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Intrinsic Hand Deformity Workup

  • Author: Dimitrios Danikas, MD, FACS; Chief Editor: Harris Gellman, MD  more...
 
Updated: Nov 06, 2015
 

Imaging Studies

See the list below:

  • Routine radiographs are indicated to reveal bone or joint pathology.
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Other Tests

See the list below:

  • Grip-strength dynamometry
    • An adjustable grip size reveals the contribution to grip strength by the intrinsic muscles.
    • Large-handle positions are used to test extrinsic flexor power, and smaller-handle positions test the intrinsic muscles.
  • Pinch gauge: This can be used to test the adductor pollicis and first dorsal interosseous muscles.
  • Electrodiagnostic studies
    • Absence of normal intrinsic electrical activity is evidence of muscle pathology.
    • A neurologic etiology can be differentiated from muscle pathology.
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Contributor Information and Disclosures
Author

Dimitrios Danikas, MD, FACS Attending Plastic Surgeon, Pikeville Medical Center

Dimitrios Danikas, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, American Academy of Anti-Aging Medicine, Northeastern Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Neumeister, MD, FRCSC, FACS Chairman, Professor, Division of Plastic Surgery, Director of Hand/Microsurgery Fellowship Program, Chief of Microsurgery and Research, Institute of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine

Michael Neumeister, MD, FRCSC, FACS is a member of the following medical societies: American Association for Hand Surgery, American Burn Association, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Canadian Society of Plastic Surgeons, Illinois State Medical Society, Illinois State Medical Society, Ontario Medical Association, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Society of University Surgeons, American Council of Academic Plastic Surgeons

Disclosure: Nothing to disclose.

Sotirios Papafragkou, MD Chair, Department of Surgery, Hand and Microvascular Surgery, Northern Maine Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

N Ake Nystrom, MD, PhD Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

William B Nolan, MD Assistant Professor, Department of Surgery, Division of Plastic Surgery, Cornell University Medical College

William B Nolan, MD is a member of the following medical societies: American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

References
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The intrinsic muscles innervated by the median nerve (abductor pollicis brevis and opponens pollicis) are checked by resisting palmar abduction of the thumb.
Image in a patient with ulnar neuropathy demonstrates the Froment sign during pinching. Loss of the ulnar-innervated adductor pollicis results in reliance on the flexor pollicis longus and exaggerated interphalangeal (IP) joint flexion. Loss of the metacarpophalangeal (MCP) joint flexor leads to MCP hyperextension over time.
The ulnar-innervated intrinsic muscles can be checked by resisting abduction of the index (first dorsal interosseous muscle) and small fingers (abductor digiti quinti muscle).
The gloved examiner checks for intrinsic tightness. With the metacarpophalangeal (MCP) joint hyperextended, the proximal interphalangeal (PIP) joint is passively flexed. The intrinsic muscles are volar to the axis of rotation of the MCP joint and dorsal to the axis of the PIP joint. MCP joint hyperextension tightens the intrinsics. Results of this test are compared with those in the contralateral, normal hand. Note intrinsic atrophy in the first dorsal web space.
Image in a patient with a partial ulnar nerve paralysis is asked to extend the digits. Hyperextension of the metacarpophalangeal (MCP) joints of the ring and small fingers occurs with the loss of intrinsic ulnar-innervated MCP flexors. The index and middle fingers have median innervated intrinsics (lumbricals) that allow the extrinsics to extend the interphalangeal (IP) joints.
When the examiner prevents metacarpophalangeal hyperextension of the ring and fifth fingers, the patient can completely extend the interphalangeal joints with the extrinsic tendons.
Table. Muscles of the Forearm
Muscles of anterior fascial compartment
Name of Muscle Nerve Supply
Pronator teresMedian nerve
Flexor carpi radialisMedian nerve
Palmaris longusMedian nerve
Flexor carpi ulnarisUlnar nerve
Flexor digitorum superficialisMedian nerve
Flexor pollicis longusAnterior interosseous



branch of median nerve



Flexor digitorum profundusUlnar and median nerves
Median nerve supplies index and middle fingers in 75% of patients. Ulnar nerve supplies middle, ring, and little fingers in 75% of patients (therefore, the middle finger has dual innervation in 75% of patients)
Pronator quadratusAnterior interosseous branch of median nerve
Muscles of lateral fascial compartment
BrachioradialisRadial nerve
Extensor carpi radialis longusRadial nerve
Muscles of posterior fascial compartment
Extensor carpi radialis brevisDeep branch of radial nerve
Extensor digitorumDeep branch of radial Nerve
Extensor digiti minimiDeep branch of radial Nerve
Extensor carpi ulnarisDeep branch of radial Nerve
AnconeusRadial nerve
SupinatorDeep branch of radial Nerve
Abductor pollicis longusDeep branch of radial Nerve
Extensor pollicis brevisDeep branch of radial Nerve
Extensor pollicis longusDeep branch of radial Nerve
Extensor indicisDeep branch of radial Nerve
Muscles of the hand lumbricals
Two radial lumbricalsMedian nerve
Two ulnar lumbricalsUlnar nerve
InterosseiUlnar nerve
Abductor pollicis brevisMedian nerve
Flexor pollicis brevisMedian nerve
Opponens pollicisMedian nerve
Adductor pollicisUlnar nerve
Abductor digiti minimiUlnar nerve
Flexor digiti minimiUlnar nerve
Opponens digiti minimiUlnar nerve
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