L4

Execution: 

  1. Use a brush like the one found in the handle of most reflex hammers, a piece of cotton or your fingers
  2. Then stroke the dermatomes in both the affected an unaffected limb
  3. To confirm changes in sensibility, you can also compare the sensation in different adjacent dermatomes by stroking across the borders of these dermatomes

 

Positive Outcome: Changes in sensibility compared to adjacent dermatomes or compared to the other side

Study

Reliability

Sn Sp LR+

LR-

Hancock et al. (2011)

NA

42 74 1.61

0.79

Iversen et al. (2013)

NA

33 88 2.9

0.75

Comment: L4 sensory loss does not seem to be able to identify a specific level of lumbar disc herniation