Hand Flapping of Asterixis on Physical Exam 70-year-old man, renal transplant, attending hospitalization for acute rejection of renal graft with emergency hemodialysis requirements. On physical examination, the presence of asterixis / flapping is highlighted This sign can be evoked by having the patient extend his arms and forearms and dorsiflexion his hands for a certain time. In seconds, a series of rapid and sudden flexion-extension movements appear at the wrist level. These arrhythmic round-trip movements, which last only a fraction of a second, often occur in bursts. They are due to a sudden loss of sustained dorsiflexion followed immediately by the resumption of the position requested for evocation. These movements flapping, asynchronous and bilateral, give this characteristic tremor its colloquial name. The electromyogram has shown a brief hiatus of the electrical activity of both muscles and their antagonists. This lapse in electrical activity coincides with fluttering or flapping movements. #Flapping #Asterixis #PhysicalExam #Hand #Clinical #Video #hyperammonemia
