Bowstring Sign

Introduction

Bowstring Sign is often used to apply pressure on the sciatic nerve and reproduce radicular pain, indicating lumbar root compression or sciatic nerve tension (sciatica).

Procedure

  1. Patient supine, examiner flexes patient’s hip with knee slightly flexed; examiner then applies pressure with thumbs on hamstring muscles
  2. If no pain is elicited, examiner then proceeds to apply pressure to the popliteal fossa (traction on the sciatic nerve).
  3. Patient is instructed to repeat motion of touching toes.
Bowstring sign - Orthopaedic test

Examiner flexes patient’s hip with knee slightly flexed. Exam then applied pressure on hamstrings muscles & then the popliteal fossa

Interpretation

Bowstring Sign can be used to differentiate between radiculopathy, sciatica and local muscular and/or ligamentous sprain.

Positive Bowstring Sign

There are two signs to show a positive Bowstring test.

  1. Leg pain: Radiculopathy, interventricular foramen encroachment, space-occupying lesion, nerve root tension, sciatica
  2. Local Back or Hamstring Pain: Consider local muscle strain or ligamentous sprain

Clinical Notes

Lasègue’s Seated Test is the same manoeuvre as Bowstring Sign, without the application of traction to the sciatic nerve at the popliteal fossa.