Inverted Supinator Test: Difference between revisions
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== Technique == | == Technique == | ||
A normal response is wrist pronation and/or elbow flexion. | The patient is seated in a sitting position. The therapist supports the arm to be tested with his/her arm in elbow flexion and forearm in slight pronation. The therapists strike the tendon with the hammer at the styliod process of radius. | ||
* A normal response is wrist pronation and/or elbow flexion. | |||
A Positive test involves finger flexion and/or elbow extension <ref name=":0">Neck and Arm Pain Syndromes E-Book: Evidence-informed Screening, Diagnosis. Cesar Fernandez de las Penas, Joshua Cleland, Peter A. Huijbregts | * A Positive test involves finger flexion and/or elbow extension <ref name=":0">Neck and Arm Pain Syndromes E-Book: Evidence-informed Screening, Diagnosis. Cesar Fernandez de las Penas, Joshua Cleland, Peter A. Huijbregts | ||
</ref> | </ref> | ||
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Research study aimed at producing a cluster of predictive clinical test findings for a sample of a patient using a clinical diagnosis as the reference standard for CSM found that selected combinations of clinical findings: (1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years are good predictors of CSM and were effective in ruling out and ruling in cervical spine myelopathy.<ref>Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113267/ Clustered clinical findings for diagnosis of cervical spine myelopathy.] Journal of Manual & Manipulative Therapy. 2010 Dec 1;18(4):175-80.</ref> The presence of 3 or 4 findings out of 5 displayed '''high specificity''' for <u>ruling in</u> CSM, and when only 1 of the 5 clinical findings was present, there was '''high sensitivity''' for <u>ruling out</u> CSM. | Research study aimed at producing a cluster of predictive clinical test findings for a sample of a patient using a clinical diagnosis as the reference standard for CSM found that selected combinations of clinical findings: (1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years are good predictors of CSM and were effective in ruling out and ruling in cervical spine myelopathy.<ref>Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113267/ Clustered clinical findings for diagnosis of cervical spine myelopathy.] Journal of Manual & Manipulative Therapy. 2010 Dec 1;18(4):175-80.</ref> The presence of 3 or 4 findings out of 5 displayed '''high specificity''' for <u>ruling in</u> CSM, and when only 1 of the 5 clinical findings was present, there was '''high sensitivity''' for <u>ruling out</u> CSM. | ||
Another study assessing the presence of the inverted radial reflex and its clinical relevance in asymptomatic patients (n=277; age range:16-78) for 6 months found incidence of the inverted supinator reflex was 27.6% (75/271) and the reflex was present bilaterally in 39% (29/75) suggesting that an isolated inverted supinator reflex, in the absence of other clinical findings, is not a reliable sign of cervical myelopathy; however, it must be interpreted with caution in the older patient.<ref>Kiely P, Baker JF, O'hEireamhoin S, Butler JS, Ahmed M, Lui DF, Devitt B, Walsh A, Poynton AR, Synnott KA. [https://journals.lww.com/spinejournal/Abstract/2010/04200/The_Evaluation_of_the_Inverted_Supinator_Reflex_in.5.aspx The evaluation of the inverted supinator reflex in asymptomatic patients.] Spine. 2010 Apr 20;35(9):955-7.</ref> | |||
{{#ev:youtube|https://www.youtube.com/watch?v=_H5Pv8istcI&vl=es|width}}<ref>Physiotutors Inverted Supinator Sign | Upper Motor Neuron Lesion. Available from https://www.youtube.com/watch?v=_H5Pv8istcI&vl=es. Accessed on 25/2/21</ref> | {{#ev:youtube|https://www.youtube.com/watch?v=_H5Pv8istcI&vl=es|width}}<ref>Physiotutors Inverted Supinator Sign | Upper Motor Neuron Lesion. Available from https://www.youtube.com/watch?v=_H5Pv8istcI&vl=es. Accessed on 25/2/21</ref> | ||
Revision as of 16:59, 2 March 2021
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (2/03/2021)
Purpose[edit | edit source]
The inverted supinator (brachioradialis) test is used for identifying a lesion at the C5-C6 spinal cord segments. The inverted supinator reflex is a test that was introduced into clinical medicine by Babinski (1910). [1]
There are two components of this abnormal reflex:
- an absence of contraction of the brachioradialis muscle when the styloid process of the radius is tapped, and
- a hyperactive response of the finger flexor muscles; a response that is subserved by a lower spinal cord segment (C8).
Technique[edit | edit source]
The patient is seated in a sitting position. The therapist supports the arm to be tested with his/her arm in elbow flexion and forearm in slight pronation. The therapists strike the tendon with the hammer at the styliod process of radius.
- A normal response is wrist pronation and/or elbow flexion.
- A Positive test involves finger flexion and/or elbow extension [2]
Evidence[edit | edit source]
The test has demonstrated a sensitivity of 61% and a specificity of 78% [2]
Research study aimed at producing a cluster of predictive clinical test findings for a sample of a patient using a clinical diagnosis as the reference standard for CSM found that selected combinations of clinical findings: (1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years are good predictors of CSM and were effective in ruling out and ruling in cervical spine myelopathy.[3] The presence of 3 or 4 findings out of 5 displayed high specificity for ruling in CSM, and when only 1 of the 5 clinical findings was present, there was high sensitivity for ruling out CSM.
Another study assessing the presence of the inverted radial reflex and its clinical relevance in asymptomatic patients (n=277; age range:16-78) for 6 months found incidence of the inverted supinator reflex was 27.6% (75/271) and the reflex was present bilaterally in 39% (29/75) suggesting that an isolated inverted supinator reflex, in the absence of other clinical findings, is not a reliable sign of cervical myelopathy; however, it must be interpreted with caution in the older patient.[4]
Resources[edit | edit source]
add any relevant resources here
References[edit | edit source]
- ↑ Estanol BV, Marin OS. Mechanism of the inverted supinator reflex. A clinical and neurophysiological study. Journal of Neurology, Neurosurgery & Psychiatry. 1976 Sep 1;39(9):905-8.
- ↑ 2.0 2.1 Neck and Arm Pain Syndromes E-Book: Evidence-informed Screening, Diagnosis. Cesar Fernandez de las Penas, Joshua Cleland, Peter A. Huijbregts
- ↑ Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. Clustered clinical findings for diagnosis of cervical spine myelopathy. Journal of Manual & Manipulative Therapy. 2010 Dec 1;18(4):175-80.
- ↑ Kiely P, Baker JF, O'hEireamhoin S, Butler JS, Ahmed M, Lui DF, Devitt B, Walsh A, Poynton AR, Synnott KA. The evaluation of the inverted supinator reflex in asymptomatic patients. Spine. 2010 Apr 20;35(9):955-7.
- ↑ Physiotutors Inverted Supinator Sign | Upper Motor Neuron Lesion. Available from https://www.youtube.com/watch?v=_H5Pv8istcI&vl=es. Accessed on 25/2/21
