Monday, 2 April 2012

Froment's sign

Level 2

Froment's sign tests for the action of adductor pollicis, which is weak with an ulnar nerve palsy.

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. 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. The FPL is innervated by the anterior interosseous branch of the median nerve, which comes off more proximally than the wrist. 

Simultaneous hyperextension of the thumb MCP joint is indicative of ulnar nerve compromise. This is also known as Jeanne's Sign.

Extra reading: Jules Froment

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