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ULY CLINIC
ULY CLINIC
25 Septemba 2025, 05:23:37
Linder’s sign
Linder’s sign is pain elicited in the lower back or leg upon passive neck flexion, indicating sciatic nerve irritation. It is primarily used to assess radiculopathy or lumbar disc pathology.
Pathophysiology
Normal physiology:
Neck flexion alone does not produce distal leg pain in healthy individuals.
Abnormal physiology (sciatica):
Passive neck flexion stretches the dural sac and spinal cord, transmitting tension along the sciatic nerve and lumbosacral nerve roots.
Irritated or compressed nerve roots (commonly due to lumbar disc herniation) generate pain radiating to the lower back and leg.
Examination Technique
Patient positioning: Place the patient supine or sitting with legs fully extended.
Passive neck flexion: Gently flex the patient’s neck toward the chest.
Observation: Ask the patient if pain occurs in the lower back or leg, noting the side and distribution.
Documentation: Record presence, location, and severity of pain, and whether it reproduces typical sciatic symptoms.
Clinical Features
Feature | Manifestation |
Pain response | Lower back or leg pain upon neck flexion |
Radiation | Along sciatic nerve distribution (posterior thigh, calf, foot) |
Associated neurologic signs | Numbness, tingling, or weakness in affected limb |
Aggravating maneuver | Passive neck flexion stretches dural sac |
Relief | Neck extension or leg relaxation may reduce symptoms |
Differential Diagnosis
Condition | Key Feature | Notes |
Lumbar disc herniation | Pain along sciatic distribution, positive Linder | Often accompanied by straight-leg raise positivity |
Piriformis syndrome | Buttock and posterior thigh pain, negative neck flexion | Local sciatic compression outside spine |
Spinal stenosis | Neurogenic claudication, worsened by standing/walking | Pain often bilateral, relieved by flexion |
Acute lumbar strain | Local back pain, no radicular component | Pain not reproduced by Linder’s maneuver |
Meningeal irritation | Pain with neck flexion but may involve full spine | Consider infection or subarachnoid pathology |
Special Populations
Elderly:
Degenerative changes may exaggerate nerve root tension.
Athletes:
Acute lumbar disc injuries or tight hamstrings may produce false positives.
Limitations
Subjective; requires patient feedback for accuracy.
May be confounded by coexisting cervical or lumbar pathology.
Must be performed gently to avoid exacerbating pain or neurological deficits.
Patient Counseling
Explain that the maneuver stretches nerve pathways, and reproduction of familiar leg pain suggests sciatic nerve involvement.
Advise avoiding sudden neck movements if pain occurs.
Emphasize the need for further evaluation, such as imaging or neurologic assessment, to identify underlying lumbar pathology.
Conclusion
Linder’s sign is a clinical test for sciatic nerve irritation, elicited by passive neck flexion in a patient with lumbar radiculopathy. Recognition of this sign helps localize nerve root pathology and guides further diagnostic and therapeutic interventions.
References
Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363–370.
Hoppenfeld S, deBoer P, Buckley R. Physical Examination of the Spine and Extremities. 2nd ed. Philadelphia, PA: Appleton & Lange; 2000.
Magee DJ. Orthopedic Physical Assessment. 6th ed. Philadelphia, PA: Elsevier; 2021.
Lasègue M. Études cliniques sur la sciatique. Rev Med. 1864;24:385–408.