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Duchenne's Sign (Ulnar Clawing)

Test, Exam and Sign Description

Historical Overview

  • Guillaume-Benjamin-Amand Duchenne, an early neurologist, first described this sign in 1870.1

Description

  • Also known as a “claw deformity,” Duchenne’s sign affects the ring and little fingers and is characterized by hyperextension of the metacarpophalangeal (MP) joints and flexion of the proximal interphalangeal (PIP) joints.2

Pathophysiology

  • Duchenne’s sign arises from low lesions of the ulnar nerve that cause loss of the lumbricals and the dorsal and palmar interosseous muscles that normally flex the MP joints and extend the PIP joints.2

Instructions

  • The presence or absence of Duchenne’s sign is determined by examiner observation.

Variations

  • Patients may exhibit minor variations in how they present with Duchenne’s sign.

Related Signs and Tests

  • Bouvier’s sign
  • Jeanne’s sign
  • Froment’s sign

Diagnostic Performance Characteristics

  • As a clinical sign, Duchenne’s sign is relevant to the medical condition of interest, but its diagnostic performance is often not evaluated in the same way as a diagnostic test. 
Presentation Photos and Related Diagrams
  • Ulnar Claw Hand
    Ulnar Claw Hand
Definition of Positive Result
  • A positive result occurs when the patient exhibits a weak “claw deformity” of the ring and little fingers.
Definition of Negative Result
  • A negative result occurs when the patient does not exhibit a weak “claw deformity” of the ring and little fingers.
Comments and Pearls
  • By testing both the intrinsic and extrinsic ulnar-innervated muscles, the level of injury can be determined.3
Diagnoses Associated with Tests, Exams and Signs
CUBITAL TUNNEL SYNDROME
References
  1. Plotogea AV, Kereszites A, and Moarcas M. Guillaume-Benjamin-Amand Duchenne - Between Medicine And Art. Bull Transylvania Univ Brasov 2009;6(51):185-8.
  2. Doyle JR. Hand and Wrist (Orthopaedic Surgery Essentials Series). Philadelphia: Lippincott Williams & Wilkins, 2006.
  3. Culp R and Jacoby SM. Musculoskeletal Examination of the Elbow, Wrist, and Hand: Making the Complex Simple. Thorofare: Slack Inc., 2012.