Execution
- 1Have the patient sit or lie with the symptomatic upper limb relaxed.
- 2Ask the patient to place the hand or forearm of the symptomatic side on top of the head.
- 3If needed, examiner passively assists the arm into abduction while avoiding excessive shoulder provocation.
- 4Ask whether the familiar arm symptoms decrease, increase, or remain unchanged.
- 5Compare the response with the patient's baseline symptoms and neurological distribution.
Positive outcome
Reduction or relief of radicular arm symptoms with the hand resting on the head is positive. Increased symptoms may suggest brachial plexus or interscalene triangle irritation rather than classic nerve root decompression.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Viikari-Juntura et al. (1989) | NA | 43 | 100 | 36 | 0.64 |
| Wainner et al. (2003) | 0.20-0.40 | 17 | 92 | NA | NA |
CommentThe sign may be helpful when symptoms are relieved by shortening or unloading the neural pathway. Reliability is not strong (Wainner reports kappa 0.20–0.40), and the test should be interpreted alongside dermatomal, myotomal, reflex, and radicular provocation findings. Rating note: Viikari 1989 reported LR+ 36 from a small sample where Sp = 100% (n ≈ 43) — a mathematically unstable point estimate. The more rigorous Wainner 2003 found Sn 17 / Sp 92 (LR+ ≈ 2.1), placing the test in moderate territory. The rating reflects the more reliable evidence; the original "high" claim relied on the small-sample artefact alone.
Moderate Clinical Value