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The Thumb Rolling Test: A Novel Variant of the Forearm Rolling Test

Published online by Cambridge University Press:  02 December 2014

Dennis A. Nowak
Dennis A. Nowak*
Affiliation:
Neurologische Fachklinik, Klinik Kipfenberg, Kipfenberg Neurologische Universitätsklinik, Friedrich-Alexander-Universität Erlangen, Germany
*
Klinik Kipfenberg, Neurologische Fachklinik, Kindinger Strasse 13, D-85110 Kipfenberg, Germany
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Abstract:

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Background:

Neurologists use a variety of tests to detect subtle upper motor neuron lesion causing a mild motor impairment of the upper limb. The forearm and index finger rolling tests are some of these. Their sensitivity varies, but in general these tests appear to be more likely to be abnormal in mild motor impairment of the arm and hand due to a cortico-spinal tract lesion than tests of power, muscle tone or reflexes. Thumb rolling involves more distal limb segments than forearm rolling and distal limb segments are typically more affected than proximal limb segments after cerebral lesions to the cortico-spinal tract.

Methods:

Thumb rolling was tested, in comparison to pronator drift, forearm rolling and index finger rolling, for its sensitivity to detect a cerebral lesion of the cortico-spinal tract in 17 consecutive patients with mild pure motor stroke affecting only one arm and hand.

Results:

Thumb rolling is more sensitive (88%) than pronator drift (47%), forearm rolling (65%) and index finger rolling (65%) to detect a cerebral lesion of the cortico-spinal tract in mild pure motor stroke of the upper limb.

Conclusion:

The thumb rolling test may be a valuable adjunct clinical test to detect a subtle lesion of the cortico-spinal tract causing mild pure motor stroke of the arm and hand when the remainder of routine neurological examination is unremarkable.

Résumé:

Résumé:Contexte:

Les neurologues utilisent différents tests pour détecter des lésions subtiles du neurone moteur supérieur causant un déficit moteur léger au niveau du membre supérieur, dont les tests du forearm and index finger rolling. Leur sensibilité varie, mais en général ces tests semblent être plus susceptibles d'être anormaux dans les cas de dysfonction légère du bras et de la main causée par une lésion du faisceau pyramidal que les tests de puissance, de tonus musculaire ou les réflexes. Le thumb rolling porte sur des segments plus distaux des membres suite à une lésion cérébrale au faisceau pyramidal.

Méthodes:

Le test du thumb rolling a été fait chez 17 patients consécutifs atteints d'un accident vasculaire cérébral moteur pur léger atteignant seulement un bras et la main, et comparé à la pronation involontaire du bras maintenu en extension, au forearm rolling et au index finger rolling.

Résultats:

Le thumb rolling est plus sensible (88%) que la pronation involontaire du bras maintenu en extension (47%), le forearm rolling (65%) et le index finger rolling (65%) pour détecter une lésion du faisceau pyramidal cérébral chez les patients porteurs d'un AVC purement moteur du membre supérieur.

Conclusion:

Le test du thumb rolling peut être un test clinique d'appoint utile pour détecter une lésion subtile du faisceau pyramidal chez les patients ayant subi unAVC avec légère atteinte motrice pure du bras et de la main quand le reste de l'examen neurologique de routine ne décèle rien de particulier.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 129 - 132
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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