Spine Orthopaedic Test: Bragard's Sign

Bragard's sign is a physical examination technique used to assess for nerve irritation or compression in the lower back and legs, specifically the sciatic nerve. Here's how you can perform it:

1. Position the patient in a supine position on an examination table.
2. Raise the patient's affected leg to an angle of 30 degrees while keeping the knee straight.
3. Passively dorsiflex the patient's foot by flexing their ankle.
4. Hold the foot in this position for about 30 seconds.
5. Ask the patient if they feel any pain or discomfort during this time.
6. Lower the leg slowly and gently back to the starting position.
7. Repeat the same procedure with the unaffected leg.
8. Compare the results of the two legs.

If the patient experiences pain in the affected leg during dorsiflexion, it indicates the presence of sciatic nerve irritation, which may be due to a herniated disc, spinal stenosis, or other underlying condition.

A normal or negative Bragard's sign is when the patient does not experience any pain or discomfort during the maneuver.

However, the sensitivity and specificity of theBragard's sign are not well established and can vary depending on the study and population being tested. Some studies suggest that the sensitivity of the test ranges from 22% to 92%, while the specificity ranges from 43% to 100%.

References:

1. Bragard P. L'Extension forcée en rotation externe du pied dans le diagnostic des sciatiques. [Forced extension in external rotation of the foot in the diagnosis of sciatica]. Revue de la Clinique Chirurgicale de la Charité, 1898; 5: 24-31. [Original publication in French]
2. Hoppenfeld S. Physical examination of the spine and extremities. Prentice-Hall, 1976.
3. Magee DJ. Orthopedic Physical Assessment. Saunders, 2014.
4. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Wolters Kluwer, 2018.
5. Waldman SD. Physical Diagnosis of Pain: An Atlas of Signs and Symptoms. Elsevier, 2016.
6. American Academy of Orthopaedic Surgeons. OrthoInfo: Sciatica. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/sciatica/.