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

I-Hsuan Tsai^*, Hao-Hsuan Tsai

Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei city.

DOI: 10.4236/ojo.2013.33032                

Abstract

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 50^th percentile values for H/M ratio and H-wave amplitude were 28% and 6.25 mV, respectively. An H-wave profile <5^th 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 <5^th 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.

Keywords

Hoffmann’s Reflex; H-Reflex; Electromyography; Electrodiagnostic Studies; Lumbosacral Radiculopathy; Sciatica

Conflicts of Interest

The authors declare no conflicts of interest.

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