11/13/24, 7\:05 PM Guide | Hoffmann’s sign

Ho

Table of contents

Background

Ho
…an involuntary
the middle
1
’’ This is considered abnormal and indicative of neural damage or irritation originating from the
cervical spine.
Houpper motor neurone lesions.
Cervical myelopathy refers to compression or damage to the spinal cord resulting from trauma or other pathological
process. Degenerative cervical myelopathy (cervical spondylotic myelopathy) is the most common form. 1
Common causes
include disc degeneration, spinal stenosis, ligament ossi2
Clinical features include impaired motor
function, dexterity, and urinary incontinence, which are usually progressive.
An upper motor neurone lesion refers to the impaired communication between the brain and spinal cord, also resulting
from trauma or a pathological process. It may result from cervical myelopathy, an acquired injury, or a degenerative
condition (e.g. brain injury, pyramidal tract lesions, metabolic and neurodegenerative disorders). 3
For more information, see
our guide to upper vs lower motor neurone lesions.

Clinical signi

The motor nerves originating from the cervical spine innervate muscles of the upper limbs, including the hand and digits.
Cervical myelopathy or an upper motor neurone lesion can impair the motor re
However, a positive Ho
positive test). 4
Therefore, a positive Ho
The primary follow-up investigation to a positive Ho
range from conservative management (e.g. physiotherapy, neck brace support, pain medication) to surgical management
(e.g. decompression, cervical disc arthroplasty, laminectomy with fusion). 5
Treatment choice depends on the duration and
severity of signs and symptoms and the underlying cause(s).

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient, including your name and role.
Con
Brie
Gain consent to proceed with the examination.
Ask the patient if they have any pain before proceeding with the clinical examination and perform a brief inspection for any
wrist or hand deformities which could contradict the test.

Perform the test

1. Ask the patient to sit comfortably, look straight ahead (to avoid looking at the side being tested, which could compromise the
results), and remain relaxed throughout the test
2. Using one hand, stabilise the patient’s wrist at the distal radioulnar joint in a prone position using your thumb and index
https\://app.geekymedics.com/osce-guides/clinical-examination/hoffmanns-sign/ 1/311/13/24, 7\:05 PM Guide | Hoffmann’s sign
3. Using your opposite hand, clasp the patient’s third middle phalanx between your index and middle
thumb to passively
again or give the wrist a gentle shake before proceeding to step 4)
4. Slide your thumb o
extension. This movement is rapid but gentle and should not cause any pain or discomfort
5. Observe for movement of the thumb or index
6. Perform steps 1-4 on the opposite side and document your
b y
" )
Figure 1. An example of a positive Ho

Interpretation of

A positive test is when any involuntary
4
A negative test is when none of the above signs are present.

To complete the examination...

Explain to the patient that the examination is now
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Summarise your

Reviewer

Dr Richard Armitage
General Practitioner

References

https\://app.geekymedics.com/osce-guides/clinical-examination/hoffmanns-sign/ 2/311/13/24, 7\:05 PM Guide | Hoffmann’s sign
1. Bartels RHMA. A new dimension in degenerative cervical myelopathy. The Lancet Neurology. 2021;20(2)\:82-83.
2. Baptiste DC, Fehlings MG. Pathophysiology of cervical myelopathy. The Spine Journal. 2006;6(6)\:S190-S197.
3. Marc Christopher Emos, Sanjeev Agarwal. Neuroanatomy, Upper Motor Neuron Lesion. Nih.gov. Published December 28, 2018.
Available from\: [LINK]
4. Annaswamy TM, Sakai T, Goetz LL, Pacheco FM, Ozarkar T. Reliability and Repeatability of the Ho
2012;4(7)\:498-503.
5. Zhang AS, Myers C, McDonald CL, Alsoof D, Anderson G, Daniels AH. Cervical Myelopathy\: Diagnosis, Contemporary Treatment,
and Outcomes. The American Journal of Medicine. 2022;135(4)\:435-443.

Image references

Figure 1. StatPearls Publishing LLC and Rian Kabir, MD. D i a g r a m d e p i c t i n g a p o s i t i v e H o CC BY-NC-ND]
Source\: geekymedics.com
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