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== Purpose  ==


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The Slump Test is a neural tension test used to detect altered neurodynamics or neural tissue sensitivity.<ref>Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-Based Clinician. Buckner: Evidence in Motion; 2008.</ref><br>


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== Technique<ref>Dutton M. Orthopaedic Examination, Evaluation and Intervention. 2nd ed. New York: McGraw-Hill Companies, Inc.; 2008.</ref>  ==


<br>
'''Note:'''


== Purpose<br>  ==
The slump test is described differently among sources. The common factor among sources is the reproduction of pain as tension is applied to the dura during testing. The technique depicted below is adapted from Mark Dutton.


The Slump Test is a neural tension test used to detect altered neurodynamics or neural tissue sensitivity.<ref>Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-Based Clinician. Buckner: Evidence in Motion; 2008.</ref><br>
'''Description:'''


== Technique<ref>Dutton M. Orthopaedic Examination, Evaluation and Intervention. 2nd ed. New York: McGraw-Hill Companies, Inc.; 2008.</ref><br> ==
To begin the test, have the patient seated with hands behind back to achieve a neutral spine. The first step is to have the patient slump forward at the thoracic and [[Lumbar Anatomy|lumbar]] spine. If this position does not cause pain, have the patient flex the neck by placing the chin on the chest and then extending one knee as much as possible.  


A positive sign for the Slump Test is reproduction of pain that is unrelieved by a change in tension of the dura.  
If extending the knee causes pain, have the patient extend the neck into neutral. If the patient is still unable to extend the knee due to pain, the test is considered positive.  


To begin the test, have the patient seated with hands behind back to achieve a neutral spine. The first step is to have the patient slump forward at the thoracic and lumbar spine. If this position is negative,&nbsp;have the patient flex the neck by placing the chin on the chest and then extending&nbsp;one knee as much as possible.  
If extending the knee does not cause pain, ask the patient to actively dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex the knee while still dorsiflexing. If the pain is reproduced, the test is considered positive.  


If&nbsp;this position causes pain, have the patient extend the neck into neutral. If the patient is still unable to extend the&nbsp;knee due to pain, the&nbsp;test is considered positive.&nbsp;
Repeat test on opposite side.  


If&nbsp;extending the knee&nbsp;does not cause pain, ask the patient to actively dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex the knee while still dorsiflexing. If the pain is reproduced, the test is considered positive.
Over-pressure can be applied during any of the test positions.  
 
Repeat test on opposite side.  


Overpressure can be applied during any of the test positions.
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{{#ev:youtube|8Qknf8yyMFQ}}<br>
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== Evidence  ==
== Evidence  ==


In patients with lumbar disc herniations, sensitivity was found to be 0.84 and specificity 0.83.<ref>Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol. Apr 2008;14(2):87-91.</ref><br>
'''Some caution is needed''' as the diagnostic accuracy of the slump test is under debate! During the slump test,<ref name="Maitland 1985">Maitland GD. The slump test: Examination and treatment. Austr J Physiother, 1985; 31: 215-219.</ref>the neural structures within the vertebral canal and foramen are slowly and progressively put on maximum stretch. A recent Cochrane review (on physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain), also looked at the available data on the Slump test.<ref name="van der Windt 2010">van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev, 2010; 17(2): CD007431.</ref> The authors listed two studies<ref name="Majlesi 2008">Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol, 2008; 14: 87–91.</ref><ref name="Stankovic 1999">Stankovic R, Johnell O, Maly P, Willner S. Use of lumbar extension, slump test, physical and neurological examination in the evaluation of patients with suspected herniated nucleus pulposus. A prospective clinical study. Man Ther, 1999; 4: 25–32.</ref> that reported results on the slump test. Stankovic et al (1999) present the results of the slump test at different cut-off values (angles at which pain occurred), showing that sensitivity of the slump test was poor (0.44, 95% CI:0.34 to 0.55), and specificity only slightly better (0.58, 95% CI:0.28 to 0.85) when using a strict cut-off (pain radiating below the knee).&nbsp;Sensitivity increased (but specificity decreased) when using a milder cut-off (pain anywhere).<ref name="Stankovic 1999" /> Majlesi et al (2008) reported similar sensitivity (0.84), but higher specificity (0.83), using an unknown cut-off for a positive test result.<ref name="Majlesi 2008" /> So it was not clear when a test was scored as “positive”. Also, the higher specificity might partly be the result of the case control design of this study: patients with back pain were selected as controls if MRI findings were completely normal.&nbsp;
 
   
== Resources ==
== References  ==
 
add any relevant resources here
 
== References<br> ==


<references />  
<references />  


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Latest revision as of 22:51, 31 January 2021

Original Editor - Whitney Bass and Kim Bevillard

Top Contributors - Kim Bevillard, Admin, Whitney Bass, Evan Thomas, Eric Robertson, Kim Jackson, Matthew Gregory, Laura Ritchie, Tony Lowe, Erik Thoomes, Kai A. Sigel, WikiSysop, Claire Knott, Wanda van Niekerk, Lucinda hampton and Rachael Lowe

Purpose[edit | edit source]

The Slump Test is a neural tension test used to detect altered neurodynamics or neural tissue sensitivity.[1]

Technique[2][edit | edit source]

Note:

The slump test is described differently among sources. The common factor among sources is the reproduction of pain as tension is applied to the dura during testing. The technique depicted below is adapted from Mark Dutton.

Description:

To begin the test, have the patient seated with hands behind back to achieve a neutral spine. The first step is to have the patient slump forward at the thoracic and lumbar spine. If this position does not cause pain, have the patient flex the neck by placing the chin on the chest and then extending one knee as much as possible.

If extending the knee causes pain, have the patient extend the neck into neutral. If the patient is still unable to extend the knee due to pain, the test is considered positive.

If extending the knee does not cause pain, ask the patient to actively dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex the knee while still dorsiflexing. If the pain is reproduced, the test is considered positive.

Repeat test on opposite side.

Over-pressure can be applied during any of the test positions.

Evidence[edit | edit source]

Some caution is needed as the diagnostic accuracy of the slump test is under debate! During the slump test,[3]the neural structures within the vertebral canal and foramen are slowly and progressively put on maximum stretch. A recent Cochrane review (on physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain), also looked at the available data on the Slump test.[4] The authors listed two studies[5][6] that reported results on the slump test. Stankovic et al (1999) present the results of the slump test at different cut-off values (angles at which pain occurred), showing that sensitivity of the slump test was poor (0.44, 95% CI:0.34 to 0.55), and specificity only slightly better (0.58, 95% CI:0.28 to 0.85) when using a strict cut-off (pain radiating below the knee). Sensitivity increased (but specificity decreased) when using a milder cut-off (pain anywhere).[6] Majlesi et al (2008) reported similar sensitivity (0.84), but higher specificity (0.83), using an unknown cut-off for a positive test result.[5] So it was not clear when a test was scored as “positive”. Also, the higher specificity might partly be the result of the case control design of this study: patients with back pain were selected as controls if MRI findings were completely normal. 

References[edit | edit source]

  1. ↑ Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-Based Clinician. Buckner: Evidence in Motion; 2008.
  2. ↑ Dutton M. Orthopaedic Examination, Evaluation and Intervention. 2nd ed. New York: McGraw-Hill Companies, Inc.; 2008.
  3. ↑ Maitland GD. The slump test: Examination and treatment. Austr J Physiother, 1985; 31: 215-219.
  4. ↑ van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev, 2010; 17(2): CD007431.
  5. ↑ 5.0 5.1 Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol, 2008; 14: 87–91.
  6. ↑ 6.0 6.1 Stankovic R, Johnell O, Maly P, Willner S. Use of lumbar extension, slump test, physical and neurological examination in the evaluation of patients with suspected herniated nucleus pulposus. A prospective clinical study. Man Ther, 1999; 4: 25–32.
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