Rigel Geneste - Ostéopathe D.O.- Pau

16/08/2026

🔆 The Lasègue test: is it still reliable for identifying Lumbar Disc Herniation (LDH)?

In clinical practice, the Lasègue test, or Straight Leg Raise (SLR) test, is commonly used when assessing patients with sciatica and suspected lumbar disc herniation.

However, current evidence suggests that the SLR test does not have sufficient diagnostic accuracy to independently establish the presence of lumbar disc herniation with nerve root involvement. Its findings should therefore be interpreted within the broader clinical context rather than used as a stand-alone diagnostic test.

1. High sensitivity but low specificity

A systematic review by Devillé et al. reported:
* Sensitivity: approximately 0.91 (95% CI 0.82–0.94)
* Specificity: approximately 0.26 (95% CI 0.16–0.38)

This means that the SLR has traditionally demonstrated relatively high sensitivity but poor specificity for surgically confirmed lumbar disc herniation. Therefore, a positive SLR alone provides limited evidence for confirming disc herniation, while a negative result may reduce its likelihood in an appropriate clinical population. Importantly, these estimates came largely from surgical populations, which limits their generalizability to routine clinical practice.

A later systematic review similarly found a pooled sensitivity of 0.92 and specificity of 0.28 in surgical populations, while emphasizing substantial heterogeneity across studies (van der Windt DAWM, et al. (2010)

2. A positive SLR does not identify the cause of neural symptoms

The SLR is better understood as a neurodynamic/pain-provocation test than as a direct “disc herniation test.” Pain reproduced during SLR is not necessarily specific to lumbar radiculopathy or disc herniation, and false-positive responses may occur for other reasons. A systematic review by Scaia et al. found considerable variability in the diagnostic performance of the SLR depending on the reference standard and definition of a positive test.

Therefore, using a positive SLR in isolation to label a patient as having a “herniated disc” risks diagnostic over-attribution. Clinical interpretation should integrate the history, symptom distribution, neurological examination, other relevant tests, and imaging when clinically indicated.

3. Disc herniation does not always mean symptoms
Structural changes on MRI are also common among people without pain.

A systematic review by Brinjikji et al. involving 3,110 asymptomatic individuals across 33 studies found that disc protrusion was present in approximately: 60–80% of pain-free individuals may present with disc abnormalities on MRI.

Other degenerative findings, including disc degeneration and disc bulging, were even more common and increased substantially with age.

This does not mean that disc herniation is clinically irrelevant. Rather, an MRI finding should be interpreted for its clinical concordance with the patient’s symptoms, neurological findings and overall presentation. Contemporary guidance similarly cautions against relying on imaging findings alone because asymptomatic lumbar disc abnormalities are common.

🔑 Clinical takeaway

A positive Lasègue/SLR test does not equal a lumbar disc herniation.

The SLR remains a useful component of the clinical examination, particularly when evaluating patients with radiating leg symptoms, but it should not be used in isolation to determine the underlying pathology.

Test findings + clinical history + neurological examination + symptom behaviour + appropriate imaging when indicated = better clinical reasoning.

The goal is not simply to identify a structural abnormality, but to determine whether that finding is clinically relevant to the patient’s presentation.

⚠️ Disclaimer:
👉 Sharing a study is NOT an endorsement.
👉 Clinicians should read the original research themselves, consider its methodology and limitations, and critically interpret the findings before applying them to clinical practice.

06/08/2026

30/07/2026

23/07/2026

L'arc douloureux classique de l'épaule, pour nous, ce n'est pas une maladie, c'est un panneau qui dit à quel angle ça coince, et qui nous oriente parce que chaque étage de l'épaule frotte à une hauteur différente, comme si on montait un bras dans un tunnel et qu'on notait à quel étage ça frotte.

C'est le test le plus utilisé en kiné pour trier conflit sous acromial, lésion coiffe et articulation acromio claviculaire.

L'arc de référence que tu as

On teste en abduction pure, pouce vers le haut, bras qui monte de 0° à 180° :

0° à 60° : Aucune douleur
Début libre, deltoïde et supra épineux travaillent sans compression.

60° à 120° : Douleur = conflit sous-acromial classique
C'est le vrai arc douloureux. A 90°, le trochiter passe sous l'acromion, bourse et supra épineux se coincent.
Douleur face externe, qui brûle, qui peut réveiller la nuit couché sur épaule.

120° à 170° : Aucune douleur
L'acromion dégage, le tendon sort du tunnel, douleur qui s'éteint, signe typique que ce n'est pas une capsulite.

170° à 180° : Douleur = conflit acromio claviculaire
Tout en haut, la clavicule écrase le ménisque AC. Douleur tout en haut de l'épaule, très localisée au dessus.

Ton exemple avec les deux zones douloureuses, 60-120 et 170-180, c'est le double conflit, très fréquent après 35 ans.

Les 3 arcs qu'on voit en pratique

1. Arc 60° à 120° : sous-acromial
Cause, bourse, supra épineux, bec acromial, posture enroulement épaules.
Tests qui confirment, Neer, Hawkins, Yocum positifs, et test de recentrage qui soulage.

2. Arc 120° à 180° : AC
Cause, arthrose acromio claviculaire, séquelle chute, bench press lourd.
Test, cross body adduction douloureuse, pression directe sur AC.

3. Arc 0° à 60° douloureux
Ce n'est pas un arc classique, on pense capsulite, calcification aiguë, tendinite longue portion biceps ou rupture coiffe. Si douleur tout le trajet 0 à 180, c'est épaule gelée.

Ce qu'on fait vraiment en bilan

Anamnèse : métier bras au dessus tête, muscu, chute, douleur nocturne.
Palpation : AC sensible ou gouttière sous acromiale.
Force : Jobe pour supra épineux, rotation externe pour infra épineux, belly press pour sub scapulaire.
Mobilité passive : si passive aussi limitée, ce n'est pas un simple conflit.
Écho : bourse épaissie, éperon, tendinose.

Ce qui nous aide vraiment

Phase aiguë 2 semaines
Glace 15 min, éviter abduction avec rotation interne, dormir sur dos ou côté opposé, pas de port au dessus tête.

Kinésithérapie clé
Recentrage antéro supérieur tête humérale, renforcement infra épineux et dentelé antérieur, travail omoplate, ouverture thoracique, étirement capsule postérieure et petit pectoral, correction geste travail, reprise progressive sous 90° puis au dessus.

Si AC
Repos pompes et dips, glace AC, taping décoaptation, renforcement sans barre devant, infiltration AC sur avis médecin si arthrose confirmée.

Si pas mieux à 6 semaines
Infiltration sous acromiale écho guidée, puis reprise kiné, arrêt si déficit de force, IRM pour coiffe.

Quand consulter vite
Perte brutale de force pour lever bras après traumatisme, épaule déformée, fièvre avec épaule rouge chaude, ou douleur qui ne cède jamais même au repos. Dans ces cas, urgences ou orthopédiste rapide pour éliminer rupture massive ou infection.

L'arc douloureux se lit en 30 secondes mais oriente tout le traitement.

Si tu veux, envoie moi exactement où ça fait mal chez ton patient et sa force en rotation externe, je te dis si on part plus sous acromial pur ou AC prédominant et quel exercice prioriser.

18/07/2026

L’ostéopathie est-elle une pseudo-science ?
Dans ce 2ème épisode d’Ostéo Talk, Etienne Bulidon s'entretien avec Pierre-Luc L'Hermite.
Ils ont essayé de dépasser les prises de position simplistes pour se poser quelques questions essentielles :
- Que signifie réellement le terme pseudo-science ?
- Que dit aujourd’hui la littérature scientifique sur l’ostéopathie ?
- Comment faire évoluer notre profession sans renoncer à l’esprit critique ?
https://open.spotify.com/episode/6gdo0w5xaHYZY7GzeU2oBp

27/06/2026

𝐈𝐧𝐭𝐞𝐫𝐬𝐞𝐜𝐭𝐢𝐨𝐧 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞: 𝐓𝐡𝐞 𝐃𝐞 𝐐𝐮𝐞𝐫𝐯𝐚𝐢𝐧'𝐬 𝐈𝐦𝐩𝐨𝐬𝐭𝐨𝐫

​When a patient presents with pain and swelling on the thumb side of the wrist, the automatic diagnosis is almost always De Quervain's Tenosynovitis. But when thumb splinting fails and Finkelstein's test is surprisingly negative, the inflammation is often happening further up the arm.

​Recent literature highlights that Intersection Syndrome is a highly specific, yet frequently overlooked, cause of dorsal forearm and wrist pain in weightlifters, racket athletes, and rowers.

​👉 What Is Intersection Syndrome?
​Intersection Syndrome is an inflammatory friction tenosynovitis that occurs not at the wrist joint itself, but further up the forearm.
​It happens exactly where two muscle groups cross over (intersect) one another: the first extensor compartment (abductor pollicis longus and extensor pollicis brevis) crosses directly over the second extensor compartment (extensor carpi radialis longus and brevis).

​👉 Pathophysiology
​This is a classic repetitive-friction injury. High-load, repetitive wrist flexion and extension (like revving a motorcycle, rowing, or performing heavy bicep curls) causes the bellies of the first compartment muscles to aggressively rub against the tendon sheaths of the second compartment beneath them. This mechanical friction creates severe localized inflammation, edema, and tendinopathy.

​👉 Typical Pain Distribution
​Patients typically present with:

​• Deep, burning pain on the back (dorsal) and thumb-side (radial) of the forearm.
• The pain is distinctly located approximately 4 to 8 centimeters proximal to Lister's tubercle (above the wrist joint), unlike De Quervain's which is directly at the radial styloid.
• Symptoms aggressively worsen with resisted wrist extension or a forceful power grip.

​👉 Key Clinical Signs
​Several clinical findings can cleanly differentiate Intersection Syndrome from De Quervain's:

​✔️ The "Creak" (Crepitus): Placing your hand over the patient's dorsal forearm while they actively flex and extend their wrist will often produce a palpable and audible "squeaking" or "crunching" sensation, often described as feeling like walking on wet snow.
✔️ Proximal Swelling: Visible swelling or a palpable sausage-like lump 4-8 cm above the wrist joint.
✔️ Negative Finkelstein’s Test: Tucking the thumb and ulnarly deviating the wrist typically does not produce the primary intense pain, whereas resisted wrist extension will.

​👉 Why It Is Frequently Misdiagnosed
​Because of its proximity to the thumb tendons, it perfectly mimics:

​• De Quervain's Tenosynovitis
• Wartenberg’s Syndrome (Superficial Radial Nerve entrapment)
• Extensor Pollicis Longus (EPL) tendinopathy
• Radial shaft stress fractures

​👉 Evidence-Based Treatment Approaches
​Thumb spica splints often fail because they don't adequately immobilize the wrist extensors.

📌 ​Conservative management
• Immobilization utilizing a forearm-based splint with the wrist in 15 to 20 degrees of extension to entirely offload the second compartment.
• Biomechanical modification (e.g., widening grip on a barbell, modifying rowing stroke mechanics).
• Soft tissue mobilization focusing on the proximal muscle bellies rather than just the tendon sheaths.

📌 ​Interventional options
• Ultrasound-guided corticosteroid injections placed precisely between the first and second extensor compartments are highly successful.
• Surgical release (tenosynovectomy) is rarely needed but highly effective for refractory cases.

​📌 Clinical Takeaway
​If your "De Quervain's" patient complains of a squeaking forearm or their pain is located 3 inches above the actual wrist joint, you are rubbing the wrong tendons. Move your assessment proximally. Immobilize the wrist extensors—not just the thumb—and the friction will finally stop.

​✅ References
• PubMed, 2025 – Tendon Anatomy and Tendon Disorders of the Wrist.
• PubMed, 2025 – Tendinitis Around the Wrist and Hand.