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 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.
Keywords
List of abbreviations:
AUC (area under the curve), DH (disk herniation), DOR (diagnostic odds ratio), MRI (magnetic resonance imaging), SLR (straight-leg raise), TESI (transforaminal epidural steroid injection)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 15, 2017
Footnotes
Supported by Region Skåne, Sweden.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
