Examination of the hand and wrist

Front Matter......Page 1
CONTENTS......Page 3
LIST OF CONTRIBUTORS......Page 4
FOREWORD......Page 5
PREFACE......Page 7
ACKNOWLEDGEMENTS......Page 8
INTRODUCTION......Page 11
The rays of the hand......Page 14
Fixed and mobile elements of the skeleton......Page 17
The transverse arches......Page 19
The longitudinal arches......Page 23
The superficial palmar aponeurosis......Page 26
The deep palmar aponeurosis......Page 31
The dorsal aponeuroses......Page 32
Functions of the fibrous skeleton......Page 33
The osseous skeleton......Page 38
The intra-articular ligaments......Page 39
The fibrous joint capsule and extrinsic capsular ligaments......Page 40
The dorsal capsule......Page 42
Collateral supporting structures......Page 43
The ulnar fibrous structures......Page 44
Distal radioulnar joint and triangular fibrocartilage complex......Page 45
The extra-articular ligaments of the wrist......Page 46
The lunate......Page 49
Gliding mechanisms......Page 50
The articular system......Page 51
Muscles......Page 52
Tendons......Page 57
Movements of the wrist......Page 64
Wrist kinematics......Page 70
Extension of the wrist......Page 73
Wrist movements and the digits......Page 75
Articulations of the fingers......Page 79
Interphalangeal articulations......Page 81
The flexor apparatus......Page 88
The extensor apparatus......Page 93
The extrinsic extensor muscles......Page 94
The intrinsic apparatus......Page 98
Mechanisms of finger flexion and extension......Page 100
Actions of the intrinsic muscles......Page 106
Action of extrinsic and intrinsic muscles on the equilibrium of the proximal phalanx......Page 108
Fibrous structures of the extensor apparatus......Page 112
Sequences of flexion and extension movements of the phalanges......Page 116
Conclusion......Page 119
Movements of the thumb......Page 121
Trapeziometacarpal joint......Page 122
Intrinsic and extrinsic muscles of the thumb......Page 125
The hypothenar eminence......Page 133
Thumb......Page 135
Little finger......Page 136
The epidermis......Page 138
Characteristic features of palmar skin......Page 140
Macroscopic appearance of palmar skin......Page 141
Relations between the skin and deeper planes: the palmar fat pads......Page 144
Skin mobility......Page 145
Blood supply of the skin......Page 146
Skin flaps......Page 148
Capillary circulation......Page 151
The cutaneous biotransducers......Page 152
Physiology of palmar skin sensation......Page 154
Palmar surface......Page 155
Planning skin cover of the hand and forearm......Page 162
Skin incisions......Page 163
The hand as an organ of information......Page 166
Tact and touch......Page 168
Functions of the hand......Page 170
Grip and prehension......Page 171
The hand and the mouth......Page 178
The hand and speech......Page 179
Thermoregulatory role......Page 180
The hand and the central nervous system......Page 181
Collaboration of the two hands......Page 183
Conclusion......Page 184
INTRODUCTION......Page 185
Estimating tissue loss......Page 186
Assessment of deformity in Dupuytren’s disease......Page 187
Circulation......Page 191
The muscles......Page 194
Joint mobility......Page 195
Examination......Page 196
Radiographic assessment see pages 226-35......Page 200
Landmarks......Page 202
Terminology......Page 203
Landmarks......Page 209
Joint mobility......Page 211
Articular swelling, effusions and instability......Page 214
Landmarks......Page 215
Use of the goniometer......Page 216
Total active and total passive mobility......Page 217
Buck-Gramcko’s method......Page 218
Tubiana’s method......Page 219
Tenosynovitis......Page 222
Tendon excursion, limitations and adhesions......Page 223
Anomalous tendon interconnections......Page 224
The thumb......Page 233
Finkelstein’s test......Page 234
The thumb......Page 235
The wrist......Page 236
The instability series......Page 240
Bone scan......Page 245
Sonography......Page 246
Arthrography......Page 247
Cinearthrography......Page 248
CT scans......Page 249
Magnetic resonance imaging......Page 251
3.2 INVESTIGATION OF THE CIRCULATION......Page 253
Radioanatomical studies......Page 254
The superficial palmar arch......Page 257
Vascularization of the fingers......Page 259
Vascularization of the thumb......Page 261
The venous system......Page 266
Invasive techniques......Page 268
Other techniques......Page 269
CONCLUSION......Page 270
The brachial plexus......Page 271
Thoracic outlet syndromes......Page 272
Axillary nerve......Page 274
Radial nerve......Page 275
Musculocutaneous nerve......Page 279
Median nerve......Page 281
Ulnar nerve......Page 285
Analytical examination of the muscles......Page 296
Testing the voluntary movements of the scapular muscles......Page 298
Analysis of arm and shoulder movements......Page 299
Analysis of movements of the elbow and forearm......Page 306
Analysis of movements of the wrist......Page 311
Analysis of the movements of the fingers......Page 314
Analysis of the movements of the first metacarpal......Page 320
Difficulties in testing voluntary movements......Page 325
Sensory recovery......Page 328
Assessing sympathetic function......Page 330
Opening the hand......Page 331
Closing the fingers......Page 332
Functional assessment......Page 334
Nature and power of the common grips......Page 336
Quality of sensory function......Page 338
Threshold tests......Page 339
Functional tests......Page 346
Objective tests......Page 350
Sensibility test battery......Page 351
Background information......Page 352
Threshold test Semmes-Weinstein monofilaments......Page 355
Functional tests......Page 360
Stress testing in nerve compression......Page 363
Summary......Page 364
Tinel’s sign......Page 365
Sensory recovery......Page 366
Electrodiagnosis......Page 367
The EMG in lesions of peripheral nerves......Page 370
Electrodiagnosis in carpal tunnel syndrome......Page 372
Local factors......Page 373
General factors......Page 376
Prognostic factors pertaining to treatment......Page 378
Prognostic factors relating to other aspects of treatment and the patient......Page 379
REFERENCES......Page 380
INDEX......Page 396