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Orthopedic tests on the thumb

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As the examiner, visually inspect the dorsal aspect of the hand. Normally the knuckle formed by the head of the third metacarpal is more prominent and protrudes further distally as compared to the knuckles of the second and fourth metacarpal heads. If the knuckle of the third metacarpal head is level with the knuckles of the second and fourth metacarpal heads, the sign is positive and indicative of a lunate dislocation. The patient should rest the involved forearm on the table. Then, ask the patient to extend the thumb so that these tendons become prominent.
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The motor system evaluation is divided into the following: body positioning, involuntary movements, muscle tone and muscle strength. Upper motor neuron lesions are characterized by weakness, spasticity, hyperreflexia, primitive reflexes and the Babinski sign. Primitive reflexes include the grasp, suck and snout reflexes. Lower motor neuron lesions are characterized by weakness, hypotonia, hyporeflexia, atrophy and fasciculations. Fasciculations are fine movements of the muscle under the skin and are indicative of lower motor neuron disease. They are caused by denervation of whole motor units leading to acetylcholine hypersensitivity at the denervated muscle.
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Thumb Arthritis

Next, the patient performs the same test on the opposite hand. The normal or uninjured side is tested first followed by the injured side. Tissues Being Tested Cerebellum of the brain Positive Test Inability to make contact between the fingers and the thumb or poor timing in completing the task. Interpretation May indicate injury to the cerebellum Common errors in performing exam Failing to perform the test bilaterally for comparison.
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Newly updated, this full-color text offers a rich array of features to help you develop your musculoskeletal assessment skills. Orthopedic Physical Assessment, 6th Edition provides rationales for various aspects of assessment and covers every joint of the body, as well as specific topics including principles of assessment, gait, posture, the head and face, the amputee, primary care, and emergency sports assessment. Artwork and photos with detailed descriptions of assessments clearly demonstrate assessment methods, tests, and causes of pathology.
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