Hoffman’s Sign Test

What is Hoffman’s Sign Test?

Spinal cord compression happens when pressure is exerted on the spinal cord. When pressure is exerted on it, there’s a chance that it might compromise its functioning and may result in the following symptoms:

• Pain in the back and other parts of the neurological system
• Numbness and weakness
• Problems with coordination and motor function
• Changes in reflexes
• Sensory deficits
• Bladder and bowel dysfunction

If these symptoms are present, a person should get checked by a healthcare professional as soon as possible, especially by someone specializing in neurology and physical therapy.

There are different methods that such specialists can take to kickstart a comprehensive examination of a patient. One of these methods is by conducting Hoffman’s Sign Test.

The Hoffman’s Sign Test is a type of physical examination devised by the German neurologist Dr. Johann Hoffman. This particular test was created to help neurologists and similar healthcare professionals detect the possibility of central nervous problems (specifically compression or pressure problems in the spine) in people through a simple technique.

How do physical therapist’s conduct Hoffman’s Sign Test:

The Hoffman’s Sign Test is an easy test to conduct! It doesn’t require any special equipment. The professional needs to have two chairs ready: one for the patient and one for the professional. The test will rely solely on the professional’s hands because they will examine a patient’s fingers and thumb reflexes.

You can begin conducting this test once you’ve prepared a small room with two chairs. Here’s how to conduct it:

• Have your patient sit down
• Tell them to relax the whole time
• Pick one of their hands and position it in a way that ensures the dorsiflexion at the wrist and the partial flexion of their fingers
• Hold the patient’s partially extended middle finger and stabilize the proximal joint using your index finger and middle finger
• Once their middle finger is in position, you need to perform a flick of your thumb (you must ensure that it makes contact with the nail of your patient’s middle finger)
• The flick doesn’t have to be too strong. It needs to be abrupt

The result of this test will depend on the reaction of the flicked middle finger.

How do you interpret the results of Hoffman’s Sign Test?

There are only two possible results for the Hoffman’s Sign Test, and it will depend on the reaction that ensues when the middle finger is flicked.

The test is negative if you flick the middle finger and there’s no reaction or movement.

The test is positive if the index finger and thumb flex after flicking the middle finger. To give you a visual, there should be a pincer-like movement when the index finger and thumb flex. The positive result is Hoffman’s Sign.

If Hoffman’s Sign is present, that points to the possibility that there is spinal cord compression, a disorder of the central nervous system, or some type of neurological disorder.

If you have a patient with a positive Hoffman’s Sign Test, it’s best to schedule them for a comprehensive examination to determine what is causing the hyperactivity of their reflexes.

When is it best to conduct the Hoffman’s Sign Test?

When a patient complains about neurological symptoms

Suppose you have a patient who discusses symptoms like weak limbs, trouble with coordination, and numbness in the fingers or feet. Those symptoms are likely signs of a neurological problem like spinal cord compression or some other issue with the central nervous system. You should propose to examine them using Hoffman’s Sign Test. Explain to them how it’s done and what it’s for.

When conducting a comprehensive neurological exam

Let’s stipulate that you have a patient who is undergoing a comprehensive neurological exam, and the first set of tests suggests that the patient has the possibility of having spinal cord compression. You can conduct the Hoffman’s Sign Test as one of the tests to help you narrow down that possibility.

When conducting routine check-ups

For example, a comprehensive examination confirms that a patient has spinal cord compression and maybe some other neurological problems. You can schedule routine check-ups to monitor their recovery, and one way to monitor their recovery is to conduct several physical examinations that were part of the comprehensive examination. If Hoffman’s Sign Test was one of them, you can conduct this test routinely to compare results from previous check-ups and see if there are any improvements.

What are the benefits of Hoffman’s Sign Test?

It can help professionals screen and detect potential neurological conditions early

Let’s say that you have a patient with spinal cord compression, but the compression is not that bad, and they decided to get checked to find a way to address it before it gets any worse. The Hoffman’s Sign Test can be one of the tests that can detect the possibility of spinal cord compression and upper back lesions. If subsequent tests confirm this early, you and the patient can ensure it doesn’t worsen.

It can help guide decision-making

If you decide to conduct the Hoffman’s Sign Test as your first test to kickstart a comprehensive examination, the great thing about this is that it can set the stage for the rest of the comprehensive examination. 

Suppose it detects the possibility of spinal cord compression or some other neurological problem. In that case, the rest of the examination should involve other physical examinations and imaging tests to narrow it down (or detect other problems if there are more than one).

It can monitor treatment progress

Speaking of guiding treatment progress, let’s say you’ve created and implemented a treatment plan that involves physical therapy, medicine, and what have you. The Hoffman’s Sign Test doesn’t have to be a one-time, big-time thing. It can be conducted again, especially during a routine examination.

If you notice that Hoffman’s Sign isn’t as prominent as before, you can say that the treatment plan is working. If the patient’s thumb and index finger still flex the same as during the initial test, then the plan must be adjusted.