PMC5946593_01
(a) The patient has been asked to extend her digits. (b) The figures depicting progressive worsening of the fixed flexion across bilateral metacarpophalangeal joints, proximal interphalangeal and distal interphalangeal joints suggestive of finger extensor weakness. This distinctive pattern of weakness involving the extensor muscles of the fingers is known as "finger drop sign" (taken 48 h apart).
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The unopposed finger flexion resulted in a "finger drop" appearance (Figure 1(a) and (b)).
The figure taken in resting position showing differential weakness over the toes with predominant weakness involving the flexors resulting in the toes pointing upward.
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Differential flexor paresis is appreciated with up going of the toes (Figure 2).