Historical Overview
- Thumb-in-palm deformity is associated with cerebral palsy (CP), which was first described by William John Little in 1853 as cerebral spastic palsy or Little’s Disease.1
Description
- CP may contribute to the development of thumb-in-palm deformity and swan neck deformity in children.2
- If CP is suspected, the patient’s parents or guardians should consult with a neurologist as soon as possible.3
Pathophysiology
- The thumb-in-palm deformity test can help to diagnose CP.
- If the patient presents with thumb-in-palm deformity, there will be little or no function in his/her hand.
Instructions
- Obtain an accurate and complete patient history. Ask the patient to rate on a scale from 1 to 10 how much pain s/he usually experiences in the affected thumb, hand, and wrist.
- Observe whether the patient’s thumb is positioned inside of his/her palm.2
- Check the patient’s grasping and pinching abilities.
- Examine the contralateral thumb and hand, to verify that the patient understands the doctor’s requests.
Variations
- When examining the hand for thumb-in-palm deformity, evaluate the surrounding skin for color and the presence of scars.4
- Also check wrist range of motion (ROM), active and passive.5
Related Signs and Tests
- ROM, active
- ROM, passive
- Grip strength6
- Muscle test
- Neurovascular exam4
- Tenderness and crepitus
- Proprioception5
Diagnostic Performance Characteristics
- To improve reliability, the thumb-in-palm deformity test must be used in conjunction with active, gross, and fine motor tests to help diagnose CP.3,5
- The grip-strength test, performed with a Jamar dynamometer, also improves reliability.6