The term asterixis is from the Greek for "fixed position" and refers to the motor disturbance that can be observed when a person is asked to maintain a given position. The severity of asterixis can be graded based on the frequency of unintentional motion seen during a clinical examination.


Synonyms: liver flap, flapping tremor, wrist flap


Alternative sites showing the motor disturbance: tongue, eyelids, fingers and elbows


Regular testing method:

(1) The patient is asked to hold both arms outstretched anteriorly.

(2) The wrists are held dorsiflexed (fingers pointing up at 90 degrees to the forearms). Sometimes the examiner will briefly push the fingers towards the trunk, then release the fingers.

(3) The fingers and hands are observed for 30 seconds.

(4) A person with asterixis will have the fingers move back and forth from the vertical.

Clinical Findings


no flapping


rare flapping


occasional flapping, usually irregular


frequent flapping


almost continuous or continuous



If the patient is conscious but unable to hold the arms out, then the patient can be asked to squeeze 2 fingers steadily.



• Asterixis is not specific for hepatic encephalopathy.


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