Crossed Straight Leg Raise Test

What is a central disc herniation?

A central disc herniation occurs when the soft inner gel of an intervertebral disc (nucleus pulposus) protrudes through a tear in the outer layer (annulus fibrosus) into the central spinal canal. This herniation can compress the spinal cord or nerve roots, leading to significant pain and neurological symptoms. It is a common condition, particularly in the lumbar region, which can cause lower back pain and radiculopathy. Early diagnosis and appropriate treatment are crucial to prevent chronic pain and disability.

Clinical tests such as the Straight Leg Raise Test, Bragard's Test, and Lasègue's sign are essential for diagnosing herniated discs and differentiating patients with isolated lower back pain from those with associated radiculopathy.

Symptoms

Central disc herniation can present with a range of symptoms depending on the severity and location of the herniation. Common symptoms include:

• Intense lower back pain
• Pain radiating down one or both legs (sciatica)
• Numbness or tingling in the legs or feet
• Muscle weakness in the lower extremities
• Loss of bladder or bowel control in severe cases (cauda equina syndrome)

Causes

Several factors can contribute to the development of a central disc herniation. Common causes include:

• Aging and degenerative disc disease
• Repetitive stress or heavy lifting
• Trauma or injury to the spine
• Poor posture and prolonged sitting
• Genetic predisposition

What is the Crossed Straight Leg Raise Test?

The Crossed Straight Leg Raise Test, also known as the well-leg raising test or Fajersztajn sign, is a clinical diagnostic tool used to assess the presence of central disc herniation. This test was first described by Fajersztajn in 1901 and is based on the principle that when the unaffected leg is raised, pain is experienced on the affected side due to nerve root irritation or compression. The test is considered positive if raising the contralateral leg produces pain in the affected leg at a hip flexion angle of 40 degrees (Hudgins, 1979).

The Crossed Straight Leg Raise Test is particularly useful in diagnosing lumbar disc herniation with severe nerve root impingement. It is also a part of the clinical neurological examination and physical examination used to diagnose lumbar and sacral radiculopathy. Unlike the standard straight leg raise test, it has a higher specificity, making it a more reliable indicator of major nerve root compression. This specificity means it is more likely to correctly identify patients with significant nerve root issues. However, its sensitivity is lower, meaning it might not detect all cases of disc herniation.

In clinical practice, the test is performed with the patient in a supine position. The examiner flexes the unaffected leg at the hip while keeping the knee extended. If the patient reports pain in the affected leg at a certain angle, the test is considered a positive test, indicating a high likelihood of central disc herniation. Despite its diagnostic value, the test results should be interpreted cautiously due to inter-rater reliability variability.

How to use our Crossed Straight Leg Raise Test template

Using our Crossed Straight Leg Raise Test template is simple. This template is designed to help healthcare professionals accurately assess and document the presence of central disc herniation in patients.

Step 1: Download our template

First, download the Crossed Straight Leg Raise Test template from our website.

Step 2: Prepare the patient

Ensure the patient is in a supine position on a comfortable examination table. Explain the procedure to the patient to ensure they understand what will happen.

Step 3: Perform the test

With the patient lying supine, identify the unaffected leg. Gently flex the unaffected leg at the hip while maintaining knee extension. Monitor the patient’s response to any pain in the affected leg.

Step 4: Document the results

Record the patient's response, noting whether they report pain in the affected leg at a hip flexion angle of 40 degrees. Use the provided grid in the template to document the results for both the left and right sides.

Step 5: Analyze and proceed

Analyze the results in conjunction with other clinical findings to diagnose lumbar nerve root compression. Magnetic resonance imaging evidence can be crucial in confirming lumbar nerve root compression in patients with low back pain and leg pain. If the test is positive, consider further diagnostic imaging or referral to a specialist for comprehensive management.

Benefits of using our template

Using our Crossed Straight Leg Raise Test template offers several advantages that can enhance your clinical practice. Here are three key benefits:

Standardized assessment

Our template ensures a standardized approach to performing the Crossed Straight Leg Raise Test, which helps maintain consistency and accuracy across different assessments. This standardization is crucial for reliable diagnosis and effective patient management.

Easy documentation

The template provides a structured format for recording test results, making it easier for healthcare professionals to document findings clearly and concisely. This improves record-keeping and facilitates better communication among medical teams.

Time efficiency

Our pre-formatted template allows clinicians to save time on documentation and focus more on patient care. The streamlined process allows for quicker assessments and more efficient use of clinical time, ultimately benefiting both healthcare providers and patients.

Reference

Hudgins, W. R. (1979). The crossed straight leg raising test: A diagnostic sign of herniated disc. Journal of Occupational Medicine: Official Publication of the Industrial Medical Association, 21(6), 407–408. https://pubmed.ncbi.nlm.nih.gov/469603/