Rheumatology

Answer 2 Radicular pain on a contralateral straight leg test. This crossover test is the most sensitive test for a herniated lumbar disc. Lumbar disc pressure is highest in the flexed forward position (100% greater than the standing position), resulting in increased pain with that position and decreased pain when the pressure is lowest (the reclining supine position). As a result of the decreased pressure when lying down, it is worthwhile to consider prescribing 48 hours of bed rest. Loss of the ankle joint reflex can be seen in a normal population and therefore is less specific in diagnosing disc herniation. Urinary or bowel incontinence suggests cauda equina syndrome. Click here to return to the questions

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