Include abdomen and rectum to search for visceral sources of pain. Inspection may reveal scoliosis or muscle spasm. Palpation may elicit pain over a diseased spine segment. Pain from hip may be confused with spine pain; manual internal/external rotation of leg at hip (with knee and hip in flexion) reproduces the hip pain.

Straight leg raising (SLR) sign—elicited by passive flexion of leg at the hip with pt in supine position; maneuver stretches L5/S1 nerve roots and sciatic nerve passing posterior to the hip; SLR sign is positive if maneuver reproduces the pain. Crossed SLR sign—positive when SLR on one leg reproduces symptoms in opposite leg or buttocks; nerve/nerve root lesion is on the painful side. Reverse SLR sign—passive extension of leg backward with pt standing; maneuver stretches L2-L4 nerve roots, lumbosacral plexus, and femoral nerve passing anterior to the hip.

Neurologic examination—search for focal atrophy, weakness, reflex loss, diminished sensation in a dermatomal distribution. Findings with radiculopathy are summarized in Table 48-1.