STUDY ON DIAGNOSTICS
The study below was a comprehensive review of the reliability of neurological examination for detecting disc herniation. The conclusion was that neurological examination itself was not very accurate at predicting disc herniation. I found this interesting because I have correctly diagnosed disc herniation over the years using neurological examination but this was in addition to a complete orthopeadic physical examination of the lumbar spine and hip. The other point to note is that most of these studies in the systematic review likely involved testers who did not have extensive experience in musculo-skeletal injuries. It would be nice to conduct a study with experienced orthopeadic physiotherapists using physical examination with neurological testing for accuracy in predicting disc herniation. Then we could see how the two compare. Food for thought.
Al Nezari NH, Schneiders AG, Hendrick PA. Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis. Spine J. 2013 Jun;13(6):657-74. doi: 10.1016/j.spinee.2013.02.007. Epub 2013 Mar 15. (Review)
Disc herniation is a common low back pain (LBP) disorder, and several clinical test procedures are routinely employed in its diagnosis. The neurological examination that assesses sensory neuron and motor responses has historically played a role in the differential diagnosis of disc herniation, particularly when radiculopathy is suspected; however, the diagnostic ability of this examination has not been explicitly investigated.
To review the scientific literature to evaluate the diagnostic accuracy of the neurological examination to detect lumbar disc herniation with suspected radiculopathy.