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Orthopaedics
Straight Leg Raising Test
Built from Pillemer — Physical Signs in Orthopaedics and Neurology
What’s inside
7 sections · 48 slides
Overview
- What this topic teaches you
- How we will build the picture
- The big idea in one slide
The Straight Leg Raising Test
What it detects, how to do it, and how to read it
- What is the SLR test?
- Sensitive, but not specific - what that means
- How to perform the test - the setup
- How to perform the test - doing it safely
- Lasegue's test - a useful add-on
- An important catch: tight hamstrings
The Medicolegal Setting
Why SLR is used to judge whether an injury is genuine
- Why the SLR test enters the courtroom
- Waddell's landmark 1980 paper
- What a 'distraction test' means
- SLR as Waddell's distraction test
- The distraction manoeuvre at the bedside
The Challenge
Why the author doubts this interpretation
- The sign that is rarely questioned
- What the author actually observes
- Backed by documented cases
Three Cases
Genuine patients who show the disputed pattern
- Case 1 - a proven S1 nerve root lesion
- Case 1: limited straight leg raise lying down
- Case 1: much greater range when seated
- A key precaution when testing seated
- Case 2 - a left S1 lesion, surgery declined
- Case 2: severely restricted raise lying down
- Case 2: greater range when seated
- Case 3 - the pattern without sitting up
- Case 3: restricted raise with both legs flat
- Case 3: raise improves when the other leg is bent up
Why It Happens
Two proposed mechanisms for the improvement
- Setting the boundaries first
- Hypothesis 1 - radiculopathy
- Hypothesis 2 - tight hamstrings and the pelvis
- The pelvic see-saw behind Hypothesis 2
- Try it on yourself - the self-test
- Self-test: the starting position
- Self-test: back arched, raise limited
- Self-test: back rounded, raise increased
Why It Matters
The consequences for injured workers
- Passing on information 'from authority'
- The conclusion
- Key takeaways
- A patient with an absent ankle reflex and S1 sensory loss raises the leg further seated than lying down. Is he faking?
- References
- Physical Signs in Orthopedic and Neurologic Disorders: A Practical Guide