Lhermitte Sign

 Lhermitte Sign

  • Lhermitte Sign differentiates between spinal cord lesions and peripheral nerve root lesions.

  • The patient sits with outstretched legs on the examination table.
  • The examiner grasps the patient’s foot with one hand and places the other on the back of the patient’s head.
  • The examiner then simultaneously flexes the outstretched leg at the hip and increasingly flexes the cervical spine.

  • The Lhermitte test is positive if an acute pain occurs that radiates into the upper or lower extremity.
    • This suggests dural or meningeal irritation of the spinal cord (root irritation) or possibly cervical myelopathy.
    • If the patient were to actively bend the head toward the breast, then this would be the Soto-Hall test.
    • Maximally flexing the cervical spine places strong tension on the spinal cord.
  • A positive Lhermitte sign can indicate stenosis of the cervical spinal canal:
    • The patient describes a sudden, generalized electric shock in the arms and trunk, especially when inclining the head.

  • Sensitivity: 3 – 17%
  • Specificity: 97% (for non-specific compressive myelopathy)

  • Spinal stenosis is usually of bony origin from pronounced spondylosis and spondylarthritis as a result of a degenerative intervertebral disk injury.
    • Early symptoms are abnormal sensations in the hands, gait disorders, and clumsiness of the hands (disturbances of fine motor function, writing and grip).
  • Differential diagnosis for patients with a positive Lhermitte Sign:
    1. Brachial plexus lesion
    2. Irritated cervical root syndrome
    3. Multiple sclerosis
    4. Spinal tumor.
    5. Amyotrophic lateral sclerosis.

  • Medscape
  • Pubmed
  • Clinical Tests for the Musculoskeletal 3rd Ed. Book

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