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Neurological Rehabilitation

A BAD Sign: Hip ABduction/ADduction Strength Ratio in Patients with Upper Motor Neuron Injury Secondary to Cervical Myelopathy

Thursday, November 16, 2023
Background and/or Objectives: Upper motor neuron (UMN) injury in cervical myelopathy manifests as mild weakness which may be difficult to recognize, and clinical tools for evaluating the extent of UMN weakness are limited. Hip abductors are important stabilizing muscles in normal gait and are susceptible to weakness with cervical compression. While the hip abduction/adduction (AB:AD) strength ratio is 1:1 in normal patients, it is unknown what this ratio is in patients with cervical myelopathy. This study aims to evaluate the AB:AD strength ratio in patients with UMN injury secondary to cervical myelopathy.

Design: Case series

Setting : Multidisciplinary spine center

Participants : Patients with diagnosis of cervical myelopathy with MRI T2 cord signal change were included. Patients were excluded with a positive pendulum test or L5 radiculopathy. Eight participants were enrolled, four of which were female, with an average age of 64.5 years old (SD 10.3 years).

Interventions: not applicable

Main Outcome Measures: Ratio of maximal voluntary isometric contraction for hip abduction and adduction was measured using a handheld dynamometer in seated and side-lying positions.

Results: The median AB:AD ratio was 0.87 (IQR 0.80-0.93) in the left limb and 1.03 (IQR 0.86-1.14) in the right limb while seated; the median AB:AD ratio was 0.76 (IQR 0.58-0.83) in the left limb and 0.70 (IQR 0.63-0.76) in the right limb while side-lying. The seated position identified 7 out of 8 patients with AB:AD < 1 in at least one limb, while the side-lying position identified all patients with AB:AD < 1 in both limbs.

Conclusions: Greater decreases in hip abduction force than hip adduction force have long been recognized in UMN injury, such as the scissoring gait of cerebral palsy spastic diplegia. A BAD test may be a quick and efficient examination technique to evaluate patients for cervical myelopathy, as mild weakness is often painless and may manifest as slowly progressive gait abnormalities.