Examination of the hand Flashcards
Important consequence of ulnar nerve damage at wrist
Why does this cause ulnar claw
Paralysis of medial 2 lumbricals, leading to:
Hyperextension of MCP joints of ring and little fingers
Flexion of IP joints of ring and little fingers (extensor muscles can’t extend at IP joints as their energy is dissipated in hyperextension at MCP joints)
When is ulnar claw apparent
At rest
How is ulnar paradox caused
Ulnar nerve damage at elbow
What muscles are paralysed in ulnar nerve damage at elbow
Medial 2 lumbricals
Flexor carpi ulnaris
Medial 1/2 of flexor digitorum profundus
Is ulnar paradox more or less evident than ulnar claw
Why
Less
Paralysis of flexor digitorum profundus means there is no Flexion at distal IP of ring and little fingers
What’s associated with median nerve damage at the elbow
Hand of benediction
What’s associated with median nerve damage at wrist
Carpal tunnel syndrome
When is hand of benediction evident
When patient tries to make a fist
Important consequence of median nerve damage at elbow
Why does this cause hand of benediction
Paralysis of:
Lateral 2 lumbricals
When patient makes a fist this leads to:
Inability to flex MCP joints of index and middle fingers
How to test radial nerve function
Hold wrist and ask patient to extend wrist against your hand
How to test median nerve function
Ask patient to abduct thumb against your finger
Ask patient to oppose thumb against your finger
How to test ulnar nerve function
Ask patient to abduct fingers against your fingers
Froment’s test - pull paper from under patients flat thumb (positive test if they can’t keep thumb flat)
How is ulnar claw formed
Ulnar nerve lesion at wrist
