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Special Test

Shoulder Abduction Test (Bakody Sign)

Shoulder Abduction Test (or Bakody Sign) is used in case of suspicion of C4 or C5 nerve root irritation. It can also be used for thoracic outlet syndrome.

How do you do shoulder abduction Test?

  • The patient is positioned in Seated or standing position, with the Stands in front of the patient.
  • The examiner asks the patient to make an active or passive abduction of the shoulder, flexes the elbow, and places the palm of the hand on the top of the patient head (elevate the arm through abduction, so that the hand or forearm rests on top of the head).
  • The patient is asked to maintain this position for 30 seconds.
See Also: Spurling Test | Cervical Radiculopathy
Shoulder Abduction Test- Bakody Sign
Shoulder Abduction Test- Bakody Sign

What does a positive Shoulder Abduction Test mean?

  • Shoulder Abduction Test (Bakody sign) is positive if the symptoms of nerve root irritation improve or resolve, because abduction of the arm decreases the length of the neurological pathway and decreases the pressure on the lower nerve roots.
  • A cervical extradural compression problem, such as a herniated disk, or nerve root compression should be suspected.
Shoulder Abduction Test procedure

Sensitivity & Specificity

A study by Davidson 1 found that this test has the following accuracy:

  • Sensitivity: 78 %
  • Specificity: 75 %

Another study by Wainner 2 to assess the reliability and accuracy of individual clinical examination for the diagnosis of cervical radiculopathy, the Bakody sign has a low Sensitivity (17 %) and a high Specificity (92 %).

Farshad and Min recently described an abduction extension test that was reported to have a sensitivity of 0.79 and a specificity of 0.98 in the detection of cervical nerve root compression. This test was performed by laterally abducting the humerus to 80° with the neck rotated towards the contralateral shoulder. With the patient in this position, an anteriorly directed pressure was applied to the posterior aspect of the humeral head. Reproduction of symptoms was considered a positive test. In their preliminary cadaveric study using this maneuver, nerve roots were displaced by approximately 4–5 mm in all cases, potentially explaining the resulting high sensitivity and specificity values.

Notes

  • Shoulder abduction can be used not only as a diagnostic sign but also may be incorporated in the conservative management of patients suffering from cervical radiculopathy affecting the lower cervical roots.
  • The specific segmental level can be determined by the dermatome distribution of the symptoms.
  • The C4–C6 nerve roots are primarily examined in this test.
  • If the nerve root irritation increases during the course of the above test, one must suspect a thoracic outlet syndrome (due to changes in the scalene muscles or to a cervical rib).
  • If the symptoms are increased with this maneuver, the implication is that pressure is increasing in the interscalene triangle.

Reference

  • Davidson RI, Dunn EJ, Metzmaker JN. The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compressive monoradiculopathies. Spine (Phila Pa 1976). 1981 Sep-Oct;6(5):441-6. doi: 10.1097/00007632-198109000-00004. PMID: 7302677.
  • Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003 Jan 1;28(1):52-62. doi: 10.1097/00007632-200301010-00014. PMID: 12544957.
  • Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007 Mar;16(3):307-19. doi: 10.1007/s00586-006-0225-6. Epub 2006 Sep 30. PMID: 17013656; PMCID: PMC2200707.
  • Fast A, Parikh S, Marin EL. The shoulder abduction relief sign in cervical radiculopathy. Arch Phys Med Rehabil. 1989 May;70(5):402-3. PMID: 2719545.
  • Evans RC: Illustrated Essentials in Orthopedic Physical Assessment. St. Louis, MO: Mosby-Year book Inc, 1994.
  • Clinical Tests for the Musculoskeletal System 3rd Edition.
  • Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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