Spine: Bragard sign: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: Bragard sign

Sample item

In a patient with leg pain on straight leg raising, the examiner lowers the leg slightly until the pain subsides and then dorsiflexes the foot, which brings the pain back. What does this confirm?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Pain is from sciatic nerve root tension and not from hamstring tightness

Dorsiflexing the ankle after lowering the leg below the pain threshold adds tension to the sciatic nerve without further stretching the hamstrings. Return of the pain therefore indicates neural tension, as in disc prolapse. It is called Bragard sign and sensitises the straight leg raise.

Option by option

  • A. A nonorganic response

    Reproducible pain with a specific sensitising manoeuvre argues against a nonorganic response.

  • B. A femoral nerve lesion

    The femoral nerve is tested with the femoral stretch test.

  • C. Pain is from sciatic nerve root tension and not from hamstring tightness (correct)

    Correct. Reproduction of pain by dorsiflexion indicates neural tension.

  • D. A hip joint disorder

    A hip disorder would not be provoked by ankle dorsiflexion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Pain is from sciatic nerve root tension and not from hamstring tightness. Dorsiflexing the ankle after lowering the leg below the pain threshold adds tension to the sciatic nerve without further stretching the hamstrings.

Why is "A nonorganic response" not the answer?

Reproducible pain with a specific sensitising manoeuvre argues against a nonorganic response.

Why is "A femoral nerve lesion" not the answer?

The femoral nerve is tested with the femoral stretch test.

Why is "A hip joint disorder" not the answer?

A hip disorder would not be provoked by ankle dorsiflexion.

What concept does this question test?

It tests Spine: Bragard sign in Orthopaedics. Return of the pain therefore indicates neural tension, as in disc prolapse. It is called Bragard sign and sensitises the straight leg raise.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: Bragard sign?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.