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ORIGINAL PAPER
Usefulness of clinical tests for assessing radicular and pseudoradicular components of pain in diagnosing sciatica – a pilot study
 
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Submission date: 2013-04-24
 
 
Acceptance date: 2013-07-25
 
 
Online publication date: 2013-09-11
 
 
Publication date: 2013-08-30
 
 
Reumatologia 2013;51(4):265-270
 
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ABSTRACT
Objectives: Varied and complicated aetiology of pain originating from the sacro-lumbar area with radiation to the lower limb is still causing disagreement and controversies around the issue of its diagnosis and treatment. Patients with low back pain radiating to the lower limb (sciatica) are clinically divided into two groups, radicular or pseudoradicular disorders. It is difficult to perform full diagnostics of these problems due to the lack of gold standards. The aim of the study was to evaluate which diagnostic tests may help in assessment of localization of pain and involvement of soft tissue in the pain pathomechanism.
Material and methods: Fifty patients with sciatica were checked using Lasegue’s test, crossed straight leg raising test (xSLR), Bragard’s test, and five sacroiliac joint (SIJ) tests: Yeoman manoeuvre, Patrick’s test, Gaenslen’s manoeuvre, Gillet test (Stork test), and standing flexion test.
Results: The results of Lasegue’s test and Bragard’s procedure showed a statistically significant correlation. Bragard’s procedure was not confirmed for the patients with a bulging disc. Crossed SLR test was confirmed only in patients with hernia. In all patients with xSLR positive test result for the Bragard’s procedure was confirmed. A positive result for at least one SI test was proven in 98% of patients, and four or five tests were confirmed in 20% of patients.
Conclusions: Simultaneous use of Lasegue’s test and Bragard’s procedure seems to be advisable but is not enough to prove sciatica as a cause of radicular pain. Patients with sciatica related to a bulging disc in a chronic state should be checked for the frequency of involvement of the sacroiliac joint.
REFERENCES (17)
1.
Baron R, Binder A. How neuropathic is sciatica? The mixed pain concept. Orthopade 2004; 33: 568-575.
 
2.
Sembrano JN, Polly DW Jr. How often is low back pain not coming from the back? Spine (Phila Pa 1976) 2009; 34: E27-E32.
 
3.
Buijs E, Visser L, Groen G. Sciatica and the sacroiliac joint: a forgotten concept. Br J Anaesth 2007; 99: 713-716.
 
4.
Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth 2007; 99: 461-473.
 
5.
Porchet F, Wietlisbach V, Burnand B, et al. Relationship between severity of lumbar disc disease and disability scores in sciatica patients. Neurosurgery 2002; 50: 1253-1259.
 
6.
Takahashi K, Shima I, Porter RW. Nerve root pressure in lumbar disc herniation. Spine (Phila Pa 1976)1999; 24: 2003-2006.
 
7.
McCarron RF, Wimpee MW, Hudkins PG, Laros GS. The inflammatory effects of nucleus pulposus. A possible element in the pathogenesis of low back pain. Spine (Phila Pa 1976) 1987; 12: 760-764.
 
8.
Boss N, Semmer N, Elfering E, et al. Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging. Spine (Phila Pa 1976) 2000; 25: 1484-1492.
 
9.
van der Wurf P, Bujis EJ, Groen GJ. A multitest regimen of pain provocation tests as an aid to reduse unnecessary minimal invasive sacroiliac joint procedures. Arch Phys Med Rehabil 2006; 87: 10-14.
 
10.
Rebain R, Baxter GD, McDonough S. A systematic review of the passive straight leg raising test as a diagnostics aid for low back pain. Spine (Phila Pa 1976) 2002; 27: E388-E395.
 
11.
Rubinstein SM, van Tulder M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol 2008; 22: 471-482.
 
12.
Majlesi J, Togay H, Ünalan H, Toprak S. The sensitivity and specificity of the slump and straight leg raising tests in patients with lumbar disc herniation. J Clin Rheum 2008; 14: 87-91.
 
13.
Rolke R. Pseudoradicular and radicular low-back pain – A disease continuum Rather than different entities? Reply to the letters by Leffler and Hansson and by Van Boxem et al. Pain 2008; 135: 314-316.
 
14.
Bush K, Cowan N, Katz DE, Gishen P. The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976) 1992; 17: 1205-1211.
 
15.
Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine (Phila Pa 1976) 1994; 19: 1475-1482.
 
16.
Slippman CW, Whyte II WS, Chow DW, et al. Sacroiliac joint syndrome. Pain Physician 2001; 4: 143-152.
 
17.
Vleeming A, Van Wingerden JP, Snijders CJ, et al. Load application to the sacrotuberous ligament: influences on sacroiliac joint mechanics. Clin Biomech 1989; 4: 204-209.
 
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
eISSN:2084-9834
ISSN:0034-6233
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