Cervical spine

Question 1

Hoffmanns test

Answer 1

Sitting

The patient’s arm must be in pronation and
their hand must be supported by the
physiotherapist (or by a plinth/table)

Therapist holds the patient’s middle finger at the level of middle phalanx. With the other hand, the therapist
holds the patient’s distal phalanx between
their thumb and index finger (with thet humb positioned over the nail)

The patient’s nail is then ‘flicked’
downward with the therapist’s thumb
(allowing the middle finger to flick upward reflexively).

Positive test= if the patient’s index finger and thumb flex
during the test = Upper motor neuron lesion affecting
the corticospinal tract.

The test is commonly used when cervical myelopathy
is suspected

False positive
Some normal patients have a positive
response if they are generally hyperreflexive. For this reason, the test should be interpreted in the context of the patient history and physical signs including other
neurological tests.