Manualmusletesting

1. Joints of Fingers

3. Flexion of metacarpophalangeal joints of fingers
LumbricalesLumbricales

4. Muscles contribute to Flexion of
metacarpophalangeal joints of fingers
LumbricalesLumbricales
• Origin:
• Four tendons of flexor digitorum
profundus.
• Radial 2: radial side only (unipennate).
• Ulnar 2: cleft between tendons ( bipennate)
• Insertion:
• Proximal phalanx of fingers 2-5 radial side
• Action:
• Flexion of MP joints
• Nerve supply

5. Normal & Good
• Position:
• Sitting with hand resting on dorsal
surface.
• Stabilization:
• Stabilize metacarpals.
• Desired Motion:
• Patient flexes fingers at MCP joints,
keeping IP joints extended.
• Resistance:
• Is given on palmar surface of proximal
row of phalanges.
• Note: Resistance may be given to each
finger separately if Lumbricales are
unequal in strength.

6. Fair & Poor
• Position:
• Sitting with hand supported.
• Stabilization:
• Stabilize metacarpals.
• Desired Motion:
• Patient flexes fingers at MCP joints
through ROM, keeping IP joints
extended.
• Patient flexes MCP joints through full
ROM for fair grade and through partial
range for poor grade.

7. Trace & Zero
• Contraction of Lumbricales may be detected by light
pressure against palmar surface of proximal phalanges as
patient attempts to flex at MCP joints.

8. Note
• The Flexor digitorum superficialis and Flexor digitorum
profundus should not be allowed to substitute for
Lumbricales with flexion of fingers.
• These muscles should be kept relaxed as much as possible
with motion limited to meta-carpophalangeal joint.
• Individual testing of fingers (in all tests) is often desirable
as they vary in strength.
Caution!!!!

9. Flexion of Proximal Interphalangeal Joints of Fingers
Flexor digitorum superficialisFlexor digitorum superficialis

10. Diseases of the fingers
• Arthritis (rheumatoid arthritis, gout
arthritis)
• Diabetes
• Fractures
• Trigger finger
• Tendonitis
• Trauma

13. Rheumatoid arthritis trigger

15. Trigger Finger
• Definition
• Trigger finger is an inflammation of the synovial sheath
that encloses the flexor tendons of the thumb and
fingers. Tendons are the cords that connect bones to
muscles in the body. Usually, tendons slide easily
through the sheath as the finger moves.
• In the case of trigger finger, however, the synovial
sheath becomes swollen and the tendon cannot move
easily through small pulleys in the finger, causing the
finger to remain in a flexed (bent) position.
• In mild cases, the finger may be straightened with a
pop, like a trigger being released.
• In severe cases, the finger becomes stuck in the bent
position.
• Usually this condition can easily be treated; contact
your doctor if you think you may have trigger finger.

16. Causes
• Often, the cause of trigger finger is unknown.
However, many cases of trigger finger are caused by
one of the following:
• Overuse of the hand from repetitive motions
– Computer operation
– Machine operation
– Repeated use of hand tools
– Playing musical instruments
• Inflammation caused by a disease
– Rheumatoid arthritis
– Gout
– Hypothyroidism

17. Risk Factors
• The following factors increase your
chances of developing trigger finger:
• Age: 40-60
• History of repetitive hand motions for work
or play
• Sex: female
• History of certain diseases:
– Rheumatoid arthritis
– Gout
– Hypothyroidism

18. Symptoms
• If you experience any of these symptoms do
not assume it is due to trigger finger. Some
of these symptoms may be caused by other
health conditions. If you experience any one
of them for a period of time, see your
physician.
– Finger or thumb stiffness
– Finger, thumb, or hand pain
– Swelling or a lump in the palm
– Catching or popping when straightening the
finger or thumb
– Finger or thumb stuck in bent position

19. Diagnosis
• Your doctor will ask about your symptoms
and medical history, and perform a
physical exam. The physical exam may
include:
• Asking you to move the affected finger or
thumb
• Feeling the hand and fingers
• For severe cases of trigger finger, your
doctor may refer you to a hand specialist.

20. Treatment
• The goals of treatment for
tenosynovitis are:
–to reduce swelling and pain
–to allow the tendon to move
freely with the tendon
sheath.

21. • Treatment options include the
following:
• Rest
• Stopping movement in the finger or
thumb, sometimes with the help of a
brace or splint, is often the best
treatment for mild cases of trigger
finger.
• Rest may be combined with
stretching of the muscle tendon unit
involved.

22. • Medications
• Several medications are used to treat tenosynovitis.
These include:
• Corticosteroids, given as an injection into the
synovial tendon sheath to reduce swelling of the
tendon sheath
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to
help reduce inflammation and pain:
– Ibuprofen (Advil, Motrin)
– Naproxen (Aleve, Naprosyn)
• For severe cases of trigger finger that do not respond
to medications, surgery may be used to release the
finger from a locked position and to allow the tendon
to move freely through the sheath.
• This surgery is usually performed on an outpatient
basis and requires only a small incision in the palm of
the hand.

23. Prevention
• The most important action you can take to
prevent trigger finger is to avoid overuse of
your thumb and fingers.
• If you have a job or hobby that involves
repetitive motions of the hand, you can take
the following steps:
– Adjust your workspace to minimize the strain on
your joints
– Alternate activities when possible
– Take breaks throughout the day
– Exercise regularly

24. Muscles contribute to Flexion of proximal interphalangeal
joints of fingers
Flexor digitorum superficialisFlexor digitorum superficialis
• Origin:
• Humeral head: common flexor origin of medial epicondyle
humerus, medial ligament of elbow.
• Ulnar head: medial border of coronoid process and fibrous arch.
• Radial head: whole length of anterior oblique line
• Insertion:
• Tendons split to insert onto sides of middle phalanges of medial
four fingers
• Action:
• Flexion of PIP & DIP joints
• Nerve supply

25. Normal & Good
• Position:
• Sitting with hand resting palm upward on
table and fingers extended.
• Stabilization:
• Stabilize proximal phalanx of finger.
• Desired Motion:
• Patient flexes middle phalanx.
• Resistance:
• Is given on palmar surface of middle
phalanx of finger.

26. Fair & Poor
• Patient flexes proximal phalanx through full range of
motion for fair grade and through partial range for
poor grade.

27. Trace & Zero
• Superficial portion of the Flexor digitorum
superficialis may be palpated at the wrist under the
Palmaris longus

28. Caution!!!

29. Flexion of Distal Interphalangeal Joints of Fingers
Flexor digitorum profundusFlexor digitorum profundus

30. Muscles contribute to Flexion of distal interphalangeal
joints of fingers
Flexor digitorum profundusFlexor digitorum profundus
• Origin:
• Medial olecranon, upper three quarters of anterior and
medial surface of ulna as far round as subcutaneous
border and narrow strip of interosseous membrane
• Insertion:
• Distal phalanges of medial four fingers.
• Tendon to index finger separates early
• Action:
• Flexion of PIP & DIP joints
• Nerve supply