Beevor`s Tegn

Beevor’s sign is named after the British neurologist Charles L. Edward Beevor (1854–1908)¹.In clinical neurology, Beevor’s sign refers to the abnormal upward movement of the umbilicus when a patient attempts to lift the head while lying supine.

This phenomenon occurs due to paresis of the lower part of the rectus abdominis muscle, causing the intact upper fibers to pull the umbilicus upward. In healthy individuals, the umbilicus normally remains stable during this movement².

Test execution

Patient position

• The patient lies supine on the examination table.

Patient instructionThe patient is asked to either:

• Flex the neck (lift the head), or

• Perform a sit-up without using the arms (arms may be crossed over the chest).

Observation

• Positive Beevor’s sign: Upward movement of the umbilicus.

• Negative Beevor’s sign: The umbilicus remains in its original position³⁴.

Interpretation of results

Beevor’s sign indicates paresis of the lower rectus abdominis fibers, typically due to neurological or neuromuscular pathology.

• Spinal cord lesions: Localizes to the thoracic level between T10–T12 or related nerve root involvement.

• Neuromuscular disorders: Strongly associated with facioscapulohumeral muscular dystrophy (FSHD), where the lower rectus abdominis is more affected than the upper portion.

Diagnostic validity and evidence

• Sensitivity: 95% for detecting FSHD among neuromuscular diseases.

• Specificity: 93% for FSHD and 100% among neurological controls.

• Other studies show specificity up to 97%, but lower sensitivity (54%)⁷⁸.

This suggests that Beevor’s sign is common in FSHD but not always present. Despite this, it remains a valuable clinical marker for localizing spinal cord lesions and identifying abdominal muscle involvement in neuromuscular disease.

Clinical relevance

• Provides a simple, bedside indicator of segmental spinal cord lesions (T10–T12).

• Serves as a highly specific sign for FSHD and is frequently used in clinical and research settings.

• Helps distinguish between neurological lesions and myopathies affecting abdominal musculature.

• May be absent in mild or early cases of neuromuscular disease, but when present, strongly suggests pathology.

Conclusion

Beevor’s sign is a simple and highly specific clinical test for detecting lesions of the lower thoracic spinal cord and neuromuscular disorders such as FSHD. Its diagnostic value lies in its high specificity but variable sensitivity, making it most useful in combination with other neurological and neuromuscular assessments.

References

1. Fathi D, Nafissi S. Beevor’s Sign in Myotonic Dystrophy Type 1: Do we need to check in every neuromuscular patient?.RRNMF Neuromuscular Journal. 2021 Sep17;2(4):33-5.

2. Desai JD. Beevor sign. Annals of Indian Academy of Neurology. 2012 Apr 1;15(2):94-5.

3. Althagafi A, Nadi M. Beevor Sign. InStatPearls [Internet] 2023 Apr 3.StatPearls Publishing.

4. Atiquzzaman M, Hasan MH, Sohan MA, Akhtar F. The moving umbilicus: Beevor’s Sign. Bangladesh Critical Care Journal.2022 Oct 18;10(2):166-7.

5. Youtu.be. Available at:https://youtu.be/nnsU8gTy8SY?si=kPtdWhZ_yKV3qbsP (Accessed: October 28, 2024).

6. Youtu.be. Available at: https://youtu.be/yj1LFDHqcsA?si=Vc0EbmdqUDv2TB0N (Accessed: October 28, 2024).

7. Mathys J, De Marchis GM. Teaching Video Neuro Images: Beevor sign: When the umbilicus is pointing to neurologic disease.Neurology. 2013 Jan 8;80(2):e20-.

8. Khare S, Seth D. Beevor’s Sign: A Review.