Unilateral Reference Values for Hoffmann’s Reflex in Patients with Suspected Lumbosacral Radiculopathies

DOI: 10.4236/ojo.2013.33032   PDF   HTML     3,716 Downloads   5,252 Views   Citations


Unilateral reference values for Hoffmann’s amplitude could be applied to the diagnosis of lumbosacral radiculopathy, especially in patients with bilateral lesions. Here, we assessed Hoffmann’s reflex by measuring H-wave amplitude and the ratio of H-wave amplitude to M-wave amplitude (the H/M ratio). We performed a cross-sectional survey of patients from a Taiwan rehabilitation center (n = 64, age 20 - 87) who presented with lower back pain that radiated to the leg and received a referral for electrodiagnostic examinations. Reference values for H-wave profile parameters were determined using data from lumbosacral radiculopathy-negative patients (n = 10, age 22 - 53), who had normal big toe test results, ankle reflex test results, motor and sensory nerve conductive studies and F-wave latency and who displayed no evidence of radiculopathy in electromyography and imaging studies. The 50th percentile values for H/M ratio and H-wave amplitude were 28% and 6.25 mV, respectively. An H-wave profile <5th percentile (H/M ratio <11% or H-wave amplitude <2.5 mV) was significantly related to both electromyography-confirmed current and chronic lumbosacral radiculopathy (n = 64). Approximately 41% of patients with an H-wave profile <5th percentile showed electromyography-confirmed chronic radiculopathy. Electromyography-confirmed current radiculopathy was observed in 35% of patients with an H/R ratio <11% and 42% of patients with an H-wave amplitude <2.5 mV.

Share and Cite:

I. Tsai and H. Tsai, "Unilateral Reference Values for Hoffmann’s Reflex in Patients with Suspected Lumbosacral Radiculopathies," Open Journal of Orthopedics, Vol. 3 No. 3, 2013, pp. 178-182. doi: 10.4236/ojo.2013.33032.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] K. H. Levin, “Approach to the Patient with Suspected Radiculopathy,” Neurology Clinics, Vol. 30, No. 2, 2012, pp. 581-604. doi:10.1016/j.ncl.2011.12.011
[2] H. N. Alrowayeh and M. A. Sabbahi, “H-Reflex Amplitude Asymmetry Is an Earlier Sign of Nerve Root Involvement than Latency in Patients with S1 Radiculopathy,” BMC Research Notes, Vol. 4, No. 102, 2011. doi:10.1186/1756-0500-4-102
[3] B. W. Koes, M. W. Van Tulder and W. C. Peul, “Diagnosis and Treatment of Sciatica,” British Medical Journal, Vol. 334, No. 7607, 2007, pp. 1313-1317. doi:10.1136/bmj.39223.428495.BE
[4] P. Goupille, D. Mulleman and J.-P. Valat, “Radiculopathy Associated with Disc Herniation,” Annals of the Rheumatic Disease, Vol. 65, No. 2, 2006, pp. 141-143. doi:10.1136/ard.2005.039669
[5] R. D. Gerwin, “Classification, Epidemiology, and Natural History of Myofascial Pain Syndrome,” Current Pain and Headache Reports, Vol. 5, No. 5, 2001, pp. 412-420. doi:10.1007/s11916-001-0052-8
[6] D. S. Binder and D. E. Nampiaparampil, “The Provocative Lumbar Facet Joint,” Current Reviews in Musculoskeletal Medicine, Vol., No. 1, 2009, pp. 15-24.
[7] K. P. Barr and M. A. Harrast, “Low Back Pain,” In: R. L. Braddom, Ed., Physical Medicine and Rehabilitation, 4th Edition, Saunders, Philadelphia, 2010, pp. 871-912.
[8] D. C. Preston and B. E. Shapiro, “Electromyography and Neuromuscular Disorders,” 2nd Edition, Elseiver, Butterworth Heinemann, Philadephia, 2005.
[9] T. R. Dillingham, “Electrodiagnostic Medicine II: Clinical Evaluation and Findings,” In: R. L. Braddom, Ed., Physical Medicine and Rehabilitation, 4th Edition, Saunders, Philadelphia, 2010, pp. 115-222.
[10] T. R. Han, J. H. Kim and N. J. Paik, “A Study on New Diagnostic Criteria of H Reflex,” Electromyography and Clinical Neurophysiology, Vol. 37, No. 4, 1997, pp. 241250.
[11] W. R. Jankus, L. R. Robinson and J. W. Little, “Normal Limits of Side-to-Side H-Reflex Amplitude Variability,” Archives of Physical Medicine and Rehabilitation, Vol. 75, No. 1, 1994, pp. 3-7.
[12] H. J. Lee and J. A. Delisa, “Manual of Nerve Conduction Study and Surface Anatomy for Needle Electromyography,” 4th Edition, Lippncott Williams and Wilkins, Philadelphia, 2004.
[13] H. C. Tong, “Incremental Ability of Needle Electromyography to Detect Radiculopathy in Patients with Radiating Low Back Pain Using Different Diagnostic Criteria,” Archives of Physical Medicine and Rehabilitation, Vol. 93, No. 6, 2012, pp. 990-992. doi:10.1016/j.apmr.2012.01.013
[14] H. Ebrahimi and S. Adibeyg, “Evaluation of Posterior Tibial h/m Ratio in Cerebrovascular Accidents,” Iranian Journal of Neurology, Vol. 7, No. 23, 2013, pp. 266-271.
[15] N. A. Maffiuletti, A. Martin, N. Babault, M. Pensini, B. Lucas and M. Schieppati, “Electrical and Mechanical Hmaxto-Mmax Ratio in Powerand Endurance-Trained Athletes,” Journal of Applied Physiology, Vol. 90, No. 1, 2001, pp. 3-9. doi:10.1002/mus.21759
[16] S. C. Cho, M. A. Ferrante, K. H. Levin, R. L. Harmon, Y. T. So and J. Vavricek, “Utility of Electrodiagnostic Testing in Evaluating Patients with Lumbosacral Radiculopathy: An Evidence-Based Review,” Muscle and Nerve, Vol. 42, No. 2, 2010, pp. 276-282.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.