Oppenheim sign

The Oppenheim sign is a neurological reflex test used to detect abnormalities in the central nervous system, specifically indicating damage to the pyramidal tract. Named after German neurologist Hermann Oppenheim, this sign serves as an alternative to the Babinski sign when the latter is difficult to elicit.

1. Historical Background and Biography

Hermann Oppenheim (1858–1919) was a prominent German neurologist who made significant contributions to the field of neurology. He studied medicine at the Universities of Berlin, Göttingen, and Bonn, and later worked at the Charité Hospital in Berlin under Carl Westphal. In 1894, Oppenheim published the textbook Lehrbuch der Nervenkrankheiten für Ärzte und Studierende, which became a standard reference in neurology and was translated into several languages.

In 1902, Oppenheim described the reflex that now bears his name in his publication Zur Pathologie der Hautreflexe der unteren Extremitäten . His work during this period was pivotal in shaping modern neurological diagnostics.

2. Description of the Oppenheim Sign

How It Is Elicited:

The examiner applies firm downward pressure with the thumb and index finger along the anteromedial surface of the tibia, from the knee to the ankle.
A positive Oppenheim sign is characterized by dorsiflexion of the big toe, often accompanied by fanning of the other toes, similar to a positive Babinski response.

Physiological vs. Pathological:

In healthy adults, no toe movement should be observed.
In individuals with upper motor neuron (UMN) lesions, the abnormal extensor plantar response is triggered.

This reflex is particularly useful in patients who have thick calloused soles or heightened foot withdrawal, making the traditional Babinski maneuver challenging to perform.

3. Clinical Significance

The Oppenheim sign is used as a supportive or alternative test to the Babinski sign and helps diagnose upper motor neuron damage. Conditions where it may be observed include:

Stroke
Multiple sclerosis
Spinal cord injury
Traumatic brain injury
Amyotrophic lateral sclerosis (ALS)

Its role is especially valuable when other plantar reflexes are difficult to interpret.

The Oppenheim sign is part of a group of “Babinski-like signs”, which all aim to provoke the same abnormal toe extension. Other signs in this group include:

Babinski sign – the standard test for UMN lesions
Chaddock sign – stimulation around the lateral malleolus
Gordon sign – squeezing of the calf muscle
Schaefer sign – squeezing the Achilles tendon

Each has utility in different clinical scenarios and patient types.

5. Hermann Oppenheim’s Broader Contributions

Beyond the Oppenheim sign, Hermann Oppenheim made several lasting contributions to neurology:

Traumatic Neuroses: In 1889, he published a treatise on traumatic neuroses, proposing that psychological trauma could cause organic changes leading to persistent neurological symptoms. This view was controversial at the time but highlighted the importance of considering psychological factors in neurological conditions .
Dystonia Musculorum Deformans: In 1911, Oppenheim introduced the term "dystonia musculorum deformans" to describe a type of childhood-onset torsion dystonia, later known as Ziehen-Oppenheim syndrome .
Restless Leg Syndrome: He was among the first to define Restless Leg Syndrome as a neurological illness and recognized a familial component to the disorder .
Textbook of Nervous Diseases: His textbook Lehrbuch der Nervenkrankheiten was considered one of the best in its field, running to seven German editions and translated into multiple languages .

6. Summary Table: Oppenheim Sign Overview

Feature	Description
First Described	Hermann Oppenheim, 1902
Stimulus Location	Anteromedial tibia (knee to ankle)
Positive Response	Big toe dorsiflexion ± fanning of other toes
Indicates	Upper motor neuron lesion (pyramidal tract damage)
Useful When	Babinski sign is difficult to elicit
Related Reflexes	Babinski, Chaddock, Gordon, Schaefer
Clinical Relevance	Supports UMN lesion diagnosis in bedside exam

7. Conclusion

The Oppenheim sign exemplifies the depth of clinical insight neurologists brought to physical examination in the early 20th century. Though less commonly used than the Babinski sign, it remains a valuable tool, especially in challenging physical exam situations. As with other pathological reflexes, it serves as a reminder of the importance of thorough bedside neurology, even in the age of advanced imaging techniques.

Hermann Oppenheim's name lives on in this subtle yet revealing test, echoing his belief in the power of detailed, hands-on clinical evaluation.