Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
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Clinical Value of Physical Examination and Electromyography in Acute and Chronic Lumbosacral Radiculopathy

급, 만성 요천추부 신경근병증 환자의 신체진찰과 근전도의 임상적 의미

  • Jeoung, Ju Hyong (Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Jeong, Ha Mok (Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kang, Seok (Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Yoon, Joon Shik (Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine)
  • 정유형 (고려대학교 구로병원 재활의학과) ;
  • 정하목 (고려대학교 구로병원 재활의학과) ;
  • 강석 (고려대학교 구로병원 재활의학과) ;
  • 윤준식 (고려대학교 구로병원 재활의학과)
  • Received : 2020.08.11
  • Accepted : 2020.12.15
  • Published : 2020.12.31
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Abstract

Objective: To investigate the diagnostic accuracy of two physical examinations (straight leg raise [SLR] and Bragard test) and electromyography (EMG) in patients with lumbosacral monoradiculopathy in acute and chronic state on confirmation of different diagnostic criteria (MRI vs MRI and diagnostic selective nerve root block [DSNRB]). Method: We identified 297 participants retrospectively from the departmental database. MRI evidence of L5 or S1 nerve root compression and a positive result in diagnostic SNRB served as reference standards. They were divided into two groups by the symptom duration: lasting more than 12 weeks in the chronic group and less than 12 weeks in the acute group. The diagnostic value of clinical tests and EMG were compared. Results: The clinical tests (SLR and Bragard test) done in acute stage on detection by MRI and DSNRB had the highest sensitivity (68%) compared to the chronic stage (63%), but sensitivity was low (57%) on confirmation of MRI alone. However, there was no significant difference on sensitivity and specificity of EMG regardless of reference standards and symptom duration. Electromyography was a significant predictor of neuropathic abnormalities on both acute (OR, 6.3; 95% CI, 2.4 to 16.7; p<0.01) and chronic (OR, 6.8; 95% CI, 2.9 to 16.3; p<0.01). Conclusion: In general, individual physical tests are easy to do and a combination of those tests could be a sensitive indicator of L5 or S1 radiculopathy. Furthermore, the use of provocation tests could provide useful information, especially in proceeding therapeutic selective nerve root block.

Keywords

References

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