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