CERVICAL SPONDYLOTIC MYELOPATHY (CSM): INVERTED SUPINATOR SIGN The inverted supinator sign is the last test (next to the Babinski and Hoffmann's sign) in the cluster of Cook to screen for CSM as a red flag in the cervical spine. According to Cook et al. (2009), the Inverted Supinator Sign has a sensitivity of 61% and a specificity of 78% in the detection of cervical cord compression. Like the Hoffmann's sign, it does not have a huge clinical impact as a stand-alone test, but is helpful when used