Hoffmann's Sign
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:
- Position 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 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]
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 DeJong’s The Neurologic Examination: Sixth edition; Lippincott Williams and Wilkins 2005, pp 495-496.
- ↑ 5.0 5.1 5.2 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)
- ↑ Whitney E, Munakomi S. Hoffmann Sign. StatPearls. 2020 Jan.
- ↑ 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.
- ↑ 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.
- ↑ 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.
