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
  2. Flex one of patient’s legs at both hip and knee, then attempt to passively straighten the knee
  3. If the patient reports pain and resists the extension, the sign is positive.
  4. If the patient does not report pain and does not resist the extension, the sign is negative
  • Specificity: 85%
  • Sensitivity: 53%
  • Specificity: 95%
  • Sensitivity: 5%


  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.