Beevor’s sign is defined as upward movement of the umbilicus during contraction of the abdominal muscles. It is a clinical indicator of paralysis or weakness of the lower rectus abdominis muscles, often associated with neurologic lesions at the T10 spinal level.

Pathophysiology

• The rectus abdominis is innervated segmentally by the thoracoabdominal nerves (T7–T12).

• Lesions affecting the lower thoracic segments (T10–T12) result in weakness of the lower fibers, while the upper fibers remain intact.

• During voluntary contraction (e.g., sit-up), the upper fibers contract normally, pulling the umbilicus upward, revealing asymmetry in muscle strength.

• This mechanism allows detection of segmental lower motor neuron or spinal cord lesions.

Examination Technique

• Patient positioning: Supine, relaxed, with arms at sides.

• Instruction: Ask the patient to raise the head and shoulders slightly off the examination table (partial sit-up).

• Observation:

  • Watch the movement of the umbilicus.

  • Upward displacement indicates weakness of the lower rectus abdominis muscles.

  • Downward movement may suggest weakness of the upper rectus abdominis (rare).

• Assessment: Compare bilateral abdominal muscle contraction for asymmetry.

Clinical utility

• Indicator of lower thoracic lesions: Beevor’s sign helps localize spinal cord injuries at T10 or lower.

• Neurologic assessment tool: Useful in patients with trauma, neuromuscular disorders, or post-surgical evaluation.

• Monitoring progression: Can aid in tracking recovery or deterioration in spinal cord disease.

Differential Diagnosis

Management

• Identify and treat underlying cause: Rehabilitation, physical therapy, or neurology referral depending on etiology.

• Supportive care: Core strengthening exercises may help in partial recovery of abdominal muscle function.

• Monitor progression: Track neurologic function and symmetry over time.

Pediatric considerations

• Rarely observed in children unless congenital myopathies or spinal cord malformations are present.

• Gentle assessment is recommended in pediatric patients.

Geriatric considerations

Muscle atrophy or chronic spinal degeneration may alter baseline abdominal strength, potentially affecting the test’s sensitivity.

Limitations

• Beevor’s sign is specific but not pathognomonic.

• False negatives may occur with generalized abdominal weakness or obesity.

• Should be interpreted alongside other neurologic assessments, including sensory and reflex testing.

Patient counseling

• Explain the purpose of the test and the importance of abdominal muscle contraction.

• Reassure that upward movement is a diagnostic observation, not a harmful maneuver.

• Discuss further neurologic evaluation if the sign is present.

Conclusion

Beevor’s sign is a valuable neurologic examination tool for detecting lower rectus abdominis paralysis and localizing thoracic spinal lesions. Proper technique and interpretation enhance diagnostic accuracy and support targeted patient management.

References

1. Beevor CE. Clinical Observations on Abdominal Muscle Function. J Neurol Psychopathol. 1903;3:77–85.

2. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008. p. 444–447.

3. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 8th ed. Maryland Heights, MO: Mosby Elsevier; 2019.

4. Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations. 3rd ed. Philadelphia, PA: Elsevier; 2013.

5. O’Rahilly R. Human Embryology & Teratology. 4th ed. Philadelphia, PA: Wiley-Liss; 2011.