The mannequin sign

Study Design. Prospective observational study. Objectives. The critical appraisal of the mannequin sign in the validation of patients with symptoms of sciatica. Summary of Background Data. 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. Conclusion. 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.