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Straight Leg Raise
The straight leg raise is a test that can be performed during a physical examination, with the leg being lifted actively by the patient or passively by the clinician. If the straight leg raise is done actively by the patient it is a test of functional leg strength, particularly the rectus femoris element of the quadriceps (checking both hip flexion and knee extension strength simultaneously). If carried out passively (also called Lasègue's sign, Lasègue test or Lazarević's sign), it is used to determine whether a patient with low back pain has an underlying nerve root sensitivity, often located at L5 (fifth lumbar spinal nerve). The rest of this article relates to the passive version of the test. Technique With the patient lying down on their back on an examination table or exam floor, the examiner lifts the patient's leg while the knee is straight. A variation is to lift the leg while the patient is sitting. However, this reduces the sensitivity of the test. In order to ...
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Charles Lasègue
Ernest-Charles Lasègue (5 September 1816–20 March 1883) was a French physician that released over one hundred scientific papers. He became recognized in the mid-19th century from his work in the fields of psychiatry and neurology. He published many of his works in a journal called ''Archives Générales de Médecine'' (Archives of General Medicine), in which he was an editor. A few of his major contributions consisted of his work with delusions of persecutions, a concept coined "folie à deux," and his description of hysterical anorexia.Chabrol, H., & Corraze, J. (2001). Charles Lasègue, 1809–1883. American Journal of Psychiatry, 158(1), 28–28. Aside from his publications, he worked various jobs before becoming the Chair of Clinical Medicine at Pitié-Salpêtrière Hospital. He remained positioned there until dying at the age of 66 due to complications from diabetes.Vandereycken, W., & Deth, R. (1990). A Tribute to Lasègue's Description of Anorexia Nervosa (1873), with ...
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Low Back Pain
Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks. In most episodes of low back pain, a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as muscle or joint strain. If the pain does not go away with conservative treatment or if it is accompanied by "red flags" such as unexplained weight loss, fever, or signific ...
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Lumbar
In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.'' The lumbar region is sometimes referred to as the lower spine, or as an area of the back in its proximity. In human anatomy the five lumbar vertebrae (vertebrae in the lumbar region of the back) are the largest and strongest in the movable part of the spinal column, and can be distinguished by the absence of a foramen in the transverse process, and by the absence of facets on the sides of the body. In most mammals, the lumbar region of the spine curves outward. The actual spinal cord terminates between vertebrae one and two of this series, called L1 and L2. The nervous tissue that extends below this point are individual strands that collectively form the cauda equina. In between each lumbar vertebra a nerve root exits, and these nerve roots come together again to form the largest single nerve in the human body, the sciatic n ...
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Anatomical Terms Of Motion
Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative to the anatomical position of the body parts involved. Anatomists and others use a unified set of terms to describe most of the movements, although other, more specialized terms are necessary for describing unique movements such as those of the hands, feet, and eyes. In general, motion is classified according to the anatomical plane it occurs in. ''Flexion'' and ''extension'' are examples of ''angular'' motions, in which two axes of a joint are brought closer together or moved further apart. ''Rotational'' motion may occur at other joints, for example the shoulder, and are described as ''internal'' or ''external''. Other terms, such as ''elevation'' and ''depression'', describe movement above or below the horizontal plane. Many anatomica ...
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Cervical Vertebrae
In tetrapods, cervical vertebrae (singular: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In sauropsid species, the cervical vertebrae bear cervical ribs. In lizards and saurischian dinosaurs, the cervical ribs are large; in birds, they are small and completely fused to the vertebrae. The vertebral transverse processes of mammals are homologous to the cervical ribs of other amniotes. Most mammals have seven cervical vertebrae, with the only three known exceptions being the manatee with six, the two-toed sloth with five or six, and the three-toed sloth with nine. In humans, cervical vertebrae are the smallest of the true vertebrae and can be readily distinguished from those of the thoracic or lumbar regions by the presence of a foramen (hole) in each transverse process, through which the vertebral artery, vertebral veins, an ...
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Sciatica
Sciatica is pain going down the leg from the lower back. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities like heavy lifting, though gradual onset may also occur. The pain is often described as shooting. Typically, symptoms are only on one side of the body. Certain causes, however, may result in pain on both sides. Lower back pain is sometimes present. Weakness or numbness may occur in various parts of the affected leg and foot. About 90% of sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots. Spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumors, and pregnancy are other possible causes of sciatica. The straight-leg-raising test is often helpful in diagnosis. The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. In most cases medical imaging is not needed. However, imaging may be obtained if bowel or blad ...
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Radiculopathy
Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). Radiculopathy can result in pain (radicular pain), weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function. In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. The radicular pain that results from a radiculopathy should not be confused with referred pain, which is different bo ...
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Meta-analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting measurements that are expected to have some degree of error. The aim then is to use approaches from statistics to derive a pooled estimate closest to the unknown common truth based on how this error is perceived. Meta-analytic results are considered the most trustworthy source of evidence by the evidence-based medicine literature.Herrera Ortiz AF., Cadavid Camacho E, Cubillos Rojas J, Cadavid Camacho T, Zoe Guevara S, Tatiana Rincón Cuenca N, Vásquez Perdomo A, Del Castillo Herazo V, & Giraldo Malo R. A Practical Guide to Perform a Systematic Literature Review and Meta-analysis. Principles and Practice of Clinical Research. 2022;7(4):47–57. https://doi.org/10.21801/ppcrj.2021.74.6 Not only can meta-analyses provide an estimate of the un ...
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Sensitivity (tests)
''Sensitivity'' and ''specificity'' mathematically describe the accuracy of a test which reports the presence or absence of a condition. Individuals for which the condition is satisfied are considered "positive" and those for which it is not are considered "negative". *Sensitivity (true positive rate) refers to the probability of a positive test, conditioned on truly being positive. *Specificity (true negative rate) refers to the probability of a negative test, conditioned on truly being negative. If the true condition can not be known, a " gold standard test" is assumed to be correct. In a diagnostic test, sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives. For all testing, both diagnostic and screening, there is usually a trade-off between sensitivity and specificity, such that higher sensitivities will mean lower specificities and vice versa. If the goal is to return the ratio at w ...
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Specificity (tests)
''Sensitivity'' and ''specificity'' mathematically describe the accuracy of a test which reports the presence or absence of a condition. Individuals for which the condition is satisfied are considered "positive" and those for which it is not are considered "negative". *Sensitivity (true positive rate) refers to the probability of a positive test, conditioned on truly being positive. *Specificity (true negative rate) refers to the probability of a negative test, conditioned on truly being negative. If the true condition can not be known, a " gold standard test" is assumed to be correct. In a diagnostic test, sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives. For all testing, both diagnostic and screening, there is usually a trade-off between sensitivity and specificity, such that higher sensitivities will mean lower specificities and vice versa. If the goal is to return the ratio at w ...
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Laza Lazarević
Lazar "Laza" Lazarević ( sr-cyr, Лазаp Лаза Лазаревић, 13 May 1851 – 10 January 1891) was a Serbian writer, psychiatrist, and neurologist. Medical career Lazarević was born in Šabac in 1851. He studied medicine at the University of Berlin Medical School. After graduating, he became a physician in Belgrade and in 1881, he was appointed Head Doctor and Chief of the Internal Department of the General State Hospital in Belgrade. Later, he became King Milan Obrenović IV's personal doctor. As a physician, he made significant contributions to the development of medicine in Serbia. He published 72 medical and scientific papers, particularly on diseases targeting the nervous system. The first cataracts operation in Serbia was performed by Lazarević and in 1884 he was the first doctor to be sent as an envoy to Austria to learn about animal lymphatic systems. He founded the first modern geriatric hospital. He participated as a field doctor in the Serbo-Turkish War ...
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Femoral Nerve Stretch Test
Femoral nerve stretch test, also known as Mackiewicz sign, is a test for spinal nerve root compression, which is associated with disc protrusion and femoral nerve injury. __TOC__ Uses The femoral nerve stretch test can identify spinal nerve root compression, which is associated with disc protrusion and femoral nerve injury. It can reliably identify spinal nerve root compression for L2, L3, and L4. It is usually positive for L2-L3 and L3-L4 (high lumbar) disc protrusions, slightly positive or negative in L4–L5 disc protrusions, and negative in cases of lumbosacral disc protrusion. Procedure To perform a femoral nerve stretch test, a patient lies prone, the knee is passively flexed to the thigh and the hip is passively extended (reverse Lasegues). The test is positive if the patient experiences anterior thigh pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant s ...
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