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Functional Hand Anatomy Flashcards

1
Q

List muscles innervated by the median nerve in order of innervation

A

PT, FCR, PL, FDS, FDP D3

AIN: FPL, FDP D2, PQ

Recurrent br: OP, APB, FPB (supericial head)

Lumbricals 1, 2

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2
Q

Describe course of median nerve

A

BP: roots C5-T1, br of lateral cord from anterior division of upper/middle trunk + br of medial cord from anterior division of lower trunk

ARM:

  • Lateral to Brachial artery, between brachialis and biceps
  • cross over coracobrachialis and run medial to brachial artery
  • *Ligament of Struthers forms tunnel to enter forearm between supracondylar process and medial epicondyle

FOREARM

  • deep to *Lacertus FIbrosis* and bicipital aponeurosis
  • between *2heads of PT*
  • AIN runs between FDP, FPL and deep to PQ with AIA (ulnar source)
    • FPL, FDP D2, PQ
  • Median proper runs b/w FDS and FDP
    • ​PT, FCR, PL, FDS, FDP
  • Palmar cut br 5cm proximal to wrist crease b/w FCr PL

WRIST

  • Recurrent motor br 50% distal to TCL, 30% wihtin CT, 20% pierce TCL
  • APB, FPBs, OP
  • Lumbrical 1,2
  • Sensory D1,2,3.5
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3
Q

List muscles innervated by radial nerve

A

Triceps (long, lateral, medial heads), BR, ECRL

Anconeus, Supinator

PIN: +/-ECRB, EDC, EDM, ECU, APL, EPB, EPL, EIP

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4
Q

Describe course of radial nerve

A

BP: roots C5-T1, posterior cord

ARM:

  • triangular interval (triceps long/lateral heads and teres major)
    • posterior to brachial artery, medial to humerus, along long head of triceps
  • Radial groove with deep brachial artery
  • PCN antebrachial
  • Triceps long/lateral/medial, BR, ECRL, ECRB, anconeus, Brachialis (medial only)
  • LIMS 10cm above lateral epicondyle w radial collateral artery
  • Radial Tunnel (Lat ECRB, ECRL, BR, Medial biceps brachialis, Floor Radiocapitellar joint, Roof BR)

ELBOW:

  • Deep branch and superficial br 4cm above supinator
  • SBRN run under BR radial to radial artery, emerge between BR and ECRL 9cm before styloid, superficial to EPB,APL,extensor retinaculum.
  • Deep br pierce supinator and wrap around radius neck to go to Posterior ocmpartment
    • Arcade of frohse = proximal edge of supinator
    • PIN as exiting supinator
    • +/- ECRB, EDC, EDM, ECU,APL, EPB, EPL, EIP
    • PIN & PIA run together deep to 4th compartment
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5
Q

What are the surface landmarks for identifying the A1 pulleys for each digit

A
  • Distal palmar crease -> D4, D5 A1 pulley
  • Proximal palmar crease ->D2
  • Midway between 2 above - > D3
  • MCP crease -> thumb
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6
Q

What is kaplan’s line

A
  • Line drawn parallel to proximal palmar crease begining in first web space and coursing through hook of hamate
  • at line perpendicular to radial border of D3 and kaplan = recurrent motor br of median n
  • at line perpendicular to ulnar border of D4 and kaplan = common ulnar digital n
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7
Q

Where are cleland and grayson ligaments relative to NV bundle and what is there function?

A
  • Cleland - dorsal to NV. Fx to retain integument in position
  • Grayson - volar to NV. Fx to prevent bowstringing of NV bundle with movement
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8
Q

Name the potential spaces in the hand

A
  • Deep
    • Thenar
    • Hypothenar
    • Midpalm
  • Superficial
    • Dorsal sub-aponeurotic
    • Dorsl subcutaneous
    • Interdigital web (collar button)
  • Extend into Forearm
    • Parona’s space
    • Radial bursa
    • Ulnar bursa
  • Palmar space
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9
Q

What are theories of carpal alignment trasnlating to function (3)

A
  • Classic
    • 2 rows
      • proximal radiocarpal row = S, L, Tq, (+Ps)
      • Mid carpal row = Tz, Tm, C, H
  • Navarro
    • 3 longitudinal colums
      • central - flex-extend = C, L, H
      • radial - trasnfers load of thumb = Tz Tm S
      • Ulnar - prono-sup.= Tq
  • Lichtman
    • oval ring concept made of 4 elements
      • S, L, Tq and the distal row
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10
Q

How do you determine if a carpal height is normal?

A
  • Carpal height = 1/2 length of D3 MC
  • Carpal height = 1.5 x Capitate height
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11
Q

What are normal angles of relation to the lunate ? (b/w S-L, R-L, C-L)

A
  • R-L <15’
  • C-L <15’
  • S-L 30-60
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12
Q

What are the ligaments of the wrist

A
  • Extrinsics - span radiocarpal and midcarpal
    • Volar
      • RSC (radioscaphocapitate)
      • long and short RL
      • UL
      • UTq
    • Dorsal
      • DRC (Dorsal radiocarpal - to Tq)
  • Intrinsics - b/w carpal bones
    • S-L, L-Tq, T-T, T-C, C-H
    • DIC (dorsal intercarpal - S-Tz - Tq)
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13
Q

What is the TFCC, what does it consist of, and its fx

A

Triangular fibrocartilage complex

  • origin: sigmoid fossa & lunate fossa of distal radius
  • insertion - ulnar styloid
  • fx; primary stabilizer of the DRUJ

Consists of:

  • triangular fibrocartilage
  • ulnar meniscus homologue
  • dorsal and volar radioulnar ligaments
  • UL and UT interosseous ligaments
  • ECU tendon sheath
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14
Q

Define the boundaries and contents of the carpal tunnel

A
  • Roof: TCL
  • Floor: volar radiocarpal ligaments
  • Radial; Trapezium and scaphoid tubercle
  • Ulnar; Pisiform and hook of hamate

Contents

  • 4FDP 4FDS tendons
  • FPL
  • median nerve
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15
Q

Define the boudaries and contents of Guyons canal

A
  • Roof: Volar carpal ligament and Pisohamate lig,
  • Floor/Radial wall: Hook or hamate and TCL insertion
  • Ulnar wall: Pisiform and PHlig insertion

Contents

Ulnar nerve and artery (nerve is ulnar)

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16
Q

List the extensor compartments

A
  1. APL, EPB
  2. ECRL, ECRB
  3. EPL
  4. EDC, EIP
  5. EDM
  6. ECU
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17
Q

What is the important stabilizer of the first CMC joint?

A

Saddle joint - biconcave b/w Tm and 1st MC

Allows for 3planes of motion (flex-ext, abd-add, pron-sup

Volar oblique (beak)ligament is primary stbailizer

APL insertion on dorsal base of MC is 2’ stabilizer

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18
Q

What tendons insert on the dorsal base of D2,3,4,5?

A
  • D2- ECRL
  • D3- ECRB
  • D4- none
  • D5- ECU
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19
Q

Name and describe the stabilizers of the MCP jts

A
  • Volar plate - Accessory CL and CL
    • areolar tissue prximal to allow for shrinkage w flexion
  • Condyloid shape of MC head with narrow dorsal and wide volar shape - non-spherical
  • DTMC - attaches to VP - lumbricals are volar and IO are dorsal to DTMC
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20
Q

What is unique about the volar plate of the MCPjt of the thumb

A
  • contains two sesamoid bones
  • Radial sesamoid- insertion of FPB +/- APB
  • Ulnar sesamoid - insertion of adductor pollicis
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21
Q

What is the difference between the proper and accessory collateral ligaments

A
  • proper CL originate on BONE (lateral condyle of MC) and the accessory originate on ligament (the Proper CL)
  • Both CLs insert on volar plate, only Proper Cl insert on bone (PP)
  • Function: Proper CL are tight in flexion and stabilize power grip
  • Function: Accessory are tight in extension
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22
Q

How do IP joints differ from MCP joints

A
  • IPs are hinge joints, MCPs are condyloid joints
  • VP prevents hyperextension in IPs
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23
Q

Where are the annular and cruciate pulleys located

A
  • 5 annular pulleys
    • A1,3,5 overlie MCP PIP DIP jts and insert on volap plate and bone
    • A2,4 lie in between
  • 3 cruciate pulleys
    • lie b/w A2-3, 3-4, 4-5 - at location of trasnverse digital arteries
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24
Q

WHat is the vascular supply ot the tendons

A
  • Segmental
    • Arises from vincula (condensation of mesotenon), bony insertions, paratenon
    • each tendon has 2 vincula - VB and VL
    • the VBS and VBP insert just proxial to FDS and FDP insertions
    • VLP (at PIP jt), VLS (at base PP)
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25
Q

What abnormalities in extensor tendons can be expected?

A
  • EDC multiple slips to D4, D5
  • Absent EDC to D5
    *
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26
Q

What is the fx of the sagittal bands

A
  • maintains EDC tendon centralized over MCP
  • Origin: VP and DTMC
  • Insertion: EDC
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27
Q

What is fx of Lateral bands

A
  • flexion MCP, extension IPs
  • Formed by Lumbrical + IO radially and just IO ulnarly
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28
Q

What is the function of the trasnverse retinacular ligament and where are they located

A
  • Origin: flexor sheath of PP
  • Insertion: conjoined tendons of lateral band,
  • Course: Runs lateral to PIP joint & superficial to collaterals
  • Function: Prevents excessive dorsal translation of lateral bands w PIPJ extension, facilitates volar translation of lateral bands w flxn
  • attenuation leads to dorsal translation of lateral bands —> swan neck
  • contracture leads to volar translocation —> boutonierre
  • (KI I CHANGED THIS, REVIEW YOURSELF AS WELL)
  • origin: deep belly of IO
  • insert: extensor hood, distal to and parallel w sagittal bands
  • Fx: insertion of IO to PP to facilitate MCP j flexion
  • ***Transverse bands Tighten in intrinsic tightness
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29
Q

What is the function of the oblique retinacular ligament and where are they located

A
  • Originates on volar PP / FTS
  • inserts after oblique course on terminal tendon
  • fxn: Coordinated PIP & DIP flexion and extension
    • (as DIP flexes, ORL tightens causing flexion of PIP; as PIP extends, ORL tightens causing extension of DIP; passive flexion of PIP relaxes ORL and allows DIP flxn)
  • contracture causes volar displacement of lateral bands (boutonierre)
  • becomes lax in swan neck
  • test: extend the PIP joint (tightens the ligament) and note resistance to passive DIP flexion (relative to when the PIP is flexed)

*

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30
Q

What is the fx, origin, insertion of the lumbricals

A
  • Fx- PIP jt extension
  • Origin - FDP tendon
  • Insertion
    • form RADIAL lateral band =>PIP extension
    • form Oblique fibers of extensor hood =>MCP flexion
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31
Q

WHere are the interossei located and what is their function

A
  • Palmar Interossei - Adduction
    • unipennate
    • form lateral band
  • Dorsal interossei - Abduction
    • bipennate
    • superficial head
    • deep head- forms transverse fibers of lateral band
  • D2: DIO radial, PIO ulnar
  • D3: DIO radial and ulnar
  • D4: DIO ulnar, PIO radial
  • D5: PIO radial * ADM acts as abductor
32
Q

What maintains the position of the conjoined lateral bands during motion of the PIP DIP jts

A
  • Triangular ligament - on dorsum, holds conjoint laterla bands from slipping volar
  • TRL - volar, prevent dorsal subluxation of conjoint lateral bands durign extension (origin on flexor sheath, insert on lateral bands
33
Q

What is the fx of the ORL (lig of landsmeer)

A
  • Origin: volar PIP jt
  • insertion: dorsal DIP jt at TT
  • Fx: links flexion and extension of pip and dip jt
34
Q

Describe the anatomy of the brachial plexus

A

Roots

  • C5-T1 - preaxial C4, postaxial T2
  • C5-C7, roots arises above names vertebrae, C8-T1, nerves arise below C7 and T1
  • Located between anterior and middle scalene

Trunks

  • Located in the posterior triangle
  • Forms upper trunk C5-6, middle trunk C7 Lower trunk C8T1
  • Each trunk divides into anterior and posterior divisions

Divisions

  • Located posterior to the clavicle
  • Anterior division of upper and middle trunk form lateral cord
  • Anterior division of lower trunk form medial cord
  • Posterior divisions of all trunks for posterior cord

Cords

  • Located around axillary artery, posterior to pectoralis minor
  • Medial cord divides into medial br of median and ulnar n
  • Lateral cord divides into lateral br of median and MSC
  • Posterior cord divides into radial and axillary n
35
Q

Where does the suprascapular nerve originate and its funxtion

A

most common to least common

  • posterior division of upper trunk
  • at bifurcaiton of upper trunk
  • proximal to bifurcation of upper trunk

Function

  • Supraspinatus (first 15’ abduction)
  • Infraspinatus (external rotation)
36
Q

Where does the lateral pectoral nerve originate and its funxtion

A

most common ->least common

  • Anterior division of upper trunk, proximal to lateral cord formation
  • at formation of lateral cord

Function

  • clavicualr head pectoralis mjor
37
Q

Describe course of ulnar nerve

A

BP: terminal br of Medial cord, C8-T1

ARM:

  • medial/posterior to brachial artery
  • MIMS 8cm proximal to epicondyle
  • run ontop of triceps with superior ulnar collateral artery
  • Arcade of struthers* (MIMS, triceps fascia)
    • runs between MIMS and Tricep fascia
  • Articular br
  • Cubital Tunnel - Osborne’s ligament b/w ME and olecranon + FCU aponeurosis, floor is ulnar collateral ligament

FOREARM

  • FCU heads*
  • FCU, FDP D4,5
  • courses between FCU and FDP
  • ulnar to ulnar artery at jx of mid&distal 1/3
  • DSU 3-6cm proximal to ulnar styloid, uulnar to FCU

WRIST

  • Guyon’s canal: roof VCL, floor TCL, ulnar pisiform, radial hook of hamate
  • Zone 1 - before bifurcation
  • Zone 2 - deep motor br
    • Pisohamate ligament * landmark for deep motor br b/w ADM FDM
    • pierces ODM, goes radially around Hook
    • Deep palmar arch + deep motor ulnar br course together deep to flexors
  • Zone 3 - superficial sensory br
    • PB, Hypothenar, 4th Common Dig, 5th proper Dig
  • Lumbrical 3,4, IO, FPBd, AdP, 1st DIO
38
Q

List muscles innervated by ulnar n

A

FCU, FDP D4,5,

PB,

AbDM, FDM, ODM, Lumbrical 5,4, IO, dFPB, AdP, 1st DIO

39
Q

What is a martin gruber anastomosis

A

Anomalous innervation of median nerve (AIN) to ulnar intrinsics (17% have some connection)

  • type 1 - median to ulnar innervating median intrinsics (60%) (cross back)
  • type 2 - median to ulnar innervating ulnar intrinsics (30%)
  • type 3 - ulnar to median, innervating median intrinsics (3%)
  • type 4- ulnat to median, innervating ulnar intrinsics (cross back)

KATHY - I MADE A NEW/DIFFERENT CARD ON THIS - I DON’T THINK THIS IS RIGHT OR THE DETAIL WE SHOULD KNOW FOR THE EXAM. LET’S TALK ABOUT IT!!! :)

40
Q

What is a riche cannieu

A

Ulnar to median n cross connect in palm (b/w deep motor br and recurrent motor br)

41
Q

Describe course of ulnar artery and its branches

A

ULNAR ARTERY

  • Brachial artery terminal branch
  • Antecubital fossa - ulnar artery medial to biceps tendon
  • Deep to PT
  • b/w FCU and FDP with ulnar nerve
  • subcutaneous radial to FCU
  • superficial to TCL, radial to Pisiform
  • Superificial br forms Superficial palmar arch**main
  • Deep branch forms Deep palmar arch

​

BRANCHES

  • Anterior & posterior IO arteries - travel on either side of IOM - AIO may persist as median artery
  • Anterior & posterior recurrent arteries-
    • AUR- supplies BR - PT
    • PUR - elbow
42
Q

Describe course of Radial artery and branches

A

RADIAL ARTERY

  • Cubital fossa - deep to BR - runs w SRN
  • subcut in wrist
  • Superficial palmar arch branch courses over APB to arch
  • Snuff box - deep to APL EPL EPB and plunges through 1st DIO
  • terminates as deep palmar arch and princeps pollicus
    • ​PP gives rises to common digital artery (thumb) and radialis indicis
43
Q

What is the median artery?

A
  • persistent AIA off of CIA from ulnar artery
  • present in 20% of people
  • RF/etiology for CTS
44
Q

What is the blood supply (arches) to the hand and their location

A
  • Superficial Palmar arch
    • superficial to long flexor and lumbrical
    • at kaplans cardinal line
    • branches: CDA 2nd 3rd 4th web space and proper 5th dig art
  • Deep Palmar arch
    • deep to long flexors, lumbricals
    • proximal to kaplans line
    • branches; palmar MC arteries - **join CDAs
  • Dorsal arteries
    • from PIA and dorsal br of AIA + br of rad/uln to form dorsal carpal arch (deep palmar MC arteries)
    • dorsal artery is primary revascularization for thumb?
  • Digital arteries
    • formed by superficial palm arch + contributing metacarpal arteries from deep palm arch just prior to bifurcation
45
Q

What is extrinsics tendon tightness

A
  • scarring/adhesions over dorsum of wrist/hand which prevent tendons from gliding
  • TEST: wrist, neutral, flex MCPs. PIPs will remain extended and will not be able to flex
46
Q

How do you test intrinsics

A
  • Lumbrical - MCP flex IP ext
  • IO - hand flat on table, D3 hyperextended to eliminated extrinsic extensors, ab/adduct D3
  • Hypothenar - abduct D5
  • Adductor pollicis - pinch between radial side of index and thumb - Fromments
47
Q

What is intrinsic muscle tightness

A
  • IO transverse fibers (from deep IO muscle belly to PP)
  • TEST -w rist in neutral, MCP extension, PIP cannot be flexed
48
Q

What are special and specific hand tests during physical examination

A
  • Finkelsteins - traction and stretching over 1st Dorsal compartment reproduces pain = dequervains
  • grind test- axial load to 1st CMC jt reproduces pain = OA
  • Tnel’s- regenerating axons
  • Fromment’s - with pinch of thumb to radial indez, weakness of intrinsics (AddP) causes FPL to flex IP
  • Boyes ORL tightness test - decreased DIP flexion w PIP extension
49
Q

What is the clinical significance of a positive ORL tightness test

A

Boyes ORL tightness test

  • examiner holds PIP extended and passively/actively get DIP flexion to occur - if unable to flex DIP with PIP exteded, means ORL is tight= subacute or chronic central slip injury ->leads to boutoniere deformity
50
Q

What is the clinical significance of a positive Bunnell intrinsic tightness test

A

With MCP hyperextended, limited PIP flexion = intrisic tighness - need to release trasnverse fibers form deep head of IO

With MCP flexed, limited PIP flexion = extrinsic tightness

51
Q

How do you test for DRUJ instability or arthritis?

A

DRUj compression test

  • holdig ulna against sigmoid notch of radius and passively pron/supinating hand - reproduction of pain suggests DRUj arthritis
52
Q

How do you test for ECU subluxation

A
  • Palpate ECU with supination and ulnar wrist deviaition - if sublux - grossly unstable
  • if ECU contraction is needed to sublux, som e stbaility remains
  • Pain with ecu subluxation is critical for considering repair
53
Q

How do you test for cubital tunnel syndrome

A
  • Elbow flexion test - supinated hand, elbow flexion for 60secs
  • tinel’s at cubital tunnel
54
Q

What is elsen’s test

A

To determine if complete central slip injury

  • injured hand placen on table spporting PP and PIP jt is over table. Ask pt with extend
  • postiive if unable to actively extend PIP but DIP is rigid
55
Q

What is foveal sign?

A

Pain at fovea - (at depression dorsal to FCU = ulnar styloid) - indicates TFCC injury

56
Q

What is the LIchtman midcarpal shift test

A
  • pronated wrist in ulnar then radial deviation, approx 15’, pressure on downward capitate - midcarpal instability if clunk
57
Q

for a patient with an apparent motor / functional deficit of the digits of the hand, how do you differentiate between a neurologic etiology vs a musculotendinous etiology?

A
  • by invoking the tenodesis effect; if intact then the musculotendinous units are intact and the problem is neurogenic.
  • if not intact, it is possible that are both musculotendinous and nerve injury
58
Q

What is the Bunnell test?

A
  • test for intrinsic tightness
  • have patient flex IP joints when a) MCPJ extended passively and b) MCPJ flexed passively
  • test is POSITIVE when IPJ flexion is limited when MCPJ is passively extended, indicating intrinsic tightness
59
Q

What is Elson’s test?

A
  • tests the integrity of the central slip
  • the affected digit is flexed over a tabletop at the PIPJ
  • extension at the PIPJ is actively resisted by the examiner
  • if the central slip is intact, all force will be transmitted through the central slip and the DIPJ will remain slightly flexed and flaccid
  • if the central slip is not intact, the force will be transmitted through the lateral bands to the terminal tendon, and the DIPJ will extend and be rigid
60
Q

What is the Bouvier test?

A
  • the Bouvier test tests the integrity of the central slip in the context of chronic ulnar nerve injury
  • with the patient’s MCPJ claw hyperextension deformity passively corrected, by being passively held to neutral or just slightly flexed at MCPJ, the patient is asked to extend the PIPJ
  • if PIPJ extension is intact, there is sufficient tension along the central slip and static reconstructive maneuvers can be employed to correct the claw
  • if PIPJ extension is not intact, there is laxity/attenutation of central slip and dynamic reconstructive maneuvers will be employed to correct the claw
61
Q

what is the origin/insertion/function of transverse retinacular ligament

A
  • TRL originates from PP/FTS at PIPJ laterally and terminates in the conjoined lateral band
  • fxn: prevent excessive dorsal translation of lateral band during extension, and facilitates volar translation during flexion
  • when attenuated, dorsal displacement lateral bands - swan neck
  • when contracted, volar displacement lateral bands - boutonniere
62
Q

what is the origin/insertion/function of the oblique retinacular ligament?

A
  • runs from volar PP / FTS dorsolaterally to insert into terminal tendon
  • facilitates coordinated movement (flxn/extn) between PIP and DIP joints
  • when contracted - lateral bands displaced volar - boutonniere
63
Q

what muscles does the deep motor branch innervate once it is in zone 2 of guyon’s canal?

A
  • hypothenar muscles: FDMB, AbdDM, OppDM
  • ulnar 2 lumbricals
  • dorsal (4) and volar (3) interossei
  • AddP
  • 1/2 of FPB
64
Q

what does superficial sensory branch of ulnar nerve innervate once it enters zone 3 in Guyon’s canal?

A
  • palmaris brevis muscle
  • sensation to D5 and ulnar 1/2 of D4
65
Q

what is the checkrein ligament, where is it found, and what is its function

A
  • checkrein ligaments are proximal thickened extensions of the volar plate at the PIPJ
  • function to prevent hyperextension while permitting flexion
66
Q

draw the extensor apparatus

A
67
Q

IN A PATIENT WITH A MARTIN-GRUBER ANASTOMOSIS, DESCRIBE THE INTRINSIC MUSCLE FINDINGS IN THE HAND IN THE FOLLOWING SCENARIOS:

  • proximal median n injury
  • distal median n injury
  • proximal ulnar n. injury:
  • distal ulnar n injury:
A
  • Martin Gruber is MEDIAN TO ULNAR Nerve communication in the forearm
  • proximal median n injury – median n. AND ulnar n intrinsics OUT
  • distal median n injury – median n intrinsics OUT, ulnar intrinsic IN
  • proximal ulnar n. injury: ulnar n intrinsics IN, median n intrinsics IN
  • distal ulnar n injury: ulnar intrinsics OUT, median n intrinsics IN
68
Q

What is a Marinacci communication?

A
  • ULNAR TO MEDIAN nerve communication in the FOREARM
69
Q

In a patient wiht a Riche-Cannieau communication, what are the intrinsic muscle findings and sensory findings in the hand in the following situations?

  • median n injury proximal to wrist
  • ulnar n injury proximal to wrist
A
  • Rich-Canneau is a DMB to RMB in the palm
  • median n injury proximal to wrist: NORMAL thenar muscle function
  • ulnar n injury proximal to wrist: NO intrinsic muscle function
  • both: sensation normal
70
Q

What is a sensory communication between the superficial sensory branch of ulnar nerve and sensory branch of median nerve in the palm called?

A
  • Berrettini communication
71
Q

If you could only repair 1 proper digital artery in a replant, which one would you repair?

A
  1. Least traumatized / smallest zone of injury / not requiring vein graft / good flow
  2. All other things being equal, then choose the “dominant” vessel:
  • in general, dominance heads to equator of hand (long finger)
  • thumb, index, long (less obvious): ulnar
  • ring (less obvious), small: radial
72
Q

how do you test interossei function while eliminating the extrinsic extensor function on IPJ extension?

A
  • hand / palm flat on table
  • lift index / hyperextend MCPJ off table then adduct/abduct (dorsal/volar interossei)
73
Q

how do you test for ORL tightness? who’s eponym goes w the test?

A
  • see Boutonneire
  • with flexible digit - when PIPJ held extended, there is limited passive flexion of DIPJ
  • Boyes
74
Q

what physical examination maneuver indicates tightness or contracture of extrinsic flexors?

A
  • with flexion of wrist/MCPJ the IPJ easily are passively extended
  • vs. w extension of wrist and (hyper) extension of MCPJ the IPJs will not be passively extended
75
Q

what diagnosis is confirmed when Love test and Hildreth sign are positive?

A
  • glomus tumour
76
Q
A

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