Froment's sign

Froment's sign is a special test of the wrist for palsy of the ulnar nerve, specifically, the action of adductor pollicis.[1] Froment's maneuver can also refer to the cogwheel effect from contralateral arm movements seen in Parkinson's disease.

Froment's sign
Deep palmar nerves
Differential diagnosispalsy of the ulnar nerve

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 the thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject's hands.[2]

  • 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 flexor pollicis longus of the thumb to maintain grip pressure causing a pinching effect.[3]
  • Clinically, this compensation manifests as flexion of the interphalangeal joint of the thumb (rather than adduction, 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.[3]
  • Note that the flexor pollicis longus 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.[2]

Eponym

It is named after French neurologist Jules Froment.[4][5]

References
  1. "Ulnar Nerve - Wheeless' Textbook of Orthopaedics". Retrieved 2008-01-26.
  2. Jeff G. Konin et al. Special Tests for Orthopedic Examination: Third Edition. Thorofare, NJ. SLACK Incorporated, 2006.
  3. Richardson, Craig and Fabre, Gerd. '"Froment's Sign." Journal of Audiovisual Media in Medicine. Vol. 26, No. 1 (2003):34.
  4. synd/1970 at Who Named It?
  5. Froment, J. (1915). "La préhension dans les paralysies du nerf cubital et le signe du pouce". La Presse Médicale. Paris. 23: 409.
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