Usefulness of clinical tests for assessing radicular and pseudoradicular components of pain in diagnosing sciatica - A pilot study

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 disdisc in a chronic state should be checked for the frequency of involvement of the sacroiliac joint. © 2013 Termedia Sp. z o.o.