Bragard’s Sign: ( Braggard’s Test)

Meniscal injuries may be the most common knee injury. Meniscus tears are
sometimes related to trauma, but significant trauma is not necessary. A
sudden twist or repeated squatting can tear the meniscus. A torn
meniscus is one of the most common knee injuries. Any activity
that causes you to forcefully twist or rotate your knee, especially when
putting the pressure of your full weight on it, can lead to a torn
meniscus.

Bragard's Sign

PURPOSE

To test for Meniscal Tearing

PROCEDURE 1

Extension of the knee and External Rotation of the Tibia

• Patient is supine with affected hip and knee flexed
• Therapist stabilizes proximal to the knee with one hand while externally rotating the tibia with the other hand = while extending the knee

Positive Sign

Pain or tenderness along the medial aspect of the joint line indicates medial meniscus injury.

PROCEDURE 2

Internal Rotation of the Tibia & Extension of the knee

• Patient is supine with affected hip and knee flexed
• Therapist stabilizes proximal to the knee with one hand while internally rotating the tibia with the other hand = while extending the knee

Positive Sign

Pain or tenderness along the lateral aspect of the joint line indicates lateral meniscus injury

 

Similiar Tests to Check Meniscus Tear

McMurray test

This test indicates tears of the middle or posterior horn of the meniscus.
With the patient supine and the hip and knee fully flexed, apply a valgus force and externally rotate the tibia while extending the knee. An audible or palpable pop or snap indicates a medial meniscal tear.
Lesions of the lateral meniscus are tested by applying a varus force and internally rotating the tibia during knee extension. The snap is produced as the torn fragment rides over the femoral condyle during extension.
A snap in extreme flexion is indicative of a posterior horn tear; a click at 90° of flexion indicates a lesion in the middle section of the meniscus.

Apley test

This test is used to distinguish between meniscal and ligamentous involvement.
With the patient in a prone position, the knee flexed at 90°, and the leg stabilized by the examiner's knee, distract the knee while rotating the tibia internally and externally. Pain during this maneuver indicates ligamentous involvement.
Then, compress the knee while internally and externally rotating the tibia again. Pain during this maneuver indicates a meniscal tear.

Bounce home test

The patient is supine with his or her heel cupped in the examiner's hand.
The examiner fully flexes the knee and then passively extends the knee. If the knee does not reach complete extension or has a rubbery or springy end feel, the knee movement may be blocked by a torn meniscus.
Childress test
Instruct the patient to squat with the knee fully flexed and attempt to "duck walk."
If the motion is blocked, a meniscal lesion is indicated; however, pain in this position may indicate a meniscal tear or patellofemoral joint involvement.

Merkel sign

Instruct the patient to stand with his or her knees extended and to rotate the trunk. This movement causes compression of the menisci.
Medial compartment pain during internal rotation of the tibia indicates a medial meniscal lesion. Lateral compartment pain occurring during external rotation of the tibia indicates a lateral meniscal lesion.

Modified Helfet test

While the patient is sitting on the edge of a table with the knee flexed 90°, instruct him or her to extend the knee.
If knee mechanics are within normal limits, the tibial tuberosity can be seen in line with the midline of the patella in full flexion; during extension, the tibia rotates and the tibial tubercle moves into line with the lateral border of the patella.
Failure of the tibia to rotate during extension indicates a meniscal lesion or cruciate ligament involvement.

O'Donoghue test

With the patient prone, the examiner flexes the knee 90°. The examiner rotates the tibia internally and externally twice, then fully extends the knee and repeats the rotations.
Increased pain during rotation in either or both knee positions indicates a meniscal tear or joint capsule irritation.
With a valgus force to a flexed and laterally rotated knee, the medial meniscus, medial collateral ligament (MCL), and the ACL all may be injured, representing the O'Donoghue triad.

Payr sign

With the patient sitting cross-legged, the examiner exerts downward pressure along the medial aspect of the knee.
Medial knee pain indicates a posterior horn lesion of the medial meniscus.

First Steinmann sign

With the patient supine and the knee and hip flexed at 90°, the examiner forcefully and quickly rotates the tibia internally and externally.
Pain in the lateral compartment with forced internal rotation indicates a lateral meniscus lesion. Medial compartment pain during forced external rotation indicates a lesion of the medial meniscus.

Second Steinmann sign

This test is indicated when point tenderness is located along the anterior joint line.
When the examiner moves the knee from extension into flexion, the meniscus is displaced posteriorly, along with its lesions. The point of tenderness also shifts posteriorly toward the collateral ligament.

Modified Bragard Test

Sensitivity and Specificity of Modified Bragard Test in Patients With Lumbosacral Radiculopathy Using Electrodiagnosis as a Reference Standard

Objective

The purpose of this study was to assess the diagnostic accuracy of a modified Bragard test compared with the straight leg raise (SLR) test in patients presenting with electrodiagnostic evidence of L5 and S1 nerve root compression.

Methods

This was a cross-sectional study conducted on 506 consecutive patients with signs and symptoms consistent with lumbosacral radiculopathy confirmed by electrodiagnostic study. Patients were evaluated from September 2013 to September 2015 in the physical medicine and rehabilitation outpatient clinic of Shahid Faghihi Teaching Hospital, Shiraz, Iran. The SLR test was investigated concomitantly to determine the sensitivity and specificity.

Results

Electrodiagnostic study findings indicated lumbosacral radiculopathy in 312 patients. Of these participants, 198 were positive on SLR testing, and of 114 SLR-negative patients, 79 were positive on Modified Bragard testing. Sensitivity of the Modified Bragard test was 69.3%, and specificity was 67.42%. Positive and negative predictive values were 73.15% and 63.16%, respectively. Positive likelihood ratio was 2.13, and negative likelihood ratio was 0.46. Diagnostic odds ratio was 4.63. In patients with symptom duration of less than 3 weeks, SLR sensitivity and specificity decreased as the Modified Bragard test diagnostic accuracy increased.

Conclusions

The Modified Bragard test is easy to perform and has an acceptable test performance, which can help to increase the discriminative power of clinical examination in patients with L5 or S1 nerve root compression who exhibit a negative SLR test result, especially in the acute phase of disease.