Inverted Supinator Sign

Execution:

1. Patient is sitting position
2. Support the patient’s forearm with your hand to ensure it is relaxed
3. Slightly pronate the forearm and locate the styloid process of the radius
4. Apply a quick series of taps near the styloid process with a reflex hammer

Positive Outcome: Rapid finger flexion

Study	Reliability	Sn	Sp	LR+	LR-
Cook et al. (2009)	ĸ=0.52	61	78	2.8	0.5
Kiely et al. (2010)	NA	NA	72.3	NA	NA
Comment: Performed individually this test is not effective for screening. Kiely et al. (2010): 39% of patients who falsely tested positive on the supinator sign had positive bilateral test outcomes