Hoffmann's Sign: Difference between revisions

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== Introduction ==
== Introduction ==
Dr. Johann Hoffmann, a German neurologist, is credited with the discovery of the eponymous Hoffmann's sign or reflex.<ref>P Hoffmann. Über eine Methode, den Erfolg einer Nervennaht zu beurteilen. Medizinische Klinik, March 28, 1915b, 11 (13): 359-360.</ref> Although his assistant, Dr. Hans Curschman, is responsible for the dissemination of this finding, leading to its universal use in neurological screening today.<ref>Bendheim, OL. "ON THE HISTORY OF HOFFMANN'S SIGN." ''Bulletin of the Institute of the History of Medicine 1937;'' 5(7): 684-86.</ref>
Dr. Johann Hoffmann, a German neurologist, is credited with the discovery of the eponymous Hoffmann's sign or reflex.<ref>P Hoffmann. Über eine Methode, den Erfolg einer Nervennaht zu beurteilen. Medizinische Klinik, March 28, 1915b, 11 (13): 359-360.</ref> Although his assistant, Dr. Hans Curschman, is responsible for the dissemination of this finding, leading to its universal use in neurological screening today.<ref>Bendheim, OL. "ON THE HISTORY OF HOFFMANN'S SIGN." ''Bulletin of the Institute of the History of Medicine 1937;'' 5(7): 684-86.</ref> The Hoffman sign has now became a part of the standard in neurological examination of the patient.<ref>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 Neurosurgery. 2019 Aug 1;128:e782-6.</ref>


== Technique ==
== Technique ==
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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 upper motor neuron lesion (UMNL) and 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 [[MS Multiple Sclerosis|multiple sclerosis]], [[hyperthyroidism]], and anxiety will also result in a positive sign.<ref name=":1" />
Conditions such as [[MS Multiple Sclerosis|multiple sclerosis]], [[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" />
Systemic disorders usually result in a bilateral response while structural anomalies such as tumors result in a unilateral response.<ref name=":1" />
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.<ref>Whitney E, Munakomi S. Hoffmann Sign. StatPearls. 2020 Jan.</ref>


== Psychometrics ==
== Psychometrics ==
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 Scans|MRI]] remains the gold standard for diagnosing cervical [[Myelopathy|myelopathies]].<ref name=":2" />
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 Scans|MRI]] remains the gold standard for diagnosing cervical [[Myelopathy|myelopathies]].<ref name=":2" />
However, a study revealed that the Hoffman sign used for the diagnosis of degenerative cervical myelopathy has concluded there is insufficient data to suggest the examination can be used alone to confirm a diagnosis of degenerative cervical myelopathy.<ref>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. 2018 Dec 1;43(23):1664-9.</ref>


== References ==
== References ==

Revision as of 09:54, 21 October 2020

Original Editor - Arnold Fredrick D'Souza Top Contributors - Arnold Fredrick D'Souza, Kim Jackson, Manisha Shrestha, Lucinda hampton and Alan Jit Ho Mak

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] The Hoffman sign has now became a part of the standard in neurological examination of the patient.[3]

Technique[edit | edit source]

The following steps[4][5] should be followed while performing this test:

  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 stabilize the proximal IP 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 characterized by flexion and adduction of the thumb and flexion of the index finger.

[6]

Interpretation[edit | edit source]

A positive Hoffmann's sign is suggestive of upper motor neuron lesion (UMNL) and corticospinal tract dysfunction localized to the cervical segments of the spinal cord.[4] In this regard, it is analogous to the Babinski sign.

Conditions such as multiple sclerosis, hyperthyroidism, and anxiety will also result in a positive sign.[5]

Systemic disorders usually result in a bilateral response while structural anomalies such as tumors result in a unilateral response.[5]

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.[7]

Psychometrics[edit | edit source]

While the solitary presence of Hoffmann's sign is inconclusive for the diagnosis of cervical myelopathy[8], a unilateral positive sign is more specific[9] and a bilateral positive finding is highly sensitive for confirmation of the same.[10] Nevertheless, MRI remains the gold standard for diagnosing cervical myelopathies.[8]

However, a study revealed that the Hoffman sign used for the diagnosis of degenerative cervical myelopathy has concluded there is insufficient data to suggest the examination can be used alone to confirm a diagnosis of degenerative cervical myelopathy.[11]

References[edit | edit source]

  1. ↑ P Hoffmann. Über eine Methode, den Erfolg einer Nervennaht zu beurteilen. Medizinische Klinik, March 28, 1915b, 11 (13): 359-360.
  2. ↑ Bendheim, OL. "ON THE HISTORY OF HOFFMANN'S SIGN." Bulletin of the Institute of the History of Medicine 1937; 5(7): 684-86.
  3. ↑ 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 Neurosurgery. 2019 Aug 1;128:e782-6.
  4. ↑ 4.0 4.1 DeJong’s The Neurologic Examination: Sixth edition; Lippincott Williams and Wilkins 2005, pp 495-496.
  5. ↑ 5.0 5.1 5.2 Barman B. Clinical Sign Revisited: Hoffman’s sign. Indian J Med Spec 2010; 1(1):44-45
  6. ↑ CRTechnologies. Hoffmann's Sign Test (CR). Available from: https://www.youtube.com/watch?v=q_4gpNizwPg (accessed 19 August 2020)
  7. ↑ Whitney E, Munakomi S. Hoffmann Sign. StatPearls. 2020 Jan.
  8. ↑ 8.0 8.1 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.
  9. ↑ Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in clinical practice, 5th edition, Elsevier, 2008, pp 362,427.
  10. ↑ Houten JK, Noce LA. Clinical correlation of cervical myelopathy and the Hoffman sign. J Neurosurg Spine 2008;9:237-42.
  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. 2018 Dec 1;43(23):1664-9.
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