Short muscles of the thumb <ul><ul><li>Locate the base of pt’s thumb and explore all sides of the thenar eminence’s thick ...
Short muscles of the thumb <ul><ul><li>Ask pt. to gently squeeze his thumb and fifth finger pads together.  </li></ul></ul...
Anatomical snuffbox and long muscles of the thumb <ul><ul><li>Follow the tendons that form the snuffbox  ( extensor pollic...
Extensor pollicis longus <ul><li>Action </li></ul><ul><ul><li>Wrist joint extension and abduction (radial deviation) of th...
Test for extensor pollicis longus
Test for extensor pollicis longus <ul><li>Patient:  Sitting or supine </li></ul><ul><li>Fixation:  The examiner stabilizes...
Extensor pollicis brevis <ul><li>Action </li></ul><ul><ul><li>Radiocarpal joint:  Abduction (radial deviation) of the hand...
Test for extensor pollicis brevis
Test for extensor pollicis brevis <ul><li>Patient:  Sitting or supine </li></ul><ul><li>Fixation:  The examiner stabilizes...
Abductor pollicis longus <ul><li>Action </li></ul><ul><ul><li>Radiocarpal joint:  Abduction (radial deviation) of the hand...
Test for abductor pollicis longus
Test for abductor pollicis longus <ul><li>Patient:  Sitting or supine </li></ul><ul><li>Fixation:  The examiner stabilizes...
Test for abductor pollicis brevis
Test for abductor pollicis brevis <ul><li>Patient:  Sitting or supine </li></ul><ul><li>Fixation:  The examiner stabilizes...
Anatomical snuffbox and long muscles of the thumb <ul><ul><li>With pt’s wrist in a neutral position, ask him to extend his...
Other structures of  the forearm and hand
Radial collateral ligament <ul><ul><li>Locate  lat. epicondyle  of the humerus and  head of radius </li></ul></ul>
Annular ligament <ul><ul><li>Place your thumb pad on the  head of radius </li></ul></ul><ul><ul><li>While passively pronat...
Ulnar collateral ligament <ul><ul><li>Locate  med. epicondyle  of humerus and the  med. aspect of the olecranon process </...
Olecranon bursa <ul><ul><li>Olecranon bursitis (Student’s elbow) </li></ul></ul><ul><ul><li>With the elbow flexed, locate ...
flexor retinaculum  and palmar aponeurosis <ul><li>Flexor retinaculum </li></ul><ul><ul><li>Located on the palmar surface ...
flexor retinaculum  and palmar aponeurosis <ul><li>Cradle pt.’s hand </li></ul><ul><li>Put your thumb pad on the flexor cr...
Extensor retinaculum <ul><li>Ask pt. to extend his fingers and wrist </li></ul><ul><li>Locate  the head of the ulna   and ...
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Forearm And Hand 5

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Forearm And Hand 5

  1. 1. Short muscles of the thumb <ul><ul><li>Locate the base of pt’s thumb and explore all sides of the thenar eminence’s thick movable tissue </li></ul></ul>
  2. 2. Short muscles of the thumb <ul><ul><li>Ask pt. to gently squeeze his thumb and fifth finger pads together. </li></ul></ul><ul><ul><li>Note how the thenar eminence becomes dense and compact </li></ul></ul>
  3. 3. Anatomical snuffbox and long muscles of the thumb <ul><ul><li>Follow the tendons that form the snuffbox ( extensor pollicis longus, brevis, and abductor pollicis ) proximally </li></ul></ul><ul><ul><li>Lay your fingers along the post. Surface of the radius as pt circumduct his thumb </li></ul></ul>
  4. 4. Extensor pollicis longus <ul><li>Action </li></ul><ul><ul><li>Wrist joint extension and abduction (radial deviation) of the hand </li></ul></ul><ul><ul><li>Carpometacarpal joint of the thumb: Adduction </li></ul></ul><ul><ul><li>MCP and interphalangeal joint of the thumb: Extension </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Posterior surface of the ulna and the interosseous membrane </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Base of the distal phalanx of the thumb </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Radial nerve (C7-8) </li></ul></ul>
  5. 5. Test for extensor pollicis longus
  6. 6. Test for extensor pollicis longus <ul><li>Patient: Sitting or supine </li></ul><ul><li>Fixation: The examiner stabilizes the hand and gives counter pressure against the palmar surface of the 1 st metacarpal and proximal phalanx </li></ul><ul><li>Test: extension of the interphalangeal joint of the thumb </li></ul><ul><li>Pressure: Against the dorsal surface of the interphalangeal joint of the thumb, in the direction of flexion </li></ul>
  7. 7. Extensor pollicis brevis <ul><li>Action </li></ul><ul><ul><li>Radiocarpal joint: Abduction (radial deviation) of the hand </li></ul></ul><ul><ul><li>Carpometacarpal and MCP joints of the thumb: Extension </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Posterior surface of the radius and the interosseous membrane </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Base of the proximal phalanx of the thumb </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Radial nerve (C7-8) </li></ul></ul>
  8. 8. Test for extensor pollicis brevis
  9. 9. Test for extensor pollicis brevis <ul><li>Patient: Sitting or supine </li></ul><ul><li>Fixation: The examiner stabilizes the wrist </li></ul><ul><li>Test: Extension of the metacarpophalangeal joint of the thumb </li></ul><ul><li>Pressure: Against the dorsal surface of the proximal phalanx, in the direction of flexion </li></ul>
  10. 10. Abductor pollicis longus <ul><li>Action </li></ul><ul><ul><li>Radiocarpal joint: Abduction (radial deviation) of the hand </li></ul></ul><ul><ul><li>Carpometacarpal joint of the thumb: Abduction </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Dorsal surface of the radius, ulna,and interosseous membrane </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Base of the first metacarpal </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Radial nerve (C7-8) </li></ul></ul>
  11. 11. Test for abductor pollicis longus
  12. 12. Test for abductor pollicis longus <ul><li>Patient: Sitting or supine </li></ul><ul><li>Fixation: The examiner stabilizes the wrist </li></ul><ul><li>Test: Abduction and slight extension of the 1 st metacarpal bone </li></ul><ul><li>Pressure: Against the lateral surface of the distal end of the 1 st metacarpal, in the direction of adduction and flexion </li></ul>
  13. 13. Test for abductor pollicis brevis
  14. 14. Test for abductor pollicis brevis <ul><li>Patient: Sitting or supine </li></ul><ul><li>Fixation: The examiner stabilizes the hand </li></ul><ul><li>Test: Abduction of the thumb ventrally from the palm </li></ul><ul><li>Pressure: Against the proximal phalanx, in the direction of adduction toward the palm </li></ul>
  15. 15. Anatomical snuffbox and long muscles of the thumb <ul><ul><li>With pt’s wrist in a neutral position, ask him to extend his thumb </li></ul></ul><ul><ul><li>Just distal to the styloid process of the radius will be a small trough formed </li></ul></ul>
  16. 16. Other structures of the forearm and hand
  17. 17. Radial collateral ligament <ul><ul><li>Locate lat. epicondyle of the humerus and head of radius </li></ul></ul>
  18. 18. Annular ligament <ul><ul><li>Place your thumb pad on the head of radius </li></ul></ul><ul><ul><li>While passively pronating and supinating the forearm, allow the head and neck of the radius to pivot under your thumb </li></ul></ul>
  19. 19. Ulnar collateral ligament <ul><ul><li>Locate med. epicondyle of humerus and the med. aspect of the olecranon process </li></ul></ul>
  20. 20. Olecranon bursa <ul><ul><li>Olecranon bursitis (Student’s elbow) </li></ul></ul><ul><ul><li>With the elbow flexed, locate olecranon process </li></ul></ul><ul><ul><li>Palpating just distally to the process, gently explore the elbow’s thin, malleable tissue </li></ul></ul><ul><ul><li>If the bursa is inflammed, the elbow will present “goose egg” swelling with localized tenderness </li></ul></ul>
  21. 21. flexor retinaculum and palmar aponeurosis <ul><li>Flexor retinaculum </li></ul><ul><ul><li>Located on the palmar surface of the wrist just distal to the flexor crease </li></ul></ul><ul><ul><li>Its transeverse fibers lie deep to the palmaris longus tendon and superficial to the other flexor tendons and median nerve </li></ul></ul><ul><li>Palmar aponeurosis </li></ul><ul><ul><li>Continuation of antebrachial fascia </li></ul></ul><ul><ul><li>Stretches superficially across the palm of the hand and is an attachment site for the palmaris longus tendon </li></ul></ul>
  22. 22. flexor retinaculum and palmar aponeurosis <ul><li>Cradle pt.’s hand </li></ul><ul><li>Put your thumb pad on the flexor crease of the wrist </li></ul><ul><li>Slide half an inch distally to the crease and sink into the tick tissues of the heel of the hand </li></ul><ul><li>Slide distally onto the palm of the hand </li></ul>
  23. 23. Extensor retinaculum <ul><li>Ask pt. to extend his fingers and wrist </li></ul><ul><li>Locate the head of the ulna and the styloid process of the radius </li></ul><ul><li>Palpate just distal to these landmarks by sliding across the transverse fibers of the retinaculum </li></ul>

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