Certified Neuroscience Registered Nurse (CNRN) Practice Exam

What does pain upon straight leg raising in a multi-trauma patient suggest?

1. Herniated nucleus pulposus

2. Femoral fracture

3. Hamstring strain

4. Sciatica

The correct answer is: Herniated nucleus pulposus

Pain upon straight leg raising in a multi-trauma patient is indicative of nerve root irritation, often associated with conditions such as a herniated nucleus pulposus. This action places the lower back and nerve roots, particularly the L4-S1 nerve roots, under stress, and if a herniated disc is present, irritation of these nerves can result in pain radiating down the leg. In cases of a herniated disk, the straight leg raise test can reproduce the patient’s radicular pain, suggesting that the disc material is compressing or pulling on nerve roots. As a result, patients typically feel pain when their leg is raised while keeping it extended, confirming the presence of nerve-related issues. Other possibilities, while related to leg pain, do not specifically present pain with this test in the same way that a herniated disc does. A femoral fracture would usually present with localized pain at the site of the fracture that may not necessarily be exacerbated by leg raising. Similarly, a hamstring strain involves pain in the muscle group and might result in difficulty with movement but would not typically cause the type of radicular symptoms indicated by the straight leg raising maneuver. Sciatica generally refers to pain along the sciatic nerve path,