The test involves tapping the nail or flicking the terminal phalanx of the middle or ring finger. A positive response is seen when terminal phalanx of the thumb flexes. A positive Hoffman's reflex may indicate an upper motor neuron lesion or a pyramidal sign. 

Hoffmann's reflex may be seen in the following conditions:

- Multiple sclerosis

- ALS 

- Diseases which cause spinal cord compression (myelopathy) such as cervical spondylitis, tumors, or degenerative arthritis.  

The test is not fool-proof as patients who don’t have cervical myelopathy mayhave a positive Hoffmann sign. A positive Hoffmann sign may be  seen in patients with hyperthyroidism, anxiety disorders, and other conditions that involve increased deep tendon reflexes.

Patients with true cervical myelopathy may not have a positive Hoffman’s sign.

The Hoffmann test is not a reliable screening tool for predicting cervical spinal cord compression.