Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression
| Autor: | Arnold D. M. Kester, Patrick C. A. J. Vroomen, J. T. Wilmink, J. A. Knottnerus, M.C.T.F.M. De Krom |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Straight leg raise musculoskeletal diseases Paper medicine.medical_specialty Adolescent Physical examination Nerve root compression Sensitivity and Specificity Diagnosis Differential Sciatica Predictive Value of Tests Spinal cord compression Correspondence medicine Humans In patient Medical History Taking Radiculopathy Physical Examination Aged Paresis Aged 80 and over Neurologic Examination medicine.diagnostic_test business.industry Odds ratio Middle Aged medicine.disease Magnetic Resonance Imaging Surgery nervous system diseases Psychiatry and Mental health Cross-Sectional Studies Predictive value of tests Female Neurology (clinical) Radiology medicine.symptom Differential diagnosis business Clinical evaluation Myelography Lumbosacral joint |
| Popis: | Objective: To evaluate patient characteristics, symptoms, and examination findings in the clinical diagnosis of lumbosacral nerve root compression causing sciatica. Methods: The study involved 274 patients with pain radiating into the leg. All had a standardised clinical assessment and magnetic resonance (MR) imaging. The associations between patient characteristics, clinical findings, and lumbosacral nerve root compression on MR imaging were analysed. Results: Nerve root compression was associated with three patient characteristics, three symptoms, and four physical examination findings (paresis, absence of tendon reflexes, a positive straight leg raising test, and increased finger-floor distance). Multivariate analysis, analysing the independent diagnostic value of the tests, showed that nerve root compression was predicted by two patient characteristics, four symptoms, and two signs (increased finger-floor distance and paresis). The straight leg raise test was not predictive. The area under the curve of the receiver-operating characteristic was 0.80 for the history items. It increased to 0.83 when the physical examination items were added. Conclusions: Various clinical findings were found to be associated with nerve root compression on MR imaging. While this set of findings agrees well with those commonly used in daily practice, the tests tended to have lower sensitivity and specificity than previously reported. Stepwise multivariate analysis showed that most of the diagnostic information revealed by physical examination findings had already been revealed by the history items. |
| Databáze: | OpenAIRE |
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