Anatomy Practical - Wrist & Hand

Question 1

Flexor Carpi Radialis

Answer 1

A: Wrist flexion & Radial deviation
O: Medial Epicondyle
I: Base of 2nd Metacarpal

Palp: Patient sitting w/ forearm supine on table. OT sitting
Palp fingers just proximal to radiocarpal joint. Ask patient to make a tight fist & radially deviate & flex wrist. Palpate from wrist proximally toward medial epicondyle

Question 2

Flexor Carpi Ulnaris

Answer 2

A: Wrist flexion, ulnar deviation
O: Medial epicondyle
I: 5th metacarpal

Palp: Patient sitting w/ supine forearm resting on table
Palpation fingers just proximal to pisiform. Ask patient to make a tight fist and ulnarly deviate. Palp from proximal wrist to medial epicondyle.

Question 3

Palmaris Longus

Answer 3

A: Wrist flexion aid
O: Medial epicondyle
I: Palmar aponeurosis

Palp: Patient sitting w/ supine forearm resting on table
Ask patient to oppose thumb to little finger & flex wrist. Tendon will be visible, palpate proximally toward medial epicondyle. Absent in 14% population

Question 4

Flexor Digitorum Superficialis

Answer 4

A: Flexes PIP
O: Medial epicondyle; oblique line of radius
I: Middle phalanges of each digits 2-5

Palp: Patient’s forearm supine
Block MP flexion . Ask to flex PIP and palpate tendons between FCR and FCU . HOOK GRIP

Question 5

Flexor Digitorum Profundus

Answer 5

A: Flexes DIP
O: Medial ulna, interosseous membrane, deep fascia of forearm
I: Distal phalanges of each digits 2-5

Palp: Place palp fingers 2 inches distal to medial epicondyle. Block PIP flexion by placing your fingers over the dorsal side of MP/PIPs and your thumb on volar middle phalanx to block motion

Question 6

Extensor Carpi Radialis Longus (ECRL)

Answer 6

A: Wrist extension & radial deviation
O: Proximal part of lateral supracondylar ridge of humerus
I: Base of 2nd Metacarpal

Palp: Patient’s forearm prone, place palp fingers just radial to lister’s tubercle. Ask patient to make tight fist & find tendons as they stand out just radial of Lister’s tubercle. ECRL is more radial of the two

Question 7

Extensor Carpi Radialis Brevis (ECRB)

Answer 7

A: Wrist extension & radial deviation
O: Lateral epicondyle
I: Base of 3rd Metacarpal

Palp: Patient’s forearm prone, place palp fingers just radial to lister’s tubercle. Ask patient to make tight fist & find tendons as they stand out just radial of Lister’s tubercle. ECRL is more radial of the two

Question 8

Extensor Carpi Ulnaris (ECU)

Answer 8

A: Wrist extension & ulnar deviation
O: Lateral epicondyle
I: Base of 5th Metacarpal

Palp: Place palp fingers just distal to ulnar styloid in the depression at the joint. Resist dorsum of patient’s hand in extension and slight ulnar deviation. Palpate ECU tendon as it passes over ulnar styloid to the 5th metacarpal. Follow the muscle belly along the ulnar boarder of forearm toward the lateral epicondyle

Question 9

Extensor Digitorum Communis (EDC)

Answer 9

A: Wrist extension, 2-5 finger extension
O: Lateral epicondyle
I: Fascia on dorsum of fingers

Palp: Patient’s forearm prone, make a tight fist.
Place fingers at the distal end of the proximal phalanx of all 4 digits. Ask patient to lift & extend MPs. Tendons become visible and palpable along each digit & run proximally b/w ECRL and ECU at the wrist and move proximally to muscle belly towards the lateral epicondyle. Important for letting go of held objects in the hand.

Question 10

Extensor Indicis (EI)

Answer 10

A: Extends index finger
O: Ulna & interosseous membrane
I: Fascia on dorsum of index finger

Palp: Patient’s forearm prone on table top
Ask patient to lift index finger off table top. Observe & palpate tendon along dorsum of index finger.

Question 11

Extensor Digiti Minimi (EDM) lol

Answer 11

A: Extends minimi
O: Lateral epicondyle
I: Fascia of dorsum of 5th digit (extensor hood)

Palp: Patient’s forearm prone, other fingers relaxed while they bring up pinky finger. Observe and palpate tendon along the 5th digit.

Question 12

Abductor Pollicis Longus (bottom)

Answer 12

A: abducts the thumb and extends at CMC
O: Proximal ulna & radius
I: Base of 1st metacarpal

Palp: Patient’s forearm neutral, slightly pronated. Ask them to extend and slightly abduct the thumb. Palpate the most prominent outer tendon on the radial boarder of the anatomical snuffbox to the radial styloid

Question 13

Extensor Pollicis Brevis (middle)

Answer 13

A: MP extension of thumb
O: Posterior distal radius
I: Dorsal base of thumb’s proximal phalanx

Palp: Patient’s forearm neutral, slightly pronated. Ask them to extend and slightly abduct the thumb. Palpate the less prominent inner tendon on the radial boarder of the anatomical snuffbox to the radial styloid

Question 14

Extensor Pollicis Longus (top)

Answer 14

A: IP extension of thumb
O: Posterior ulna
I: Dorsal base of thumb’s distal phalanx

Palp: Patient’s forearm neutral, slightly pronated. Ask them to extend and slightly abduct the thumb to expose the snuffbox. Palpate the tendon that forms the more dorsal ulnar boarder of the snuffbox. Palpate from radial styloid to distal phalanx of the thumb.

Question 15

Flexor Pollicis Longus

Answer 15

A: MP and IP flexion of thumb
O: Anterior radius
I: Base of distal phalanx of thumb

Palp: Patient’s hand SUPINE
Place palp finger at volar IP joint. Hold thumb MP to limit motion and ask patient to flex IP joint of thumb

Question 16

Abductor Pollicis Brevis

Answer 16

A: Abducts CMC

Palp: Patient’s hand supine
Place palp fingers on radial side of thenar. Ask patient to radially abduct the thumb. Important for typing, piano playing and rock climbing

Question 17

Flexor Pollicis Brevis

Answer 17

A: Flexes thumb CMC & MP

Palp: Patient in MP flexion with IP in full extension
Place palp finger over thenar at the MP crease of thumb. Ask patient to hold as you apply pressure to resist flexion at the proximal phalanx of thumb.

Question 18

Opponens Pollicis

Answer 18

A: Thumb opposition

Palp: Patient’s hand supine
Place palp fingers on thenar eminence. Ask patient to oppose thumb to pinky. Provide resistance to opposition at proximal phalanx to enhance palpation.

Question 19

Adductor Pollicis

Answer 19

A: Adducts thumb CMC

Palp: Patient’s hand supine
Place palpation thumb in web space between thumb and index. Ask patient to adduct as you provide resistance to proximal phalanx of both thumb and index simultaneously.

Question 20

Abductor Digiti Minimi

Answer 20

A: Abducts Minimi

Palp: Patient’s hand supine
Place palp finger on ulnar boarder of hand. Position 5th digit in slight abduction (finger straight). Ask patient to hold as you apply gentle resistance in abduction to ulnar side of proximal phalanx.

Question 21

Flexor Digiti Minimi

Answer 21

A: Flexes Minimi

Palp: Patient’s hand supine
Place palp finger at the end of the 5th metacarpal just proximal to MP joint. Position patient’s 5th digit in MP flexion with PIP and DIP in full extension. Ask patient to hold as you apply resistance to flexion over the proximal phalanx.

Question 22

Opponens Digiti Minimi

Answer 22

A: Draws 5th digit anteriorly and rotates toward opposition with thumb

Palp: Patient’s hand supine
Palpate over radial side of hypothenar eminence. Ask patient to oppose thumb to 5th digit. Provide resistance to opposition by applying resistance in the direction at proximal phalanx.