Bakody Tegn

Bakody’s Sign, also known as the Shoulder Abduction Test, is a diagnostic maneuver used to identify cervical nerve root compression, particularly in cases of cervical radiculopathy¹. The test helps differentiate cervical radiculopathy and thoracic outlet syndrome from other causes of neck and upper extremity pain². Symptom relief when the patient places the hand on top of the head suggests possible nerve root compression in the cervical spine, most often in the C4–C6 region³. This position reduces tension on the affected nerve root by unloading the brachial plexus when the shoulder is abducted and slightly flexed⁴. It is often performed alongside other tests, such as Spurling’s Test, to diagnose conditions like cervical spondylosis, herniated cervical discs, and neurological pain in the neck and arm⁵.

Execution of the Test

• Patient position: The patient sits or lies supine

• Test movement:

  • The arm on the painful side is lifted actively or passively overhead

  • The patient places the hand on top of the head with the palm facing downward

  • The position is held for at least 30 seconds

• Observation: The examiner notes whether the pain decreases, disappears, or worsens

• The test is repeated on the unaffected side for comparison

• Findings should be documented in the patient record⁶

Interpretation of Results

• Positive Bakody’s Sign: Reduction of symptoms when the painful arm is placed on the head → indicates decreased mechanical traction on the cervical nerve roots and brachial plexus⁷

• Negative Bakody’s Sign: Increased symptoms in the same position → may indicate interscalene compression⁸

• Diagnostic accuracy: Specificity ranges from 80–100%, while sensitivity is lower (26–50%)⁹. This makes it a useful but not conclusive stand-alone test.

Summary

Bakody’s Sign is a simple, non-invasive test used to evaluate cervical radiculopathy by assessing symptom relief during shoulder abduction. While highly specific, its relatively low sensitivity means it should be interpreted alongside other clinical tests and patient history.

Sources:

1. Kimura R, Kobayashi T, Miyakoshi N. Bakody’s Test Positive Thoracic Outlet Syndrome Caused by Anomalous Muscle: A Case Report. Cureus. 2023 Jan;15(1).

2. Woessner DA, Webb CW. Physical Examination of the Cervical and Thoracic Spine. InThe Sports Medicine Resource Manual 2008 (pp. 90-99). Elsevier Inc..

3. Taber's Medical Dictionary [Internet]. Bakody sign. [cited 2025 Jan 10]. Available from: https://www.tabers.com/tabersonline/view/Tabers-Dictionary/773522/all/Bakody_sign. Accessed 2025 January 10.

4. Bakody S. The Bakody sign. Neurology. 1945 Mar; 3(3): 221-2. doi: 10.1212/WNL.3.3.221

5. Johnson I. Bakody sign. Surgical Neurology. 1977 Jun 1;7(6):370. Available from: https://pubmed.ncbi.nlm.nih.gov/882910/. Accessed 2025 January 10.

6. Farshad M, Min K. Abduction extension cervical nerve root stress test: anatomical basis and clinical relevance. European Spine Journal. 2013 Jul;22:1522-5.

7. Magee, David J. Orthopedic Physical Assessment. St. Louis, Mo: Saunders Elsevier, 2008.

8. Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine (Phila Pa 1976). 1989 Mar;14(3):253–7.