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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Hoffman's Sign



- Discussion:
    - positive Hoffmann’s reflex reflects presence of an upper motor neuron lesion from spinal cord compression;
   - is elicited by flipping either the volar or dorsal surfaces of the middle finger and observing the reflexcontration of the thumb and index 
          finger;
   - this sign is evidence by upper motor neuron disease because here should normally be no reaction;
          - positioning the neck in extension (sometimes flexion) may worsen the reflex;
   - at or above the level of compression, upper extremity should be diminished or absent due to nerve root compression;
   - in the report by Sung and Wang (2001), asymptomatic patients with a positive Hoffmann’s reflex were prospectively studied with 
          cervical radiographs and magnetic resonance imaging;
          - to determine a relationship between a positive Hoffmann’s reflex and cervical pathology in asymptomatic patients and to evaluate if 
                  further work-up was necessary in this patient population;
          - 16 patients without cervical pain or radiculopathy and a positive Hoffmann’s reflex were prospectively studied with cervical 
                  radiographs and magnetic resonance imaging;
          - all 16 patients were asymptomatic;
          - 14 patients (87.5%) demonstrated spondylosis on cervical radiographs;
          - MRI showed pathologic findings in all 16 patients;
          - 15 patients (94%) had cervical involvement with cord compression from a herniated nucleus pulposus;
          - remaining patient had a T5-T6 thoracic disc with resultant compression


Correlation Between a Positive Hoffmann’s Reflex and Cervical Pathology in Asymptomatic Individuals 



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:12 pm