The cascade sign is indicative of which problem?

• A. Carpal tunnel syndrome
• B. Metacarpal or phalangeal fracture/tendon damage
• C. Ulnar neuropathy
• D. Radiocarpal arthritis

Answer: (B)

The cascade sign reflects disruption of finger alignment due to injury to the bones or tendons of the hand. When a metacarpal or phalangeal fracture occurs, or a tendon is torn or damaged, the normal pull and balance of the intact tendons cause the neighboring joints to shift in a cascading, sequential way along the digits. That pattern—the cascade of deformities across the fingers—is a clue to structural injury in the metacarpal/phalangeal region, rather than a nerve issue or wrist joint problem. Carpal tunnel syndrome is a nerve compression syndrome with sensory/motor symptoms, not a cascade of finger alignment. Ulnar neuropathy typically shows intrinsic hand weakness and clawing, not a cascade across digits. Radiocarpal arthritis involves changes at the wrist joint, not this finger cascade pattern.