Bakody Sign, also called the Shoulder Abduction Relief Test, assesses whether placing the hand on top of the head reduces familiar arm symptoms. Symptom relief may support suspicion of cervical radicular symptom behaviour, but it does not confirm cervical radiculopathy. A 2021 diagnostic accuracy study found that several history items and clinical tests can assist cervical radiculopathy assessment, while cautioning that there is no perfect gold standard and diagnostic values should not be overinterpreted.
A client reports neck pain with symptoms travelling into the arm. They notice that resting the hand on top of the head reduces tingling or arm discomfort. Bakody Sign can help document whether shoulder abduction changes symptoms in a way that supports cervical radicular reasoning.
This test is different from a pain provocation test. A positive response is usually symptom relief, not symptom reproduction.
Test name: Bakody Sign
Also known as: Shoulder Abduction Relief Test
Body region: Cervical spine, shoulder girdle and upper limb
Purpose: Assess whether shoulder abduction relieves familiar arm symptoms
Positive finding: Reduction or relief of familiar arm symptoms when the hand is placed on the head
Negative finding: No relief, worsening or no meaningful symptom change
Best used with: Spurling’s Test, cervical distraction, neurological screen, cervical ROM and upper limb neurodynamic testing
Key limitation: It does not diagnose cervical radiculopathy on its own
Bakody Sign is performed by asking the client to place the hand of the symptomatic arm on top of the head. In some clients with cervical radicular symptom behaviour, this position may reduce symptoms by altering neural or foraminal loading.
The test should focus on symptom change, including location, intensity and quality.
Bakody Sign is used when cervical radicular symptoms are part of the assessment.
It may help inform whether symptoms are influenced by cervical or upper-limb positioning and whether relief occurs with shoulder abduction.
The test assesses symptom response to shoulder abduction with the hand resting on the head. It does not directly visualise a nerve root, confirm compression or identify the exact cause of symptoms.
This test may be useful for clients with neck-related arm pain, paraesthesia, numbness, radiating symptoms or symptoms that appear to change with neck and arm position.
Use when the client has arm symptoms that may be related to cervical radicular involvement and can safely place the hand on the head.
Use caution with shoulder pain, acute shoulder injury, severe neurological symptoms, progressive weakness, dizziness, vascular symptoms or inability to raise the arm comfortably.
Chair or standing space
Pain/symptom scale
Measurz recording workflow
Optional neurological screen notes
Position the client sitting or standing upright.
Ask the client to start in their usual symptomatic position.
Stand beside or in front of the client to observe neck, shoulder and arm position.
No examiner hand placement is usually required unless support is needed.
Avoid forcing the arm. The client should move comfortably.
Ask the client to place the hand of the symptomatic arm on top of the head.
Ask whether arm symptoms reduce, centralise, increase or remain unchanged.
A positive Bakody Sign is reduction or relief of familiar arm symptoms in the shoulder-abduction position.
A negative finding is no relief, worsening or no meaningful symptom change.
Stop if shoulder pain, dizziness, vascular symptoms, neurological worsening or severe discomfort occurs.
Do not force shoulder abduction. Record whether symptoms are relieved, unchanged or worsened.
A positive Bakody Sign may support cervical radicular symptom reasoning when it reduces familiar arm symptoms and aligns with the history, neurological findings and other cervical tests.
A negative test does not exclude cervical radicular symptoms. Some clients may not improve with this position, and shoulder symptoms may limit the test.
Interpretation is stronger when paired with Spurling’s Test, cervical distraction, neurological screen, cervical ROM, upper-limb neurodynamic testing and symptom distribution.
High-quality 2020+ diagnostic accuracy values for Bakody Sign alone appear limited. Current cervical radiculopathy evidence supports using history, neurological findings and multiple clinical tests rather than relying on one sign.
A 2021 diagnostic accuracy study found that some interview items, Spurling’s Test and reduced reflexes were useful to increase the probability of cervical radiculopathy when positive, while also warning against overinterpreting diagnostic accuracy because there is no perfect gold standard.
No stand-alone sensitivity, specificity or likelihood ratio values for Bakody Sign are included.
A 2025 scoping review reported heterogeneity in neurological examination procedures and diagnostic accuracy for cervical radiculopathy, supporting cautious interpretation and clear documentation of neurological and symptom findings.
Reliability for Bakody Sign depends on consistent starting symptoms, arm position, test duration and symptom criteria.
Common errors include calling symptom reproduction positive, forcing shoulder abduction, ignoring shoulder pathology, failing to record symptom change and using the sign alone to diagnose cervical radiculopathy.
Limitations include shoulder mobility restrictions, variable symptom behaviour, overlap with thoracic outlet and peripheral nerve symptoms, and limited stand-alone diagnostic accuracy evidence.
Use Bakody Sign to record whether arm symptoms are relieved by shoulder abduction. It can support clinical reasoning when combined with cervical and neurological findings.
Record test name, side tested, result, symptom location, symptom intensity before and after, symptom quality, arm position, neck position, time held, shoulder pain, neurological symptoms, comparison side if relevant, confidence in result and reason for stopping.
Add related findings such as Spurling’s, cervical distraction, cervical ROM, neurological screen, grip strength and upper limb neurodynamic testing.
Spurling’s Test
Cervical Distraction Test
Upper Limb Tension Test
Cervical ROM Tests
Adson’s Test
Roos Stress Test
Shoulder ROM Tests
Grip Strength Test
It assesses whether placing the hand on the head reduces familiar arm symptoms.
A positive finding is symptom relief or reduction, not symptom reproduction.
No. It may support clinical reasoning but does not diagnose cervical radiculopathy on its own.
Record the worsening response and stop if symptoms escalate or the position is not tolerated.
Record symptom location, intensity before and after, side, arm position, neck position and related cervical findings.
Bakody Sign is a symptom relief test.
A positive result is reduction of familiar arm symptoms.
It should not be used as a stand-alone diagnostic test.
Shoulder symptoms may limit the test.
Measurz should capture symptom change before and after the position.
Sleijser-Koehorst, M. L. S., Coppieters, M. W., Epping, R., Rooker, S., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2021). Diagnostic accuracy of patient interview items and clinical tests for cervical radiculopathy. Physiotherapy, 111, 74–82. https://doi.org/10.1016/j.physio.2020.07.007
Yousif, M. S., Occhipinti, G., Bianchini, F., Feller, D., Schmid, A. B., & Mourad, F. (2025). Neurological examination for cervical radiculopathy: A scoping review. BMC Musculoskeletal Disorders, 26, 334. https://doi.org/10.1186/s12891-025-08560-9
