Hoffmann Sign More Prevalent Than Babinski Sign in Less Severe Neurological Deficits from Cervical Myelopathy
Doctors have different techniques for assessing the neurological, or nerve, function in your body. For example, when an infant is being examined during a well-baby check-up, one thing that is performed is the Babinski sign or reflex. Until the age of two years, if the doctor or nurse strokes the sole of the baby's foot firmly, the biggest toe, or the great toe, should bend and the rest of the toes should spread or fan out. In adults, if this happens, it tells the doctor that there is something wrong.
Most people who have studied biology or child development know about the Babinski sign, but there is another sign that is lesser known, called the Hoffmann sign. To do this test, the doctor or nurse taps the patient's nail on the third or fourth finger. Normally, nothing should happen. However, if there are problems with the neurological system, the test will be positive and the patient will involuntarily bend, or flex, the end of the thumb and index finger.
The authors of this article found that there wasn't any information on how the Hoffmann sign may be used when examining patients with cervical myelopathy. Patients who have cervical myelopathy have a problem in the part of the spinal cord that passes through the neck, because of changes in the spinal canal from tumors, diseases, or injury. Because the nerves must pass through this part of the spinal cord, if there is a problem, it can affect the rest of the body as the nerves either can't get through properly. How serious it is depends on how seriously the nerves are affected. The problem can be mild or it can be severe enough to affect a patient's ability to breathe.
To do their research, the authors reviewed 225 medical records of patients who underwent decompressive cervical spine surgery for cervical myelopathy between January 2003 and December 2006. They then studied how often the Hoffmann sign was present in 617 new patients who were seen for lower-back pain and/or symptoms of leg pain or numbness.
The first group included 125 men and the average age of all the patients was 57.4 years. The researchers found the Hoffmann sign in 154 of the patients and the Babinski sign in 75 patients. In the second group, 290 patients had only lower back pain or leg pain, and 36 had a positive Hoffmann sign. Twenty-five had the sign in one hand, and 11 in both hands. After the test was found to be positive, 31 of the patients underwent a magnetic resonance imaging (MRI), a method of allowing doctors to see three-dimensional images of inside the body. Among those who had the sign in two hands, 10 of the 11 were found to have compression in the spinal area of the neck. Among the patients who had the sign in one hand, 20 also had compression.
When analyzing the data, the authors found that the Hoffmann sign could be more able to detect neurological problems from cervical myelopathy before the Babinski sign can. This means that if a patient comes in with subtle signs of the disorder, using the Hoffmann sign, doctors may be able to make the diagnosis earlier than if waiting to rely on the Babinski sign. The authors did point out, however, that there may be other reasons for a positive Hoffmann sign, such as in people with hyperreflexia, where the reflexes are much more active than in the general population. As well, patients with diabetic neuropathy, a condition where the nerve endings can become quite painful, also had positive Hoffmann signs, even if there was no other neurological problem.
The authors concluded that they felt if patients had the Hoffmann sign in both hands, they had a higher chance of having problems with pressure in the neck.
John K. Houten, MD, and Louis A. Noce, MD. Clinical correlations of cervical myelopathy and the Hoffmann sign. In Journal of Neurosurgery: Spine. September 2008. VOl. 9. Pp. 237-242.
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