Sciatica, Lumboischialgia: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing).
    • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
    • Gait (fluid, limping).
    • Body or joint posture (upright, bent, gentle posture; asymmetries? (pelvic obliquity (= leg length difference < 2 cm), scoliosis); increased or decreased thoracic kyphosis?, lumbar lordosis?)
    • Malpositions (deformities, contractures, shortenings).
    • Muscle atrophies (side comparison!, if necessary circumference measurements).
  • Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); [soft tissue swelling; tenderness (localization! ); restricted mobility (spinal movement restrictions); “tapping signs” (testing for painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain?; compression pain, anterior, lateral or saggital); hyper- or hypomobility?]
  • Functional tests (regional tests)
    • Straight leg raising test (leg raising test): if the test is positive, then shortening of the dorsal leg muscles (pseudolasègue) or nerve stretching pain must be differentiated (true lasègue).
    • Amplification of the pain by:
      • Hip flexion of the leg extended at the knee (Lasègue’s sign* ); additionally dorsiflexion of the foot (Bragard’s sign).
      • Increased cervical spine flexion (Kernig sign).
      • Hyperextension of the hip joint (Wassermann’s sign).
      • Pressure on the intervertebral space below L 5 or S 1.
  • Neurological examination – including testing of reflexes and determination of muscle strength and testing of the Lasègue sign. The Lasègue test (synonyms: Lasègue sign, Lazarević sign or Lasègue-Lazarević sign) describes a possible stretching pain of the sciatic nerve and/or spinal nerve roots in the lumbar (lumbar spine) and sacral (sacrum) segments of the spinal cord. Procedure: The patient lies flat on his back when performing the Lasègue test. The extended leg is passively flexed (bent) at the hip joint by up to 70 degrees. If there is a pain reaction, flexion (bending) is not continued to the physiologically possible flexion. Lasègue test positive: If there is significant pain in the leg up to an angle of about 45 degrees, shooting into the leg from the back and radiating below the knee, the test is considered positive. This is called a positive Lasègue sign.
  • Cancer screening
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.