Three Phase Hyperextension Test

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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.

See Also: Prone Knee Bending Test

How do you do the Mennell Sign?

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.

Three Phase Hyperextension Test phase 1
Phase I

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.

Three Phase Hyperextension Test phase 2
Phase II

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.

Three Phase Hyperextension Test phase 3
Phase 3

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?

Sensitivity & Specificity

Albert and colleagues found this test to have a sensitivity of 54–70% and a specificity of 100%.


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