Woltman’s sign denotes slow-relaxing, or "hung-up", tendon reflexes. These are most commonly seen in the context of untreated hypothyroidism, but have also been recorded in other situations, including treatment with β-blockers, diabetes mellitus, and complete heart block. The phenomenon is sometimes labeled pseudomyotonia because of its superficial resemblance to the slow muscle relaxation of myotonia, but electrophysiological testing does not show myotonic discharges.
Chorea may result in apparently "hung-up" reflexes, perhaps due to a choreiform jerk after muscle relaxation.
The mechanisms underlying Woltman’s sign are uncertain: changes in basal metabolic rate and in muscle fibre types (selective loss of fast twitch fibers) have been suggested.
Larner AJ. Normalisation of slow-relaxing tendon reflexes (Woltman’s sign) after cardiac pacing for complete heart block. British Journal ofClinical Practice 1995; 49: 331-332