Mennell's Sign

Original Editor - Anna Fuhrmann Top Contributors - Anna Fuhrmann, Ahmed M Diab and Chelsea Mclene

Purpose

The Mennell's sign is a pain-provocation test that is used to examine degenerative progress in the sacroiliac joint. It was developed by the orthopaedic physician James Mennell to test for spondyloarthropathy diseases such as Ankylosing Spondylitis (Morbus Bechterew).

Technique

The Mennell's sign can be realised in two different ways:

1. Classic Extension Test: The patient lies in prone position, the examiner passively lifts the straight leg into hip extension while manually putting pressure on the sacroiliac (SI) joint. If the patient experiences familiar pain in the hip region, the Mennell's sign is positive. No report of pain in the hip region does not rule out damage to the same. To find more precise results this test was then further developed into the Three-Phases Test.
2. The Three-Phases Test: The Three-Phases Test differentiates between the involvement of the lumbar spine, the SI joint and the hip. The patient is again in prone position and the examiner lifts the ipsilateral leg with an inward rotation by reaching underneath the thigh from medial.

• Hip joint: Pressure is applied to the Tuber ischiadicum while extending the leg as described above.
• Sacroiliac joint: Pressure is applied directly to the Sacroiliac joint while extending the leg as described above.
• Lumbar spine: Fixation of the vertebra Th12 in ventral-caudal position while extending the leg as described above.

Evidence

A study with 70 patients (between 18 and 30 years of age) conducted by Sadowska-Wróblewska et al. found that a positive Mennell's sign in combination with reduced respiratory excursion and swollen joints of the lower extremities are significantly more frequent in patients with early spondylitis than in patients with lumbar disc disease. This study calculated the following values for sensitivity, specificity and Youden index for the positive Mennell's sign:

	Sensitivity	Specificity	Youden index
Positive Mennell's sign	34	88	22

The values can be interpreted in so far that for early spondylitis the test does not show positive for more than 75% of patients but when it is positive in 88% of those cases, the disease is correctly identified.

Testing in clinical practice

Clinical examination tests work best when used in a combination of three to five tests, this is especially true for SI joint dysfunction and pain.

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Examples of further tests for the SI joint/ pelvic region include:

• Thigh Thrust Test
• Anterior Innominate Test
• Belt Test
• Erichsen's Sign
• Sacroiliac Compression Test
• Sacroiliac Distraction Test

and for the lumbar region:

• Antalgic Posture Sign
• Bechterew's Sitting Test
• Bowstring Sign
• Bragard's Sign
• Cox Sign