Froment's Sign Test

What is ulnar nerve palsy?

The ulnar nerve is an integral part of our hands and forearms. The nerve and its components (e.g., flexor pollicis longus, adductor pollicis, etc.) help us move with our wrists and fingers and even allow us to grip objects. It works alongside other nerves, like the median nerve, which helps with arm and hand movements and allows us to feel sensations with our upper extremities.

Since this is a nerve, it can cause specific injuries and a condition known as palsy.

Ulnar nerve palsy symptoms

Ulnar nerve palsy is a condition characterized by muscle weakness in the hand and forearm. It also causes the loss of sensation in those areas of our upper extremities, specifically in the ring and pinky fingers. Those with ulnar nerve palsy will also likely experience the following symptoms:

• It becomes more difficult for them to coordinate their fingers
• They will feel pain that feels like shocks, burning, or tingling
• Gradual weakening of their hands, especially as they repeatedly use them
• Difficulty or inability to grip objects (whether they're doing a pinch grip or full grip)
• They might experience difficulty maintaining grips if they are still able to grip

Causes of ulnar nerve palsy

Ulnar nerve palsy can be caused by dislocating or breaking one's elbow, so an athlete or elderly person is more prone to this than a normal individual.

The ulnar nerve is also near the skin's surface, so it can be injured if excessive pressure is applied to the arm or hand, causing ulnar nerve palsy. This can then be associated with repetitive stress injuries, which can occur in occupations or activities that involve prolonged elbow flexion or wrist movements.

Another cause is a disease or illness that affects nerves. For instance, this is also related to chronic conditions, such as cubital tunnel syndrome, where the nerve is compressed at the elbow. To diagnose ulnar nerve palsy, healthcare professionals will conduct a comprehensive orthopedic examination that involves special tests designed to determine the possibility of ulnar nerve problems and imaging tests to confirm the specific problem. One such test is the Froment's Sign Test.

What is Froment's Sign Test?

Froment's Sign Test is a physical examination of the hand designed to detect potential ulnar nerve palsy or injuries. It tests the strength of the thumb, specifically the thumb's adductor pollicis, by having a patient grip a flat object.

How is this conducted?

Froment's Sign Test is one of the most straightforward physical examinations a healthcare professional can conduct. It requires nothing special: a piece of paper, the patient's affected hand, and one test conductor's hands. Once a piece of paper has been prepared, the conductor must do the following:

• Have the patient sit down.
• Then, the conductor must sit in front of them, facing them.
• Next, the conductor will hand a piece of paper to the patient.
• The patient will be asked to hold the paper between their thumb and index finger in a pinch grip.
• The conductor will then try to pull the paper from the patient's pinch grip.
• The patient must resist the pull.

That's it!

How are the results interpreted?

Determining the test results will depend on the patient's resistance while the conductor attempts to pull the piece of paper from them. The result is negative if the patient can fully resist the pull with no difficulty. The result is positive if the patient experiences difficulty resisting the pull and will compensate by flexing the thumb's flexor pollicis longus to reinforce their pinching grip. A positive sign means a possible ulnar nerve palsy or injury.

Next steps after conducting the test

After conducting this test, it would be best for the conductor to conduct other tests related to ulnar nerve palsy/injuries like Tinel's Sign, Jeanne's Sign (similar to Froment's Sign), and Wartenberg's Sign for consistency. Imaging tests down the line should confirm the specific problem.

How to use our Froment's Sign Test template

More often than not, tests like Froment's Sign Test do not come with specific test result sheets for professionals to record their findings, so we took it upon ourselves to create one for professionals such as yourself!

Our Froment's Sign Test template includes sections indicating a patient's medical history and purpose of visit. It also comes with the test instructions, just in case you need to refresh yourself on how to conduct it.

There are also two checkboxes: one for indicating a positive result and one for a negative result. The positive result choice indicates what counts as a positive result. The same goes for the negative. At the end, there is a notes section where professionals can indicate their observations and next steps.

This template can be printed. For those who've gone paperless, the PDF file is interactive. You can tick the checkboxes with a mouse click or screen tap. There are interactive blank fields where you can write down patient information and your findings.

Benefits of conducting this test

Using our Froment's Sign Test template offers the following benefits:

It is quick and easy to conduct

Like many other physical examinations and provocation tests, Froment's Sign Test is quick and easy to conduct. The instructions are simple enough to be done in a minute or two. Professionals can get results quickly, move on to other scheduled tests to check for consistency, and eventually diagnose the patient's specific problem.

It can be used as a monitoring test

Once the patient is confirmed to have ulnar nerve palsy and they're undergoing treatment like physical therapy for strengthening the hand and fingers, you can schedule follow-up appointments to observe the patient for any improvements. You can conduct this again during follow-up appointments to see if they are regaining strength in their thumb and hand. If they've been exhibiting more strength without flexing their thumb, or if it takes longer before they start compensating by bending it, the treatment is working, and they're slowly regaining strength. If not, then it would be best to adjust the treatment plan.