|
[article] | Titre : |
Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms |
| Type de document : |
Article |
| Auteurs : |
Harald Ekedahl ; Bo Jönsson ; Marten Annertz |
| Article en page(s) : |
p. 726-735 |
| Langues : |
Anglais (eng) |
| Descripteurs : |
HE Vinci
Imagerie par résonance magnétique ; Rééducation et réadaptation
|
| Mots-clés : |
Magnetic resonance imaging Neurologic examination Examen neurologique Radiculopathy Radiculopathie Reproducibility of Results Reproductibilité des résultats |
| Résumé : |
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. |
| Disponible en ligne : |
Oui |
| En ligne : |
https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...] |
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 4 (2018) . - p. 726-735
[article] Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms [Article] / Harald Ekedahl ; Bo Jönsson ; Marten Annertz . - p. 726-735. Langues : Anglais ( eng) in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 4 (2018) . - p. 726-735 | Descripteurs : |
HE Vinci
Imagerie par résonance magnétique ; Rééducation et réadaptation
|
| Mots-clés : |
Magnetic resonance imaging Neurologic examination Examen neurologique Radiculopathy Radiculopathie Reproducibility of Results Reproductibilité des résultats |
| Résumé : |
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. |
| Disponible en ligne : |
Oui |
| En ligne : |
https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...] |
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