### Date : 2024-06-08 15:58 ### Topic : Hoffman's Sign and Ankle Clonus #medicine #neurology ---- ### Hoffman's Sign and Ankle Clonus #### Hoffman's Sign **Hoffman's sign** is a neurological test used to evaluate the presence of an upper motor neuron lesion, which can indicate conditions such as multiple sclerosis, spinal cord compression, or other central nervous system disorders. <iframe title="Hoffmann's Sign or Reflex | Upper Motor Neuron Lesion" src="https://www.youtube.com/embed/uVI55amnVuk?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> ##### How to Perform Hoffman's Sign: 1. **Position:** The patient's hand is relaxed, and the examiner holds the middle finger. 2. **Procedure:** The examiner flicks the fingernail or the terminal phalanx of the patient's middle finger downwards. 3. **Observation:** The response is observed in the thumb and index finger. ##### Interpretation: - **Positive Hoffman's Sign:** The thumb flexes and adducts (moves towards the palm) and the index finger also flexes slightly. This indicates hyperexcitability of the corticospinal tract and suggests an upper motor neuron lesion. - **Negative Hoffman's Sign:** No movement or only minimal movement of the thumb and index finger. This is normal. #### Ankle Clonus **Ankle clonus** is a physical examination finding indicative of upper motor neuron lesions. It involves repetitive, rhythmic contractions of the calf muscle following sudden dorsiflexion of the foot. ##### How to Perform Ankle Clonus: 1. **Position:** The patient is lying down with their leg supported and relaxed. 2. **Procedure:** The examiner rapidly dorsiflexes the foot (pulls the toes upward towards the shin) and holds it in this position. 3. **Observation:** The response is observed in the foot and ankle. ##### Interpretation: - **Positive Ankle Clonus:** Rhythmic oscillations (twitching) of the foot occur, indicating hyperreflexia associated with upper motor neuron lesions. The number of beats can be counted; sustained clonus is more than five beats. - **Negative Ankle Clonus:** No oscillations or only a few unsustained beats, indicating normal reflexes. ### Clinical Relevance Both Hoffman's sign and ankle clonus are signs of **upper motor neuron lesions**, which can be associated with conditions such as: - **Multiple Sclerosis:** A demyelinating disease affecting the CNS. - **Spinal Cord Injury or Compression:** Caused by trauma, tumors, or degenerative diseases. - **Amyotrophic Lateral Sclerosis (ALS):** A neurodegenerative disorder affecting motor neurons. - **Stroke:** An acute cerebrovascular event leading to localized CNS damage. ### Patient Example **Patient:** Jee Hoon Ju, 45-year-old male **Presentation:** Jee Hoon Ju presents with complaints of muscle weakness, spasticity, and occasional episodes of muscle twitching in his legs. He has a history of neck trauma from a car accident six months ago. **Examination:** - **Hoffman's Sign:** Positive in both hands. Flicking the middle finger results in thumb flexion and adduction. - **Ankle Clonus:** Positive in the right ankle. Rapid dorsiflexion of the foot results in sustained rhythmic oscillations (approximately 7 beats). **Investigations:** - **MRI of the Cervical Spine:** Reveals compression of the spinal cord at the C5-C6 level due to a herniated disc and spondylotic changes. **Management:** - **Surgical Consultation:** Referral for potential decompressive surgery. - **Physical Therapy:** To address spasticity and improve mobility. - **Medications:** Prescribed baclofen for muscle spasticity. **Outcome:** Jee Hoon Ju undergoes decompressive surgery with subsequent improvement in neurological symptoms. Regular physical therapy and medication help manage residual spasticity.