Editor’s Note: This article is the latest installment in Dr. Miller’s periodic “Dynamic Diagnosis” series: concise anecdotes designed to serve as clinical pearls for your practice.
Since the mandate for using electronic health care record (EHR) systems became effective in 2014, I have been exposed to various EHR software. Each time I encounter a new EHR or review an updated version, my first focus is on the examination content within the system.
The items preprogrammed into most systems are usually consistent from one system to another. However, an area of examination that is often overlooked in many systems is observed objective findings.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Fortin’s Finger Sign
Fortin’s finger sign is simply having the patient point out the sacroiliac joint as the primary location of pain. The patient will demonstrate this by placing a finger on the posterior superior iliac spine / Dimple of Venus or covering the SI joint area with his whole hand.
Minor’s Sign
Minor’s sign also deals with SI joint pathology and often needs to be differentiated from the third observable finding we are discussing here, Vanzetti’s sign.
Patients with SI pathology exhibit Minor’s sign when they move from a seated to a standing position. The patient will place his hand over the dysfunctional SI joint to brace it, push the pelvis forward to extend the hip joints, allowing the lumbar spine to straighten.
Once the patient is up, a tilted posture and limp will be present for 15 to 20 steps, after which the patient usually reaches an upright position. The presence of Minor’s, followed by the tilted posture and brief period of limping that resolve, could be termed an “antalgic transitioning.” This pattern is the key to understanding Minor’s sign.
If the patient’s abnormal posture persists, with or without a limp, the examiner’s thoughts should turn to the possible presence of Vanzetti’s sign.
Vanzetti’s Sign
Vanzetti’s sign is the familiar stance of a patient with disc pathology. The sign is present when it appears that the patient’s torso has shifted to one side and is offset from the pelvis and lower extremities. The shift, like all antalgic postures, is to provide relief from pain. The shift and offset appearance are unlike lateral bending. The entire torso is not leaning.
Vanzetti’s sign may be so persistent that it can be observed in recumbent and seated postures. The sign’s consistency is another factor that differentiates Minor’s and Vanzetti’s signs, SI joint, and disc pathologies.
Clinical Takeaway
All the information listed above is obtained solely by observing the patient. The events, movements, and postures could be encountered during any patient examination. To take advantage of this important diagnostic information, be alert and make efforts to have these essential signs available for selection in the examination portion of your EHR so they can be recorded when observed.
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