The finger flexor reflex is a stretch reflex of the long finger flexors, mainly testing C8. The Hoffmann sign is a way of eliciting it: flicking the nail of the middle finger makes the thumb and index finger flex. A clear or one-sided Hoffmann sign suggests an upper motor neuron lesion.
| Nerve root | C8 (C7-T1) |
|---|---|
| Area | Distal phalanx of the middle finger (Hoffmann) or the palmar surface of the fingers (finger flexor jerk) |
| How to test | For Hoffmann, the examiner holds the relaxed middle finger and flicks its nail downward; flexion of the thumb tip and index finger is positive. The finger flexor jerk is tested by tapping the examiner's fingers placed across the patient's slightly flexed fingers. |
| Muscles | |
| Nerve Supply | Median nerve; Ulnar nerve |
Tests the C8 reflex arc and, when exaggerated, reveals loss of descending inhibition from the brain or cervical cord.
A positive Hoffmann sign is a classic screening sign for cervical myelopathy, though it can be present in some healthy people with brisk reflexes and is most meaningful when it is one-sided or comes with other upper motor neuron signs. A negative test does not rule out myelopathy. Tendon reflexes are graded 0 (absent) to 4+ (clonus), with 2+ normal; symmetry matters more than the absolute grade.
Compression of the cervical cord by degenerative changes often produces a positive Hoffmann sign, hand clumsiness and gait imbalance.
Demyelinating lesions in the brain or cervical cord can produce a positive Hoffmann sign along with other upper motor neuron signs.
Compression of the C8 root reduces the finger flexor reflex and weakens grip.
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