Correlation of bell and hyperextension tests with widely used clinical manoeuvers in the diagnosis of sciatica associated with disc herniation

Abstract EN

Aim of work: To correlate the reliabilities and diagnostic values of two clinical signs widely used straight leg raising (SLR) and crossed straight leg raising (CSLR) tests with those of two less well-known tests, Bell test (BT) and Hyperextension test (HT).

Also to evaluate the sensitivity, specificity, PPV and NPV of these four tests considered separately or in combination for the diagnosis of sciatica associated with lumbar disc herniation.

Material & Methods: Fifty-eight patients were included in our study.

All patients used to suffer from acute or chronic low back pain with or without sciatica.

Their mean age was 47 +17 years and the mean duration of the disease 8 + 10.5 months.

Radiographic assessment for diagnosis was done with at least one of the three available investigations (MRI, CT scanning and Myelography).

According to the radiographic findings the patients were divided into two groups: Group I: Disc herniation group comprised of 30 patients, and Group II: Non-disc herniation group comprised of 28 patients.

Physical examination including BT, HT, SLR tests and CSLR were performed to all patients to observe the value in clinical diagnosis in both groups.

Results: The sensitivity of BT and HT showed better results than XSLR.

However the results obtained from SLR test still had the best sensitivity for the diagnosis of sciatica with disc herniation.

Moreover, the specificity of HT showed the best results obtained than other three clinical signs.

In addition, the PPV of BT and HT showed interesting results.

Also the combinations of physical signs observed in this study did not improve the sensitivity or NPV for the diagnosis of sciatica associated with disc herniation.

On the other hand, the combinations of some physical signs showed highly improved specificity and PPV.

Conclusion: The values observed in this study suggested that the reliabilities for BT and HT signs could be included in the systemic clinical assessment of patients with radicular pain.