Three-Phase Hyperextension Test

Three-Phase Hyperextension Test (or Mennell sign) is used to differentiate whether the pathology is in the lumbar spine,…
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 Three-Phase Hyperextension Test

What is Three-Phase Hyperextension Test?

  • Three-Phase Hyperextension Test (or Mennell sign) is used to differentiate whether the pathology is in the lumbar spine, the sacroiliac joint or the hip joint.

How it's Performed?

  • The patient is prone.
  • In the first phase of the test, the examiner grasps the patient’s extended leg and raises it into hyperextension while immobilizing the pelvis with the other hand.
  • In the second phase, the examiner immobilizes the patient’s sacrum parallel to the sacroiliac joint with the same hand and passively raises the patient’s leg into hyperextension.
  • In the third phase, the examiner immobilizes the fifth lumbar vertebra with the heel of one hand while passively guiding the patient’s leg into hyperextension with the other hand.
  • By moving the immobilizing hand up the spine, the examiner can also evaluate higher segments of the lumbar spine.

What does a positive Three-Phase Hyperextension Test mean?

  • Under normal conditions no pain should occur in any phase of the test.
  • The hip should allow about 10 to 20° of hyperextension.
  • The sacroiliac joint should exhibit slight movement (joint play), and the lumbar spine should allow elastic hyperextension (lordosis) at the lumbosacral junction.
  • phase 1: Pain with the ilium immobilized suggests a hip disorder or muscle contracture (rectus femoris and/or psoas).
  • phase 2: Pain when the sacrum is immobilized suggests motion restriction of the sacroiliac joint or other disorders of this joint, such as ankylosing spondylitis (Mennell sign).
  • phase 3: While pain when the lumbar spine is immobilized suggests a disorder of the lumbosacral junction (vertebral motion restriction or protrusion or extrusion of an intervertebral disk). 

Sensitivity & Specificity

  • Sensitivity: 34 %
  • Specificity: 88 %

Reference

  • Clinical Tests for the Musculoskeletal 3rd Ed. Book
Three-Phase Hyperextension Test 1

Three-Phase Hyperextension Test - Phase I


Three-Phase Hyperextension Test 2

Three-Phase Hyperextension Test - Phase II

Three-Phase Hyperextension Test 2

Three-Phase Hyperextension Test - Phase III

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