A10. Examination of the pyramidal signs

From greek.doctor
  • Babinski sign
    • Most important pyramidal sign
    • Procedure:
      • Ask patient to lie on their back
      • Scratch the lateral half of the sole of the foot from bottom to top
      • Response is usually not seen at the beginning of the movement but rather after some centimetres
    • Negative:
      • Plantarflexion, flexion of all toes
    • Positive:
      • Dorsiflexion of the big toe
      • The other toes spread out
  • Triple flexion response/triflexion response
    • Same procedure as for Babinski sign
    • Can be felt more easily with one hand on the quadriceps muscle
    • Negative:
      • Plantarflexion of all toes
    • Positive:
      • Dorsiflexion of foot + flexion of knee + flexion of hip
  • Achilles clonus
    • Procedure:
      • Ask patient to lie on their back
      • Dorsiflex the foot quickly
    • Negative:
      • No clonus in the gastrocnemius
    • Positive:
      • Clonus in the gastrocnemius
  • Patellar clonus
    • Procedure:
      • Ask patient to lie on their back
      • Quickly thrust the patella downwards
    • Negative:
      • No clonus in the quadriceps
    • Positive:
      • Clonus in the quadriceps
  • Hoffman sign
    • Procedure:
      • Hold the PIP joint of the middle finger, stabilizing it
      • Repeatedly flick down the distal phalanx of the middle finger
    • Negative:
      • No flexion of the distal phalanx of the thumb or the index finger
      • Bilateral response may be normal
    • Positive
      • Flexion of the distal phalanx of the thumb or the index finger
  • Trömner sign
    • Procedure:
      • Hold the PIP joint of the middle finger, stabilizing it
      • Suddenly flick the volar aspect of the distal phalanx of the middle finger
    • Negative:
      • No flexion of the distal phalanx of the thumb or the index finger
      • Bilateral response may be normal
    • Positive
      • Flexion of the distal phalanx of the thumb or the index finger