Reading the palm with MUNIX: A ‘reversed split hand’ in spinal muscular atrophy

The split hand phenomenon in amyotrophic lateral sclerosis (ALS), first reported by Wilbourn and Sweeney (1994) and Wilbourn (2000), has proved a resilient clinical sign, although it is not always present in ALS (Wilbourn 2000; Menon et al, 2004), and it is occasionally found in other neuromuscular disorders (Wilbourn 2000; Kuwobara et al, 2008). It consists of marked atrophy of the thenar eminence (APB) and first dorsal interosseous (FDI) muscles with relative sparing of the abductor digiti minimi (ADM).

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