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Cascade Sign

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Illustration of the Cascade sign
Natural cascade of fingers (left). Normally, fingertips point towards the scaphoid tuberosity when in a fist. Scissoring (rotation of the phalanx resulting in crossing of fingers when making a fist) (right) changes the trajectory of the fingertip; here, rotation of the fourth digit suggests a fracture with a rotated distal fragment[1]
  • Cascade Sign

Purpose

  • Assess fingers for rotational deformity following trauma

Description

  • Patient is seated, elbow flexed and forearm supinated
  • Ask the patient to "make a fist" which includes flexion of digits 2-5
  • Digits should come together over the hypothenar muscles and scaphoid bone
  • Positive test:
    • Fingers overlap or are askew

Pathology

Evidence

  • Unknown

See Also

References

  1. ↑ Colmers-Gray, Isabelle N., Herma Louison, and Assaf Kadar. "Assessment and management of common hand fractures in adults." bmj 388 (2025).
Created by:
John Kiel on 20 August 2019 23:40:55
Authors:
Last edited:
27 August 2025 12:45:45
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