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A patient is treated for low back pain with unilateral lower extremity radiculopathy. The MRI report indicates the patient’s condition is caused by a moderate L3 disk herniation. Which of the following special tests would be MOST likely to recreate the patient’s symptoms?

1. Straight leg raise test
2. Prone knee bending test
3. Slump test
4. Crossed straight leg raise test

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient is treated for low back pain with unilateral lower extremity radiculopathy. The MRI report indicates the patient’s condition is caused by a moderate L3 disk herniation. Which of the following special tests would be MOST likely to recreate the patient’s symptoms?

1. Straight leg raise test
2. Prone knee bending test
3. Slump test
4. Crossed straight leg raise test

Neurodynamic Mobility
There are several tests of neurodynamic mobility that can be used to assess the sensitivity of the nervous system to mechanical stress. These tests include the straight leg raise test, prone knee bending test, slump test, and crossed straight leg raise test.

This particular question requires knowledge of which of the tests target the L3 nerve root. 

Let’s explore each of the options:

Option 1 - Straight leg raise test
The straight leg raise test is performed with the patient in supine. The therapist flexes the patient’s hip while maintaining knee extension and then adds ankle dorsiflexion or cervical flexion to elicit symptoms. This test places tension on the sciatic nerve and therefore targets the lower lumbar and upper sacral nerve roots (i.e., L4-S2). 

Option 2 - Prone knee bending test
The prone knee bending test is performed with the patient in prone. The therapist flexes the patient’s knee to elicit symptoms. Unlike the other options that affect the sciatic nerve, this test places tension on the femoral nerve and therefore targets the upper lumbar nerve roots (i.e., L2-L4).

Option 3 - Slump test
The slump test is performed with the patient in sitting. The patient “slumps” into a position of lumbar and thoracic flexion and then brings their chin toward their chest. The therapist then passively moves the patient’s knee into extension and ankle into dorsiflexion to elicit symptoms. This test places tension on the sciatic nerve and therefore targets the lower lumbar and upper sacral nerve roots (i.e., L4-S2).

Option 4 - Crossed straight leg raise test
The crossed straight leg raise test is similar to the straight leg raise test, except it is performed on the unaffected extremity. If performing the maneuver on the unaffected extremity causes symptoms in the affected extremity, it indicates that a large disk protrusion is likely present. This test would still target the lower lumbar and upper sacral nerve roots (i.e., L4-S2).

The correct answer is Option 2

Let’s explore the all student data:
20% of students selected Option 1, Straight leg raise test
55% of students selected Option 2, Prone knee bending test, the correct response
15% of students selected Option 3, Slump test
10% of students selected Option 4, Crossed straight leg raise test

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 256 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!