Hoffmann's Sign: Difference between revisions
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<div class="editorbox"> '''Original Editor '''- [[User:Arnold Fredrick D'Souza|Arnold Fredrick D'Souza]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | |||
== 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> | ||
== 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: | ||
# | # 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. | # 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. | # Perform a sharp and forceful flick of your thumb, making contact with the nail of the subject’s middle finger. | ||
| Line 12: | Line 14: | ||
== 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" /> | 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 [[Multiple Sclerosis (MS)|multiple sclerosis]], [[hyperthyroidism]], and anxiety will also result in a positive signs.<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 == | |||
While the solitary presence of Hoffmann's sign is inconclusive for the diagnosis of [[Cervical Myelopathy|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> It is one of the components of Cook's cluster test for diagnosing cervical myelopathy.<ref>Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113267/ Clustered clinical findings for diagnosis of cervical spine myelopathy.] Journal of Manual & Manipulative Therapy. 2010 Dec 1;18(4):175-80.</ref> Nevertheless, [[MRI Scans|MRI]] remains the gold standard for diagnosing cervical [[Myelopathy|myelopathies]].<ref name=":2" /> | |||
However, a study revealed that in subjects with degenerative cervical myelopathy, there is insufficient data to support its solitary use in confirming the diagnosis.<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 == | ||
<references /> | <references /> | ||
[[Category:Neurology]] | |||
[[Category:Neurological - Assessment and Examination]] | |||
[[Category:Assessment]] | |||
[[Category:Special Tests]] | |||
[[Category:Neurological - Special Tests]] | |||
[[Category:Cervical Spine]] | |||
[[Category:Cervical Spine - Special Tests]] | |||
Latest revision as of 06:35, 9 June 2022
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]
Technique[edit | edit source]
The following steps[3][4] 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 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 multiple sclerosis, hyperthyroidism, and anxiety will also result in a positive signs.[4]
Systemic disorders usually result in a bilateral response while structural anomalies such as tumors 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.[6]
Psychometrics[edit | edit source]
While the solitary presence of Hoffmann's sign is inconclusive for the diagnosis of cervical myelopathy[7], a unilateral positive sign is more specific[8] and a bilateral positive finding is highly sensitive for confirmation of the same.[9] It is one of the components of Cook's cluster test for diagnosing cervical myelopathy.[10] Nevertheless, MRI remains the gold standard for diagnosing cervical myelopathies.[7]
However, a study revealed that in subjects with degenerative cervical myelopathy, there is insufficient data to support its solitary use in confirming the diagnosis.[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.
- ↑ 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)
- ↑ Whitney E, Munakomi S. Hoffmann Sign. StatPearls. 2020 Jan.
- ↑ 7.0 7.1 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.
- ↑ Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. Clustered clinical findings for diagnosis of cervical spine myelopathy. Journal of Manual & Manipulative Therapy. 2010 Dec 1;18(4):175-80.
- ↑ 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.
