Lower back - Examination

We met on the 14th August to talk about our examination routines for patients with symptoms related to their lower back

The recording of the meeting is here: Discussion on lower back exam

remember: a tests sensitivity is the chance that it will be positive if the thing being tested is really there.

: a tests specificity is the chance that it will be negative it the thing being tested is not there.

Supine SLR is not very sensitive and is likely to miss about half of cases of nerve root irritation (lateral recess or exit foramina) but if it is positive its likely correct (sensitivity 0.52 specificity 0.89)

Slump test is much less likely to miss nerve root irritation (sensitivity 0.84 and specificity 0.83)

Diagnosing a sacroiliac joint as a pain generator: The Laslett sacroiliac joint cluster is a set of 5 tests which are at the moment the most accurate way we have of assessing in our clinic if pain comes from the SIJ (sensitivity 0.91 and specificity 0.78). They are positive if they cause pain in the back of the pelvis/lower back NOT if they are painful to the groin or lateral hip. If a patient has sacroiliac joint area pain, 3 or more positives on Laslett cluster and does not do well with our care and has a VAS of 5 or more then we can ask Circle to arrange the joint to be injected. Before this they will likely have lumbar and sacroiliac joint MRI to be sure we are not missing anything else. If the joint injection provides good benefit but the pain then returns (injections usually provide <8 months relief) then other treatment such as nerve ablation or joint fusion can be considered.

Neck / upper back - Examination

We met on the 21st August 23 to talk about examination and notes for upper back

The recording of the meeting is here: Discussion on neck exam