Positive Lasegue symptom. Symptoms of Lasegue, Neri in neurology

Pain in the lumbar region is a fairly common occurrence. It can be caused by quite a variety of conditions. Pain in the lumbar region is recorded in the following pathologies:

vertebrogenic and discogenic lesions of nerve roots;
renal colic;
pancreatic diseases;
pathological changes in vertebral bone tissue.

The symptoms described by various authors, indicating pathology of the spinal disc segment, help to establish the cause of the pain syndrome, diagnose damage to the nerve roots and clarify the severity of the disease.

The most frequently studied phenomenon, which has diagnostic significance and also plays a role in determining the patient’s ability to work, is Lasegue’s symptom.

Mechanism of occurrence

In a normal state, in a healthy person, the nerve root is located freely in the intervertebral foramen, without tension and without causing pain when flexing the hip (except for some discomfort at extreme degrees of flexion).

Stretching of a nerve root becomes painful to one degree or another when it is pinched in the intervertebral foramen, as well as when it is stretched due to the convexity of a herniated intervertebral disc. In these situations, any strain while slowly lifting the lower limb will be painful.

A positive Lasègue symptom occurs when pain occurs when raising the hip less than 60 degrees. The appearance of discomfort or pain at an angle of more than 60 degrees may be a false-positive Lasegue symptom. This situation can arise even when examining a healthy person who leads a sedentary lifestyle or has reduced flexibility.

What diseases does a positive test indicate?

A symptom of tension may indicate the presence of the following pathologies:

Herniated discs of the lumbar region, which protrude to the side and change the course of the nerve roots.
Osteochondrosis. This pathology is accompanied by the formation of bone growths along the edges of the vertebrae, their displacement, as well as narrowing of the intervertebral foramina.
Large formations near the nerve roots. These can be hematomas, tumors of various types, abscesses.
Piriformis syndrome. With this pathology, the muscle in the obturator foramen of the pelvis spasms and puts pressure on the nerve, partially blocking its work.
Lesions of the sciatic nerve, which are observed with diabetes, infections or intoxication of the body.
Muscular-tonic syndromes.
Myositis.
Fetal pressure on the pelvic structures, which is observed in late pregnancy.

The test results are not a sufficient basis for making a particular diagnosis, as they may have a significant error due to the difference in the pain threshold of patients. It is for this reason that patients are additionally prescribed tests such as the Neri symptom or the Bekhterev-Fayerstein symptom. Based on all these tests, as well as additional studies, the disease can be accurately determined, and an adequate one can be selected.

How is Lasegue's symptom caused?

The symptom manifests itself when the lower leg is extended in a patient lying on his back with the hip flexed. The examination should be carried out carefully, without making sudden movements, since pain with a positive Lasègue symptom can be of high intensity. Lasègue's symptom is positive if pain occurs in the lumbar region, along the back of the thigh and lower leg of the corresponding side. Soreness is usually localized on the side of the affected nerve root. For example, Lasegue's sign on the right is caused by flexion of the right leg.

The first phase of Lasegue's symptom: the occurrence or appearance of pain in a patient lying on his back when trying to bend or flex an extended leg at the hip joint.
The second phase of Lasegue's symptom: if you subsequently bend the leg at the knee without straightening the hip joint, then the pain syndrome either disappears or its intensity sharply decreases.

An important point: it is not allowed to cause the Lasegue tension symptom after the use of anesthesia, since the protective pain reflex in such conditions is significantly reduced; manipulation in this case can lead to tearing of axons and cause motor disorders (up to paresis).

Diagnosis of pinched sciatic nerve

Accurate diagnosis and effective treatment of pinched sciatic nerve.
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Pinched sciatic nerve is a condition that can be caused by various reasons associated with pathological processes in the spinal column, muscles, and sacroiliac joint. It is important to establish the correct diagnosis, since the effectiveness of treatment depends on this.

To diagnose the causes of pinched sciatic nerve, the following studies are used:

X-ray of the lumbar spine.
Ultrasound examination of the spinal column.
CT scan.
MRI.
Electroneuromyography.

Doctor's appointment

During the initial appointment of a patient with symptoms of sciatic nerve compression, the doctor collects an anamnesis of the disease, life, and conducts an examination.

First of all, the doctor will most likely ask you the following questions:

How long have you had symptoms, how strong are they, how often do they bother you?
When did they first arise, what preceded it?
Do you experience a feeling of numbness or weakness in your legs?
Do pain and other symptoms get worse when you are in a certain position?
Does pain interfere with your daily activities?
What usually helps you cope with pain? Do you take any over-the-counter pain medications?
How do pain sensations change during the day?

It is important for the doctor to find out what profession the patient has, whether his work involves intense physical activity, heavy lifting, or, on the contrary, prolonged sitting in one place, and whether he plays sports. It is necessary to clarify whether there were any previous problems with the spine.

Medical examination

If a pinched sciatic nerve is suspected, the doctor examines the area of the lower back, sacrum, checks the tone and strength of the muscles of the lower back, lower extremities, and evaluates the sensitivity along the sciatic nerve using a special needle and brush. The doctor presses on certain points to identify pain.

The patient may be asked to do some physical exercise and asked if the pain gets worse during exercise. This helps to judge which nerve is affected:

squat down and stand up;
walk on tiptoes or on heels;
alternately raise the right and left outstretched legs, lying on your back;
lean forward, backward, to the sides (this helps to assess the mobility of the spine).

The doctor also evaluates the patient’s standing position and his gait.

To identify sciatic nerve irritation, your doctor will check for some specific symptoms:

Neri's symptom.
It is checked with the patient in the supine position. The doctor places his hand under the back of the patient's head and bends his head, bringing his chin to his chest. A symptom is considered positive if it causes pain in the lower back.
Lasègue's symptom.
The patient lies on his back. The doctor takes the patient's straightened leg with his hands and bends it at the hip joint. The result is assessed depending on how far the leg was lifted and how much pain it caused:

I degree:
pain occurs only when the leg is raised to 60 degrees, it is not very strong and goes away quickly. In this case, there is a slight protective tension in the muscles of the back and abdomen.
II degree:
moderate pain that occurs when raising the leg to 45 degrees. At the same time, the protective tension of the abdominal and back muscles is clearly visible.
III degree:
severe pain and sharp muscle tension occurs when the doctor raises the leg to 30 degrees.

Modified Lasègue symptom.
The patient lies on his stomach, his legs hanging off the couch. When bending the leg at the hip joint and lowering it down, pain occurs in the lower back.
Vengerov's sign.
They check the same way as Lasegue's symptom, but the patient's attention needs to be diverted. The fact that the symptom is positive is indicated by the tension of the abdominal muscles when raising the leg.
Bekhterev's symptom
. When Lasegue's symptom is tested on the “healthy” leg, pain occurs in the “sick” leg.
Landing symptom
. The patient is asked to sit in a supine position with legs straight. He can't do it, because of the pain he has to bend his legs.
Sicard's sign
. The patient, who is lying on his back, is asked to strongly bend the foot at the ankle joint towards the sole. The symptom is positive if pain occurs along the back of the leg, along the sciatic nerve.
Gowers-Sicard sign
. Pain in the area of the sciatic nerve occurs when the foot is flexed in the opposite direction, in the dorsal direction.
Turin's symptom
. The patient experiences severe pain along the back of the leg when dorsiflexing the big toe.
Marching test
. The doctor asks the patient to march in place and at the same time feels the muscles of the lower back. You can feel their intense tension.

Instrumental research methods

In some cases, diagnosis of the causes of a pinched sciatic nerve is limited only to a doctor’s examination. Additional diagnostic methods are not always needed. After examining the patient, the doctor can prescribe conservative treatment and further monitor his condition. If the pain does not go away and intensifies, movement and sensitivity disorders appear, you need to conduct an examination.

There are some symptoms that are called "red flags". If they are detected, this indicates that the patient may have a serious pathology, and, at a minimum, an x-ray should be immediately performed. Sometimes it is worth starting immediately with a CT scan and MRI.

Key red flags:

The pain is very strong, disturbing not only during movements and physical activity, but also at rest. Sometimes the pain intensifies at night and prevents sleep. This is how metastases of malignant tumors in the spine can manifest themselves.
Decreased or loss of sensitivity in the genital area and anus.
Dysfunction of the pelvic organs, loss of control over urination and defecation.
Lower paraparesis - weakening of the leg muscles, impaired movement and decreased reflexes.
Fever is an increase in body temperature over 38 degrees.
Decreased immunity, which is indicated by frequent, chronic, severe infections.
Symptoms that first appear in a person over 50 years of age: at this age, the likelihood of developing malignant tumors and serious chronic diseases increases.
Unreasonable weight loss, despite the fact that the patient eats well, does not go on a diet, and does not exhaust himself with physical work and high stress in sports.

X-ray of the spinal column

Radiography is the simplest, fastest, inexpensive and accessible method for diagnosing many spinal diseases. It is not as informative as computed tomography or MRI, but it allows you to quickly identify or exclude gross changes in the vertebrae.

Pathologies that can be identified using radiography and which may be associated with pinched sciatic nerve:

Fractures and displacements of the vertebrae.
Spinal stenosis is a narrowing of the spinal canal, which can lead to pinching of the spinal cord and roots.
The intervertebral discs themselves are practically invisible on x-rays, but indirect signs of their damage can be detected, for example, a decrease in the distance between adjacent vertebrae.
Osteophytes are bone growths on the vertebrae.
Spondylolisthesis is an anterior displacement of the overlying vertebra relative to the underlying one.
Osteoporosis, a condition in which bone loss and decreased density occurs, usually occurs in older people.
Malignant tumors, metastases in the spine.
Congenital anomalies of the spinal column.
Infectious processes in the vertebrae.

The x-ray usually lasts about 5 minutes. Modern digital devices make it possible to obtain clear images in which many structures are clearly visualized.

The study does not require special preparation. Women who are pregnant or trying to conceive should tell their doctor, as x-rays are contraindicated during pregnancy.

Pictures are taken in a lying or standing position, in different projections, in front, profile, at certain angles. The doctor selects projections that provide the most informative images.

Ultrasound of the spine

In some cases, patients with symptoms of a pinched sciatic nerve are shown an ultrasound examination of the spinal column. This is also a simple, affordable, but, unlike radiography, a completely safe diagnostic method, since it does not use X-ray radiation. Ultrasound can show soft tissue abnormalities that are not visible on x-rays.

Ultrasound of the spine helps to identify:

pathological processes in tissues caused by age-related changes;
changes in the spinal canal;
lesions of the intervertebral discs (and their degree can also be assessed using ultrasound);
protrusion and herniation of intervertebral discs;
osteochondrosis;
osteoarthritis – degenerative changes in the intervertebral joints;
developmental anomalies of the spinal column.

While X-rays are contraindicated during pregnancy, ultrasound can be performed even on expectant mothers, as it will not harm the embryo or fetus. With the help of modern ultrasound machines, many pathologies can be detected even in the early stages.

CT scan

Computed tomography is a more accurate and informative diagnostic method compared to radiography. This method allows you to create images with layer-by-layer “slices” of certain areas of the body, three-dimensional images. Since CT machines are now available in many clinics, many doctors often prefer it as the first diagnostic method rather than radiography.

The main advantages of computed tomography in the diagnosis of pinched sciatic nerve and spinal pathologies:

This is a non-invasive, painless and safe method. However, it is worth remembering that, like during radiography, X-ray radiation is used during CT, so the study is contraindicated during pregnancy.
Computed tomography can clearly visualize many bone and soft tissue pathologies. It is best suited for examining bones and other dense structures.
Unlike MRI, CT is less sensitive to patient movement and can be performed on people with pacemakers.
Under the guidance of computed tomography, biopsy (if a tumor is detected) and other invasive procedures requiring navigation can be performed.

Computed tomography is more effective in detecting intervertebral protrusions and hernias compared to radiography. Sometimes, for a more accurate diagnosis, CT myelography is used using radiopaque solutions.

For spinal stenosis, vertebral fractures, infectious processes, and degenerative diseases, CT can provide the doctor with a lot of valuable information, performed alone or in combination with MRI.

MRI

Magnetic resonance imaging, like computed tomography, produces slice-by-slice and three-dimensional images, but uses a strong magnetic field instead of X-rays. Thus, it is a safer diagnostic method. For example, there is no evidence that an MRI scan on a pregnant woman can cause any harm to the unborn baby. However, during pregnancy this study is prescribed with caution and only in cases where it cannot be avoided. MRI is especially undesirable in the first trimester.

MRI is best at visualizing soft tissue, but it can also diagnose bone pathologies. Using this diagnostic method, you can obtain a lot of valuable information about the condition of the spinal cord, its roots and the sciatic nerve. Magnetic resonance imaging helps in planning surgical interventions. Compared to computed tomography, it is better at visualizing tumors, abscesses and other soft tissue formations.

To obtain clearer images, the patient may be given an intravenous gadolinium solution. It is much less likely to cause allergic reactions compared to iodine preparations, which are used for contrast during radiography and CT.

But MRI also has some limitations. Due to the strong magnetic field, it cannot be performed if there are any metal implants or foreign bodies in the patient's body. MRI machines are mainly designed for patients weighing no more than 150 kg. During the study, the person is in a confined space and must lie still, so difficulties arise for people suffering from claustrophobia, mentally ill people in a state of excitement.

Electromyography

Electromyography is a study during which the electrical activity of muscles, nerves, and neuromuscular transmission of impulses is checked. This diagnostic method is prescribed when pinching of the sciatic nerve is accompanied by impaired sensitivity or movement, manifested by the following symptoms:

Numbness.
Paresthesia is an unpleasant sensation in the form of tingling, “crawling goosebumps.”
Muscle pain, spasms.
Weakness in certain muscle groups, weakened reflexes.

During electromyography, special electrodes are used - they record electrical impulses in tissues. Needle electrodes are inserted directly into the muscles being tested. They are used to study the electrical activity of muscles at rest and under tension. Skin electrodes are placed along the nerve and record passing nerve impulses.

Despite the fact that electroneuromyography can be painful, it is a safe diagnostic method, it does not lead to complications and allows the doctor to obtain important data, assess the cause of deterioration in sensitivity and movements, and the degree of damage to nerve structures.

Densitometry

Densitometry is an advanced form of radiography that measures bone density. The procedure is primarily indicated for older people and is needed in order to figure out whether problems with the musculoskeletal system that lead to pinching of the sciatic nerve are caused by osteoporosis.

Densitometry is a simple test that does not require special preparation. It is similar to a regular x-ray, but uses lower doses of x-rays. Before the procedure, you should not take calcium supplements for at least 24 hours, as this may distort the results.

Bone density is measured at the hip and lumbar spine. The device emits a beam of low-intensity X-rays with two energy peaks. One peak is absorbed by soft tissues, and the second by bone. If you subtract what is absorbed by soft tissue from the total, you get your actual bone mineral density. Densitometry can also be performed in CT and MRI modes. It allows you to detect changes in bone density by 2-5% and detect osteoporosis in the early stages.

Examination by a specialist in soft manual techniques

Diagnosis of pinched sciatic nerve in osteopathy and other areas where soft manual techniques are used has its own specifics. Here, the main diagnostic tool is the doctor’s hands, which, as a result of special training and many years of practice, acquire a special increased sensitivity.

The approaches to understanding the mechanisms of disease development among osteopathic doctors are somewhat different from those adopted in neurology, orthopedics, and neurosurgery. They are based on some key principles:

The human body is structured and functions as a single integrated system.
In this system everything is interconnected. Malfunction of one “gear” leads to failures in the entire system. It is important to look for deep cause-and-effect relationships.
The original cause of the problem may not be located at all where the pathological process developed and the symptoms arose. A classic example: flat feet and problems with the joints of the legs lead to a misalignment of the pelvis and sacrum, because of this, in turn, the lumbar spine suffers, followed by the thoracic and cervical spine, and ultimately this, in combination with other factors, can even cause headaches. It is necessary to identify and eliminate all links in this pathological chain.
The task of a specialist in soft manual techniques is not to eliminate symptoms or even rid a person of a specific disease, but to generally restore health, the ability to self-recovery and self-healing. Hence the specificity of diagnosis.

During osteopathic diagnostics, the doctor works with the patient at a deep level, detecting the smallest deviations that even modern high-precision diagnostic equipment is unable to detect.

The Bobyr Clinic uses the author’s technique – defanotherapy – which can be classified as a new generation of soft manual techniques. During the first session, the doctor also performs manual diagnostics. The main task of such a specialist is to detect areas of pathological stress that lead to disruption of the correct position and function of the spinal column, difficulty in blood flow and lymph outflow, pinching of nerve roots and trunks, as a result, pain and other symptoms.

During defanotherapy sessions, these problems are corrected using special techniques, and at the end they conduct something like psychotraining and give instructions on the correct position of the spinal column. This helps consolidate the effect and prevent future exacerbations.

If you are worried about lower back pain, lumbago, sciatica, come see a doctor at the Bobyr Clinic.
A specialist will examine you, establish an accurate diagnosis and create an optimal treatment program. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Interpretation of Lasegue's symptom

In the presence of a pathological process localized in the area of the nerve root, pain may appear when the hip is flexed at different angles (10, 15, 20, 30 degrees). The level at which Lasegue's symptom occurs allows us to judge the severity of the patient's condition and is of great importance for diagnosing the stage of the disease.

In order to track the dynamics of the clinical manifestations of a radicular lesion, it is advisable, when recording the examination results, to indicate the approximate angle at which the patient experiences pain (an example of such a recording: Lasegue’s symptom on the right is positive, 30 degrees). This will make it possible in the future, during repeated examinations, to compare the current result with the previous one and, based on the comparison results, make a judgment about the dynamics of the patient’s condition. In particular, an increase in the angle between the plane on which the patient lies and his thigh will indicate a gradual improvement in the patient’s condition.

How is diagnostics carried out?

If there are characteristic complaints, a medical history, a positive test for Lasegue’s symptom, as well as other neurological signs, the patient may be prescribed the following types of studies:

radiography of the lumbosacral spine with functional tests (recently this method has been inferior to other imaging examinations);
computed tomography or magnetic resonance imaging with contrast;
electromyographic study (especially useful for diagnosing paresis, paralysis, innervation disorders);

When does a positive Lasègue symptom occur?

In neurology, this phenomenon belongs to the group of so-called tension symptoms; from the name it is clear that the formation of this diagnostic sign is associated with tension and tension of the nerve trunk.

The most common case when a positive Lasègue symptom is observed is with osteochondrosis. Inflammation in the area of the nerve root leads to its compression and tension. Other symptoms of this group (Nery, Bekhterev) will also be positive.
Acute discogenic lumbodynia. This condition occurs when the fibrous ring is torn, leading to protrusion of the intervertebral disc in the spinal disc segment. The cause of such a violation may be awkward movement in the lumbar spine, sudden lifting of weight. Clinically, acute discogenic lumbodynia is manifested by sharp pain in the lumbar region, often causing the patient to “freeze” in the position in which the pain syndrome found him. The duration of a painful attack is from half an hour to several hours. When diagnosing, an important role is played by the symptoms of Matskevich and Lasègue, the “board” symptom (impossibility of flexion in the lumbar region).
Subacute discogenic lumbodynia. The reason is prolonged physical activity in a position that is uncomfortable for the patient (often in a bent state). Unlike the acute condition, subacute lumbodynia is characterized by a delayed development of pain.

Treatment

Prescription of treatment is possible only after identifying the cause of the complaints and a positive test. His approaches depend on the disease, its stage and the age of the patient.

For osteochondrosis, active forms of vitamin D, NSAIDs, chondroprotectors, calcium-sparing agents and, if necessary, estrogens are prescribed. These hormones prevent the development of osteoporosis. During the period of remission, manual therapy will be useful.

In the case of radiculopathy, muscle relaxants and non-steroidal anti-inflammatory drugs are used, which relieve swelling in the root area and relieve pain. During an exacerbation, traditional methods are not recommended to be used due to the risk of worsening the condition.

For hernias, conservative treatment methods are most often used (anti-inflammatory drugs, wearing corsets, chondroprotectors).

Surgery and traction are extreme measures.

Other diagnostic signs accompanying Lasegue's symptom

Neri - the occurrence of pain in the lumbar region when the head is flexed.
Matskevich's symptom is pain in the groin area and the anterior surface of the thigh when the patient bends the lower leg while lying on his stomach.
Dejerine's symptom is increased pain when coughing or sneezing.
Bekhterev's symptom (in a number of sources referred to as Lasegue's cross symptom) - when a lying patient sits down, his leg bends at the knee joint on the side of the nerve root lesion. If you straighten this leg, the healthy one will bend. In cases where a positive Lasègue symptom is recorded, ankylosing spondylitis' symptom is usually also positive.
Lerrey's phenomenon - a pronounced increase in pain in the lumbar region in the event of a sharp transition from a lying position to a sitting position - is almost always a symptom accompanying the Lasègue sign.

Symptoms

The clinical picture will manifest itself due to disruption of the spinal roots and nerve endings in the sacral plexus.

Depending on the degree of tension, the symptoms are manifested by the following condition. The syndrome will be considered positive when, with the straight leg extended upward at a certain angle, intense pain is felt in the thigh or lower leg. As a result of the next phase, they pass or the severity decreases significantly.

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The peculiarity of this condition is that the sensation of pain disappears when performing flexion movements of the hip or knee joint. This is explained by the fact that as a result of a decrease in tension, the roots begin to relax.

In medical practice, the following signs are identified that will indicate the presence of Lasègue syndrome in a patient:

raising the lower limb will always be accompanied by severe pain;
during the test, the skin in the thigh area on the outside numb
when lifting the uninjured leg, pain will appear in the injured limb; this condition is called cross symptom;
As a result of flexion of the joints, subside .

In the case when the pain does not disappear, they speak of a negative syndrome. In this case, there is a need to further identify the cause leading to unpleasant sensations.

What does this research method reveal?

There is a certain number of symptoms that associate pain in the back and limbs with inflammatory processes occurring in the spine. This group of syndromes is called tension symptoms. It is in this category that Neri's symptom falls.

Neri tension syndrome allows you to diagnose the following diseases:

Myeloradiculopathy is an inflammatory process in the lumbar region, in which the L5-S1 nerve roots are pinched. As a result of this disease, a person’s sweating is impaired, and there is a decrease or complete absence of sensitivity of the skin. Laboratory testing of spinal cord fluid can detect the presence of leukocytes and red blood cells in the blood.
Radiculitis is an inflammation affecting the spinal roots. The disease develops as a result of osteochondrosis and may be accompanied by the appearance of neoplasms and intervertebral hernias. Radiculitis also occurs as a result of previous injuries in the spinal column.
As a result of hypothermia, spasm of the lumbar muscles occurs. This condition also affects the spinal nerves, which undergo elongation and compression. In this case, the syndrome also manifests itself.
Osteochondrosis of 2, 3 and 4 degrees also causes the manifestation of this symptom.