The elbow flex-ex: a new sign to detect unilateral upper extremity non-organic paresis

Abstract

The elbow flex-ex sign is useful in differentiating between functional and organic arm paresis.

Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment

“…The patient is asked to flex or extend the normal arm while the "weak" arm is examined at the same time. In patients with functional weakness, there is a detectable oppositional force in the "weak" arm when the normal arm is tested [24]. In 44 patients tested, the sign has correctly distinguished cause in all cases [24].…”

“…In patients with functional weakness, there is a detectable oppositional force in the "weak" arm when the normal arm is tested [24]. In 44 patients tested, the sign has correctly distinguished cause in all cases [24]. For sensory symptoms, split vibratory sensation on forehead or sternum is commonly used [20•].…”

“…A positive sign is present when the "weak" arm drifts downward without pronation with the patient's eyes closed [20•]. Lombardi and colleagues recently proposed a new sign to detect functional arm weakness-"the elbow flex-ex" test [24]. The patient is asked to flex or extend the normal arm while the "weak" arm is examined at the same time.…”

Importance of clinical tests to detect non-organic paresis

“…Lombardi et al 2 describe a new sign to detect unilateral upper extremity non-organic paresis, ‘the elbow flex-ex test’. This test uses the complementary opposition of the paretic arm, as a part of synergic movement during the elbow flexion/extension of the normal arm (first part).…”

Introducing a 'neuropsychiatry' special issue: but what does that mean?

“…Conversion disorder might be viewed as a quintessential psychiatric condition—many of the developments of 20th Century psychiatry, such as the operationalised approach of DSM to diagnosis owed their existence to the study of hysteria, yet as we see in this issue5 6 the diagnosis depends on skills in neurological examination.…”