THE “STRAIGHT LEG” TEST: INJURED WORKERS BEING EXAMINED FOR WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers are both evaluated and treated within the Workers’ Compensation System for their work-related complaints.  Workers suffering from back injuries will be physically examined in order to determine a proper diagnosis.

Lumbar Spine Physical Examinations require that the physician or examiner perform a variety of physical tests.  One of these tests is the “straight leg.”

This article will discuss the “straight leg” test, what it means for a back condition, and what it means for Industrially Injured Workers.

Who Conducts Lumbar Spine Physical Examinations?

Physical Examinations are done by medical professionals in the capacity of Treaters,  Qualified Medical Evaluators, and Agreed Medical Evaluators.

Specialties conducting physical examinations for the spine may include Chiropractors, Neurologists, Neurosurgeons, Nurse Practitioners, Occupational Medicine Doctors, Orthopedic Surgeons, Physical Medicine Doctors, Physician Assistants, Osteopaths, Primary Care Physicians, and Sports Medicine Doctors.

What is the Common Back Complaint Relevant to the “Straight Leg” Test?

The common back complaint, relevant to the straight leg test, is back pain which radiates down one or both lower extremities.  The symptoms can include numbness in the lower extremities.

Are There Other Names for the” Straight Leg” Test?

Yes. The straight leg test has different names.   This includes the names “Lasegue Test” and the “Straight Leg Raise Test.”

How is the Straight Leg Test Performed?

“The straight leg raise test is performed with the patient in a supine position. The examiner gently raises the patient’s leg by flexing the hip with the knee in extension, and the test is considered positive when the patient experiences pain along the lower limb in the same distribution of the lower radicular nerve roots (usually L5 or S1).” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

In sum, when an Injured Worker is sitting, the examiner will take the worker’s leg and raise it upward.

What Makes a Positive Straight Leg Test?

“[A] positive straight leg raise test is determined when pain is elicited by lower limb flexion at an angle lower than 45 degrees. During the test, if the pain is reproduced during the leg straightening, patients usually request that the examiner aborts the maneuver and by flexing the patient’s knee, the buttock pain is usually relieved(Figure 1).”  Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

Based upon a review of many medical reports, I have seen Injured Workers have positive straight leg findings with one examiner and not with others.  Thus, in my opinion there is some variability concerning results.

What Is the Aim of the Straight Leg Test?

The straight leg test may indicate whether there is a “sciatic compromise due to lumbosacral nerve root irritation.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

It should be noted, however, that “there are multiple causes of a positive test such as facet joint cyst or hypertrophy.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

If the Test is Positive, What Will Happen?

If a test is positive, there is the possibility of nerve root irritation and possible entrapment.  The positive straight leg test is simply the beginning of the process of making a comprehensive diagnosis.  Thus, the Injured Worker may be requested to participate in additional testing which can include MRI testing, CT scans, X-Rays, and Nerve Conduction Studies.

In sum, a positive finding suggests the need for additional testing to rule out a herniated disc.

What Does a Positive Straight Leg Test Mean for Injured Workers?

For Injured Workers, a positive straight leg test will trigger the examiner to consider ruling out the possibility of a herniated disc injury in the lumbar spine. Thus, a thorough assessment will require additional testing to occur via imaging studies and nerve testing. A positive test may trigger a referral to an orthopedic surgeon or neurosurgeon.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

THE LOWER EXTREMITY FUNCTIONAL SCALE (LEFS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In Workers’ Compensation, Doctors and Medical Evaluators, in order to address matters of disability and impairment, frequently use testing. Testing can be in the form of self-reporting questionnaires filled out by Injured Workers.

Many Injured Workers have injuries to their lower extremities.  Lower extremity injuries can include the hips, knees, ankles and feet.

This article will describe the Lower Extremity Functional Scale (LEFS), what the questions are asked, how it is scored, and what it means to an Injured Worker.

What is the Lower Extremity Functional Scale?

“The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person’s ability to perform everyday tasks.” Honorhealth.com

What is the Purpose of the LEFS?

“The LEFS can be used by clinicians as a measure of patients’ initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention.” Honorhealth.com

How Are You to Answer the Questions?

When provided the LEFS, there is language on the form. It provides as follows: “We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.”  Honorhealth.com

“Today, do you or would you have any difficulty at all with:”

What Are the Activities That Are to Be Assessed?

There are twenty activities that are to be addressed within the LEFS:

Usual work, housework or school activities

Usual hobbies, recreational or sporting activities.

Walking between rooms

Getting into or out of the bath

Walking between rooms

Putting on shoes or socks

Squatting

Lifting an object, like a bag of groceries from the floor

Performing light activities around a home

Performing heavy activities around a home

Getting into or out of a car

Walking 2 blocks

Walking a mile.

Going up or down 10 stairs (about 1 flight of stairs)

Standing for 1 hour

Sitting for 1 hour

Running on even ground

Running on uneven ground

Making sharp turns while running fast

Hopping

Rolling over in bed

How Are the Questions Answered?

The questions are answered with respect to a level of difficulty.  The levels of difficulty are as follows: extreme difficulty or inability to perform activity, quite a bit of difficulty, moderate difficulty, a little bit of difficulty, and no difficulty.

How Is It Scored?

Each level of difficulty is assigned a number from 0 to 4.  The range being from “O” for being extreme difficulty or inability to perform to “4” being able to perform with no difficulty.

Extreme Difficulty or Unable to Perform Activity (0)

Quite a Bit of Difficulty (1)

Moderate Difficulty (2)

A Little Bit of Difficulty (3)

No difficulty (4)

What Is the Total Score?

The total score can range from 0 to 80.  The lower the score implies the greater the disability.

How Can This Scale Be Used in Workers’ Compensation?

In California, the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition, employs the use of “activities of daily living” (ADL) to address impairment.   “Activities of daily living” include the following items

Per the AMA Guides 5th Edition, Table 1-2, See Page 599, the following are the definitions of each ADL. These ADLs include standing, sitting, walking, climbing stairs, lifting, dressing oneself and bathing.

Thus, the LEFS may assist doctors and examiners as to the nature and extent of the injury’s impact on the ADLs.   The ADL assessment can impact the assignment of the permanent impairment number.

Are There Any Concerns with Respect to LEFS?

The LEFS presents problems with respect to workers’ compensation.

First, the scale is to be filled out with respect to the individual’s perception as of the day of the evaluation.  Thus, if someone’s condition gets worse during the day from prolonged weight bearing, their answer in the morning may be different from that in the afternoon. Likewise, there is the issue of the Injured Worker having good days versus bad days. Further, there is the issue of whether the assessment is made with respect to one being medicated or not.  For example, an Injured Worker may be able to perform well on activities while on narcotics but have problems without.

Second, the scale may be used for credibility issues.  Since the scale documents activities on a particular day, contemporaneous sub rosa film may show the Injured Worker performing activities either consistent or inconsistent with their answers.

Third, the scale asks a “would” question concerning the activities.  To some extent, the Injured Worker is being asked to speculate as to their ability to perform certain functions.  In workers’ compensation, speculation cannot be used as a basis for an award and is therefore problematic.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

 

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