Assesses for the presence of cervical myelopathy.

  • Lhermitte’s Sign

  • Shock-like pain or paresthesia into the spine and/or upper extremities that worsens with cervical flexion

Patient Position
  • Seated with legs resting straight out on the table to create maximum tension
Examiner Position
  • Seated or standing behind patient
Steps of Performance
  1. Passively flex the neck
Alternative Methods
  • Patient may also be supine for exam

Cervical hyperflexion elongates the dural sac, meninges, spinal cord, and nerve roots under resistance, leading to stretching or tearing. Conditions such as spinal cord compression or demyelination cause an activation of ascending spinothalamic tracts at the cervical level during neck flexion.

General

Positives

Sharp, shooting nerve pain that radiates down the spine or the extremities

  • Suggestive of sclerotic cord lesions or other scarring in the cord or dura
    • Causes may include but are not limited to demyelination in multiple sclerosis (MS), B12 deficiency, cord tumors, posterior column trauma or disease, meningeal adhesions or irritation, stenosis, or disc herniation
    • Clinically suspected cervical myelopathy is confirmed by MRI

Pertinent Negatives

DATA
TAGS
References
Teive H, Zavala J, Haratz S. Vitamin B12 deficiency induced psychosis - A case report. Sao Paolo Med. 2017;127(3):171-173. doi:10.26226/morressier.589b235bd462b8028d891b4f.
Khare S, Seth D. Lhermitte′s sign: The current status. Annals of Indian Academy of Neurology. 2015;18(2):154. doi:10.4103/0972-2327.150622 .
Lefebvre R, Novak C. Cervical Orthopedic Tests. University of Western States. Published 2021. Accessed April 18, 2022.
Vizniak NA, Buse M. Evidence-Informed Orthopedic Assessment. Canada: Professional Health Systems Inc.; 2022.
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. 2003;28(1):52-62. doi:10.1097/00007632-200301010-00014

Assesses for the presence of cervical myelopathy.

  • Shock-like pain or paresthesia into the spine and/or upper extremities that worsens with cervical flexion

Patient Position
  • Seated with legs resting straight out on the table to create maximum tension
Examiner Position
  • Seated or standing behind patient
Steps of Performance
  1. Passively flex the neck
Alternative Methods
  • Patient may also be supine for exam

Cervical hyperflexion elongates the dural sac, meninges, spinal cord, and nerve roots under resistance, leading to stretching or tearing. Conditions such as spinal cord compression or demyelination cause an activation of ascending spinothalamic tracts at the cervical level during neck flexion.

General

Positives

Sharp, shooting nerve pain that radiates down the spine or the extremities

  • Suggestive of sclerotic cord lesions or other scarring in the cord or dura
    • Causes may include but are not limited to demyelination in multiple sclerosis (MS), B12 deficiency, cord tumors, posterior column trauma or disease, meningeal adhesions or irritation, stenosis, or disc herniation
    • Clinically suspected cervical myelopathy is confirmed by MRI

Pertinent Negatives