Beevor’s sign

Named after: Charles Edward Beevor

Definition: Upward (Cephalad) movement of the umbilicus in a supine patient attempting either to flex the head onto the chest against resistance or performing a sit-up. It is not a pathologic reflex, but a sign resulting from imbalance in muscle strength between the upper and lower abdominal muscles.

Mechanism: Normally, the rectus abdominis muscle contracts as a single unit with no predominance of upper half over the lower part or left over the right side. Therefore, normally on trunk flexion, the navel does not move.

• Weakness of upper part of rectus abdominis (Navel moves upward): Beevor’s sign
• Weakness of lower part of rectus abdominis (Navel moves downward): Inverted Beevor’s sign

The nerve supply to the rectus abdominis muscle at the level of the umbilicus is T10 nerve roots.

Eliciting Beevor’s sign:

1. Patient is initially in supine position
2. Ask the patient to either flex his neck or to sit-up without using the arms
3. Watch for the movement of navel

Conditions where Beevor’s sign is positive:

1. Spinal lesions (e.g. tumor, syringomyelia) between T10-T12 segment
2. Myopathies affecting abdominal muscles, particularly Fascio-scapulo-humeral dystrophy (FSHD)
3. Observed less frequently in other conditions:
   • Pompe disease
   • Myotonic dystrophy
   • Amyotrophic lateral sclerosis
   • Adult form of acid maltase deficiency

References:

1. Althagafi A, Nadi M. Beevor Sign. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545262/
2. A Dictionary of Neurological Signs By A.J. Larner