Crossed Straight Leg Raise Test

Original Editor - Jonathan Wong Top Contributors - Jonathan Wong and Chelsea Mclene

Background[edit | edit source]

The crossed straight leg raise test, also known by “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[edit | edit source]

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[edit | edit source]

With 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 affected leg at a hip flexion angle of 40 degrees[1].

Evidence[edit | edit source]

  • A systematic review establishes the crossed straight leg raise test (XSLR) 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[3].
  • 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[4].

Clinical considerations[edit | edit source]

Lack of inter-rater reliability means test results should be interpreted with caution for diagnosis[4].

Resources[edit | edit source]

References[edit | edit source]