Electrodiagnostic approach to patients with suspected radiculopathy

The Relationship Between History and Physical Examination Findings and the Outcome of Electrodiagnostic Testing in Patients With Sciatica Referred to Physical Therapy

“…4,9,12,20,32 The values for diagnostic sensitivity and specificity for crossed straight leg raise testing in this investigation were 11% and 84%, respectively, values also consistent with previously published reports. 4,9,12,20,35 While both studies included patients with sciatica, the study by Lauder et al 26 consisted of consecutive patients referred for EDX testing, whereas the patients in this investigation were referred to physical therapy and consented to undergo EDX testing as part of their participation in a randomized clinical trial. Whether this resulted in meaningful differences between study populations is unclear, but the lead author of the aforementioned study 26 expressed concern for selection bias in discussing her results.…”

“…In this investigation, 19 of 38 (50.0%) patients were classified as having evidence of radiculopathy, a percentage that is consistent with previous research 5,8,15,26 ; therefore, the likelihood that patients were misclassified based on their EDX test findings is low, given the demonstrated effectiveness of the 6-muscle EMG screening examination used in this study for identifying EMG-confirmable radiculopathies. 12,13 The results of this investigation are likely clinically meaningful because they suggest that the relationship between select patient history and physical examination findings and the outcome of EDX testing is weak and appears to be of limited clinical usefulness. Obtaining patient history and conducting the physical examination are noninvasive and relatively pain-free processes that can help ascertain whether a patient with LBP or sciatica requires further diagnostic testing.…”

“…Although not all radiculopathies can be confirmed on needle EMG, even when a patient's signs, symptoms, and imaging findings suggest that radiculopathy may be the diagnosis, the EMG screening examination used in this study has been demonstrated to identify 98% to 100% of EMG-confirmable radiculopathies (ie, those with motor axonal loss or motor conduction block). 12,13 This is significant in terms of this investigation because it improves the likelihood that patients were properly classified based on the results of their EDX testing. In this investigation, 19 of 38 (50.0%) patients were classified as having evidence of radiculopathy, a percentage that is consistent with previous research 5,8,15,26 ; therefore, the likelihood that patients were misclassified based on their EDX test findings is low, given the demonstrated effectiveness of the 6-muscle EMG screening examination used in this study for identifying EMG-confirmable radiculopathies.…”

“…9,14,23,31 Research has demonstrated the relationship between some patient history and physical examination findings in patients with sciatica and the presence of disc herniation or nerve root impingement on diagnostic imaging. 4,9,12,20,27,36,39 However, few studies have investigated the relationship between patient history and physical examination findings and the results of EDX testing, particularly in patients with sciatica. 26,39 Lauder et al, 26 in a multicenter design, investigated the relationship between history and physical examination findings and the results of EDX testing in patients with sciatica referred for EDX testing.…”

“…7,9,12,25,26,38 The majority of LBP is considered nonspecific, having no clear pathoanatomic cause 1,3 ; however, one specific cause of LBP is lumbosacral radiculopathy. 6,33 Known commonly as sciatica or lumbar radiculopathy, this condition has some unique defining characteristics.…”