Hoffman’s Sign
Nail of middle finger is flicked downward, flexing the finger, causing it to rebound into extension; if their thumb and index finger flexes the Hoffman’s sign is present, suggesting UMN disease.
Patient 1:
This is an older man who presented with progressive neck pain, numbness and weakness in the hands, and difficulty walking. He was diagnosed with severe cervical myelopathy from degenerative joint disease.
This patient also has hyperreflexia and a spastic gait.
The Hoffman’s Sign description says “Nail of middle finger is flicked downward, flexing the finger, causing it to rebound into extension;” but in this video, I see the tester flicking the patient’s distal middle finger “upward” into extension with a rebound flexion.
The description is unclear when the patient’s thumb and index finger should flex during a positive Hoffman’s sign. Should the thumb and index finger flex alongside middle finger extension or with middle finger flexion?
Thanks for your question and comments to our website. You are right, the description in the site (flicking down on the nail) is the way Hoffman described his finger flexion sign, and the way it’s shown in the video (flicking upwards) is the way Trömner did it- per the DeJong’s Neurological Exam text that I use as a reference for these neuro exam findings, these two tests are equivalent and are both commonly referred to as Hoffman’s sign. With both, whether you flick downwards or flick upwards, the response is flexion and adduction of the thumb, and flexion of the index finger (essentially a pinching motion). The significance is that it suggests a corticospinal lesion about C5-6 but it isn’t very sensitive or specific, so it needs to be seen as part of the entire clinical picture. Hope this helps!