The mannequin sign.
METHODS
Prospective observational study.


OBJECTIVE
The critical appraisal of the mannequin sign in the validation of patients with symptoms of sciatica.


BACKGROUND
Sixty-five consecutive patients with magnetic resonance imaging-proven lumbar disc herniation and symptoms of sciatica. Mean patient age was 48 (range 28-62) years. Thirty-seven patients were male and 28 were female.


METHODS
The mannequin sign is positive when a patient adopts an antalgic posture with the relevant lower limb flexed at the hip and knee with the pelvis tilting towards the affected side, in the classic manner of a mannequin's pose. Reproducibility of the sign was recorded when all patients were examined by a second clinician. Lumbar disc herniation with nerve root impingement was confirmed by magnetic resonance imaging.


RESULTS
The mannequin sign had 100% reproducibility and 80% sensitivity in diagnosing lumbar disc herniations with nerve root impingement. Twenty-four patients had L4-L5 disc herniations and 41 had L5-S1 disc herniations.


CONCLUSIONS
Astute clinical examination can minimize inaccurate diagnosis, unnecessary investigations, and even inappropriate surgical intervention. The mannequin sign, first observed and anecdotally reported by the senior author (D.C.), has now been critically appraised.
Westbrook
Anthony
A
Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, Derby, England. twestb@doctors.org.uk
Tambe
Amol
A
Subramanian
Kanthalu
K
Monk
J
J
Calthorpe
Denis
D
D000328:Adult; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D011446:Prospective Studies; D012585:Sciatica / Q000175:diagnosis*; D012680:Sensitivity and Specificity