Praxis für Physiotherapie Torsten Husemann

15/12/2025

𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄 𝗼𝗳 𝗦𝗶𝗴𝗻𝘀 𝗶𝗻𝗱𝗶𝗰𝗮𝘁𝗶𝗻𝗴 𝗣𝘆𝗿𝗮𝗺𝗶𝗱𝗮𝗹 𝗧𝗿𝗮𝗰𝘁 𝗟𝗲𝘀𝗶𝗼𝗻𝘀 – Part 1

Pyramidal signs refer to a set of neurological symptoms that indicate damage or dysfunction in the pyramidal tract of the brain or spinal cord. These signs include weakness, spasticity, hyperreflexia, and various clinical signs (https://www.routledge.com/Hankeys-Clinical-Neurology/Gorelick-Testai-Hankey-Wardlaw/p/book/9780367280321).

✅ 𝗮. 𝗕𝗮𝗯𝗶𝗻𝘀𝗸𝗶 𝘀𝗶𝗴𝗻

The Babinski sign or extensor plantar response was first described in 1896 by the French neurologist of Polish ancestry Joseph F.F. Babinski to indicate the presence of pyramidal tract dysfunction (PTD, https://pubmed.ncbi.nlm.nih.gov/24906707/). The Babinski sign is elicited by firmly stroking the lateral border of the sole from heel to the base of the toes and then medially across the ball of the foot. A pathological response consists of dorsiflexion (extension) of the great toe combined with fanning and extension of the other toes. It indicates corticospinal tract dysfunction. Compared with the reference standard, the Babinski sign had low sensitivity (50.8%, 95%CI 41.5–60.1) but high specificity (99%, 95%CI 97.7–100) in identifying PTD with a positive likelihood ratioof 51.8 (95%CI 16.6–161.2). When present, it seems to be a highly accurate “rule-in” finding (https://pubmed.ncbi.nlm.nih.gov/24906707/).

✅ 𝗯. 𝗢𝗽𝗽𝗲𝗻𝗵𝗲𝗶𝗺 𝘀𝗶𝗴𝗻

The Oppenheim sign is obtained by applying firm downward pressure with the examiner’s thumb and index finger along the anterior surface of the tibia (https://karger.com/mng/article-abstract/12/6/518/198234/Zur-Pathologie-der-Hautreflexe-an-den-unteren?redirectedFrom=fulltext). A positive (pathological) response is extension of the great toe, often accompanied by spreading of the other toes, reflecting impaired corticospinal inhibition. Araújo et al. describe a positive predictive value of 61,3% (https://pubmed.ncbi.nlm.nih.gov/29443235/).

✅ 𝗰. 𝗚𝗼𝗿𝗱𝗼𝗻 𝘀𝗶𝗴𝗻

The Gordon sign is provoked by firmly squeezing the calf muscles (https://pubmed.ncbi.nlm.nih.gov/18637037/). In patients with corticospinal tract lesions, this maneuver produces extension of the great toe, sometimes with fanning of the lesser toes, analogous to the Babinski response. The Gordon sign was given a fair rating for inter-observer consistency with a kappa of 0.3515 (95% CI = 0.255-0.448) and the highest intra-observer consistency with a kappa of 0.673 among the Babinski reflex and its variants (https://pubmed.ncbi.nlm.nih.gov/18637037/). No studies have determined its clinical validity (https://www.ncbi.nlm.nih.gov/books/NBK513343/).

✅ 𝗱. 𝗥𝗼𝘀𝘀𝗼𝗹𝗶𝗺𝗼 𝘀𝗶𝗴𝗻

Grigorii Ivanovich Rossolimo (1860–1928) was a Russian neurologist, who published his observations of increased flexion of the toes in 1902 (https://pubmed.ncbi.nlm.nih.gov/15642914/).The Rossolimo sign is elicited by tapping the plantar surfaces of the distal phalanges of the toes. A pathological response consists of brisk flexion of the toes. It is considered a sign of pyramidal tract involvement affecting the lower limb. The Rossolimo sigs has a high diagnostic sensitivity for neurological examination of cervical and thoracic spondylotic myelopathy patients (https://pubmed.ncbi.nlm.nih.gov/20625382/).

✅ 𝗲. 𝗧𝗿ö𝗺𝗻𝗲𝗿 𝘀𝗶𝗴𝗻

The Trömner sign is evoked by tapping the palmar surface of the distal phalanx of the middle or ring finger. A positive response is flexion of the terminal phalanx and sometimes opposition of the thumb. It reflects heightened excitability of finger flexor reflex pathways due to corticospinal tract dysfunction (https://pmc.ncbi.nlm.nih.gov/articles/PMC3099157/).
High sensitivity (94%) and relatively high negative predictive value (85%) for Trömner sign in one study indicate the usefulness in ruling out cervical spondylotic myelopathy. High incidence of positive Trömner sign in presymptomatic cervical cord compression patients suggests it could have a useful role in early detection of presymptomatic patients (https://pubmed.ncbi.nlm.nih.gov/27404855/).
Note: Mild bilateral Trömner responses may occur in physiologically hyperexcitable individuals; the sign is considered pathological when clearly asymmetric or exaggerated.

✅ 𝗳. 𝗛𝗼𝗳𝗳𝗺𝗮𝗻𝗻 𝘀𝗶𝗴𝗻

The Hoffmann sign is produced by flicking the distal phalanx of the middle or ring finger downward, allowing it to rebound. A pathological response is reflex flexion and adduction of the thumb and/or flexion of the index finger. It suggests corticospinal tract hyperexcitability. A systematic review of the utility of the Hoffmann sign for the diagnosis of degenerative cervical myelopathy (DCM) indicated that the Hoffman sign has a positive likelihood ratio of 2.2 (95% CI 1.5-3.3) and a negative likelihood ratio of 0.63 (95% CI 0.5-0.8), documenting insufficient data to support use of the Hoffman sign alone to confirm or refute a diagnosis of DCM.

Note: As with the Trömner sign, a subtle bilateral Hoffmann response may occur in healthy subjects; unilateral or markedly pronounced responses are more indicative of pathology.

📷 Illustration: https://link.springer.com/chapter/10.1007/978-3-540-69091-7_11

15/12/2025

12/12/2025

Just published 🔥

𝗡𝗲𝘂𝗿𝗼𝗹𝗼𝗴𝗶𝗰𝗮𝗹 𝗘𝘅𝗮𝗺𝗶𝗻𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗖𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗥𝗮𝗱𝗶𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆: 𝗔 𝗦𝗰𝗼𝗽𝗶𝗻𝗴

Cervical radiculopathy is a prevalent neuromusculoskeletal disorder characterized by segmental neurological deficits due to impaired conduction in one or more cervical nerve roots. Classical epidemiological studies have reported incidence rates between 0.63 and 5.8 per 1,000 people, with variability influenced by diagnostic criteria, geographical characteristics, and occupational factors (https://pubmed.ncbi.nlm.nih.gov/32710604/; Schmid et al., 2018). Despite its frequency in clinical practice, diagnostic approaches remain inconsistent. Many clinical guidelines and research studies continue to emphasize radicular pain distribution rather than the loss-of-function signs (https://pubmed.ncbi.nlm.nih.gov/22531897/, https://pubmed.ncbi.nlm.nih.gov/28838857/) emphasized by the International Association for the Study of Pain (IASP), which defines radiculopathy as sensory and/or motor deficit caused by impaired axonal conduction (https://pubmed.ncbi.nlm.nih.gov/37235637/).
Previous reviews have predominantly focused on provocative tests or neurodynamic assessments. Both are designed to detect predominantly gain of nerve function, not loss of function and is therefore incompatible with the IASP definition.

Bedside neurological examination (BNE) comprising sensory, motor, and tendon reflex testing—provides the only direct clinical evaluation of nerve-root function loss.

📘 A brand-new scoping review by Yousif et al. (https://pubmed.ncbi.nlm.nih.gov/40188056/) aimed to map the literature regarding the diagnostic accuracy, components, and performance of the bedside neurological examination (BNE) for cervical radiculopathy (CR).

📊 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀

From an initial 12,365 records, six cross-sectional studies met the inclusion criteria. These studies compared the BNE to either electrodiagnostic tests (Needle EMG and NCS) or Magnetic Resonance Imaging (MRI).

𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝘁𝗶𝗰 𝗔𝗰𝗰𝘂𝗿𝗮𝗰𝘆 𝗼𝗳 𝗕𝗡𝗘 𝗖𝗼𝗺𝗽𝗼𝗻𝗲𝗻𝘁𝘀

✅ 𝗧𝗲𝗻𝗱𝗼𝗻 𝗥𝗲𝗳𝗹𝗲𝘅𝗲𝘀

Tendon reflex deficits (most commonly biceps, brachioradialis, and triceps) consistently demonstrated high specificity, ranging from 81% to 99%, depending on the reference standard. Sensitivity, however, was uniformly low, typically between 21% and 28% when compared with electrodiagnostic testing, although one MRI-based study reported a higher sensitivity of 67%. Positive likelihood ratios ranged widely, from 1.38 to 10, with the highest values seen when reflex loss was matched to a specific nerve-root level. Negative likelihood ratios were poor (around 0.80–0.95), indicating that a normal reflex does not rule out radiculopathy.

✅ 𝗦𝗼𝗺𝗮𝘁𝗼𝘀𝗲𝗻𝘀𝗼𝗿𝘆 𝗧𝗲𝘀𝘁𝗶𝗻𝗴

Sensory testing—primarily using light touch or pinprick across dermatomes—showed the lowest sensitivity of all BNE components. Sensitivity commonly fell between 25% and 52%, even when combining modalities. Specificity ranged from 46% to 89%, making sensory loss only modestly helpful for diagnostic confirmation. Positive likelihood ratios were generally low, between 0.69 and 2.27, indicating minimal change in post-test probability. Negative likelihood ratios hovered around 0.78–1.35, reinforcing the limited value of normal sensation for excluding radiculopathy.

✅ 𝗠𝘂𝘀𝗰𝗹𝗲 𝗦𝘁𝗿𝗲𝗻𝗴𝘁𝗵 𝗧𝗲𝘀𝘁𝗶𝗻𝗴

Myotomal strength testing demonstrated moderate sensitivity when compared with electrodiagnostic studies (typically 54% to 73%) and higher specificity, often between 61% and 93%. When MRI served as the reference standard, sensitivity varied more widely (from 30% to 81%), with specificity around 72%. Positive likelihood ratios ranged from 1.05 to 7.71, with the highest values associated with strong, focal weakness in a representative myotome (e.g., biceps or triceps). Negative likelihood ratios were consistently above 0.40, indicating only limited rule-out capacity.

✅ 𝗖𝗼𝗺𝗯𝗶𝗻𝗲𝗱 𝗕𝗡𝗘 𝗖𝗼𝗺𝗽𝗼𝗻𝗲𝗻𝘁𝘀

When multiple deficits were present—for example, concurrent sensory loss and reduced reflexes—specificity increased markedly, often reaching 97–99%, with positive likelihood ratios as high as 14–22. Sensitivity in these combinations, however, was very low (generally 7–22%), meaning that absence of combined deficits does little to exclude radiculopathy.

💡𝗢𝘃𝗲𝗿𝗮𝗹𝗹 𝗜𝗻𝘁𝗲𝗿𝗽𝗿𝗲𝘁𝗮𝘁𝗶𝗼𝗻

✏️ The diagnostic profile of BNE components demonstrates that deficits in tendon reflexes or muscle strength meaningfully increase the likelihood of cervical radiculopathy, particularly when they occur together or in anatomically congruent patterns. In contrast, normal findings—especially for sensory testing—do not substantially lower the probability of disease. Clinically, 𝗕𝗡𝗘 𝗶𝘀 𝘁𝗵𝗲𝗿𝗲𝗳𝗼𝗿𝗲 𝗯𝗲𝘀𝘁 𝘂𝘀𝗲𝗱 𝘁𝗼 𝗿𝘂𝗹𝗲 𝗶𝗻 𝗿𝗮𝘁𝗵𝗲𝗿 𝘁𝗵𝗮𝗻 𝘁𝗼 𝗿𝘂𝗹𝗲 𝗼𝘂𝘁 𝗰𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗿𝗮𝗱𝗶𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆.

✏️ The scoping review confirms the 𝗹𝗮𝗰𝗸 𝗼𝗳 𝗮 𝘂𝗻𝗶𝘃𝗲𝗿𝘀𝗮𝗹𝗹𝘆 𝗮𝗰𝗰𝗲𝗽𝘁𝗲𝗱 𝗰𝗿𝗶𝘁𝗲𝗿𝗶𝗮 for CR, the heterogeneity of diagnostic criteria, and the use of suboptimal reference standards (EMG/NCS: testing only large-myelinated fibers, i.e.,A-β and motor fibers and MRI: does not necessarily reflect neural function). The reporting of the BNE procedure itself was poor and vague.

✏️ Despite these limitations, the BNE is considered a 𝘃𝗶𝘁𝗮𝗹 𝗰𝗼𝗺𝗽𝗼𝗻𝗲𝗻𝘁 of the initial diagnostic workup for suspected radiculopathy.

✏️ Future research must establish a consensus on the operational definition of radiculopathy, its reference standard, and the optimal performance of the BNE to determine its full clinical utility.

📷 Illustration: Neurologic examination of the upper extremities. https://shop.elsevier.com/books/millers-review-of-orthopaedics/thompson/978-0-443-11214-0

11/12/2025

Just published in NEJM 🔥

Complex Regional Pain Syndrome

📘 Goebel (2025), https://www.nejm.org/doi/full/10.1056/NEJMcp2415752

👉 Complex regional pain syndrome (CRPS) is a rare post-traumatic chronic pain condition that affects a distal limb and is classified in the International Classification of Diseases, 11th Revision, as “chronic primary pain”; the condition may be autoimmune mediated.

👉 CRPS is diagnosed according to the Budapest criteria, which require the presence of objective limb abnormalities in two of four categories: sensory, vasomotor, edema or sudomotor, and motor or trophic.

👉 Approximately 80% of patients have substantial improvement within 18 months after disease onset;later improvement is rare.

👉Patient information should emphasize the nerve-function–related cause of CRPS that explains the relentless pain despite no or minor tissue change.

👉 Rehabilitative treatment with CRPS-specific physical and occupational therapy is key to improving function in the impaired limb.

👉 Treatment with simple analgesic drugs, tricyclic agents, and serotonin–norepinephrine reuptake inhibitors may improve quality of life but will typically incompletely reduce pain. Multidisciplinary pain-management treatment that follows the principles of cognitive behavioral therapy and spinal cord stimulator treatment — in persistent CRPS — can be offered at specialist centers.

📷 Illustration: . Pain Mechanisms. Shown are the mechanisms of nociceptive pain (Panel A), neuropathic pain (Panel B), and nociplastic pain (Panel C). CRPS itself is considered (mostly) nociplastic pain.

10/12/2025

27/11/2025

🔥👉Zusammenfassung der Innervation des Nervus ulnaris und Verletzungen des Nervus ulnaris

Der N. Ulnaris kommt vom medialen Faszikulus (C8, T1) und verläuft durch den Kubitaltunnel hinter dem medialen Epikondylus zum Flexor carpi ulnaris (FCU) und der Hälfte des Flexor digitorum profundus (FDP) (Finger 4 und 5).

👉Jetzt den Artikel (mit Quellen) auf physiomeets.science lesen! 🥳💪

20/11/2025

12/11/2025

🔥 Spektrum der Rotatorenmanschetten-Erkrankung

👉Einleitung

Rotatorenmanschettenrisse stellen ein Spektrum von Erkrankungen dar, das von Tendinopathien über Teilrisse bis hin zu Vollrissen unterschiedlicher Größe reicht (siehe Abbildung modifiziert nach Bedi et al. 2024, 1).

👉RM-Tendinopathie

Die vermutete Mechanismen der RM-Tendinopathie umfassen intrinsische, extrinsische oder kombinierte Mechanismen (2, 3, 4)

Den ganzen Artikel mit Quellen jetzt auf physiomeets.science lesen! 🥳💪