Quantiﬁcation of the Tro¨mner signs: a sensitive marker for cervical spondylotic myelopathy

Eur Spine J, 2011 · DOI: 10.1007/s00586-010-1681-6 · Published: January 9, 2011

Simple Explanation

The Trömner sign is a clinical test where the thumb and index finger flex in response to tapping the middle finger. It indicates potential upper motor neuron lesions in the cervical spinal cord. This study uses electrophysiological assessments to quantify the Trömner sign and relate it to the severity of spinal cord compression in patients with cervical spondylotic myelopathy (CSM). The electrophysiological assessment of the Trömner sign can serve as an objective marker for evaluating the severity of cervical cord compression, offering a more sensitive diagnostic tool.

Study Duration

July 2008 through December 2009

Participants

46 CSM patients, 30 healthy controls

Evidence Level

Not specified

Key Findings

1
Quantiﬁed electrophysiological tests showed positive Tro¨mner signs in all CSM patients, indicating high sensitivity.
2
The diagnostic sensitivity of the quantiﬁed Tro¨mner sign was higher (100%) compared to manual Tro¨mner (93.5%) and Hoffmann signs (89.1%).
3
A negative linear relationship was found between the amplitude of muscle action potentials (MAP) obtained in the Tro¨mner signs and the cord compression ratios in CSM patients, suggesting that increased MAP amplitude is associated with more severe cord compression.

Research Summary

This study quantified the Trömner sign using electrophysiological assessments to evaluate its diagnostic sensitivity for cervical spondylotic myelopathy (CSM). The results demonstrated that the quantiﬁed Trömner sign has a higher diagnostic sensitivity than manual testing methods and that the amplitude of muscle action potentials correlates with the severity of cord compression. The study concludes that electrophysiological assessment of the Trömner sign can serve as an objective marker for evaluating the severity of cervical cord compression in CSM patients.

Practical Implications

Improved Diagnosis

The quantiﬁed Trömner sign offers a more sensitive method for diagnosing CSM compared to traditional manual tests.

Objective Severity Assessment

Electrophysiological assessment of the Trömner sign can serve as an objective marker for evaluating the severity of cord compression, aiding in treatment decisions.

Understanding Pathophysiology

The correlation between MAP amplitude and cord compression ratios provides insights into the pathophysiology of spinal cord dysfunction in CSM.

Study Limitations

1
The study did not investigate the speciﬁcity of the Trömner sign for differential diagnosis of other spinal cord diseases.
2
The sample size of 46 CSM patients and 30 controls might limit the generalizability of the findings.
3
The electrophysiological test of the Hoffmann sign was not performed because of its inconsistency in quantiﬁcation for nipping nail stimulation.

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