lumbar radiculopathy test ?

Answer 2

Preferential posture and deformities of the spinal column.
Determine the degree of flexion :
- measure finger - floor distance when they bend forward. More than 25 cm => test positive
- is there pain when they bend backward then lean on both side ?

Question 3

What muscle strength test do you do in case of lumbar radiculopathy testing ?

Answer 3

Walk on heels and toes then deep knee bend.
Test individuals muscles.

Question 4

What do you need to pay attention to while doing the sensory examination in lumbar radiculopathy ?

Answer 4

Dermatose L4-5, S1, saddle area.

Question 5

Which reflexes do you look at in case of lumbar radiculopathy ?

Answer 5

Patellar and ankle jerk.

Question 6

Step of the straight leg raise test :

Answer 6

= Lasègue sign
Supine patient :
Raise extended leg slowly with hand under heel
- avoid compensatory movement : tensing of the hip may be caused by pain

Positive test => radiating pain below the knee
- note the angle made

Question 7

Step of Bragard’s test :

Answer 7

Immediately do after straight leg raise.

Lower extended leg until no pain
Bring foot in dorsiflexion

Positive test => pain return

Question 8

Step of the crossed straight leg raise test :

Answer 8

Raise unaffected leg at hip keep extended

Positive test => radiating pain in the affected leg

Question 9

Step of the reverse straight leg raise test :

Answer 9

Prone patient
Extend affected leg at the hip

Positive test => radiating pain on the anterior aspect of the tight

Question 10

What are the causes of radiculaire syndrome ?

Answer 10

It is due to a root compression that can be the result of :
- herniated nucleus pulposus (HNP)
- tumors
- spondylarthrosis
- spondylolisthesis
- root irritation caused by diabetes or neuroborreliosis

Question 11

What is HNP ?

Answer 11

Herniated nucleus pulposus : a slipped disc.
Protrusion/herniation of the central part of the vertebral disc into the vertebral space causing a compression of the spinal cord roots

Question 12

How do you detect corrective lumbar scoliosis ?

Answer 12

Seen on inspection because the patient lean on open side to reduce the compression / pain.
=> antalgic posture

Question 13

What are the indications of a radicular syndrome ?

Answer 13

Reduced degree of flexion : finger floor distance >25 cm
Returning to straight posture is pleasant except if there’s ligament pain while standing then it’s more painful.

Question 14

What is the clinical significance of a positive straight leg raise test ?

Answer 14

Consistent with disorder of the root that is stretched via sciatic nerve in particular L5, S1.
OR
Due to sciatica with peripheral cause.

Question 15

What is the clinical significance of a positive reverse straight leg raise test ?

Answer 15

Radicular syndrome at L3, L4 => femoral nerve disorder.