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How to elicit Asterlxis or Liver Flap an OSCE guide

Asterixis is also called as  Flapping Tremor
1. Explain procedure to the patient.
2. Ask the patient to fully extend his/her arms and dorsiflex his/her wrists.
3. His/her fingers are held widely separated.
4. Holds In the same position for a few seconds.
5. Comment as asterlxis present or not.
Alternate Method for elicitation of flapping tremor
Asterlxis can also be elicited in the legs, head and the trunk.
Note the following
  • The patient is elaborately positioned because the flap is best demonstrated in that position.
  • Asterlxis Is said to be present if the wrist and fingers Involuntarily flex abruptly and irregularly: fhe patient compensates by extending the wrist but the correction is only partial, tlcxion and partial extension occur alternately so that In the end the wrist comes to a flexed position.
  • Asterixis occurs because of non-rhythmic, transient loss of posture In the arms.

This sign is very important for those students who are preparing for USMLE and MRCP