Test: Cecin's Sign ('X' sign)

Video Link

Background/Purpose

Procedure

From a standing position, the patient is asked to bend the lumbar spine to an angle he is capable of tolerating the pain in the lumbar region, buttocks, thighs, and/or in the territory of the sciatic nerve. As soon as the patient starts to experience pain irradiation, he is asked to cough. If coughing does not change pain severity, sneezing is induced by asking the patient to sniff pepper or snuff. The maneuver was considered positive if the patient experienced the onset and/or worsening of pain in the buttock, in the dermatome of the ipsilateral crural and/or sciatic nerve, i.e., pain of greater severity than that caused by simple flexion. If the patient did not experience pain at a 75º angle, he was asked to bend his spine further, decreasing the angle between 75º to 30º or less (Figure 1B). He was then asked to cough or sneezing was stimulated. Similarly, the development of pain or worsening of preexisting pain indicated positive Cecin's sign. This second phase is necessary since, depending on the size and location of the herniated disk, it might not be positive at 75º.
Performed: Bilaterally

Dialog

Stand and bend to point of pain and cough or sneeze.

Criteria

• Maneuver performed without pain
• Maneuver performed without radicular symptoms

Measurement

LOINC Code

0

Scale/Grading

Pass/Fail