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Thread: Clonus in feet and positive Hoffman's

  1. #1

    Unhappy Clonus in feet and positive Hoffman's

    I've dealt with Complex Regional Pain Syndrome since 2004 and always attributed my weird symptoms to that. I have muscle spasms, spasticity, severe pain, poor balance, etc. I also tend to drop things from my hands, but who doesn't?? My symptoms have gotten progressively worse and moreso lately. Over the years I've seen many doctors, including neurologists. Had MRIs, EMGs, NCSs, etc etc. I do have unrelated mild L4&5 DDD and mild scoliosis.

    On Wednesday I had a consult for a Spinal Cord Stimulator. This MD did a more thorough neuro exam than I ever have received. He asked me, "What did they ever say about your clonus?" I said MY WHAT?! I have a 3-4 beat clonus in both feet. I also have a positive Hoffman's sign in both hands.

    I'm being sent for a cervical and lumbar MRI in a week (first available). MD says these "positive" exam results could be from spinal cord compression/tumor/lesion. For the feet it's L1 or below and the hand test is indicative of C7 or above. He also said I could have "just been born this way." He doesn't seem overly concerned.

    Can anyone here shed some light? Of course I've googled like crazy and everything comes back to motor neuron diseases such as MS. (If it helps, I'm a 25 year old female.)

  2. #2
    Super Moderator Sue Pendleton's Avatar
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    Where and by whom were you diagnosed with CRPS? Is it Type 1, RSD or Type 2? Are you losing mobility or mental acuity due to this or currently still just dealing with the spasticity, pain and balance? CRPS doesn't normally effect the entire body especially RSD that tends to effect one limb. MS is rarely diagnosed based on one MRI or MRI alone. What have your previous MRIs indicated? Did your EMGs indicate peripheral or central nervous system problems? To be quite honest I understood Hoffman's sign was a good indicator of regeneration in peripheral nerves. Clonus is a type of spasticity and can also be related to tight tendons or muscle atrophy. IOWs, you need a doctor who will look at all of your MRIs as a series. Then add in your other tests and I would not look at MS unless you have had a lumbar puncture with a thorough work up of the fluid; an MRI of the brain and a thorough opthamology exam.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  3. #3
    I was initially diagnosed at Thomas Jefferson in Philadelphia and have confirmed that diagnosis at Johns Hopkins and the University of South Carolina, along with a few other docs I've seen along the way. I have Type 2, damage to my peroneal nerve.

    I'm aware that it doesn't "normally" affect the entire body, but there is nothing normal about CRPS. I have close friends with gastroparesis from this, and other issues, from it beginning in one limb.

    The pain has gotten worse over time so it's lead to a decrease in mobility. Balance seems to be worse than it was 8 years ago. No mental acuity changes that I'm aware of. EMGs consistently indicate peroneal neuropathy. (This all stems from a car accident in which the dash crushed my knees. Had an osteochondral fracture of left femur.) Previous lumbar and thoracic MRI in 2005 showed mild L4&5 degenerative disc disease and a mild scoliosis that required no treatment, just monitoring with xrays. I don't know if I ever had a cervical MRI. I get very good opthalmalogy exams every year which haven't showed anything of major concern.

    Can you lead me to some resources that show Hoffman's as a good thing? I can't seem to find those. I never had damage to nerves in my neck to begin with, that I'm aware of.

  4. #4
    Hoffmans - You need your Cervical Spine evaluated with a MRI. They need to look for central stenosis, occult injury to the cervical spinal cord. Please let us know what it shows. I hope it is okay.

  5. #5
    Will keep you posted.

    Side note, I'm not trying to pin the blame on MS. Just figured someone could shed light on these 2 issues. I lurk around these forums for other reasons.

  6. #6
    Super Moderator Sue Pendleton's Avatar
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    My bad, I had Hoffman's mixed up with another reflex involving the legs. I agree with Arndog. If you have no other signs of MS than spasitcity than you need to get your cervical spine imaged and, again, I hope it shows nothing.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  7. #7
    Ihave a positive hoffmans on one side and clonus indefinite on one foot ( i mean it would carry on forever if it was not stopped) It can be a cervical matter, and spinal cord issue. Dont worry too much I have been told some people have positive Hoffmans without any issues your clonus is no problem

  8. #8
    Moderator jody's Avatar
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    I have hoffmans signs and clonus in feet and legs. cervical compression at c-5, and I have a l5-s1 incomplete injury. I was diagnosed with ms, but the later tests did not support the diagnosis of ms, however that is still my diagnoses due to other symptoms, including the reflex thing.

  9. #9
    Moderator jody's Avatar
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    Quote Originally Posted by arndog View Post
    Hoffmans - You need your Cervical Spine evaluated with a MRI. They need to look for central stenosis, occult injury to the cervical spinal cord. Please let us know what it shows. I hope it is okay.
    I agree with this even with my present diagnosis.

  10. #10
    Cervical MRI didn't show anything and lumbar showed the herinated disc I already knew about. There was no change. So I guess I'm just left wondering for the time being.

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