Process of Examination
To perform the test, a patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject's hands.
- A normal individual will be able to maintain a hold on the object without difficulty.
- However, with ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect.
- Clinically, this compensation manifests as flexion of the IP joint of the thumb (rather than extension, as would occur with correct use of the adductor pollicis).
- The compensation of the affected hand results in a weak pinch grip with the tips of the thumb and index finger, therefore, with the thumb in obvious flexion.
- Note that the FPL is normally innervated by the anterior interosseous branch of the median nerve.
- Anterior interosseous branch comes off more proximally than the wrist, in evaluating lacerations near the wrist.
- Simultaneous hyperextension of the thumb MCP joint is indicative of ulnar nerve compromise. This is also known as Jeanne's Sign.
Read more about this topic: Froment's Sign
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