Hoffmann’s sign, Hoffmann-Tinel sign, and Tinel’s sign are used to determine nerve damage. A positive Hoffmann’s sign may indicate upper motor abnormalities caused by compression or irritation of the spine, and further testing is required to determine the specific cause. Tinel’s sign is associated with carpal tunnel syndrome.
Hoffmann’s sign, Hoffmann-Tinel sign, and Tinel’s sign are methods doctors use to determine nerve damage. By applying gentle percussion or jolting specific nerves in the fingers or wrist, physical responses or sensations experienced by patients may indicate local or nervous system irritation. Individuals may or may not complain or show other symptoms related to a specific disease process. The presence of Hoffmann’s sign does not provide a definitive diagnosis and generally requires tests of reflexes in other areas of the body along with blood tests and imaging studies.
Dr. Paul Hoffmann, a German physiologist, is credited with developing Hoffmann’s sign. Doctors typically do the evaluation by sliding the bottom part of the nail over the index, middle, or ring finger. The twitching or flexing shown in the other fingers of the hand in response usually represents a positive Hoffmann’s sign. Neurological studies indicate that a positive sign usually indicates upper motor abnormalities caused by compression or irritation of the spine. Under these circumstances, nerve cells remain in a constant state of excitement known as tetany.
Patients who show a positive sign can suffer from a number of conditions, including multiple sclerosis and spinal stenosis. Anxiety disorders or hyperthyroidism could also produce the reflex response. Multiple sclerosis patients typically develop lesions, or scars, along spinal nerves after nerve demyelination occurs, which compresses or irritates sensitive nerve tissue. Patients diagnosed with spinal stenosis usually also complain of tingling in the extremities or weakness and pain in the back. Narrowing of the vertebral cavity or spinal misalignment also puts pressure on the spinal nerves, producing various symptoms away from the actual site of involvement.
Determining the specific causes of a positive Hoffmann’s sign and associated symptoms generally requires further testing. Doctors might do a Babinski reflex test in which the bottom of the foot is stroked. A flare up and out of the toes usually indicates brain involvement. Laboratory blood tests could indicate autoimmune disorders, inflammatory conditions, or infections, as well as other possible medical conditions. Imaging studies typically point to specific areas of the brain or spine that are affected by the disease.
Tinel’s sign, developed by French neurologist Jules Tinel, is associated with carpal tunnel syndrome. Patients place one arm palm up on a flat surface. Doctors tap the ridged area, which contains the ulnar nerve. Individuals with carpal tunnel syndrome usually experience tingling or paralysis in the fingers of the hand due to compressed nerve tissue. Further physical evaluation usually involves other sensory responses elicited by applying pressure to the wrist or by the patient hyperextending the affected hand.
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