Hoffmann's Sign: Difference between revisions
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== Technique == | == Technique == | ||
The following steps<ref name=":0">DeJong’s The Neurologic Examination: Sixth edition; Lippincott Williams and Wilkins 2005, pp 495-496.</ref> should be followed while performing this test: | The following steps<ref name=":0">DeJong’s The Neurologic Examination: Sixth edition; Lippincott Williams and Wilkins 2005, pp 495-496.</ref><ref name=":1">Barman B. Clinical Sign Revisited: Hoffman’s sign. Indian J Med Spec 2010; 1(1):44-45</ref> should be followed while performing this test: | ||
# Place the subject’s relaxed hand ensuring dorsiflexion at the wrist and partial flexion of the fingers. | # Place the subject’s relaxed hand ensuring dorsiflexion at the wrist and partial flexion of the fingers. | ||
# Hold the subject's partially extended middle finger between your index and middle finger, ensuring you stabilize the proximal IP joint. | # Hold the subject's partially extended middle finger between your index and middle finger, ensuring you stabilize the proximal IP joint. | ||
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== Interpretation == | == Interpretation == | ||
A positive Hoffmann's sign is suggestive of corticospinal tract dysfunction localized to the cervical segments of the spinal cord.<ref name=":0" /> In this regard, it is analogous to the [[Babinski Sign|Babinski sign]]. | A positive Hoffmann's sign is suggestive of corticospinal tract dysfunction localized to the cervical segments of the spinal cord.<ref name=":0" /> In this regard, it is analogous to the [[Babinski Sign|Babinski sign]]. | ||
Conditions such as hyperthyroidism and anxiety will also result in a positive sign.<ref name=":1" /> | |||
Systemic disorders usually result in a bilateral response while structural anomalies such as tumors result in a unilateral response.<ref name=":1" /> | |||
== Psychometric properties == | == Psychometric properties == | ||
While the solitary presence of Hoffmann's sign is inconclusive for the diagnosis of cervical myelopathy<ref name=":2">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. doi: 10.1097/BRS.0000000000002697. PMID: 29668564.</ref>, a unilateral positive sign is more specific<ref>Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in clinical practice, 5th edition, Elsevier, 2008, pp 362,427.</ref> and a bilateral positive finding is highly sensitive for confirmation of the same.<ref>Houten JK, Noce LA. Clinical correlation of cervical myelopathy and the Hoffman sign. J Neurosurg Spine 2008;9:237-42.</ref> Nevertheless, MRI remains the gold standard for diagnosing cervical myelopathies.<ref name=":2" /> | |||
== References == | == References == | ||
<references /> | <references /> |
Revision as of 10:46, 19 August 2020
Introduction[edit | edit source]
Dr. Johann Hoffmann, a German neurologist, is credited with the discovery of the eponymous Hoffmann's sign or reflex.[1] Although his assistant, Dr. Hans Curschman is responsible for the dissemination of this finding, leading to its universal use in neurological screening today.[2]
Technique[edit | edit source]
The following steps[3][4] should be followed while performing this test:
- Place the subject’s relaxed hand ensuring dorsiflexion at the wrist and partial flexion of the fingers.
- Hold the subject's partially extended middle finger between your index and middle finger, ensuring you stabilize the proximal IP joint.
- Perform a sharp and forceful flick of your thumb, making contact with the nail of the subject’s middle finger.
- The subject's finger will flex immediately followed by relaxation.
- The presence of Hoffmann's sign is characterized by flexion and adduction of the thumb and flexion of the index finger.
Interpretation[edit | edit source]
A positive Hoffmann's sign is suggestive of corticospinal tract dysfunction localized to the cervical segments of the spinal cord.[3] In this regard, it is analogous to the Babinski sign.
Conditions such as hyperthyroidism and anxiety will also result in a positive sign.[4]
Systemic disorders usually result in a bilateral response while structural anomalies such as tumors result in a unilateral response.[4]
Psychometric properties[edit | edit source]
While the solitary presence of Hoffmann's sign is inconclusive for the diagnosis of cervical myelopathy[6], a unilateral positive sign is more specific[7] and a bilateral positive finding is highly sensitive for confirmation of the same.[8] Nevertheless, MRI remains the gold standard for diagnosing cervical myelopathies.[6]
References[edit | edit source]
- ↑ P Hoffmann. Über eine Methode, den Erfolg einer Nervennaht zu beurteilen. Medizinische Klinik, March 28, 1915b, 11 (13): 359-360.
- ↑ Bendheim, OL. "ON THE HISTORY OF HOFFMANN'S SIGN." Bulletin of the Institute of the History of Medicine 1937; 5(7): 684-86.
- ↑ 3.0 3.1 DeJong’s The Neurologic Examination: Sixth edition; Lippincott Williams and Wilkins 2005, pp 495-496.
- ↑ 4.0 4.1 4.2 Barman B. Clinical Sign Revisited: Hoffman’s sign. Indian J Med Spec 2010; 1(1):44-45
- ↑ CRTechnologies. Hoffmann's Sign Test (CR). Available from: https://www.youtube.com/watch?v=q_4gpNizwPg (accessed 19 August 2020)
- ↑ 6.0 6.1 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. doi: 10.1097/BRS.0000000000002697. PMID: 29668564.
- ↑ Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in clinical practice, 5th edition, Elsevier, 2008, pp 362,427.
- ↑ Houten JK, Noce LA. Clinical correlation of cervical myelopathy and the Hoffman sign. J Neurosurg Spine 2008;9:237-42.