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

Ekedahl, Harald LU ; Jönsson, Bo LU ; Annertz, Mårten LU and Frobell, Richard B. LU (2018) In Archives of Physical Medicine and Rehabilitation 99(4). p.726-735
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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Magnetic resonance imaging, Neurologic examination, Radiculopathy, Rehabilitation, Validity of results
in
Archives of Physical Medicine and Rehabilitation
volume
99
issue
4
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85044130123
ISSN
0003-9993
DOI
10.1016/j.apmr.2017.11.006
language
English
LU publication?
yes
id
4d87e870-482e-4e82-a973-20072243a548
date added to LUP
2018-04-04 12:37:38
date last changed
2019-01-06 13:49:47
@article{4d87e870-482e-4e82-a973-20072243a548,
  abstract     = {<p>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.</p>},
  author       = {Ekedahl, Harald and Jönsson, Bo and Annertz, Mårten and Frobell, Richard B.},
  issn         = {0003-9993},
  keyword      = {Magnetic resonance imaging,Neurologic examination,Radiculopathy,Rehabilitation,Validity of results},
  language     = {eng},
  month        = {04},
  number       = {4},
  pages        = {726--735},
  publisher    = {Elsevier},
  series       = {Archives of Physical Medicine and Rehabilitation},
  title        = {Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms},
  url          = {http://dx.doi.org/10.1016/j.apmr.2017.11.006},
  volume       = {99},
  year         = {2018},
}