Sensitization of Hoffmann’s sign in response to a reverse Lhermitte’s sign: a case report

JOURNAL OF MANUAL & MANIPULATIVE THERAPY, 2022 · DOI: https://doi.org/10.1080/10669817.2022.2056363 · Published: March 24, 2022

Healthcare Neurology Rehabilitation

Simple Explanation

This case report discusses how a specific physical exam finding (Hoffmann's sign) was made more sensitive by combining it with another finding (Reverse Lhermitte's sign). This helped doctors diagnose a patient's condition. The patient initially presented with lower back pain, but the exam revealed signs of a potential problem in the neck (cervical spondylotic myelopathy or CSM). By sensitizing the Hoffmann's sign, clinicians were better able to identify CSM early, leading to appropriate medical management.

Study Duration

7 weeks

Participants

One 66-year-old male

Evidence Level

Level 4: Case Report

Key Findings

1
The patient initially presented with symptoms suggesting lumbar radiculopathy, but a Reverse Lhermitte’s Sign pointed towards a cervical issue.
2
Performing the Hoffmann’s Sign during cervical extension exaggerated the response, suggesting cervical spinal cord compression.
3
The sensitized Hoffmann's Sign, combined with the Reverse Lhermitte’s Sign, aided in the early diagnosis of CSM, which was later confirmed by MRI and treated with surgery.

Research Summary

This case report describes how sensitizing Hoffmann’s Sign following a Reverse Lhermitte’s Sign aided reasoning in a 66-year-old male. The patient presented with lumbar radiculopathy, but a Reverse Lhermitte’s Sign suggested cervical involvement. The Hoffmann’s Sign became exaggerated when performed in cervical extension. The sensitized Hoffmann’s Sign helped in the differential diagnosis of early CSM, which was confirmed by MRI and treated with surgery.

Practical Implications

Enhanced Diagnostic Accuracy

Sensitizing the Hoffmann's Sign with cervical extension may improve diagnostic accuracy for early CSM.

Informed Clinical Reasoning

Clinicians should consider cervical spine involvement in patients presenting with lumbar symptoms, especially when a Reverse Lhermitte's Sign is present.

Early Intervention

Early identification of CSM can lead to timely intervention and potentially prevent neurological decline.

Study Limitations

1
The case report findings cannot be generalizable.
2
It is unknown if patient management or outcomes would have been different if the cervical MRI would have been performed earlier.
3
Clinicians should proceed with caution when considering performing Hoffmann’s Sign in sustained cervical extension as the diagnostic utility and risk is unknown.

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