E-Pearl of the Week: Hanes Sign

September 5, 2012


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September 5, 2012

Hanes Sign

First described by Dr. Frederic Hanes in 1943, the Hanes Sign, or Whistle–Smile Reflex, is an aid to the clinical diagnosis of parkinsonian syndrome. When a normal patient is asked to whistle, he or she does so and then gives a sheepish grin due to the "absurdity of unmotivated whistling" (1). As a feature of facial paucity, the parkinsonian patient does not smile after whistling is completed. This reportedly reliable sign serves as a useful clinical clue for parkinsonism in addition to the cardinal motor features of Parkinson disease: tremor at rest, rigidity, bradykinesia, and gait and balance difficulty (2).


  1. Hanes MF. Two Clinically Useful Signs. JAMA 1943; 1152–1153.
  2. Fernandez HH. Updates in the medical management of Parkinson disease. Cleve Clin J Med 2012; 79: 28–35.

Submitted by Jonathan M. Beary, D.O. & Dimitrios A. Nacopoulos, M.D.

Disclosure: Drs. Beary and Nacopoulos report no disclosures.

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