A New Clinical Sign of Lumbrical Plus Finger

Paradoxical finger extension is the classical clinical presentation of the lumbrical plus syndrome. We report a new additional sign, increased metacarpophalangeal flexion of the involved finger when the patient tries to make a fist. Three cases of lumbrical tightness are discussed, illustrating this new sign in 3 different clinical settings. The new sign was present in all 3 cases. Lumbrical tenotomy corrected the paradoxical interphalangeal extension and partly the increased metacarpophalangeal flexion. The lumbrical tendon has a relatively high moment arm relative to the metacarpophalangeal joint, which could explain the basis of this clinical sign. This new physical examination sign may help in diagnosing the lumbrical plus syndrome, a subtle complication of flexor digitorum profundus lesions that is not easily diagnosed but which is easily addressed.