Which statement about the straight leg raise (SLR) test in lumbar disc disease is correct?

• A A positive SLR has higher specificity than sensitivity for L5 and S1 radiculopathy
• B The test is most useful for diagnosing upper lumbar disc prolapse affecting L2 to L4 roots
• C Reproduction of low back pain alone constitutes a positive test
• D Pain reproduced in the opposite leg on raising the affected leg has higher specificity than a positive SLR on the affected side ✓

Explanation

The crossed SLR (pain radiating into the symptomatic leg when the asymptomatic leg is raised) is less sensitive but considerably more specific for disc herniation. The SLR stretches the lumbosacral nerve roots and is highly sensitive for L5 and S1 radiculopathy but poorly specific. Reproducing back pain alone is not a positive result, and upper lumbar root compression is assessed with the femoral stretch test instead.

Reference: Apley's System of Orthopaedics and Fractures, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.