An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression – A comparative clinical study

Tejus, MN; Singh, Vikram; Ananthakrishnan, Ramesh; Kumar, Vimal; Maurya, Ved Prakash; Madhugiri, Venkatesh S

doi:10.1016/j.clineuro.2015.04.009

Cited by 15 publications

(19 citation statements)

References 26 publications

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“…Therefore, testing of a single reflex is insufficient to detect early DCM. However, a combination of Hoffmann’s reflex, extensor plantar reflex, and finger flexion reflex may be used as a rapid screening tool [30]. When tested together, these reflexes have been shown to have a sensitivity of 91.67% and specificity of 87.5% in determining if a patients symptoms are due to cervical spinal cord compression.…”

Section: Discussionmentioning

confidence: 99%

Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes

et al. 2018

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IntroductionDegenerative Cervical Myelopathy [DCM] often presents with non-specific symptoms and signs. It progresses insidiously and leads to permanent neurological dysfunction. Decompressive surgery can halt disease progression, however significant delays in diagnosis result in increased disability and limit recovery. The nature of early DCM symptoms is unknown, moreover it has been suggested incomplete examination contributes to missed diagnosis. This study examines how DCM is currently assessed, if assessment differs between stages of healthcare, and whether this influences patient management.Study designRetrospective cohort study.MethodsCervical MRI scans (N = 1123) at a tertiary neurosciences center, over a single year, were screened for patients with DCM (N = 43). Signs, symptoms, and disease severity of DCM were extracted from patient records. Patients were considered at 3 phases of clinical assessment: primary care, secondary care, and surgical assessment.ResultsUpper limb paraesthesia and urinary dysfunction were consistently the most and least prevalent symptoms respectively. Differences between assessing clinicians were present in the reporting of: limb pain (p<0.005), objective limb weakness (p = 0.01), hyperreflexia (p<0.005), Hoffmann reflex (p<0.005), extensor plantar reflex (p = 0.007), and lower limb spasticity (p<0.005). Pathological reflexes were least frequently assessed by primary care doctors.ConclusionDCM assessment varies significantly between assessors. Reporting of key features of DCM is especially low in primary care. Incomplete assessment may hinder early diagnosis and referral to spinal surgery.

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Section: Discussionmentioning

confidence: 99%

Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes

et al. 2018

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“…However, similar to symptoms, combinations of examination findings may improve diagnostic accuracy. Tejus et al showed that a combination of the finger flexion, Hoffman’s reflex, and plantar reflex could be effectively used as a marker of cervical spinal cord compression in patients with neck-related complaints, with a sensitivity of 91.7% and a specificity of 87.5%, and their absence had a negative predictive value of 77.8% [47]. While examination findings would be limited to professional use, they could be a helpful addition to diagnostic algorithms, and their predictive power with symptoms requires further assessment.…”

Section: Discussionmentioning

confidence: 99%

A Novel Insight Into the Challenges of Diagnosing Degenerative Cervical Myelopathy Using Web-Based Symptom Checkers

Davies¹,

Munro²,

Kotter³

2019

J Med Internet Res

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BackgroundDegenerative cervical myelopathy (DCM) is a common debilitating condition resulting from degeneration of the cervical spine. While decompressive surgery can halt disease progression, existing spinal cord damage is often permanent, leaving patients with lifelong disability. Early surgery improves the likelihood of recovery, yet the average time from the onset of symptoms to correct diagnosis is over 2 years. The majority of delays occur initially, before and within primary care, mainly due to a lack of recognition. Symptom checkers are widely used by patients before medical consultation and can be useful for preliminary triage and diagnosis. Lack of recognition of DCM by symptom checkers may contribute to the delay in diagnosis.ObjectiveThe aims of this study were to investigate whether Web-based symptom checkers were able to recognize relevant symptoms of DCM, to characterize the DCM differential they returned , and to evaluate the diagnostic performance of recognized DCM symptoms.MethodsWe pooled classical DCM symptoms from leading review articles. These symptoms were entered into the algorithms used by the top 20 symptom checker websites (N=4; Google Search). The most widely cited symptom checker, WebMD, was used to characterize the differential diagnosis for DCM symptoms.ResultsA total of 31 classical DCM symptoms were identified, of which 45% (14/31) listed DCM as a differential and 10% (3/31) placed DCM in the top third of the differential. The mean differential rank for motor symptoms was significantly better than that for arthritic symptoms (P=.01) and the average differential rank for all symptoms (P=.048). The symptom checker WebMD performed best at recognizing DCM, placing the condition nearer to the top of the differential list (mean rank of 5.6) than either Healthline (rank of 12.9, P=.02) or Healthtools.AARP (rank of 15.5, P=.001). On WebMD, only one combination of symptoms resulted in DCM as the primary differential: neck, shoulder, and arm pain with hand weakness. Moreover, 151 differential diagnoses for DCM symptoms were recorded on WebMD. Multiple sclerosis and peripheral neuropathy were the most common differentials, shortlisted for 52% (16/31) and 32% (10/31) of the DCM symptoms, respectively.ConclusionsDCM symptoms are poorly identified by Web-based symptom checkers, which leads to a large differential of many other common conditions. While a diagnosis becomes more likely as the number of symptoms increases, this represents more advanced disease and will not support much-needed earlier diagnosis. Symptom checkers remain an attractive concept with potential. Further research is required to support their optimization.

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“…In this case, the patient had both a positive Romberg sign and features suggesting a positive Walking Romberg Sign due to the unsteady gait. Other clinical tests that can be performed when suspecting myelopathy are Hoffmann's reflex and examining for the presence of hyperreflexia on lower limb tendon reflex testing, but the accuracy of these tests is not better than the tests performed on this patient, as there are often false negatives [6,19,29,33]. Performing a cluster of tests might help to increase the accuracy of diagnosis, as has been reported in cervical myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of diagnostic accuracy of single red flags and other test and measures suggests that clinicians should integrate a cluster of subjective and physical examination findings in order to determine the need for further referral. Indeed, due to the poor sensitivity of most of the subjective information and physical tests, these cannot be used alone as screening tools [17][18][19]25,29]. In this case, the association of gait abnormalities with the onset of LBP, in association with the positive Romberg test, the deficit of strength and sensation and the subtle urinary incontinence episodes were determinant in the decision to identify patients with suspected thoracic myelopathy, as these cases may rapidly worsen (with potentially irreversible consequences) [5,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Both the Babinski sign and Clonus test were found to be negative. The accuracy of these tests has been studied with regard to cervical myelopathy, with both tests shown to demonstrate low sensitivity but high specificity [19,29,30]. Moreover, in a report of 205 patients with thoracic myelopathy, only 40% had a positive Babinski sign or Clonus test [6].…”

Section: Discussionmentioning

confidence: 99%

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The screening process of a patient with low back pain and suspected thoracic myelopathy: a case report

Christe

Hall

2017

Journal of Manual & Manipulative Therapy

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An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression – A comparative clinical study

Cited by 15 publications

References 26 publications

Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes

Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes

A Novel Insight Into the Challenges of Diagnosing Degenerative Cervical Myelopathy Using Web-Based Symptom Checkers

The screening process of a patient with low back pain and suspected thoracic myelopathy: a case report

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