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Complex made Simple...clinically relevant education by Judy C. Colditz, OT/L, CHT, FAOTA

June 2013 No. 25

DIFFERENCE BETWEEN FROMENT’S SIGN AND JEANNE’S SIGN IN ULNAR PALSY

Thumb stability is possible because of coordinat- ulnar palsy flexes at the interphalangeal (IP) joint,
ed contraction of the thumb muscles. Imagine three while the uninjured thumb will not flex [or only mini-
people pulling equally on three guy wires attached to mally]. The absence of the AP power removes one
the top of a pole that is resting on the ground. If any of the MP joint flexion/IP joint extension forces, so
one individual alters tension on a guy wire, the pole the flexor pollicis longus (FPL) power becomes more
moves. The thumb is similar to the pole, but more dominate.
complex since the muscles (guy wires) have to main-
tain balance at three joints simultaneously. Jeanne’s Sign (2)
When the ulnar nerve is not functioning, the Similar to Froment’s
thumb loses the pull of the adductor pollicis (AP), as sign, Jeanne’s sign is also
well as one belly of the flexor pollicis brevis (FPB). seen in response to pinch
These losses remove one of the essential “guy wires” forces. Instead of isolated
and the balance is thrown off. thumb IP flexion, the IP
Many think the adductor pollicis only brings the flexion is accompanied by
first metacarpal toward the second metacarpal (ad- MP joint hyperextension.
duction). The AP insertion into the ulnar sesamoid/ Some individuals
volar plate is have normal MP joint volar
indeed primar- plate laxity, allowing hy-
ily responsible perextension of the joint.
for adduction, Therefore if Jeanne’s sign
but the insertion is seen, one must deter-
into the base mine whether it is related Jeanne’s Sign: MP joint
of the proximal to a normally lax volar hyperextension with IP
phalanx/dorsal plate or to the absence joint flexion.
apparatus also of part or all (innervation is variable) of the FPB--or
directs power to both.
Froment’s sign: As paper is pulled both metacarpo- The most vital observation is the comparison to
away by the examiner, thumb on left phalangeal (MP) the contralateral uninjured thumb. If both thumbs are
shows IP joint flexion as compared to
joint flexion and fully innervated it is likely (but not absolute) that the
thumb on right.
IP joint exten- pinch pattern will be similar.
sion.
Froment’s sign (1) 1. Froment, J. “La prehension dans les paralysies, du
When the patient grasps a piece of paper be- nerf cubital et la signe du ponce.” Presse med.23 (1915): 409.
tween the thumb & index fingertips of both hands 2. Jeanne M. “La deformation du ponce la paralysie cu-
and the examiner pulls on the paper, the thumb with bitale.” Bul Mem Soc Chir Paris 41 (1915): 703-19.

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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.