OnExam

This test is used to detect meningeal inflammation from infection or subarachnoid hemorrhage. Use in the presence of clinical features that suggest meningitis (i.e., fever, headache, neck stiffness, photophobia, nausea, vomiting).

Performing the Test

  1. Position the patient supine with arms extended
  2. Passively flex the patient’s neck while holding down the thorax
  3. Watch the hips and knees as you flex the patient’s neck
  4. If the patient does not flex hips or knees, the sign is negative
  5. If the patient flexes hips and knees in reaction to the maneuver, the sign is positive
  • Interpretation
    • Children
      • Specificity: 74%
      • Sensitivity: 66%
      Adults
      • Specificity: 95%
      • Sensitivity: 5%

    References

    1. Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2003.
    2. Lincoln, Matthew, McSheffrey eds. Essentials of Clinical Examination Handbook. 6th ed. Toronto, ON: University of Toronto Medical Society: 2010.