Clinical aspect of palm

Surface anatomy

 

 1 thenar eminence 2 hypothenar eminence

  • To test the flexors of the fingers (flexor digitorum profundus and flexor digitorum superficialis) the fingers are flexed against resistance etc.

  • The lumbricals can be tested by causing flexion at the metacarpophalangeal joints and extension at the interphalangeal joint- ie the writing position.

  • The interossei are tested by asking for adduction or abduction of the fingers against resistance. Remember that all the muscles of the fingers are supplied by the ulnar nerve except LOAF – lateral two lumbricals, opponens pollicis brevis, abductor pollicis brevis, flexor pollicis brevis all of the thenar eminence. To test therefore the function of the median nerve in the hand m it is important to test the action of the thenar muscles.

  • The pen touching test helps to identify the paralysis of the abductor pollicis brevis, a thenar muscle. The hand is laid on the table and a pen is held a little above the thumb. With the thumb touching the ground, the subject is asked to raise the thumb in order to touch the pen. If he cannot do this, it means the abductor muscle is paralysed and the lesion is probably from the median nerve at the wrist.

  • The test of the function of the ulnar nerve at the hand is usually the function of the adductor pollicis which lies in its own compartment in the hand called the adductor pollicis compartment. This is performed by the paper handling test. When a newspaper is held with the thumb upwards, the paralysed thumb does not adduct with the rest of the fingers since the adductor muscle is paralysed. But a trick action o f the flexor pollicis longus flexes the thumb and in doing so prominently flexes the interphalangeal joint of the thumb and its easily recognised as Froment’s sign positive.

  • Extensor action on the fingers can be tested by asking the subject to extend the fingers against resistance.

  • Rupture of the tendons of insertion of the flexors and the extensors can occur. For example rupture of the collateral slip of the dorsal digital expansion which is inserted into the terminal phalanx, is called baseball or mallet finger. Rupture of the flexor tendons of the fingers may also arise –e.g. rupture of the flexor digitorum superficialis. It is commoner to have knife cut of the tendons. Rupture or division of both tendons cause loss of ability to flex the two interphalangeal joints while the rupture of only the profundus tendon affects the distal interphalangeal joint. Rupture of the superficialis alone (not common) only weakenes the act of flexion since the profundus can perform the action of flexion alone.

  • Testing the wrist joint range of movement involves the technique of extension to 70o and flexion to 80o in the normal range. If pain occurs in this range or if there is inability to make the range, then the extensors of the carpus (extensor carpi radialis longus and brevis, and other extensors of the wrist that cross the joint must be sought for. It also includes the technique of testing for the range of ulnar and radial deviations performed by the agencies of the extensor carpi radialis and the flexor carpi radialis (radial deviation) and the extensor carpi ulnaris and the flexor carpi ulnaris (for ulnar deviation).

Digits

The digits are supplied by arteries and nerves which run along their medial and lateral borders. Injections of local anesthetic solution to deaden the nerves must be applied at the interdigital clefts with needle directed at the lateral and medial aspects of the digits, most especially but also around the circumference of the digits generally. This is the same for the lower extremity.

 

 

 

 

 

Layer ofor
Lymph drainage
Organ integration
Clinical anatomy
Clinical examination
Wrist joint

Intercarpal joints

Midcarpal

Carpometacarpal joint of thumb

Carpometacarpal of 2nd to 5th fingers

Intermetacarpal joints

Metacarpophalangeal joints

Interphalangeal joints

Carpal injuries
Metacarpal injuries
Phalangeal injuries of hand
Injuries to metacarpophalangeal joints
Injuries to interphalangeal joints
See body map

 

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