Masse's Sign (Ulnar)

Test, Exam and Sign Description

Masse’s sign displays palmar arch flattening and loss of ulnar hand elevation, secondary to weakness of the opponens digiti quinti and little finger flexion of the metacarpophalangeal (MP) joint.

Pathophysiology

A positive Masse’s sign can arise from cubital tunnel syndrome, medial epicondylitis (Golfer’s elbow) or elbow contracture release.

Instructions

1. Ask the patient about his/her duration of pain, including night pain

2. Check for numbness in the affected areas of the ring and small fingers

3. Complete a neurovascular examination¹

3. Evaluate the transverse metacarpal arch

Variation

Check for atrophy of the intrinsic hand muscles, which may be a sign of chronic cubital tunnel syndrome.²

Related Signs and Tests

Tinel’s sign: ulnar nerve (Guyon’s)
Froment’s sign
Sensory exam by nerve
Ulnar intrinsic atrophy

Presentation Photos and Related Diagrams

Masse's sign - flattening of the palmar arch secondary to hypothenar ulnar intrinsic muscle loss.

Definition of Positive Result

The transverse metacarpal arch is flattened without the muscular force of the hypothenar oppones digiti quinti, the primary flexor of the fifth carpal metacarpal joint.

Definition of Negative Result

The transverse metacarpal arch is rounded with muscle tone, no flattening is visualized.

Comments and Pearls

Sign of severe ulnar intrinsic muscle atrophy

Diagnoses Associated with Tests, Exams and Signs

CUBITAL TUNNEL SYNDROME

References

1. Peimer, C. (1996). Compression Neuropathies: Ulnar. In Surgery of the hand and upper extremity (Vol. 2, pp. 1345-1346). New York, NY: McGraw-Hill, Health Professions Division.

2. Skinner, H., McMahon, P. (2014). Hand Surgery. In Current diagnosis & treatment in orthopedics (5th ed., p. 484). New York, NY: McGraw-Hill Medical

3. Palmer BA, Hughes TB. Cubital Tunnel Syndrome. J Hand Surg Am 2010;35A:153-63. PMID: 20117320