pain in back of the thigh

[physiobob]

Hi Physiobob,

interested by your comment on SLR, particularly the specific value of 30 degrees to validate discal involvement. Have you got the references for this value?

Hi Craig, don't ahve a reference but I'll look for it. This however is what is in my old notes from the Uni of Sydney. As stated my comment is however in relation to discal herniation and not anything else, hence my comment on the SLR being positive 'For What'. The SLR in many ways is pretty useless as perhaps more of the population have ranges of hip flexion for this under 60 degress than those above 60 degrees, at least it seems that way in the clinic (for males that is).

In one online GP resource I did find the following commment:

# Interpretations: What patient experiences

Interpretations: What patient experiences

1. Radiating pain into the legs

• 1. Suggests radiculopathy
• 2. Higher likelihood findings suggesting radiculopathy
  • 1. Excruciating sciatica-like pain
  • 2. Pain occurs at 30 to 40 degrees of leg elevation

2. Crossed pain into opposite leg

• 1. Indicates severe impingement
• 2. Almost always due to a large disk herniation

Here's also a few interesting abstracts

Spine. 1992 Apr;17(4):395-9.
Straight leg raising test versus radiologic size, shape, and position of lumbar disc hernias.
Thelander U, Fagerlund M, Friberg S, Larsson S.

Department of Orthopaedic Surgery, University Hospital, Umea, Sweden.

In 30 patients with a computed tomography-verified lumbar disc herniation, the relation between the straight leg raising test and the size, shape, and position of the hernia was evaluated before, 3, and 24 months after inception of nonoperative treatment. Hernia size was expressed as an index relating it to the size of the spinal canal. The limitation of the straight leg raising test was not related to size or position of the hernia. Before treatment, straight leg raising was equally restricted in patients with sharply pointed or blunt hernias, but after 3 months straight leg raising was less limited in patients with sharply pointed hernias, whereas after 24 months straight leg raising was regularly normalized. Size index was lower for sharply pointed hernias at all three computed tomography scans. A decrease in hernia size over time, irrespective of shape, was not correlated to a concomitant improvement in straight leg raising. It must be presumed that additional factors, such as inflammatory reactions affecting the nerve roots, are of importance for the magnitude of straight leg raising.

PMID: 1579873 [PubMed - indexed for MEDLINE]


J Bone Joint Surg Am. 1987 Apr;69(4):517-22.
Significance of the straight-leg-raising test in the diagnosis and clinical evaluation of lower lumbar intervertebral-disc protrusion.
Xin SQ, Zhang QZ, Fan DH.

The cases of 113 patients who had protrusion of a lumbar intervertebral disc were analyzed to determine the relationship between the findings at operation and the location of the pain that resulted from the straight-leg-raising test. The study showed a close relationship between the location of the pain and the position of the protrusion of the disc. The degree of limitation of straight-leg raising was also found to have a direct relationship to the size and position of the protrusion and to its relationship to the spinal nerve. The protrusions were classified into three types according to position in relation to the dura mater and to the pattern of pain that was induced by passive straight-leg raising. On straight-leg raising, central protrusions tended to cause pain in the back, lateral protrusions caused pain in the lower extremity, and intermediate protrusions caused both. On this basis, the distribution of pain on straight-leg raising allowed an accurate prediction of the location of the lesion in 100 (88.5 per cent) of the 113 patients.

PMID: 3571310 [PubMed - indexed for MEDLINE]

Spine. 1979 Mar-Apr;4(2):174-5.
Myelographic defect on the side opposite the leg pain. A case report with an explanation of mechanism of action.
Auld AW, DeWall JG.

An explanation for leg pain on the opposite side of the myelographic defect in one case is reported. Disc herniation was located superior to the exit of the root and thus displaced the dura and compressed the root on the opposite side against the pedicle producing contralateral leg pain

PMID: 264033 [PubMed - indexed for MEDLINE]