Hand Exam

Question 1

Name the innervation for
FDS
FDP
Lumbricles

Answer 1

• FDS - all median nerve
• FDP - split: to IF and MF = median, to RF and SF = ulnar n.
• Lumbricles - split: 1st and 2nd (IF and MF control) = median, 3rd and 4th (RF and SF control) = ulnar n

Question 2

Froment’s sign

Answer 2

ulnar n. Injury. Ask pt to grip paper b/t ulnar side of thumb and radial side of IF proximal phalanx….Negative if able to grip w/o flexing IP joint of thumb, thus using ADDuctor pollicis (ulnar n.). Positive sign = flexion at thumb IP joint (using AIN) in order to keep paper from slipping. May also notice 1st web space (b/t thumb and index) wasting

Question 3

Bouvier Test

Answer 3

• used to determine the ability of PIP joints to extend with MCP flexion
  * With wrist in neutral position, examiner holds the MCP flexed and looks for ability to extend PIPs
  * If can extend PIP -> Positive test and patient has “simple clawing” - only need to perform procedures that flex MCPs (insert tendon graft prox phalanx, 1st annular pulley, second annular pulley)
  * If cannot extend PIP -> Neg test -> insert tendon grafts distal to lateral bands