A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study

M.W.J. Coppieters, J.L. Crooke, P.R. Lawrenson, S.J. Khoo, T. Skulstad, Y. Bet-Or

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: A modified straight leg raise test for the sural nerve (SLR<inf>SURAL</inf>) has been proposed to assist in the differential diagnosis of sural nerve pathology in people with posterior calf or ankle pain, or lateral foot pain. The biomechanical rationale is that strain in the dorsolateral ankle and foot structures following dorsiflexion-inversion can be selectively increased in the sural nerve with hip flexion. There are however no studies which have investigated whether hip flexion can increase strain in the sural nerve at the ankle. Objectives: To measure strain and longitudinal excursion of the sural nerve and Achilles tendon during a modified SLR. Design: Cross-sectional cadaver study, with a repeated-measures design. Method: Strain and excursion were measured unilaterally in seven embalmed cadavers using differential transducers and a digital calliper. Data were analysed with repeated-measures ANOVAs (p<0.05). Results: With hip flexion (mean (SD): 54.6 (10.6) degrees), strain increased in the sural nerve (0.9 (0.5)%; p=0.008), but not in the Achilles tendon (0.3 (0.3)%; p=0.16). The sural nerve moved 1.0 (0.5) mm proximally with hip flexion (p=0.02). Conclusions: The load placed on the sciatic nerve following hip flexion is transmitted distally to the sural nerve. These findings provide biomechanical support for the SLR<inf>SURAL</inf>. The relatively small changes in strain and excursion were most likely due to limited available ankle mobility in the tested cadavers. Further research is required to establish the diagnostic accuracy of SLR<inf>SURAL</inf> in a clinical setting.
Original languageEnglish
Pages (from-to)587-591
JournalManual Therapy
Volume20
Issue number4
DOIs
Publication statusPublished - 2015

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Sural Nerve
Tendinopathy
Cadaver
Leg
Cross-Sectional Studies
Pathology
Ankle
Hip
Foot
Pain
Achilles Tendon
Transducers
Analysis of Variance
Differential Diagnosis
Research

Cite this

Coppieters, M.W.J. ; Crooke, J.L. ; Lawrenson, P.R. ; Khoo, S.J. ; Skulstad, T. ; Bet-Or, Y. / A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study. In: Manual Therapy. 2015 ; Vol. 20, No. 4. pp. 587-591.
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title = "A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study",
abstract = "Background: A modified straight leg raise test for the sural nerve (SLRSURAL) has been proposed to assist in the differential diagnosis of sural nerve pathology in people with posterior calf or ankle pain, or lateral foot pain. The biomechanical rationale is that strain in the dorsolateral ankle and foot structures following dorsiflexion-inversion can be selectively increased in the sural nerve with hip flexion. There are however no studies which have investigated whether hip flexion can increase strain in the sural nerve at the ankle. Objectives: To measure strain and longitudinal excursion of the sural nerve and Achilles tendon during a modified SLR. Design: Cross-sectional cadaver study, with a repeated-measures design. Method: Strain and excursion were measured unilaterally in seven embalmed cadavers using differential transducers and a digital calliper. Data were analysed with repeated-measures ANOVAs (p<0.05). Results: With hip flexion (mean (SD): 54.6 (10.6) degrees), strain increased in the sural nerve (0.9 (0.5){\%}; p=0.008), but not in the Achilles tendon (0.3 (0.3){\%}; p=0.16). The sural nerve moved 1.0 (0.5) mm proximally with hip flexion (p=0.02). Conclusions: The load placed on the sciatic nerve following hip flexion is transmitted distally to the sural nerve. These findings provide biomechanical support for the SLRSURAL. The relatively small changes in strain and excursion were most likely due to limited available ankle mobility in the tested cadavers. Further research is required to establish the diagnostic accuracy of SLRSURAL in a clinical setting.",
author = "M.W.J. Coppieters and J.L. Crooke and P.R. Lawrenson and S.J. Khoo and T. Skulstad and Y. Bet-Or",
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publisher = "Churchill Livingstone",
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A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study. / Coppieters, M.W.J.; Crooke, J.L.; Lawrenson, P.R.; Khoo, S.J.; Skulstad, T.; Bet-Or, Y.

In: Manual Therapy, Vol. 20, No. 4, 2015, p. 587-591.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study

AU - Coppieters, M.W.J.

AU - Crooke, J.L.

AU - Lawrenson, P.R.

AU - Khoo, S.J.

AU - Skulstad, T.

AU - Bet-Or, Y.

PY - 2015

Y1 - 2015

N2 - Background: A modified straight leg raise test for the sural nerve (SLRSURAL) has been proposed to assist in the differential diagnosis of sural nerve pathology in people with posterior calf or ankle pain, or lateral foot pain. The biomechanical rationale is that strain in the dorsolateral ankle and foot structures following dorsiflexion-inversion can be selectively increased in the sural nerve with hip flexion. There are however no studies which have investigated whether hip flexion can increase strain in the sural nerve at the ankle. Objectives: To measure strain and longitudinal excursion of the sural nerve and Achilles tendon during a modified SLR. Design: Cross-sectional cadaver study, with a repeated-measures design. Method: Strain and excursion were measured unilaterally in seven embalmed cadavers using differential transducers and a digital calliper. Data were analysed with repeated-measures ANOVAs (p<0.05). Results: With hip flexion (mean (SD): 54.6 (10.6) degrees), strain increased in the sural nerve (0.9 (0.5)%; p=0.008), but not in the Achilles tendon (0.3 (0.3)%; p=0.16). The sural nerve moved 1.0 (0.5) mm proximally with hip flexion (p=0.02). Conclusions: The load placed on the sciatic nerve following hip flexion is transmitted distally to the sural nerve. These findings provide biomechanical support for the SLRSURAL. The relatively small changes in strain and excursion were most likely due to limited available ankle mobility in the tested cadavers. Further research is required to establish the diagnostic accuracy of SLRSURAL in a clinical setting.

AB - Background: A modified straight leg raise test for the sural nerve (SLRSURAL) has been proposed to assist in the differential diagnosis of sural nerve pathology in people with posterior calf or ankle pain, or lateral foot pain. The biomechanical rationale is that strain in the dorsolateral ankle and foot structures following dorsiflexion-inversion can be selectively increased in the sural nerve with hip flexion. There are however no studies which have investigated whether hip flexion can increase strain in the sural nerve at the ankle. Objectives: To measure strain and longitudinal excursion of the sural nerve and Achilles tendon during a modified SLR. Design: Cross-sectional cadaver study, with a repeated-measures design. Method: Strain and excursion were measured unilaterally in seven embalmed cadavers using differential transducers and a digital calliper. Data were analysed with repeated-measures ANOVAs (p<0.05). Results: With hip flexion (mean (SD): 54.6 (10.6) degrees), strain increased in the sural nerve (0.9 (0.5)%; p=0.008), but not in the Achilles tendon (0.3 (0.3)%; p=0.16). The sural nerve moved 1.0 (0.5) mm proximally with hip flexion (p=0.02). Conclusions: The load placed on the sciatic nerve following hip flexion is transmitted distally to the sural nerve. These findings provide biomechanical support for the SLRSURAL. The relatively small changes in strain and excursion were most likely due to limited available ankle mobility in the tested cadavers. Further research is required to establish the diagnostic accuracy of SLRSURAL in a clinical setting.

U2 - 10.1016/j.math.2015.01.013

DO - 10.1016/j.math.2015.01.013

M3 - Article

VL - 20

SP - 587

EP - 591

JO - Manual Therapy

JF - Manual Therapy

SN - 1356-689X

IS - 4

ER -