A reflexive knee and hip flexion associated with cervical flexion that raises suspicion for myelopathy.

  • Often mistakenly referred to as the Soto-Hall

  • Neck pain with myelopathic symptoms
  • Sudden onset of neck pain with associated fever

Patient Position
  • Supine
Examiner Position
  • At the patient's side
Steps of Performance
  1. Passively flex the patient’s neck through its entire range of motion while observing for involuntary knee and/or hip flexion
Alternative Methods
  • Brudzinski’s sign could be noticed in any patient position that involves deep cervical flexion

Neck flexion stretches the spinal cord and its constituent parts (i.e. dural sac, meninges, nerve roots). When myelopathy is present, this stretch could illicit sharp neurological symptoms around the impingement/irritation sight. Knee/hip flexion reduces tension on the spinal cord distally, helping to relieve the disturbance arising from the myelopathy.

General

Positives

Involuntary hip and knee flexion

  • Myelopathy
    • If symptoms of meningeal irritation or meningitis are present (e.g. nuchal rigidity, fever, or general signs of illness) a cerebrospinal fluid (CSF) analysis is indicated.

Pertinent Negatives

DATA
TAGS
References
Akaishi T, Kobayashi J, Abe M, et al. Sensitivity and specificity of meningeal signs in patients with meningitis. Journal of General and Family Medicine. 2019;20(5):193-198. doi:10.1002/jgf2.268
Lefebvre R, Novak C. Cervical Orthopedic Tests. University of Western States. Published 2021. Accessed April 17, 2022.
Vizniak NA, Buse M. Evidence-Informed Orthopedic Assessment. Canada: Professional Health Systems Inc.; 2018.
Nakao JH, Jafri FN, Shah K, Newman DH. Jolt accentuation of headache and other clinical signs: Poor predictors of meningitis in adults. The American Journal of Emergency Medicine. 2014;32(1):24-28. doi:10.1016/j.ajem.2013.09.012
Thomas K, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clinical Infectious Diseases. 2002;35(1):46-52. doi:10.1086/340979

A reflexive knee and hip flexion associated with cervical flexion that raises suspicion for myelopathy.

  • Neck pain with myelopathic symptoms
  • Sudden onset of neck pain with associated fever

Patient Position
  • Supine
Examiner Position
  • At the patient's side
Steps of Performance
  1. Passively flex the patient’s neck through its entire range of motion while observing for involuntary knee and/or hip flexion
Alternative Methods
  • Brudzinski’s sign could be noticed in any patient position that involves deep cervical flexion

Neck flexion stretches the spinal cord and its constituent parts (i.e. dural sac, meninges, nerve roots). When myelopathy is present, this stretch could illicit sharp neurological symptoms around the impingement/irritation sight. Knee/hip flexion reduces tension on the spinal cord distally, helping to relieve the disturbance arising from the myelopathy.

General

Positives

Involuntary hip and knee flexion

  • Myelopathy
    • If symptoms of meningeal irritation or meningitis are present (e.g. nuchal rigidity, fever, or general signs of illness) a cerebrospinal fluid (CSF) analysis is indicated.

Pertinent Negatives