What is the value of dural signs ?
A patient suffering from a lumbar internal derangement frequently shows dural signs in the functional examination. Those dural signs are pathognomic for a disco-dural conflict.
Dural signs in the lumbar spine are
- The patient performs a flexion in standing and produces some back pain (central, unilateral or bilateral) or gluteal pain ; he stays in the flexed position and an accessory neck flexion makes this lumbar or gluteal pain worse or better
- or, flexion in standing, end range, is negative and on accessory neck flexion, from the end range flexed position, lumbar or gluteal pain is produced
- or, a straight leg raise is e.g. end range painful and an accessory neck flexion increases or decreases the pain
- a crossed straight leg raise is also a nice example : the e.g. left SLR produces lumbar pain on the right side of the spine
Dural symptoms are
- back pain, suprascapular, or gluteal pain on coughing or sneezing.
- In the thoracic spine pain (anterior and/or posterior) on taking a deep breath could be a dural symptom.
- Pain in the gluteal area on coughing could be a dural symptom too, but could also be the result of a sacro iliac arthritis.
- Pain in the leg on coughing could be the result of a primary posterolateral protrusion or a neuroma.
Keep one important message in mind : one single positive test has no clinical meaning at all ; focus on the complete image : history, inspection and a cluster of positive and negative tests.
For more detailed analysis and recent scientific background of the clinical images described above, I refer to the ETGOM training programs in Modern Orthopaedic Medicine Cyriax and to our publications.