Bakody’s sign is an orthopaedic test to help diagnose a cervical radiculopathy condition. It is a medical test also known as the shoulder abduction test. It can be classified as a orthopaedic test of the cervical spine. It is said to be as definitive as Spurling’s Test for determining cervical foraminal compression, and is much less painful to perform for the patient.
You may have read me mentioning the Bakody’s sign position in my article on how to help a trapped nerve in the neck. You might be wondering what I was talking about? Well I’ll explain more about it in this post. The best thing about this particular orthopaedic test is that it is not only a diagnostic tool, but can be used as a treatment tool as well!
Are you suffering an electric pain that is running into your shoulder, down the arm & into the elbow or wrist? Did you know this simple arm movement could help you get some instant pain relief? I will tell you more about this easy to do nerve tension test. I explain why & how to do the test, and why I recommend it as also as home treatment advice for helping patients to control nerve pain in the arm.
Bakody’s Sign was developed by, Dr. John Bakody. He was a neurosurgeon who practiced in Des Moines, Iowa, USA from the 1950’s through the 1990’s. A paper describing the technique was published in Surgical Neurology in June, 1977.
* Credit to chiropractor, Catherine Bakody, D.C, who emailed me the history behind her fathers discovery and enlightened me on extra details behind his findings.
It is used during a physical examination done by healthcare professionals, like doctors, surgeons & chiropractors, when trying to determine the cause of a suspected biomechanical source of pain.
Common situations this could be useful are:
- Acute neck pain
- Shoulder & arm pain from a suspected compressed cervical spine nerve root
- Diagnosing a possible herniated cervical disc pathology
- Ruling out referral pain coming from the neck in to the shoulder region
I personally find it both a fantastic diagnostic plus a home treatment exercise. I always use it when examining a patients’ neck for a possible nerve compression issue. It can used for both new or chronic neck pain situations, but tends to be better in the acute phase.
How To Perform The Shoulder Abduction Test
- Step 1 – passively, or actively, raise the affected painful arm above the head
- Step 2 – place the palm of the hand on top of the head
- Step 3 – observe if pain levels improve or worsen
That is it, nice and simple. This might appear very basic, yet it is such a powerful tool to know how to use during a new patient workup.
Here is a video explaining the step by step process to help you visualise what it looks like.
How to Interpret The Results
You get two possible outcomes:
- Positive result
- Negative result
Positive Bakody’s Sign
A positive sign is when the patient feels better when they place the hand of their painful arm on top of their head. Some people may instinctively perform this position on their own as they naturally find it relieving.
The probable mechanism is that elevation of the suprascapular nerve relieves traction on the lower trunk of the brachial plexus. This means that the mechanical tension on the nerves going from your neck into your arm is made less by putting your hand on your head. If the affected arm is hanging by your side that pulls on the brachial plexus and irritates it causing more pain.
Negative Bakody’s Sign
A negative sign is when the patient feels worse when they place the hand of their painful arm on top of their head.
The probable mechanism is that the mechanical tension on the nerves going from your neck into your arm is made worse due to inter-scalene muscle compression. So if placing a hand on the top of the head worsens the brachialgia (arm pain) this could be seen as positive for interscalene compression and is sometimes referred to as negative Bakody’s sign.
Sensitivity & Specificity
I read that the sensitivity and specificity values are 30%-42% and 90-100% respectively.
The sensitivity of a clinical test refers to the ability of the test to correctly identify those patients with the disease. The specificity of a clinical test refers to the ability of the test to correctly identify those patients without the disease. So a positive Bakody’s sign is very good at saying that yes you do have an active disc condition with an associated nerve entrapment.
Other very useful orthopaedic tests for a suspected cervical disc pathology or radiculopathy are:
- Spurling’s Test,
- Doorbells Sign,
- Cervical Compression Test,
- O’ Donoghue’s Test.
The major benefit is Bakody’s sign is such a simple neck pain test which is used to screen for a cervical radiculopathy condition.
Don’t know what is a radiculopathy? Well it is a medical term for trapped or pinched nerve coming from your neck and normally going into down your arm.
I always use this specific cervical spine test when I suspect that a patient has a cervical disc herniation causing an associated C4, C5, C6 or C7 radiculopathy.
It might also be useful when assessing sports injuries on the side of the field. Great for a differential diagnosis like a stinger injury problem for a player during a rugby game.
I have a whole bunch of possible self-treatment suggestions for a trapped nerve pain here. Read that list if you haven’t already.
My extra bonus tips for trying to find a pain relief position are:
- Try turning your head away from the painful side,
- Try tucking your chin in a little bit like this DNS neck exercise,
- Try laying on your back with a pillow under your head plus a rolled up towel under your neck to support the natural cervical lordosis curve in the spine.
At the end of the day, the main goal is to help take the pressure off the irritated spinal nerve that is coming out your neck. Think of the nerve as if it were a rope. You need to help take the tension out of the rope and create some slack. To do this you would need to lift the rope up and rest it on your head.[expand title=”References”]
- Davidson RI, Dunn EJ, Metzmaker JN. The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compressive monoradiculopathies. Spine. 1981 Sep-Oct;6(5):441-6.
- Viikari-Juntura E1, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine. 1989 Mar;14(3):253-7.
- Fast A1, Parikh S, Marin EL. The shoulder abduction relief sign in cervical radiculopathy. Arch Phys Med Rehabil. 1989 May;70(5):402-3.
- Rubinstein SM1, 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. Epub 2006 Sep 30.