Jump to content

Bakody Sign

Original Editor- Ashmita Patrao Top Contributors - Ashmita Patrao, Yasmin Maraya S Verzosa, Kim Jackson, Chelsea Mclene, Kapil Narale, Kirenga Bamurange Liliane, Janine van Dyk and Matt Huey

Purpose

The purpose of this test is to help identify cervical nerve root compression, particularly in cases of cervical radiculopathy. This maneuver helps differentiate cervical radiculopathy and thoracic outlet syndrome from other types of neck pain or upper limb conditions. Bakody’s test (shoulder abduction relief test) is a diagnostic test for cervical spondylosis.[1] It is also known as the Shoulder Abduction Test.[2] According to Taber's Medical Dictionary, this test is used to assess cervical nerve root pain in the C4-C6 region. It is considered indicative, but not conclusive, of cervical neuropathy if the patient's pain decreases when they place their hand on top of their head. [3]

Dr. Sigurd Bakody, a neurologist, first described this technique in the early 1940s.[4] He Published his findings in Surgical Neurology [5].

When a patient experiences relief of pain by placing their hand on top of their head, it suggests that there may be nerve root compression in the cervical spine. This is called "Plexus relief" which occurs when the shoulder in abduction and 45° flexion, as described in Bakody’s shoulder abduction test.[5][6] Arm abduction alleviates symptoms by relieving the stretching pressure on the affected nerve root.[2]

It is used to diagnose cervical radiculopathy and is as definitive as the spurling's test, but is less painful. It can also be used in case of a herniated disc pathology, spinal nerve root compression, or acute neck pain which may be neural related.

Technique

The patient could be in a sitting position or supine. The upper limb is actively or passively raised above the head with the palm of the patient touching the head.

Guide for performing the Bakody Sign test:  

  1. Begin by explaining the procedure to the patient and obtaining their consent.  
  2. Ensure the patient is sitting or standing comfortably with their back straight.  
  3. Ask the patient to raise the arm on the side of the radicular pain and place their hand on top of their head.  
  4. Instruct the patient to maintain this position for at least 30 seconds.  
  5. Observe whether the patient experiences symptom relief, such as reduced pain, numbness, tingling, or weakness in the affected arm.  
  6. Repeat the test on the unaffected side for comparison.  
  7. If the patient reports any discomfort or symptoms during the test, stop it immediately.  
  8. Document the test results in the patient’s medical records.  

Positive sign: Reduction in symptoms with the painful arm placed on top of the head. The suggested mechanism includes reduction of pain as the traction force to the nerves and the lower brachial plexus trunks are relieved. With the arm hanging at the side of one's body, the mechanical traction acting on the nerve increases, thus increasing symptoms. [7]

Negative sign: Increase in the symptoms when the patient's hand is placed on the head. These symptoms are probably increased due to inter-scalene muscle compression. Thus placing the hand could be termed positive for inter-scalene compression and negative for Bakody sign.[7]

Evidence

The test has a specificity range of 80%-100% and a sensitivity range of 26%-50%.[8]

This test can be useful in the confirmation of cervical radiculopathy compared to shoulder pathology[9][10]. Patients who experience a decrease in symptoms with this test do show a higher prevalence for a cervical pathology.

References

  1. ↑ Kimura R, Kobayashi T, Miyakoshi N. Bakody’s Test Positive Thoracic Outlet Syndrome Caused by Anomalous Muscle: A Case Report. Cureus. 2023 Jan;15(1).
  2. ↑ 2.0 2.1 Woessner DA, Webb CW. Physical Examination of the Cervical and Thoracic Spine. InThe Sports Medicine Resource Manual 2008 (pp. 90-99). Elsevier Inc..
  3. ↑ Taber's Medical Dictionary [Internet]. Bakody sign. [cited 2025 Jan 10]. Available from: https://www.tabers.com/tabersonline/view/Tabers-Dictionary/773522/all/Bakody_sign. Accessed 2025 January 10.
  4. ↑ Bakody S. The Bakody sign. Neurology. 1945 Mar; 3(3): 221-2. doi: 10.1212/WNL.3.3.221
  5. ↑ 5.0 5.1 Johnson I. Bakody sign. Surgical Neurology. 1977 Jun 1;7(6):370. Available from: https://pubmed.ncbi.nlm.nih.gov/882910/. Accessed 2025 January 10.
  6. ↑ Farshad M, Min K. Abduction extension cervical nerve root stress test: anatomical basis and clinical relevance. European Spine Journal. 2013 Jul;22:1522-5.
  7. ↑ 7.0 7.1 Magee, David J. Orthopedic Physical Assessment. St. Louis, Mo: Saunders Elsevier, 2008.
  8. ↑ Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine (Phila Pa 1976). 1989 Mar;14(3):253–7.
  9. ↑ DAVIDSON, R. I., DUNN, E. J., & METZMAKER, J. N. (1981). The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compressive monoradiculopathies. Spine, 6(5), 441-446.
  10. ↑ Jo, H. J., Shin, M. H., Hur, J. W., Kim, J. S., Ryu, K. S., & Park, C. K. (2012). Unrecognized shoulder disorders in treatment of cervical spondylosis presenting neck and shoulder pain. Korean Journal of Spine, 9(3), 223.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Bakody_Sign&oldid=367452"