Muscle wasting in the thenar eminence, first three and fingers, and half the fourth fingers on radial side of the hand. Median Nerve (depending on area impingement). 
Muscle wasting due to nerve disfunction. Rheumatoid Arthritis - MCP swelling, Swan neck deformities, Ulnar deviation at MCP joints, Nodules along tendon sheaths. Osteoarthritis - Heberden’s nodes: DIP, Bouchard’s nodes: PIP. Ganglions - Cystic structure that arises from synovial sheath. Observe upper extremity as the patient enters the room. Were any diagnostic test/imaging performed and what were the results?. Presence and location of numbness, pins and needles and/or tingling. Handedness, occupation, previous injury and fracture history. Mechanism of the injury - How the injury occurred and what was the cause e.g. Each physical therapist will develop their own style and technique, but a good interview will include the basic elements discussed below: Thorough history taking is an important first step in treating the patient. Diagnosing hand and wrist conditions is often difficult and for this reason, bilateral comparison can be useful Subjective History A hand and wrist examination done in a structured manner will help to facilitate the most appropriate working diagnosis for treatment. Optimal overall function is important to so many activities of daily living. Mnemonic: Like the deep flexor muscles, remember Ps.The hand and wrist is form a group of complex, delicately balanced joints which are considered the most active portion of the upper extremity. Its origin and innervation are characteristic of a extensor muscle, but it is actually a strong flexor of forearm. These structures can be grasped between thumb and index finger just distal to lateral epicondyle. MCP (Metacarpophalangeal joint): Saggital bandĮxtensor digitorum minimi – 2 tendons (EDM/EDQ)īrachioradiailis, ECRL and ECRB are the components of Mobile wad of Henry. ECRB, EDC, EDM, ECU (lateral epicondyle group) are supplied by raidal nerve branche – PIN (posterior interosseous nerve).ĭeforming force in distal radius fracture. Nerve supply: Radial nerve or one of it’s branches Brachioradialis and ECRL originates from: Lateral condyle. All other fingers represent origin point as lateral epicondyle: Little finger – extensor Carpi radialis brevis, extensor Digitorum (C-D) Ring finger – extensor Digitorum minimi (D) Middle finger – extensor Carpi ulnaris Index finger – Anconeus (A).Ĭommon extensor origin: Lateral epicondyle The thumb is above and represents the origin point as lateral condyle for Brachioradialis and extensor Carpi radialis longus (B-C). Then go in the sequence of thumb (B-C), little finger (C-D), ring finger (D), middle finger (C) and index finger (A). Mnemonic: Do it yourself as shown in the picture! Hold your elbow with thumbs up and other 4 fingers curling behind the lateral epicondyle. Total muscles: 12 (4 Superficial + 3 Mobile wad + 5 Deep) Superficial Externsors Other 2 are pronators: PT, PQ Posterior Forearm (Compartment) Muscles 
Profundus test will isolate and test functionĪnterior radius and interosseous membraneįDP and FPL are most susceptible to Volkmann’s ischemic contracture (VIC) Nerve supply: Anterior interosseous branch of median nerve (AIN) except Flexor digitorum profondus of ring and little fingers which is also supplied by ulnar nerve.īase of distal phalanges (at proximal phalanx, it passes between 2 slips of FDS – camper’s chiasm) Mnemonic: All 3 deep flexors have a word starting with “ P“.Īll these 3 are supplied by AIN and can be tested with “OK” sign. Sublimis test will isolate and test function Pisiform (sesamoid – developed within tendon of FCU), hook of hamate, 5th metacarpalįlexor digitorum superficialis (Sublimis FDS)īase of middle phalanges (at proximal phalanx splits into medial and lateral slips)įlex Proximal Interphalangeal (PIP) joint Radial artery lies between FCR and Brachioradialis Median nerve compression (pronator syndrome)
Nerve supply: Median nerve except FCU which is supplied by ulnar nerve Muscle
FDS: also originates from anteroproximal radius. Ulnar head of FCU: also originates from medial margin of olecranon and from aponeurosis from the posterior border of ulna. Ulnar (deep) head of pronator teres (may be absent): also originates from proximal ulna (medial margin of coronoid process think of it as a Y shaped muscle).
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