Crossed Straight Leg Raise Test
Background
The crossed straight leg raise test (XSLR), also known as “well-leg raising test” or “Fajersztajn sign”, was first noted by Fajersztajn in 1901. It refers to 'when the contralateral or unaffected leg is flexed at the hip, the patient experiences pain on the ipsilateral or affected side' [1].
Purpose
A positive test suggests central disc herniation in cases of severe nerve root irritation or compression, and is associated with a lumbar disc herniation in 97% of patients [1]. The XSLR is usually only positive in patients with major nerve root impingement, and is more specific than the straight leg raise test [2].
Technique
With the patient in supine, the examiner flexes their unaffected leg at the hip while maintaining knee extension. The test is deemed positive when patient reports pain in the affected (contralateral) leg at a hip flexion angle of 40 degrees [1].
Here is a video that explains how to perform the Crossed Straight Leg Test, and the indication of a positive finding:
Evidence
- A systematic review establishes the crossed straight leg raise test as having low sensitivity but high specificity [1]. However, these results were from populations with a very high prevalence of disc herniation and a severe spectrum of disease, and cannot be generalised to populations with lower prevalences. There is insufficient evidence for the clinical utility of the XSLR in diagnosing disc herniation in primary care populations and other patient populations not (yet) referred for surgery [4].
- Intra-rater reliability for a positive XSLR was moderate to substantial, while inter-rater reliability for a positive XSLR in two “mixed” samples of participants was essentially none to moderate [5].
Clinical Considerations
Lack of inter-rater reliability means that the test results should be interpreted with caution for diagnosis [5].
References
- ↑ 1.0 1.1 1.2 1.3 Hudgins WR. The crossed-straight-leg-raising test. New England Journal of Medicine. 1977;297(20):1127–.
- ↑ Windt D, Simons E, Riphagen I, Ammendolia C, Verhagen A, Laslett M, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane database of systematic reviews. 2010;2011(2):CD007431–CD007431.
- ↑ The Student Physical Therapist. Crossed Straight Leg Raise Test. Available from: https://www.youtube.com/watch?v=5oFp7Krd9qk&ab_channel=TheStudentPhysicalTherapist (accessed 24 September 2024).
- ↑ Windt D, Simons E, Riphagen I, Ammendolia C, Verhagen A, Laslett M, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane database of systematic reviews. 2010;2011(2):CD007431–CD007431.
- ↑ 5.0 5.1 Nee RJ, Coppieters MW, Boyd BS. Reliability of the straight leg raise test for suspected lumbar radicular pain: A systematic review with meta-analysis. Musculoskeletal science & practice. 2022;59:102529–102529.