Hello Surgeon

X

How can we help you today?

Special Test

Beevor Sign Significance & causes

Beevor Sign is used to evaluate the rectus abdominis muscle weakness or paralysis due to spinal cord lesions between T10-12. It was first described by Dr. Charles Beevor, a neurologist and a clinician-scientist

How do you perform the Beevor Sign?

The patient is positioned supine, with the knees flexed and both feet flat on the bed. The patient is asked to raise the head against resistance, cough, or attempt to sit up with the hands resting behind the head. The clinician observes for motion at the umbilicus, which should remain in a straight line.

As an alternative, the patient can perform a bilateral leg lift to test the lowermost fibres of abdominal musculature.

Beevor's Sign
Beevor's Sign test

What is the positive Beevor Sign?

The umbilicus shifts to the side of stronger musculature. Superior shift implicates weakness of muscles innervated by lower thoracic spine whereas inferior shift implicates upper thoracic spine weakness at or below T7.

Positive Beevor sign, an upward deflection of the umbilicus on flexion of the neck, is the result of paralysis of the inferior portion of the rectus abdominis muscle, so that the upper fibers predominate, pulling the umbilicus upwards.

False positive test occurs when the abdominal musculature is extensively weak, the thorax may pull away from the pelvis and arching of back occurs causing tautness of the anterior abdominal muscles mimicking actual contraction of the muscles.

See Also: Lasegue Test
positive Beevor Sign

Notes

Beevor sign is a common finding in patients with facioscapulohumeral dystrophy, even before functional weakness of abdominal wall muscles is apparent, but is absent in patients with other facioscapulohumeral disorders.

Beevor sign can be present in the following conditions:

  1. Spinal cord lesion between T10 and T12 segment, tumors, for instance. Noteworthy, reports exist of acute Beevor sign with spinal cord infarction due to vascular lesion below T10.
  2. Facioscapulohumeral muscular dystrophy (FSHD) is autosomal dominant muscle dystrophy. Beevor sign is considered as a “sine qua non” clinical sign of this disease. Although some authors reported that this sign is 90% sensitive and specific for FSHD, other researchers believe it is specific (over 90%) but less sensitive (54%)  and can help in diagnosis. Furthermore, it is found more frequently in typical than atypical FSHD.

There are less frequent reports for this sign in the following diseases:

  1. Pompe disease: type 2 glycogen storage disease.
  2. GNE myopathy (autosomal recessive myopathy): this sign was observed in 90% of the patients in one study.
  3. Tubular aggregate myopathy.
  4. Myotonic dystrophy.
  5. Sporadic inclusion body myositis (IBM).
  6. Amyotrophic lateral sclerosis.
  7. Acid maltase deficiency in an adult patient.
See Also: Rectus Abdominis Muscle
rectus abdominis muscle
Rectus abdominis muscle

References

  1. Post M: Physical Examination of the Musculoskeletal System. Chicago, IL: Year Book Medical Publishers, 1987.
  2. Hoppenfeld S: Orthopedic Neurology – A Diagnostic Guide to Neurological Levels. Philadelphia, PA: JB Lippincott, 1977.
  3. Althagafi A, Nadi M. Beevor Sign. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545262/
  4. McCarter SJ, Burkholder DB, Klaas JP, Boes CJ. Charles E. Beevor’s lasting contributions to neurology: More than just a sign. Neurology. 2018 Mar 13;90(11):513-517.
  5. Leon-Sarmiento FE, Bayona EA, Bayona-Prieto J. A sudden Beevor’s sign. Clin Med Res. 2007 Jun;5(2):121-2. 
  6. Sharma C, Acharya M, Kumawat BL, Nath K. Beevor’s sign in facioscapulohumeral muscular dystrophy. BMJ Case Rep. 2014 May 14;2014.
  7. Eger K, Jordan B, Habermann S, Zierz S. Beevor’s sign in facioscapulohumeral muscular dystrophy: an old sign with new implications. J Neurol. 2010 Mar;257(3):436-8.
  8. Milisenda JC, Rico Caballero V, García AI, Tomás X, Grau JM. «Extended» Beevor’s sing as a new clinical sign in sporadic inclusion body myositis. Med Clin (Barc). 2017 Apr 21;148(8):e43.
  9. Preethish-Kumar V, Pogoryelova O, Polavarapu K, Gayathri N, Seena V, Hudson J, Nishino I, Prasad C, Lochmüller H, Nalini A. Beevor’s sign: a potential clinical marker for GNE myopathy. Eur J Neurol. 2016 Aug;23(8):e46-8.
  10. Desai JD. Beevor’s sign. Ann Indian Acad Neurol. 2012 Apr;15(2):94-5.
  11. Pandian JD, Mathuranath PS. Beevor’s sign in amyotrophic lateral sclerosis. Neurol India. 1997 Oct-Dec;45(4):283-284. 
  12. Oya Y, Morita H, Ogawa M, Nonaka I, Tsujino S, Kawai M. [Adult form of acid maltase deficiency presenting with pattern of muscle weakness resembling facioscapulohumeral dystrophy]. Rinsho Shinkeigaku. 2001 Jul;41(7):390-6.
  13. Awerbuch GI, Nigro MA, Wishnow R. Beevor’s sign and facioscapulohumeral dystrophy. Arch Neurol. 1990 Nov;47(11):1208-9. 
  14. Shahrizaila N, Wills AJ. Significance of Beevor’s sign in facioscapulohumeral dystrophy and other neuromuscular diseases. J Neurol Neurosurg Psychiatry. 2005 Jun;76(6):869-70. 
Angle Meter App for Android & iOS
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Orthopedic FRCS VIVAs Quiz
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Top 12 Best Free Orthopedic Apps
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
All-in-one Orthopedic App
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase