Straight Leg Raise Test 5 – Crossed Straight Leg (Well-Leg) Raising Test of Fajersztajn

Purpose: To test if a modified straight leg raise test with a bias towards the movement of the dura and contralateral lumbosacral (L4,5,S1) nerve roots assist in the differential diagnosis of nerve root pathology (disc prolapse) in people with neurologic symptoms associated with radiculopathy (1, 2).

Patient position: Supine lying.

Examiner position: Standing beside the patient, at the side of the limb to be tested.

Procedure: Perform the limb/joint positioning sequence in the following order

1. Neutral alignment at the cervical, thoracic and lumbar spine, while the patient is on supine lying,
2. Hip flexion on the unaffected side (to the end of the available range or until the patient reports radicular symptoms on the affected/contralateral side) and having the knee at full extension (with the examiner’s one hand holding the anterior aspect of the patient’s distal thigh and the other hand holding the posterior aspect of the patient’s ankle).
3. Lower the leg slowly until the radicular symptoms are relieved and hold the leg at this level.
4. Sensitizing position: Ankle dorsiflexion (3, 4). The return of radicular symptoms on the contralateral leg, during ankle dorsiflexion on the unaffected side with/without further straight leg raise (hip flexion) indicates a positive test.

Additional Notes: In the cadaveric study, Fajersztajn showed that the crossed straight leg raise test can increase strain in the dura and contralateral lumbosacral nerve roots (3, 4).

It has also been shown that approximately one-third of the patients with confirmed disc protrusions have a positive crossed straight leg raise test (1).

Among these patients with a positive test, disc protrusion was found on the medial aspect of the affected nerve root (1, 2, 4).

Outcome: This test is positive if (a) the limb/joint positioning sequence reproduces symptoms associated with radiculopathy, (b) the sensitizing position reproduces symptoms, and (c) there is a repeatable and measurable asymmetry between both sides along with the reproduction of symptoms.

Reference:

1. Woodhall B, Hayes GJ. The well-leg-raising test of Fajersztajn in the diagnosis of ruptured lumbar intervertebral disc. JBJS. 1950;32(4):786-92.
2. Urban LM. The straight-leg-raising test: A review. Journal of Orthopaedic & Sports Physical Therapy. 1981;2(3):117-33.
3. Fajerstajn J. Ueber das gekreutzte Ischiasphaenomen. Wiener Klin Wochenschr. 1901;14:41-7.
4. Scham SM, Taylor TK. Tension signs in lumbar disc prolapse. Clinical orthopaedics and related research. 1971;75:195-204.