During your neurology rounds, your chief resident is examining a patient just admitted with acute weakness in the lower extremities. Later he performs the test shown in the image. If the test is positive what observation are you going to make?
A. Adduction and flexion of the thumb
B. Upgoing deviation of the middle finger
C. Flapping tremor of the little finger
D. Fasciculations of the index and middle finger
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The Hoffman sign is an involuntary flexion movement of the thumb and/or index finger when the clinician flicks the fingernail of the middle finger down.
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The reflex pathway causes the thumb to abduct and flex rapidly.
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A positive Hoffman sign may be an indicator of an upper motor neuron lesion or corticospinal pathway dysfunction most likely due to compression of the cervical spinal cord
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Unfortunately, nearly 3-5% of population can have a positive Hoffman sign without having an upper motor neuron problem or cervical cord compression
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The Hoffman sign is not a reliable physical sign to screen for spinal cord compression