Hyperreflexia, clonus and positive Hoffman's sign

[@strictmachine06]

Us medical students appreciate these videos on the tube! Thanks a bunch.

[@dbell582]

Darn right we do! Thanks for the videos. They help when I can't figure it out from a book. :)

[@nataliaornellastomasi8859]

Same here in Brazil! Very helpful. Helping medical students all over the world haha

[@OrthoEvalPal]

Thank you!! The positive feedback from all around the world has encouraged me to start sharing more. My plan is to start podcasting about many orthopedic and neurological and doing webinars. I will post on KZbin when I prepare to launch.

[@IceDr4gonfly]

Thank you for the awesome video! I teach medical students and I am always on the lookout for good videos for educational purposes. I'm sending the link to your page to my colleagues at the University of Toronto. Thanks again!

[@OrthoEvalPal]

Thank you so much! Make sure they subscribe because I am going to be ramping this up significantly and giving out a lot of great information in the next couple of months. I plan to start a podcast series along with webinars with actual patient scenarios.

[@nicolechamberlain8077]

Thank you for this video, it's great to see what actual positive tests look like. This patient was awesome to consent to being recorded and helping us internet folk learn!!

[@OrthoEvalPal]

Thanks Nicole! Glad it is helpful and yes, the patients are great for volunteering. Stay tuned! More to come

[@ghettoman1238]

Hypnotized by your shirt 👚

[@somehuman119]

Your shirt should have a seizure trigger warning lol

[@vatoloco2116]

Bwahaha exactly my thoughts😂

[@vatoloco2116]

It's got to do with the low quality 240p

[@quranrecitationsandmemoriz1474]

😆 👍

[@sanaenayat7174]

Lol

[@3rdvoidmen594]

@@vatoloco2116 nope, it’s moire...look it up

[@littlegiant101]

This patient was super awesome fr allowing this!!... Great video... It cleared a few things... even learnt a few things my professor hadn't gotten around to yet!

[@OrthoEvalPal]

Yes. All of these folks are very willing to help educate others. Thanks for viewing!

[@pageturner7947]

You do realize these videos are mostly watched not by med students but by folks trying to figure out what is wrong with us

[@gispaAPRN]

BRAVO! Thank you for sharing this. The problem with most videos/books etc is that nobody demonstrates on a patient with POSITIVE signs. It helps to see this in ACTION, and you delivered. Thank you, again!

[@OrthoEvalPal]

Thank you Gigi!! More to come.

[@daisysamson24]

Thank you to this patient for allowing me to learn. It definitely helps SEEING these reflexes.

[@axxenm]

Thank you for the video; Also many more thanks to the patient who was willing to be recorded for us to learn

[@ANGLBNDR]

I was diagnosed in 2006 with relapsing/remitting multiple sclerosis, and clonus in my legs has been a constant specter. Hypereflexia is now less ominous! Also, your shirt generates a fascinating moiré pattern! I would consider never wearing it for video shoots :D

[@143LoveConquersAll]

"Moiré" = nice word! 🤩 I'd never heard of that one before. Had to look it up! 😉 Sorry to hear of your health problems 😞 I hope you're doing ok?!

[@etherealbae2160]

Thanks so much to the patient for letting us see this to learn. Very helpful!

[@OrthoEvalPal]

Hi EtherealBae, Yes my patients have been very good at allowing themselves to be videoed. They always say " Anything to help others"

[@etherealbae2160]

@@OrthoEvalPal Please be sure to pass along the feedback that it really is making a difference! And thank you for posting.

[@yeseniaurquilla3703]

I had never seen sustained clonus like that, thank you for sharing.

[@OrthoEvalPal]

Hi Yesenia, Yes, this one is quite impressive. Check this one out kzbin.info/www/bejne/n2Sci6mvndOplaM

[@leeseckinger5119]

Crazy shirt

[@eldenboi8354]

Lee Seckinger hahaha its like his shirts on drugs

[@Chellabell72]

I thought it was just me 🤣

[@alraziosmany]

😂 when shirt's reflection ruins your deeds

[@princemensah3458]

🤣🤣🤣🤣🤣

[@yuimizuki9916]

😂😂😂😂😂😂

[@ppss-t1l]

Great teacher, very useful source of practical information for doctors. Paul explains things better than many medical books.

[@ImPrismuh]

FINALLY! I found a video on what all those different tests look like if they are all positive. I’ve always wondered why doctors flick people’s finger tips

[@Arian_orta]

Ty! This helped me understand what a positive Hoffman's sign looks like! OTA therapist here.

[@elecktronbluegirl]

Me: "I gotta read the comments about his shirt.." 😂🏃

[@حيدرمحمدحسين-ض3ه]

Very grateful for your nice illustration and for the gentleman for his cooperation.

[@ramonahashemyrad1533]

Thank you sir (patient) for your participation in our education and thank you doctor.

[@pb29590xxxx]

Excellent educational video. Your shirt is super trippy looking in this video. Appreciated. That clonus was amazing to witness.

[@yourcuteguy9737]

Totally appreciate the patient and doctor.

[@raissasantos4808]

Thank you for this video. I was hospitalized with transverse myelitis a couple of days ago, and my doc said I had hyperreflexia. I had no idea what it was, but this video cleared it up

[@jenannelong1936]

I presented with the same symptoms, only spasticity instead of weakness. My diagnosis was ALS. This video was encouraged me.

[@JackNoman]

How are you holding up

[@TheAdhdGardener]

I have the same leg clonus for years from having MS. It drives me insane and is done on its own every 20secs or so in the evening thru the night😑 just starts outta nowhere and can tell when it's about to come on

[@LaDivaAlexandra]

Great video on hyperactive reflexes. Studying for my boards and now this video has really helped me visualize hyperactive reflexes . Reading at times isn’t enough, videos help me to remember . Thank you so much Doctor

[@OrthoEvalPal]

I am glad it helps. More to come!!

[@OrthoEvalPal]

Severe spinal stenosis of the cervical cord.

[@Jeannieramirez76]

I am seeing an ortho doc Friday for these very symptoms

[@vinnievalentine421]

I have the opposite of that, barely any reflexes. What would that be from.

[@OrthoEvalPal]

@@vinnievalentine421 I don't worry as much about low reflexes as much as I do hyperreflexia. It's the asymmetry I look for.

[@vinnievalentine421]

@@OrthoEvalPal doesn't answer my question but ok.

[@Disenteng.Buring]

@@OrthoEvalPal is spinal stenosis curable?

[@medicmissions5286]

Excellent Video! You seem like a very thorough physician ! God bless you (med student)

[@waseemkhawer9088]

Shirt distracted me Watch it with one eye covered Or prefer audio mode. Frankly the best video for knowledge seekers

[@NabilMotlagh]

Amazing ability to tease this out. screening for further referral and taking a comprehensive look

[@OrthoEvalPal]

Thanks Nabil! Lots more to come!

[@sillybugMaryam]

Excellent video. Thanks for showing this patient.

[@votki1818]

That shirt is more alive than me smh

[@abdimohamud4604]

Paul how are you please I have question. My body twitching all the time I can see some times. Doctor can’t see. The have done allot of blood test and electro lights as well mri. They have not find anything I’n my body. What is your recommendation. I also feel weakness in my hands. I can’t lift 10 lb proprely. Some times. I might feel or think my hands are slipping the ligaments or muscles. Thank you so much

[@futurernari5901]

Excellent video. Any relationship to Florence Nightingale?

[@OrthoEvalPal]

Thank you! More to come! Haha.

[@moc6992]

THANK YOU SIR. I appreciate this video very much cause now I have a visual. No matter how many times I read the definitions I would find myself going back to look up the words and definitions. Now when I see the words I can this of this video.

[@mastersonhigh1117]

Excellent example on clonus! Thank you.

[@akadopeboi]

That shirt sent me to another dimension.

[@laurandonofrio9298]

Thank you for your videos. This one is great. Thanks again!

[@annip5573]

Thank you very much für graciously uploading this video and sharing the information!!!

[@OrthoEvalPal]

You are very welcome!

[@heybejaybe809]

Your shirt is opening a portal!

[@sumairaabbasi1052]

What was his final diagnosis?

[@abdullahmon6008]

Amazing neuro exams and signs .. thanks for sharing

[@OrthoEvalPal]

You are welcome Abdullah!

[@lexc8714]

Why not do finger escape, 10sec test also? Any numbness, bowel or urinary incontinence aside from weakness?

[@dangatang0]

This mans shirt is an optical illusion

[@maheenzehra1630]

Am i the only one wondering what happened to the patient later? After all he helped yall understand clonus n hyperreflexia.

[@mitch19636]

I have those symptoms for as long as I can remember. I have ACM II, CP and a few other brain malformations.

[@mjade1673]

Who was flicking their own fingernails?😄 me , was . Anyone else ? 😄👍

[@markyounger1240]

What is even more interesting is the physics of the shirt and the way it appears during the video.

[@reneerenata6858]

Thank you so much!!! I had never seen clonus before like that!!

[@pageturner7947]

What’s the treatment for this? I have hyperreflexes in my knees so badly, my whole body spasmed when he tapped it. This is not normal

[@Haghenveien]

Wow, that clonus is something. I have clonus myself but it's nothing like that. I have to say that my hyperreflexia is even better.

[@pageturner7947]

I have that🙁

[@OrthoEvalPal]

Yes it is! He has severe Cervical cord compression

[@toperyano4853]

i have this kind of symptomps. i already had surgery on my lower back slipdisc. but this kind of symptomps not fade even if i undergo surgery. and the pain on my back getting worst

[@destinyperez8763]

I was positive for all these tests demonstrated. I have my follow up appointment today and hoping for some answers! Thank you for this informative video!

[@JackNoman]

What was the result?

[@destinyperez8763]

Unfortunately, no known cause. 🤷🏻‍♀️ I had an MRI, NCS, and EMG done and all came back clear even though I had positive signs of all tests in the video. I have debilitating tremors in my legs and arms and sometimes neck as well as muscle fatigue, which are my main concerns. All my neurologist did was put me on low dose Gabapentin to mitigate neuropathy (idiopathic). Super exhausting and frustrating to not know what’s going on with my body

[@pluejr7698]

​@destinyperez8763 any update on what's going on?

[@svdaedalus]

Great video. thanks for sharing. and thanks to your patient for consenting

[@OrthoEvalPal]

You are welcome!

[@101010III]

You're awesome!! Thank you very much

[@RickyRicardo84]

Great video! Thank you for this.

[@evanwilliamson3602]

Can mitochondrial disease cause clonus upon examination?

[@consider-thesaurus8867]

What did he say? I was in a plaid shirt trance.

[@eriktorchia2937]

Great video and a wonderful reference to see true positive tests.

[@shahulhameed-r]

Thank you very much.very informative video.

[@OrthoEvalPal]

Glad it was helpful!

[@TheDrMeade]

How do you decide that it is cervical spine cord compression vs. brain issue? Is that based on medical history or your exam here? I guess the Hoffman's plus Babinski plus the clonus would have had me thinking lesion above the level of the cord? What am I missing? Thanks.

[@OrthoEvalPal]

Hi Jessica, You are not missing anything. Both can present this way. the cervical spine is more common and I have seen about 3 more people with this since this gentleman all due to Central cord stenosis of the cervical spine

[@heyitsbillyz]

Jessica, you're right that these are UMN signs, which doesn't necessarily mean it's above the level of the cord. It simply means the lesion is above the affected anterior horn motor neurons. A spinal cord injury can damage the descending lateral corticospinal tract that runs from the motor cortex to the anterior horn, causing the hyperreflexia seen in the video.

[@andromeda0505]

Thank you Thank you Thank you.... I would also like to know about what the diagnosis of this gentleman's condition was

[@OrthoEvalPal]

You are welcome! Severe Cervical central cord stenosis

[@andromeda0505]

@@OrthoEvalPal Ohh alright. What was the cause ?

[@OrthoEvalPal]

@@andromeda0505 this is degenerative and typically happens over time

[@andromeda0505]

@@OrthoEvalPal thank you so much sir.

[@suedaley3047]

I’d love to know what his final diagnosis was.

[@OrthoEvalPal]

It was severe cervical spinal stenosis

[@rebecamedina1389]

Nice video!! Thank you for sharing this with us!

[@OrthoEvalPal]

You are welcome Rebeca. Lots more to come.

[@davidgenovesi7327]

Great video! Did they figure out what this gentleman was experiencing?

[@vasileiospetropoulos2046]

Hyperflexia when is a problem?

[@OrthoEvalPal]

Hyperefflexia can be seen in the normal population but you should keep an eye out for UMN issues and do the Hoffman's and clonus also. You can see this in patients with central spinal cord stenosis, MS, transverse myelitis, TBI, hyperthyroidism etc..

[@nerdyaoo]

Thank you ❤

[@mattdesjarlais4789]

Great video! Very informative. Question: how do you get your shirt to camo like the Predator so well?

[@OrthoEvalPal]

Thanks Matt! Feel free to check out my podcasts.orthoevalpal.com/episodes/ The shirt thing was not my doing but I get more comments about that then anything. Best, Paul

[@kanary7662]

Great job 👏

[@abdullahibrahim8938]

Great work but small note, try to not mention diseases and conditions that sounds terrifying while the patient are there unless the final diagnosis is made

[@OrthoEvalPal]

Thank you! The patients are all told that prior to the video being done because they are already evaluated previously.

[@nsmalik-g2c]

I had an accident last year in April, and got my right leg tibia fractured. The cast was on for almost 6 to 7 months (no surgery) . I'm noticing hyperreflexia(or whatever u sy it) my knee reflex a lot when hitted . Can u guide me, should I visit my Ortho surgeon or can u suggest any exercise for it?

[@celts6gers2]

Thanks for the great video. Did you get a confirmed diagnosis for this patient after investigations?

[@mikemetrusias4324]

I have a positive Romberg sing and hoffman's reflex and conus. The neurosurgeon had me stand with my face to the wall and fully retract my leg backwards and hold it up with my arms. Then I let it go and my leg stayed up! What's that called?

[@OrthoEvalPal]

Not sure that there is a name for that but can be a sign that you have some increased tone not allowing the muscle to relax.

[@mikemetrusias4324]

As it turns out I had onset CSM. I thought I cramping too much. He never named what that test was. It was the first thing he made me do. I think Dr.Shaker Kurpad will be world renown in time. I was perfect for his CSM study so I got in to see him right away.

[@frankparent463]

Yo paul, your shirt feels like i ve taken lucy in the sky with diamonds

[@OrthoEvalPal]

I get that a lot. Weird how it recorded that way.

[@ryanquick705]

So Dr., the left leg didn't see to reflex abnormally, but you noted brisk movement. If it was bilateral with no other signs would you suspect it to be normal reflex for this gentleman? I know briskness can be subjective.

[@paulmarquis7958]

Yes, there is a small percentage of people who will be hyperreflexive and that is normal for them.

[@ryanquick705]

+Paul Marquis So bilateral briskness on knee jerk is not typically cause for concern without clonus or positive Hoffman or Babinski? Have had knee jerk reaction equivalent to his left leg like, just with less outward velocity for sometime. Dr. Google says ALS, which i realize is it is a bad idea to Google symptoms.

[@paulmarquis7958]

I always encourage people to NOT diagnose themselves over the internet. If you are concerned, then you should speak to your doctor and/or neurologist. I don't usually concern myself if all you have are brisk reflexes without a positive Hoffman's, Babinski or clonus.

[@ryanquick705]

+Paul Marquis I have heard that a lt. I suffer from anxiety that is consuming, even while medicated. one last question, what feature(s) of his left leg reflex made it brisk?

[@mjade1673]

Ryan Quick i'm so sorry i'm just a layman's idiot. But... Is your anxiety ADD related? Just found out mine was. After a long road (3yrs) of finally pin pointing / eliminating all my food allergies. And still being left with anxiety. (after it had subsided for a long while). And this overwhelming confusion that would leave me sitting on the couch all day at the mere prospects of getting anything done or going to the grocery store! (I'm primarily inattentive type). Crazy stuff. I knew it was no longer fatigue for certain. And i couldn't understand it all. (I had had my birth control method removed so the resumption of my hormonal cycle highlighted and worsened ADD symptoms once again. Coffee was no longer cutting it for me. And i was sinking fast. So i got curious/diligent). And luckily stumbled across it by chance researching something else. (Honestly feel like it was gifted at me, lol). And went oh yeah many years ago i always said i'ld look into if i had ADD or not after i figured out what was making me sleep all the time/sick (gluten-gliadin). 3 siblings with ADHD/mainly ADD type. And Dad was clearly undiagnosed. Then found out just before this my mom has it. Once again strong on the inattentive part. But she's mixed type as well (most common). I hope you can figure it out :(. 👍 Best of luck

[@deb73042]

Oh bye very helpful video. Thank you!

[@OrthoEvalPal]

Thanks Debra! Much more to come.

[@marjorierizzo2485]

Thank you, the video was informative.

[@sidouleo9618]

Thank you so much ! great video

[@deb73042]

I loved it when you knew where to push to make his clonus stop shaking. That was 😎

[@pageturner7947]

Maybe I can try that with myself

[@cintiasosacawen7304]

thanks for the video!!! it help me to understand this sign..

[@sobster123]

What a brilliant vid. Thanks a lot doc! N patient of course.🙂

[@jesuslima4380]

Thank you ! Great video ! Very educational

[@OrthoEvalPal]

You are welcome! Much more to come soon. Thanks, Paul

[@nadezhdaprotasovitskaya9394]

Love it, thanks for sharing!

[@OrthoEvalPal]

Thanks for watching Nadezhda!

[@sabrina4592]

Paul’s shirt is phasing multiple realities

[@aminuddinshah4997]

Sir, can i know why my both legs automatically moves after my friend knock my both knee ? does it bad or good ? i means my legs move upward very fast, i feel weird bcs only me being like that,

[@OrthoEvalPal]

many people have a lot of movement when having reflexes tested. Good question for your doctor. Also, have all of your other reflexes tested too.

[@mansourriachi9247]

Awesome vid doc. Very educational. I have a follow up question; given the patient's history and neurological symps, would you expect L'Hermitte's test to be positive in this case? Thanks for your time

[@OrthoEvalPal]

Hi Mansour, Yes I would. I didn't do it because this guy had already gone through full evaluation and I cut it short. Great question!

[@cubzer0]

thank you!

[@sejalbajpeyee1615]

Thank u so much!! Love from india

[@YB-lv6ks]

WHY does it look like Pendular Knee Jerk in HIS Right LEG ?? Answer me pleasem I'm confused

[@davidbuschhorn6539]

This was the kind of thing that made me feel GREAT after my neuro sent me for a SFEMG and it was screaming ALS. When he tapped my knee? Nothing. Babinski? Nothing. I almost shouted, "YES! IT'S NOT ALS!!!" What this guy looks like is ALS. His cervical surgery wouldn't cause all this.

[@OrthoEvalPal]

ALS was ruled out.

[@davidbuschhorn6539]

Thank goodness! Did they ever work it out? Some sort of anterior horn disease?

[@rameezhassan1151]

Dear sir,how was ALS Ruled out

[@brianhawthorne8480]

great video. thanks for sharing.

[@inexp1]

Dude that’s insane wow

[@OrthoEvalPal]

Yes, agreed

[@mohammadtailakh820]

excellent video thanks for the education

[@8yuhg]

I’m like trying to watch this and I’m getting nauseous

[@MsBubu900]

Thanks so much

[@keishaellis4029]

great reference thanks for sharing

[@hudaibrahimmohammed2443]

thanks, great video

[@steamriceroll]

Thank you.

[@MohammedJaafer280]

really good and educational

[@OrthoEvalPal]

Thank you!

[@mikemetrusias4324]

Thank you so much for your explanation. It's a pity doctors in Wisconsin don't explain much to their patients. It's why we look to youtube for answers.

[@OrthoEvalPal]

Hi Mike, Thanks for watching! Just to let you know, I will be adding a ton of new videos and much more in the near future. If you haven't already subscribed, please do so and you will get some great information regarding orthopedic evaluations. Best, Paul

[@kaim3ra17]

Yo sometimes this medical stuff blows my mind

[@jvp4397]

great video thank you for sharing

[@OrthoEvalPal]

You are welcome!