Amoss’ sign is a clinical maneuver in which a patient uses the hands to assist in rising from a supine to a sitting position to avoid pain caused by spinal flexion. A positive sign is indicative of spinal pathology, often associated with conditions causing pain during trunk flexion, such as spondylitis, vertebral fractures, or spinal infections.

Pathophysiology

Spinal flexion stretches or compresses pain-sensitive structures, including vertebral bodies, intervertebral discs, ligaments, and paraspinal muscles. Conditions such as ankylosing spondylitis, vertebral osteomyelitis, or compression fractures increase pain perception during forward bending. The patient instinctively uses upper extremity support on the examination table to reduce spinal flexion and load, minimizing discomfort.

Examination technique

1. Patient positioning: Ask the patient to lie supine on the examination table.

2. Instruction: Request that the patient sit up without using their arms initially.

3. Observation: Note whether the patient places hands behind the back on the table to push up.

4. Assessment: The use of the hands as support to rise indicates a positive Amoss’ sign.

5. Documentation: Record whether one or both hands are used and the degree of support required.

Clinical utility

• Screening for spinal pain: Useful in detecting discomfort from vertebral fractures, inflammatory spondylitis, or degenerative disease.

• Adjunct to other spinal tests: Often assessed alongside Schober’s test, straight-leg raise, and spinal palpation.

• Indicator of severity: The need for assistance reflects functional limitation and pain intensity.

Differential diagnosis

Pediatric considerations

• Rarely used in children; positive sign may indicate trauma or congenital spinal anomaly.

• Observe carefully to avoid distress or secondary injury.

Geriatric considerations

• Older adults may demonstrate positive Amoss’ sign due to osteoporotic vertebral fractures or degenerative spondylosis.

• Functional limitation may affect mobility; integrate fall risk assessment.

Limitations

• Not pathognomonic; positive sign indicates spinal discomfort but not the specific etiology.

• False negatives may occur in mild disease or when pain is masked by analgesics.

• Should be interpreted alongside history, imaging, and neurological examination.

Patient counseling

• Explain that the sign reflects spinal pain or stiffness and is a protective mechanism.

• Advise the patient on safe movement techniques to reduce pain during daily activities.

• Recommend further evaluation, including imaging, if spinal pathology is suspected.

Conclusion

Amoss’ sign is a simple but valuable clinical maneuver for identifying spinal pain and functional limitation. It is particularly useful in screening for vertebral pathology and assessing pain severity during flexion. Interpretation should be combined with additional clinical and imaging assessments to guide diagnosis and management.

References

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2. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 7th ed. Maryland Heights, MO: Mosby Elsevier; 2010.

3. Cameron JL. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2021.

4. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill; 2020.