Hoffman's sign or reflex is a test that doctors use to examine the reflexes of the upper extremities. The sign takes its name from a German neurologist called Johann Hoffman.
A positive Hoffman sign indicates an upper motor neuron lesion and corticospinal pathway dysfunction likely due to cervical cord compression. However, up to 3% of the population has been found to have a positive Hoffman without cord compression or upper motor neuron disease.[2]
Procedure. The Hoffmann's reflex test itself involves loosely holding the middle finger and flicking the fingernail downward, allowing the middle finger to flick upward reflexively. A positive response is seen when there is flexion and adduction of the thumb on the same hand.
Healthcare providers use the deep tendon reflex (DTR) examination to check for hyperreflexia as part of a neurological exam. The best-known of the reflexes is the patellar, or knee-jerk, reflex. The DTR exam involves a healthcare provider tapping your knee with a rubber hammer (it shouldn't hurt).
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.
A positive response is known as hyperreflexia. In the case of the Hoffman's sign, this occurs when the nervous system overreacts to the flick on the fingernail. Typically, the nervous system works to temper the spinal reflexes, so a person does not overreact to stimuli.
The presence of the Babinski reflex is indicative of dysfunction of the CST. Oftentimes, the presence of the reflex is the first indication of spinal cord injury after acute trauma. Care must be exercised in interpreting the results because many patients have significant withdrawal responses to plantar stimulation.
These tests show how well the nerves between your spinal cord and body communicate. Providers most commonly see clonus in your ankle joint when they briskly flex your foot up toward your shin. If you have clonus, your foot will then involuntarily bounce up and down.
It involves tapping the index finger against the thumb rapidly while the clinician judges whether the movement is normal or abnormal by visually evaluating amplitude, frequency and accuracy. Visual grading is subjective and for non-expert evaluators, is insensitive to small but meaningful changes.
Autonomic Dysreflexia (AD), sometimes referred to as Autonomic Hyperreflexia, is a potentially life-threatening medical condition that many people with spinal cord injury (SCI) experience when there is a pain or discomfort below their level of injury, even if the pain or discomfort cannot be felt.
Cervical stenosis typically presents with myelopathy, including gait disturbance, hyperreflexia, and weakness, while lumbar stenosis is associated with radiculopathy and neurogenic claudication.
The Froment's sign test is performed to determine the presence of an ulnar nerve injury. Bending the thumb when pinching a piece of paper is a sign of an ulnar nerve injury. The anterior interosseous nerve innervates the flexor pollicis longus muscle.
Thumb Abduction. Patient sits with the wrist in neutral, and thumb relaxed in adduction. Therapist stabilizes metacarpals by maintaining wrist in neutral in somewhat of a handshake position. Resistance is applied to the lateral aspect of proximal phalanx in the direction of adduction.
The reflex may be present in infants without any underlying conditions. After the age of 2 years, though, the Babinski reflex should be absent. A positive result in adults or children over the age of 2 years may be a sign of an underlying issue in the central nervous system.
In older children and adults without neurological problems, the foot will remain still, or the toes may curl downward during the Babinski test. If you do have a Babinski sign, your big toe will bend back, and your other four toes will spread out like a fan.
In babies, an abnormal Babinski reflex would mean that your baby's foot doesn't respond at all to being stroked or responds weakly, or one foot responds differently than the other. An abnormal Babinski reflex could indicate that there's something wrong with the signals the brain is sending to the spinal cord.
Older patients that develop MS have more symptoms in general, such as positive Babinski's reflex, decreased muscle strength, ataxia and a diminished sense of vibration and proprioception.
You could also test yourself for the reflex by resting your foot on your knee, but you won't be able to relax your foot as well. It's much easier to either test someone else or have another person test you.
Common disorders that manifest detrusor hyperreflexia are stroke, Parkinson's disease, dementia, spinal cord injury, and multiple sclerosis. The cause of detrusor instability is much more difficult to identify and, therefore, it is most commonly considered idiopathic.
Hyper-reflexia is mostly associated with antecedent diarrhoea, the AMAN subtype and antiganglioside antibodies, but all GBS subtypes and MFS may present with hyper-reflexia. Hyper-reflexia is typically generalised, usually present from the early progressive phase, it may disappear in a few weeks or may persist.
Major symptoms include hypertension, headache, sweating, flushing or pallor above the level of the lesion, and bradycardia. Other less common signs include pupillary changes, Horner syndrome, nausea, and anxiety. The most common precipitants of autonomic hyperreflexia involve the urinary tract.