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