Physical Examination: Experimental Procedures for Future Study

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Spock Maneuver and Stoop Sign[edit]

(Author’s term)

This is an experimental clinical examination technique. Its validity is unknown. The name was coined by the author after the well-known TV character Spock on the show Star Trek. He would grasp his opponents in the region of their trapezius muscles, and thereby immediately neutralize them (it was called the “Vulcan nerve pinch”). (https://en.wikipedia.org/wiki/Vulcan_nerve_pinch)


Spock.png
Screenshot showing the Vulcan nerve pinch.
Source: Wikimedia Commons, but originating as a “screen capture from the 3rd Season Star Trek: The Original Series episode ‘And the Children Shall Lead’. DVD cap, around 41:00…The image is of sufficient resolution for commentary and identification but lower resolution than the original.” It is used here under fair use rules to illustrate an education¬al point and is not replaceable by any free content known to the author. Wikipedia states: “As a screenshot, the image is not replaceable by free content; any other image of the work would also be copyrighted, and any version that is not true to the original would be inadequate for identification or critical commentary…This image is a screenshot of a copyrighted television program. As such, the copyright for it is most likely owned by the company or corporation that produced it. It is believed that the use of a limited number of web-resolution screenshots…”
This image shows Spock grabbing the target close to the neck. Generally, trapezius tenderness is tested more laterally in the mid-trapezius.


Given that fibromyalgia patients are well known to have mechanical allodynia, the thought arose that perhaps they would be especially sensitive in this area. Children often grab this area during play fighting and squeeze until the other child’s says “Uncle!” or “I give up.”

Suggested procedure:

Inform them that you plan to press down firmly on their shoulder area muscles. Obtain their informed consent.

Stand behind the patient while the patient stands with their back to you. (It is well known that the psychology of danger plays an important role in fibromyalgia. By standing behind them, it is likely that threat processors in the brain are slightly activated, and this may help bring out a response that offers more clarity to the situation.)

Place your second and third fingers tips on top of their mid-trapezius muscle on one side, and then gradually increase the force of downward pressure.

Be ready to respond in case they stumble.

Observe to see if they drop the shoulder on the side that is being pressed.

Observe to see if they stoop by flexing their knees. This seems to be an involuntary withdrawal reaction and the patient may not be able to resist stooping even if you tell them to try not to.

Normally, in healthy non-pain patients, even firm pressure will not cause the patient to stoop down.

My current impression (as of 2017) is that if the patient stoops in response to a modest force, they have highly sensitized withdrawal reflexes and their case is quite severe. Perhaps this is a feature of central sensitization.

Sink/slide in the chair test[edit]

This is the author’s idea for a test. It is experimental, as it has only been tried in a very small number of patients. It is a way of testing for withdrawal reactions. It is similar to the Spock Maneuver and Stoop Sign. The patient sits in a wide chair, i.e. several inches wider than their body. The chair should have a smooth surface so that the clothes can slide over it. The examining clinician presses on the trapezius tender point in the same manner as in the Spock Sign. A positive test consists of the patient sinking down in the chair and sliding their buttocks forward. Once again, the movement serves to remove the body part away from the pressure applied by the thumb.