Storage manoeuvre

A positioning maneuver is a sequence of different body movements that are used for the differential diagnosis and treatment of vertigo (Barket 2024).

A distinction is made in positioning maneuvers between diagnostic and therapeutic maneuvers. These include, for example:

Positioning maneuver according to Dix-Hallpike:

This is used to diagnose benign paroxysmal positional vertigo (Herold 2025).

Procedure:

Diseases of the cervical spine should be investigated first in order to rule out any contraindications. Then the head is guided with both hands of the examiner. For the examination of the right semicircular canal, the head of the seated patient is turned 45° to the right, then the entire upper body is brought rapidly backwards by 90° into a head-down position. The head should be reclined by approx. 45°. The maneuver is then performed for the other side (Antwerpes 2023 / Goebeler 2018).

Pathophysiology:

In the clinical picture of benign paroxysmal positional vertigo (BPLS), the pathogenesis is probably a detachment of the otoliths from the macula utriculi of the inner ear. The otoliths are then carried into the semicircular canals, where they accumulate to form conglomerates (Antwerpes 2023. There, the otoliths cause irritation and thus trigger vertigo (Schädler 2022).

Epley maneuver:

This is a therapeutic positioning maneuver that is used for benign paroxysmal positional vertigo. The aim of this maneuver is to remove the otoliths from the posterior semicircular canal (Fäh 2021).

Procedure:

With the patient seated, the head is turned 45° to the affected side. In this position, the patient is then quickly transferred to the back. Wait approx. 30 s until the symptoms have subsided. Then turn the head 90° to the unaffected side and wait another 30 seconds. Finally, turn the head and body 90° until the face is facing downwards. After approx. 10 - 15 s, the patient can sit up again. However, he should not roll back onto his back. This maneuver can be repeated several times a day (Fäh 2021).

Semont maneuver

This is a positioning maneuver used in BPLS to remove otoliths from the posterior semicircular canal (Hülsemann 2022).

Procedure:

The patient sits on the edge of a couch and turns the head 45° to the unaffected side. Then - while maintaining the head position - the patient is quickly repositioned to the affected side. This position is maintained for approx. 1 minute. The patient is then quickly repositioned by 180°. This position should also be maintained for 1 minute. The patient can then be sat up again. This maneuver should also be repeated several times a day (Hülsemann 2022).

Gufoni maneuver:

The maneuver is used to treat horizontal BPLS (Kubat 2021).

Execution:

The patient sits upright on the edge of the bed, arms close to the trunk and is placed on the healthy side at a rapid pace. The head is then turned rapidly 45° downwards in the healthy direction. After 2 minutes, the patient sits upright again (Kubat 2021).

Barbecue maneuver:

This maneuver is also used to treat BLPS, especially in the case of otoliths in the horizontal semicircular canal (Kubat 2021).

Execution:

The patient lying on their back turns their head to the affected side. The patient then turns three times in 90° steps from the affected side to the healthy side. As soon as he has returned to the affected side, he sits up again (Schaaf 2020).

Brandt-Daroff exercises:

This exercise is the easiest to learn, but the success rate is slightly lower than with the above maneuvers.

Execution:

The patient sits on a couch and places the head and upper body of the affected side on the couch. After a short time, the patient sits up again and then lies down with their head and upper body on the other side of the couch (Steinhäuser 2017).

Pagnini-McClure maneuver, also known as the supine roll test:

This test is used to diagnose lateral arch gait (Sauer 2023).

Procedure:

The patient lies on his back with his upper body raised by about 20 - 30°. The head is then quickly turned to one side and any nystagmus or dizziness sensations are observed.

After the head is returned to the starting position, the opposite side is examined (Fleischmann 2022).

1. Antwerpes F, Reh F, Dodegge M, Vogt M (2023) Positioning test according to Hallpike. DocCheck Flexikon. Doi: https://flexikon.doccheck.com/en/Positioning_test_according_to_Hallpike
2. Barket R, Antwerpes F (2024) Positioning maneuver. DocCheck Flexikon. Doi: https://flexikon.doccheck.com/en/positioning%C3%B6maneuver
3. Fäh C, Antwerpes F (2021) Positioning exercise according to Epley. DocCheck Flexikom. Doi: https://flexikon.doccheck.com/en/Epley-Man%C3%B6ver
4. Fleischmann T, Hohenstein C (2022) Clinical Emergency Medicine. Volume 2 Skills: Emergency Medicine according to the EU Curriculum. Elsevier Urban and Fischer Verlag 118
5. Goebeler M, Westhofen M, Walter P (2018) Ophthalmology, dermatology, ENT in 5 days. Springer Verlag Germany 405 - 406
6. Herold G et al (2025) Internal medicine. Herold Publishing House 318
7. Hülsemann J, Antwerpes F (2022) Semont maneuver. DocCheck Flexikon. Doi: https://flexikon.doccheck.com/en/Semont-Man%C3%B6ver
8. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al. (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education
9. Kubat H, Schulze E, Feurer I (2021) Headwork in good hands: examination and treatment of craniocervical syndromes. Hogrefe publishing house Bern
10. Sauer D, Herdtle S, Kiefl D (2023) Clinical Guide: Clinical Acute and Emergency Medicine. Elsevier Urban and Fischer Publishers Germany 85
11. Schaaf H, Hesse G, Hansen H C (2020) Elsevier Essentials Schwindel: Das Wichtigste für Ärzte aller Fachrichtungen. Elsevier Urban and Fischer Publishers Germany 57
12. Schädler S (2022) Balance and dizziness: basics - examination - therapy. Elsevier Urban and Fischer Publishers 108
13. Steinhäuser J (2017) PraxisSkills Allgemeinmedizin: Medizinische Prozeduren für die Hausarztpraxis. Schattauer Publishers Stuttgart 17