Jump to content

Hoffmann's Sign

Original Editor - Arnold Fredrick D'Souza Top Contributors - Arnold Fredrick D'Souza, Angeliki Chorti, Swati Singh, Alexandra Stead, Kim Jackson, Vidya Acharya, Misha Ahir, Manisha Shrestha, Lucinda hampton and Alan Jit Ho Mak

Purpose

Hoffmann's sign is a neurological reflex test that may indicate the presence of an upper motor neuron lesion, especially those affecting the cervical spinal cord.[1]

Dr. Johann Hoffmann, a German neurologist, first identified the Hoffmann reflex, which is commonly used to check for neurological conditions. [1] His assistant, Dr. Hans Curschmann, played a key role in promoting its use.[1] Today, it remains a standard tool in most neurological assessments.[2][3]

Technique

Hoffmann's sign is quick and easy to execute. The following steps should be followed while performing this test: [4][5]

  1. Position the subject’s relaxed hand, ensuring dorsiflexion at the wrist and partial flexion of the fingers.
  2. Hold the subject's partially extended middle finger between your index and middle finger, ensuring you stabilise the proximal interphalangeal joint.
  3. Perform a sharp and forceful flick of your thumb, making contact with the nail of the subject’s middle finger.
  4. The subject's finger will flex immediately followed by relaxation.
  5. The presence of Hoffmann's sign is characterised by flexion and adduction of the thumb and flexion of the index finger.


Normal response to the test is shown below:

[6]

A positive Hoffmann's sign is suggestive of corticospinal tract dysfunction localised to the cervical segments of the spinal cord.[5] In this regard, it is analogous to the Babinski sign for the upper extremities. Conditions such as multiple sclerosis, hyperthyroidism myelopathy with vitamin B12 deficiency,[7] and anxiety may also result in positive signs.[4]

Systemic disorders typically result in a bilateral response, whereas structural anomalies such as tumours result in a unilateral response.[4] It is worth noting that up to 3% of the population has been found with a positive sign without any indication of cord compression or UMNL disease.[8]

Evidence / Clinical Significance

Hoffmann's sign is one of the components of Cook's cluster test for diagnosing cervical myelopathy.[9]

It can aid in diagnosis and screening, but clinicians can not rely on this completely for confirmation of cervical cord compression.[10] Although the solitary presence of Hoffmann's sign is inconclusive for the diagnosis of degenerative cervical myelopathy, [11] it can still be used in symptomatic patients. In fact, as the cervical spine canal becomes narrower or segment compression is higher, the higher is the chance to find this sign, making it more useful to combine with corresponding MRI imaging. [12] Nevertheless, MRI remains the gold standard for diagnosing cervical myelopathies.[10]

A unilateral positive sign may not be a strong indicator of cervical spinal cord compression [12][13][14] but a bilateral positive finding is better at confirming the same in patients with cervical myelopathy and lumbar symptoms.[15] Compared to the Babinski sign, Hoffmann's sign may be more commonly encountered in patients with less severe neurological presentations.[15] Some support that Hoffman's sign demonstrated accuracy is indeed linked to disease severity, although it may be positive in very few cases of early diagnosed patients with degenerative cord compression in musculoskeletal care.[16] In contrast, a negative finding is more accurate in more severe cases.[17]

Resources

Hoffman's sign infographic
Hoffmann's sign infographic

References

  1. ↑ 1.0 1.1 1.2 Whitney E, Munakomi S. Hoffmann Sign. 2024 Sep 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
  2. ↑ Hoffmann P . Über eine Methode, den Erfolg einer Nervennaht zu beurteilen. Med Klin. 1915; 11(13): 359-60.
  3. ↑ Bendheim OL. On the history of Hoffmann's sign. Bulletin of the Institute of the History of Medicine 1937; 5(7): 684-86.
  4. ↑ 4.0 4.1 4.2 Barman B. Clinical Sign Revisited: Hoffman’s sign. Indian J Med Spec 2010; 1(1):44-5.
  5. ↑ 5.0 5.1 Campbell W. DeJong’s The Neurologic Examination 6th ed. Lippincott Williams and Wilkins 2005. pp 495-6.
  6. ↑ CRTechnologies. Hoffmann's Sign Test (CR). Available from: https://www.youtube.com/watch?v=q_4gpNizwPg [accessed 5/12/2025]
  7. ↑ Xu Y, Chen W, Jiang J. Cervical spondylotic myelopathy with vitamin B12 deficiency: Two case reports. Exp Ther Med. 2013 Oct;6(4):943-946.
  8. ↑ Annaswamy TM, Sakai T, Goetz LL, Pacheco FM, Ozarkar T. Reliability and repeatability of the Hoffmann sign. PM R. 2012 Jul;4(7):498-503. [[[1]]] [[list]]
  9. ↑ Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. Clustered clinical findings for diagnosis of cervical spine myelopathy. J Manual Manip Ther. 2010 Dec 1;18(4):175-80.
  10. ↑ 10.0 10.1 Whitney E, Munakomi S. Hoffmann Sign [Sep, 10 2024]. PubMed. Treasure Island (FL): StatPearls Publishing.
  11. ↑ Fogarty A, Lenza E, Gupta G, Jarzem P, Dasgupta K, Radhakrishna M. A Systematic Review of the Utility of the Hoffmann Sign for the Diagnosis of Degenerative Cervical Myelopathy. Spine (Phila Pa 1976). 2018 Dec 1;43(23):1664-1669.
  12. ↑ 12.0 12.1 Cao J, Liu Y, Wang Y, Zhao L, Wang W, Zhang M, Wang L. A Clinical Correlation Research of the Hoffmann Sign and Neurological Imaging Findings in Cervical Spinal Cord Compression. World Neurosurg. 2019 Aug;128:e782-e786.
  13. ↑ Glaser JA, Curé JK, Bailey KL, Morrow DL. Cervical spinal cord compression and the Hoffmann sign. Iowa Orthop J. 2001;21:49-52.
  14. ↑ Grijalva RA, Hsu FP, Wycliffe ND, Tsao BE, Williams P, Akpolat YT, Cheng WK. Hoffmann sign: clinical correlation of neurological imaging findings in the cervical spine and brain. Spine (Phila Pa 1976). 2015 Apr 1;40(7):475-9.
  15. ↑ 15.0 15.1 Houten JK, Noce LA. Clinical correlation of cervical myelopathy and the Hoffman sign. J Neurosurg Spine 2008;9:237-42.
  16. ↑ Cervellini M, Feller D, Maselli F, Rossettini G, Cook C, Tabrah J, Chauhan RV, Taylor A, Kerry R, Young I, Dunning J, Hutting N, Mourad F. Understanding degenerative cervical myelopathy in musculoskeletal practice. J Man Manip Ther. 2025 Jun;33(3):207-223.
  17. ↑ Jiang Z, Davies B, Zipser C, Margetis K, Martin A, Matsoukas S, Zipser-Mohammadzada F, Kheram N, Boraschi A, Zakin E, Obadaseraye OR, Fehlings MG, Wilson J, Yurac R, Cook CE, Milligan J, Tabrah J, Widdop S, Wood L, Roberts EA, Rujeedawa T, Tetreault L; AO Spine RECODE-DCM Diagnostic Criteria Incubator. The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis. Global Spine J. 2024 May;14(4):1369-94.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Hoffmann%27s_Sign&oldid=374879"