Which test is used to differentiate true leg weakness from non-organic weakness in a clinical exam?

• A. Milgram's Test
• B. Hoover Test
• C. Kemp Test
• D. Brudzinski-Kernig Test

Answer: (B)

The key idea is to detect genuine motor effort by looking for clear, reciprocal leg action during a simple movement. In this test, you have the patient lie on their back and place your hands under the heels of both legs. When the patient tries to raise one leg, a real effort typically makes the opposite leg press down into your hand (as the body stabilizes and the hip and leg muscles engage together). If you don’t feel that downward pressure from the opposite leg, it suggests the patient isn’t truly generating force with the lifted leg—pointing to non-organic or non-physiologic weakness rather than a true neurological or muscular deficit. This makes it a practical, bedside way to differentiate true leg weakness from non-organic weakness.

Other tests listed aren’t designed for this purpose: for example, Milgram’s test relates to disc pathology in the lower back, Kemp’s test to facet joint pain, and Brudzinski-Kernig tests assess meningeal irritation.