Abstract
Background
Gore and Nadkarni described a ‘Gore sign’ of reproducing radiating leg pain by palpation of distal nerve root endings in the foot for L5 and S1 nerve roots in lumbar radiculopathy due to disc prolapse.
Purpose
This sign was explored and observation of symptoms recorded.
Results
There were 31 patients, 20 females and 11 males, aged 25 to 76 years. 13 patients had acute disc prolapse, 14 had lumbar canal stenosis, 3 had annular tears and one had a facet cyst. Radiating leg pain was reproduced in all patients by palpation of distal nerve root endings and was immediately relieved by local anaesthetic injection around distal nerve root endings in all patients (second part of Gore test).
New clinical signs were observed which have not been described before:
Back pain was reproduced in 21 patients.
L4 nerve root pain was reproduced in 13 patients by palpation of the proximal tibia.
Crossed leg pain was reproduced in 5 patients.
Reproduction of pain by palpation of more than one distal nerve root ending was observed in 16 patients.
Cessation of radiating leg pain by palpation of distal nerve root endings in two patients.
These test were positive in patients with varied pathology producing radiculopathy, not just disc prolapse.
Conclusion
Provocative nerve root tension signs can be difficult in severe pain. The tests described above can be performed without having to move the patient's lower limb. These observations open up discussion on the mechanism of radiculopathy and new ways of treatment.
Conflicts of interest: None
Sources of funding: None
