In patients with cervical disc herniation, it is important to judge early degenerative cervical myelopathty (DCM).
Although imaging techniques such as MRI and CT are becoming more and more advanced, physical examination has always been an important part of clinicians' judgment of the condition.
This physical examination is very simple and can be performed anytime, anywhere, which is convenient for patients to check themselves at home and has important diagnostic significance.
Today, I would like to share a very practical and extremely commonly used action in the clinic -
Hoffmann's Sign test
"Hoffmann's sign" is a 19th-century German neurologist, Johann Hoffmann, invented to determine the examination of motor neuron disorders of the upper limbs, which is an important indicator of clinical judgment of cervical spinal cord damage.
The operation is very simple!
Step 1: The back of the wrist is extended by about 30°
Step 2: Gently pinch the patient's middle finger and lift it
Step 3: Gently scrape the fingernails of the middle finger
Step 4: Observe whether the thumb and rest of the fingers have a "jump" adduction
Step Five: Don't forget to do it with your other hand too
Figure 1 "Hoffmann sign" operation demonstration
How to tell if there is a problem?
When the middle finger nail is scraped, the thumb and rest of the fingers have a "jump" adduction action, which is positive for Hoffmann's sign. In general, this indicates that the pyramid beam is damaged.
Common causes may be cervical disc compression of the spinal cord, or the presence of other cerebrovascular lesions.
In the following patient, C4/5, C5/6, C6/7 segment cervical disc herniation compresses the spinal cord, resulting in active pathological reflexes in the left limb. The patient was positive for Hoffmann's sign, as shown in the figure below.
Fig. 2 Positive "Hoffmann's sign"
Figure 3 MRI suggests spinal cord compression
Although a positive Hoffmann sign is not an absolute pathological finding, clinicians may need to determine the condition in combination with signs, symptoms, and medical history.
However, it is of high value for the patient's family self-examination.
In summary, if Hoffmann's sign is positive, it suggests that there is probably a problem with the brain center and that you need to seek medical attention as soon as possible.
If you have cervical disc herniation, check it yourself often, detect it early, and intervene early.
Reference
Weir Robin Anthony., Chew Cindy. (2019). Hoffmann's sign. Postgrad Med J, 95(1129), 626. doi:10.1136/postgradmedj-2019-136471