ulnar nerve test, cubital tunnel sign, little finger abduction sign, ulnar neuropathy sign, positive Wartenberg’s Sign
Professionals want to understand what Wartenberg’s Sign means, how to observe it and how to record it in an upper-limb nerve assessment.
Wartenberg’s Sign is observed when the little finger rests or drifts into abduction due to weakness or imbalance of ulnar nerve-innervated intrinsic hand muscles. It may support suspicion of ulnar neuropathy when combined with ulnar-distribution paraesthesia, sensory change, weakness, Tinel’s sign, elbow flexion symptoms and functional hand findings. A recent expert consensus study for cubital tunnel syndrome included Wartenberg or Froment-type findings among late motor signs, but not as a stand-alone diagnostic criterion.
A client reports tingling into the ring and little fingers, reduced grip control or difficulty keeping the little finger close to the hand. When their hand rests on the table, the little finger drifts away from the ring finger.
Wartenberg’s Sign helps document a possible ulnar nerve motor finding. It should be interpreted with the full upper-limb nerve assessment, because little-finger position can also be influenced by habit, joint posture, previous injury or muscle imbalance.
Test name: Wartenberg’s Sign
Body region: Hand, intrinsic muscles, ulnar nerve
Purpose: Observe possible ulnar nerve motor involvement
Positive finding: Resting or persistent abduction of the little finger, especially when the client attempts to adduct it
Negative finding: Little finger remains aligned or can adduct normally without drift
Best used with: Tinel’s at the elbow, elbow flexion test, sensory testing, grip strength, pinch strength, Froment-type observation and ULTT3
Key limitation: It does not diagnose cubital tunnel syndrome or ulnar neuropathy on its own
Wartenberg’s Sign is a clinical observation of little-finger abduction. It is commonly linked to ulnar nerve motor involvement because the ulnar nerve supplies intrinsic hand muscles that help control finger adduction and abduction.
A positive sign is not simply a little finger that looks slightly separated. It is more meaningful when the client cannot actively bring the little finger back toward the ring finger, or when it repeatedly drifts into abduction with related ulnar nerve symptoms.
Wartenberg’s Sign is used when ulnar nerve involvement is being considered.
It may be relevant when the client reports:
Tingling into the ring and little fingers
Medial elbow symptoms
Hand weakness
Reduced grip or pinch control
Clumsiness with fine motor tasks
Symptoms with elbow flexion
Suspected cubital tunnel or ulnar neuropathy
It assesses a visible motor sign that may suggest ulnar nerve-innervated intrinsic hand muscle weakness or imbalance. It does not measure nerve conduction, locate the compression site or confirm the cause of symptoms.
This sign may be useful for clients with suspected ulnar nerve involvement, cubital tunnel symptoms, hand weakness, ring and little finger paraesthesia, manual work symptoms, gripping difficulty or progressive intrinsic hand changes.
Use when symptoms, history or observation suggest possible ulnar nerve involvement.
Use caution with recent hand trauma, deformity, severe pain, previous little-finger injury, surgery, Dupuytren’s changes or structural finger positioning that may affect observation.
Observation space
Pain and symptom scale
Measurz recording workflow
Optional grip or pinch dynamometer
Optional sensory testing tools
Ask the client to place both hands relaxed on a table or hold the hands in front of the body.
The fingers should be relaxed and visible.
Observe from the front and above.
Manual contact is usually not required.
Observe whether the little finger rests in abduction. Then ask the client to bring the little finger toward the ring finger and hold it there.
Ask the client to report weakness, cramping, tingling, numbness, hand clumsiness or familiar symptoms.
A positive Wartenberg’s Sign is persistent little-finger abduction or inability to actively adduct the little finger toward the ring finger.
A negative finding is normal resting alignment and the ability to adduct and hold the little finger without drift.
Stop if pain, cramping or symptoms become uncomfortable.
Do not overinterpret mild postural differences. Compare sides and record related nerve findings.
A positive Wartenberg’s Sign may increase suspicion of ulnar nerve motor involvement when it appears with ulnar-distribution sensory symptoms, medial elbow symptoms, weakness, positive Tinel’s at the elbow or other intrinsic hand findings.
A positive sign does not identify the compression site. Ulnar nerve involvement may occur at the elbow, wrist or less commonly from more proximal neurological causes.
A negative sign does not exclude cubital tunnel syndrome or ulnar neuropathy, especially in early or sensory-dominant presentations.
High-quality diagnostic accuracy values for Wartenberg’s Sign alone appear limited.
Condition or presentation: suspected ulnar neuropathy or cubital tunnel syndrome
Population: not clearly established for stand-alone diagnostic accuracy studies
Test variation: observation of little-finger abduction or inability to adduct
Reference standard: not consistently established for this sign alone
Sensitivity: not available
Specificity: not available
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: often a later motor sign, not always present, does not localise compression site, and must be interpreted with sensory and motor findings
A recent consensus study reported agreement that late motor findings such as clawing, Wartenberg or Froment-type signs are among clinically relevant criteria in cubital tunnel syndrome assessment, alongside ulnar-distribution paraesthesia, symptoms with elbow flexion and medial elbow Tinel’s sign.
Reliability depends on consistent hand position, side-to-side comparison and whether the finding is recorded as resting abduction, inability to adduct or both.
Its validity is strongest as part of a broader ulnar nerve motor and sensory examination, not as a stand-alone test.
Common errors include recording mild finger spacing as positive, not asking the client to actively adduct the little finger, failing to compare sides and using the sign alone to diagnose cubital tunnel syndrome.
Limitations include late presentation, variable hand posture, previous injury, joint stiffness, structural deformity and lack of stand-alone diagnostic accuracy evidence.
Use Wartenberg’s Sign to document visible ulnar motor involvement and decide whether further neurological testing, strength testing or referral is appropriate.
Record test name, side tested, result, little-finger resting position, ability to adduct, drift present or absent, symptom distribution, sensory findings, motor findings, grip or pinch strength, comparison side, confidence in result and related ulnar nerve tests.
Add Tinel’s at the elbow, elbow flexion symptoms, ULTT3, Wartenberg/Froment-type observations, grip strength and referral notes where relevant.
Tinel’s Test at the Elbow
Upper Limb Tension Test 3
Grip Strength Test
Phalen’s Test
Wrist Tinel’s Test
Arm Squeeze Test
Elbow Flexion Test
Cervical ROM Tests
It assesses possible ulnar nerve motor involvement through little-finger abduction or inability to adduct the little finger.
A positive sign is persistent little-finger abduction or inability to bring the little finger back toward the ring finger.
No. It may support suspicion, but it does not diagnose cubital tunnel syndrome on its own.
No. Early ulnar nerve presentations may be sensory without visible motor signs.
Record side, finger position, ability to adduct, sensory symptoms, motor findings, comparison side and related ulnar nerve tests.
Wartenberg’s Sign is an ulnar nerve motor observation.
It is more meaningful when paired with ulnar sensory symptoms or weakness.
It does not diagnose cubital tunnel syndrome on its own.
A negative sign does not rule out ulnar nerve involvement.
Measurz should capture side, finger position, motor control and related nerve findings.
Dy, C. J., Mackinnon, S. E., Novak, C. B., & colleagues. (2023). Cubital tunnel syndrome: Does a consensus exist for diagnosis? The Journal of Hand Surgery.
Nakashian, M. N., Ireland, D., & Kane, P. M. (2020). Cubital tunnel syndrome: Current concepts. Current Reviews in Musculoskeletal Medicine, 13(4), 520–524.
