Accuracy of physical examination for chronic lumbar radiculopathy
Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests...
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| Veröffentlicht in: | BMC musculoskeletal disorders 2013-07, Vol.14 (1), p.206-206, Article 206 |
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| description | Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain.
A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.
The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR |
| doi_str_mv | 10.1186/1471-2474-14-206 |
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A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.
The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06-37.21) for L4, 1.74 (95% CI 1.04-2.93) for L5, and 1.29 (95% CI 0.97-1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed.
The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians' overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.</description><identifier>ISSN: 1471-2474</identifier><identifier>EISSN: 1471-2474</identifier><identifier>DOI: 10.1186/1471-2474-14-206</identifier><identifier>PMID: 23837886</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Accuracy ; Adult ; Back pain ; Back surgery ; Care and treatment ; Chronic Disease ; Clinical medical disciplines: 750 ; Confidence intervals ; Diagnosis ; Exercise Test ; Female ; Fysikalsk medisin og rehabilitering: 764 ; Health sciences ; Hospitals ; Humans ; Klinisk medisinske fag: 750 ; Low Back Pain - diagnosis ; Low Back Pain - etiology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Medical disciplines: 700 ; Medical imaging ; Medical research ; Medicine, Experimental ; Medisinske Fag: 700 ; Middle Aged ; Musculoskeletal diseases ; Nerve Compression Syndromes - complications ; Nerve Compression Syndromes - diagnosis ; Neurosciences ; Neurosurgery ; NMR ; Nuclear magnetic resonance ; Periodic health examinations ; Physical diagnosis ; Physical Examination - methods ; Physical medicine and rehabilitation: 764 ; Radiculopathy ; Radiculopathy - diagnosis ; Radiculopathy - etiology ; Radiologi og bildediagnostikk: 763 ; Radiology and diagnostic imaging: 763 ; Reproducibility of Results ; Spinal Nerve Roots - pathology ; Studies ; Surgery ; Tomography ; Tomography, X-Ray Computed ; VDP ; Young Adult</subject><ispartof>BMC musculoskeletal disorders, 2013-07, Vol.14 (1), p.206-206, Article 206</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Iversen et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Copyright © 2013 Iversen et al.; licensee BioMed Central Ltd. 2013 Iversen et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b640t-e1994f57a1ba5ab0cbe447de454c01c119635f17788693d717348f1ddd0ba2e93</citedby><cites>FETCH-LOGICAL-b640t-e1994f57a1ba5ab0cbe447de454c01c119635f17788693d717348f1ddd0ba2e93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716914/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716914/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,26566,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23837886$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iversen, Trond</creatorcontrib><creatorcontrib>Solberg, Tore K</creatorcontrib><creatorcontrib>Romner, Bertil</creatorcontrib><creatorcontrib>Wilsgaard, Tom</creatorcontrib><creatorcontrib>Nygaard, Øystein</creatorcontrib><creatorcontrib>Waterloo, Knut</creatorcontrib><creatorcontrib>Brox, Jens Ivar</creatorcontrib><creatorcontrib>Ingebrigtsen, Tor</creatorcontrib><title>Accuracy of physical examination for chronic lumbar radiculopathy</title><title>BMC musculoskeletal disorders</title><addtitle>BMC Musculoskelet Disord</addtitle><description>Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain.
A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.
The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06-37.21) for L4, 1.74 (95% CI 1.04-2.93) for L5, and 1.29 (95% CI 0.97-1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed.
The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians' overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.</description><subject>Accuracy</subject><subject>Adult</subject><subject>Back pain</subject><subject>Back surgery</subject><subject>Care and treatment</subject><subject>Chronic Disease</subject><subject>Clinical medical disciplines: 750</subject><subject>Confidence intervals</subject><subject>Diagnosis</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Fysikalsk medisin og rehabilitering: 764</subject><subject>Health sciences</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Klinisk medisinske fag: 750</subject><subject>Low Back Pain - diagnosis</subject><subject>Low Back Pain - etiology</subject><subject>Lumbar Vertebrae</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical disciplines: 700</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Medisinske Fag: 700</subject><subject>Middle Aged</subject><subject>Musculoskeletal diseases</subject><subject>Nerve Compression Syndromes - complications</subject><subject>Nerve Compression Syndromes - diagnosis</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Periodic health examinations</subject><subject>Physical diagnosis</subject><subject>Physical Examination - methods</subject><subject>Physical medicine and rehabilitation: 764</subject><subject>Radiculopathy</subject><subject>Radiculopathy - diagnosis</subject><subject>Radiculopathy - etiology</subject><subject>Radiologi og bildediagnostikk: 763</subject><subject>Radiology and diagnostic imaging: 763</subject><subject>Reproducibility of Results</subject><subject>Spinal Nerve Roots - pathology</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><subject>VDP</subject><subject>Young Adult</subject><issn>1471-2474</issn><issn>1471-2474</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>3HK</sourceid><recordid>eNp1UsFu1DAQjRCIlsKdUxWJC5cUT-zY8QVptaIFqRIXOFsTx-66SuzFTlD373HYdrWLinzwaObNm5k3UxTvgVwBtPwTMAFVzQSrgFU14S-K84Pr5ZF9VrxJ6Z4QEC2Vr4uzmrZUtC0_L1YrreeIelcGW243u-Q0DqV5wNF5nFzwpQ2x1JsYvNPlMI8dxjJi7_Q8hC1Om93b4pXFIZl3j_9F8fP6y4_11-r2-8239eq26jgjU2VASmYbgdBhgx3RnWFM9IY1TBPQAJLTxoJY2pK0FyAoay30fU86rI2kF8XnPe927kbTa-OniIPaRjdi3KmATp1GvNuou_BbUQFcAssEl3sCHV2anFc-RFRACBWKk1pkwHoP6Fz4T4XTiA6jWjRWi8bZUnkFmeXjY58x_JpNmtTokjbDgN6EOWUYAK9Fy5eCH_6B3oc5-qxiRhHZUEHhCHWHg1HO25CL64VUrRrKMpf82_zVM6j8ejM6HbyxLvtPEsiTHCGlaOxhUCBqua7nRrs8XsEh4emc6B9WYcfk</recordid><startdate>20130709</startdate><enddate>20130709</enddate><creator>Iversen, Trond</creator><creator>Solberg, Tore K</creator><creator>Romner, Bertil</creator><creator>Wilsgaard, Tom</creator><creator>Nygaard, Øystein</creator><creator>Waterloo, Knut</creator><creator>Brox, Jens Ivar</creator><creator>Ingebrigtsen, Tor</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>3HK</scope><scope>5PM</scope></search><sort><creationdate>20130709</creationdate><title>Accuracy of physical examination for chronic lumbar radiculopathy</title><author>Iversen, Trond ; Solberg, Tore K ; Romner, Bertil ; Wilsgaard, Tom ; Nygaard, Øystein ; Waterloo, Knut ; Brox, Jens Ivar ; Ingebrigtsen, Tor</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b640t-e1994f57a1ba5ab0cbe447de454c01c119635f17788693d717348f1ddd0ba2e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Accuracy</topic><topic>Adult</topic><topic>Back pain</topic><topic>Back surgery</topic><topic>Care and treatment</topic><topic>Chronic Disease</topic><topic>Clinical medical disciplines: 750</topic><topic>Confidence intervals</topic><topic>Diagnosis</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Fysikalsk medisin og rehabilitering: 764</topic><topic>Health sciences</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Klinisk medisinske fag: 750</topic><topic>Low Back Pain - diagnosis</topic><topic>Low Back Pain - etiology</topic><topic>Lumbar Vertebrae</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical disciplines: 700</topic><topic>Medical imaging</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Medisinske Fag: 700</topic><topic>Middle Aged</topic><topic>Musculoskeletal diseases</topic><topic>Nerve Compression Syndromes - complications</topic><topic>Nerve Compression Syndromes - diagnosis</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Periodic health examinations</topic><topic>Physical diagnosis</topic><topic>Physical Examination - methods</topic><topic>Physical medicine and rehabilitation: 764</topic><topic>Radiculopathy</topic><topic>Radiculopathy - diagnosis</topic><topic>Radiculopathy - etiology</topic><topic>Radiologi og bildediagnostikk: 763</topic><topic>Radiology and diagnostic imaging: 763</topic><topic>Reproducibility of Results</topic><topic>Spinal Nerve Roots - pathology</topic><topic>Studies</topic><topic>Surgery</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed</topic><topic>VDP</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iversen, Trond</creatorcontrib><creatorcontrib>Solberg, Tore K</creatorcontrib><creatorcontrib>Romner, Bertil</creatorcontrib><creatorcontrib>Wilsgaard, Tom</creatorcontrib><creatorcontrib>Nygaard, Øystein</creatorcontrib><creatorcontrib>Waterloo, Knut</creatorcontrib><creatorcontrib>Brox, Jens Ivar</creatorcontrib><creatorcontrib>Ingebrigtsen, Tor</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC musculoskeletal disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iversen, Trond</au><au>Solberg, Tore K</au><au>Romner, Bertil</au><au>Wilsgaard, Tom</au><au>Nygaard, Øystein</au><au>Waterloo, Knut</au><au>Brox, Jens Ivar</au><au>Ingebrigtsen, Tor</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy of physical examination for chronic lumbar radiculopathy</atitle><jtitle>BMC musculoskeletal disorders</jtitle><addtitle>BMC Musculoskelet Disord</addtitle><date>2013-07-09</date><risdate>2013</risdate><volume>14</volume><issue>1</issue><spage>206</spage><epage>206</epage><pages>206-206</pages><artnum>206</artnum><issn>1471-2474</issn><eissn>1471-2474</eissn><abstract>Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain.
A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.
The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06-37.21) for L4, 1.74 (95% CI 1.04-2.93) for L5, and 1.29 (95% CI 0.97-1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed.
The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians' overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>23837886</pmid><doi>10.1186/1471-2474-14-206</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Accuracy Adult Back pain Back surgery Care and treatment Chronic Disease Clinical medical disciplines: 750 Confidence intervals Diagnosis Exercise Test Female Fysikalsk medisin og rehabilitering: 764 Health sciences Hospitals Humans Klinisk medisinske fag: 750 Low Back Pain - diagnosis Low Back Pain - etiology Lumbar Vertebrae Magnetic Resonance Imaging Male Medical disciplines: 700 Medical imaging Medical research Medicine, Experimental Medisinske Fag: 700 Middle Aged Musculoskeletal diseases Nerve Compression Syndromes - complications Nerve Compression Syndromes - diagnosis Neurosciences Neurosurgery NMR Nuclear magnetic resonance Periodic health examinations Physical diagnosis Physical Examination - methods Physical medicine and rehabilitation: 764 Radiculopathy Radiculopathy - diagnosis Radiculopathy - etiology Radiologi og bildediagnostikk: 763 Radiology and diagnostic imaging: 763 Reproducibility of Results Spinal Nerve Roots - pathology Studies Surgery Tomography Tomography, X-Ray Computed VDP Young Adult |
| title | Accuracy of physical examination for chronic lumbar radiculopathy |
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