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The straight leg raise is a test that can be performed during a physical examination, with the leg being lifted actively by the patient or passively by the clinician. If the straight leg raise is done actively by the patient, it is a test of functional leg strength, particularly the rectus femoris element of the quadriceps (checking both hip flexion and knee extension strength simultaneously).
To perform a femoral nerve stretch test, a patient lies prone, the knee is passively flexed to the thigh and the hip is passively extended (reverse Lasègues). [2] The test is positive if the patient experiences anterior thigh pain. [2]
Involuntary extension of the "normal" leg occurs when flexing the contralateral leg against resistance. To perform the test, the examiner should hold one hand under the heel of the "normal" limb and ask the patient to flex the contralateral hip against resistance (while the patient is supine), asking the patient to keep the weak leg straight while raising it.
The neurologic exam, straight leg raise, and femoral nerve stretch are typically normal. Abnormal signs may be revealed if the patient is observed walking until they exhibit NC. For example, a positive "stoop test" is observed if bending forward or stooping while walking relieves symptoms. [2]
If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip. This constitutes a positive Thomas test. [2] Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present.
A positive Trendelenburg's sign is caused by weakness or ineffective action of the abductor muscles of the lower limb, the gluteus medius muscle and the gluteus minimus muscle. [2] Damage to the motor nerve supply of the lateral gluteal muscles (gluteus medius muscle and gluteus minimus muscle)
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, [1] but not deeper investigation such as neuroimaging.
Distraction tests: positive tests are rechecked when the patient's attention is distracted, such as a straight leg raise test; Regional disturbances: regional weakness or sensory changes which deviate from accepted neuroanatomy; Overreaction: subjective signs regarding the patient's demeanor and reaction to testing