Thumb and thenar eminence

Thumb and thenar eminence

/uni25CF Abductor pollicis brevis, opponens pollicis and flexor pollicis brevis can be tested together by oppos - ing the thumb to the little finger.

(b) Figure 35.11 (a) Tinel’s test; (b) Phalen’s test. Figure 35.12 Palpating the anatomical snuff box between the tendons of extensor pollicis longus and abductor pollicis brevis. (b) Figure 35.13 Testing the range of (a) wrist extension; (b) wrist /f_l exion. (a) (b) Figure 35.14 Testing the (a) /f_l exor digitorum super /f_i cialis; (b) /f_l exor digitorum profundus.

/uni25CF Flexor pollicis longus . The muscle is supplied by the anterior interosseus nerve (branch of the median nerve) and can be tested by asking the patient to bring the tips of the thumb and index finger together (the ‘OK’ sign; Figure 35.15 ). /uni25CF Extensor pollicis longus . The integrity of the tendon is tested by asking the patient to lift the thumb o ff a table with the palm flat on the table ( Figure 35.16 ). /uni25CF Adductor pollicis . Test using Froment’s sign (see Table 35.9 and Figure 35.17 ). /uni25CF Abductor pollicis brevis . This muscle is supplied by the median nerve. With the hand lying flat on a table with the palm facing upwards, ask the patient to raise the thumb towards the ceiling. Ask the patient to resist as you push the thumb back towards the palm ( Figure 35.18 ). Harry Finkelstein , 1883–1975, American surgeon, one of the cofounders of the Hospital for Joint Diseases, New Y ork, NY , USA. In 1932, along with E J Haboush invented a stabilising apparatus and operative technique for bone lengthening, anticipating by decades the current widely utilised Ilizarov technique. Hand and wrist examination /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Figure 35.15 Test for /f_l exor pollicis longus supplied by the anterior interosseus nerve. Figure 35.16 Testing the integrity of extensor pollicis longus. Inspection of the standing patient Dorsum and palm – asymmetry, deformity, muscle wasting Inspection of the supine patient Skin, scars, soft tissues Palpation of bony structures and joints of the hand Movements Wrist – /f_l exion and extension, ulnar and radial deviation Hand – thumb movements, metatarsophalangeal joints and small joints of the hand Special tests Allen’s test Tinel’s and Phalen’s tests for the median nerve Froment’s sign Finkelstein’s test Figure 35.17 Froment’s sign; the arrow illustrates the /f_l exed posture of the thumb interphalangeal joint, indicating weakness of the ulnar nerve-innervated adductor pollicis muscle. Figure 35.18 Testing the power of the abductor pollicis brevis sup

plied by the median nerve.