Brachial Plexus Tension Test
Although the brachial plexus tension test involves shoulder joint movement, it also provides maximum stretch on the brachial plexus, which affects the lower branches of the cervical spine (C5) the most. If this test is positive, the early stages of a C5 nerve root disorder may be present along with the subtle signs of a positive doorbell sign (pain that occurs at the superior scapulovertebral border and radiates with the use of deep palpation of the C5 segment) and pain in the deltoid area. The deltoid pain is often misconstrued as an articular problem of the shoulder.
Patients with radicular symptoms and pronounced Dejerine’s sign, especially if it is in the lumbar spine, should be told to bend the knees and lean into a wall during a cough or sneeze. This maneuver reduces intradiscal pressure and minimizes the effect of the cough or sneeze on the nerve root. A more worrisome situation is the sudden, unexpected absence of Dejerine’s sign when all other clinical findings indicate an active nerve root compression. The loss of the sign indicates fragmentation of the disc with momentary decompression of the nerve.