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Bakody’s Sign: Cervical Radiculopathy Orthopaedic Test

Bakody's Sign PositionBakody’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.

History

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.

Uses

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:

  1. Positive result
  2. 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.

Main Benefit

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.

Treatment Options

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:

  1. Try turning your head away from the painful side,
  2. Try tucking your chin in a little bit like this DNS neck exercise,
  3. 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.

References
  • Mish

    Thank you ever so much for this entire article and all the links included. I had luckily discovered Bakody’s on my own, which allowed me to get places…like the bathroom…and the hospital lol, but I was so excited to see there was a term for it and confirmation of my symptoms/diagnosis. It was actually your “Extra tips for pain relief” and the 3 bullet points that literally made me laugh and cry with relief and gladness because it worked for me – I had my face stuffed into my mattress and my hands for 3 days and bed sores on my elbows. The amazing thing is, it actually works standing as well! I couldn’t believe it. Shifting my head a few inches provides almost instant relief. Now I can use both hands!
    Thank you thank you thank you!

  • Jamie

    Sensitivity rules out, specificity rules in. You have something incorrect in your article.

  • Glad you got some laughter healing added to the article 🙂

  • Akosua Pinaman

    I am experiencing that excruciating pain right now and didn’t know what it was till I googled today and much grateful for this article but I must mention your last line of your opening paragraph really got me laughing out loud and forgot about the pain for a moment because that is exactly what I am experiencing. Thanks!

  • @peatmarchyahoocouk:disqus Yes it does sound like the nerve is involved. Maybe something else to consider is the McKenzie Treat Your Own Neck book. I have it and it seems good advice and from what I have read on the Amazon reviews lots of people find it useful. I fully understand how frustrating pain can be stopping you from proper function in your life like the fiddle playing. Let me know how things go.

  • peatmarch@yahoo.co.uk

    Many thanks for your feedback gary.The pain is rampant especially a t night when i stand up. It’s comparable as someone sticking a knife in my fore arm and upper arm I was literally crying with it last night. When I move my chin ie tuck my neck in it sends severe shooting pains down my arm followed by pins and needles that last 5 10 mins. Is that prescriptive of nerve damage??? and once again thankyou. I’m just really worried because it’s taken over my life and as a fiddle player it’s devastating.

  • @peatmarchyahoocouk:disqus I know how severe it can get as I have seen the effects in patients. If it is a cervical disc herniation diagnoses I would suggest asking for nerve conduction study to confirm any actual changes in the nerve, discussing with a doc about specific neuropathic pain medication. A more natural route might be intravenous magnesium I have added the pdf to show a doctor how to use magnesium according to the South African Pain guidelines. I have seen drastic reductions in severe pain levels just through magnesium. Other than having a chiropractor maybe use some cold laser on your neck and help adjust your mid to upper back to make sure your not overloading your neck from there.

  • peatmarch@yahoo.co.uk

    Many thanks pal, i will try it . I’m going for a scan in 2 weeks but this has ruined my life. never known pain like it.

  • Hay Peat, 3 months is a long time to have a pain have you had it checked out yet? This arm position is a great temporary pain relief treatment. If it helps you try it sitting and laying down.

  • peatmarch@yahoo.co.uk

    many thanks i am in a mess and have been for 3 months now. incredible pain in back and right arm. i’m a fiddle player and can’t play now.this is agony how can I get cured?? Peatmarch@yahoo.co.uk

  • Moazzam

    It really works for sometime while you are in this position but when you tilt your head to the left where the pain is residing then it hurts again.

  • david hudson

    tried it and does give some relief