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Anatomy

Upper Limb

Question 32 of 234

A 21 year old man presents to ED with multiple lacerations to his right upper limb, after falling through a ground floor window during a fight. He is unable to flex the distal interphalangeal joints of the fourth and fifth digits. Which of the following muscles is most likely affected:

Answer:

The ulnar nerve runs a superficial course and is vulnerable to laceration. The flexor digitorum profundus, innervated by the ulnar nerve medially and the median nerve laterally, acts to flex the distal interphalangeal joints and the metacarpophalangeal joints of the medial four fingers. The flexor digitorum superficialis, innervated by the deeper median nerve, acts to flex the proximal interphalangeal joints and the metacarpophalangeal joints of the medial four fingers. The flexor carpi ulnaris acts to flex and adduct the wrist. The interossei mainly act to adduct and abduct the fingers. The lumbricals act to flex the medial four fingers at the metacarpophalangeal joints and extend them at the interphalangeal joints.

Hand Movements

Anatomy / Upper Limb / Wrist and Hand

Last Updated: 29th January 2019

Hand movements are complex. The table below shows an overview of hand and thumb movements and the main muscles bringing about these movements.

Table: Movements of the Finger Joints

Finger Movements Primary Muscle (Assisting Muscles) Primary Nerve (s)
Flexion of MCPJ of digits 2 – 5 Lumbricals (flexor digitorum superficialis, flexor digitorum profundus, flexor digiti minimi, interossei) Median and ulnar
Flexion of PIPJ of digits 2 – 5 Flexor digitorum superficialis (flexor digitorum profundus) Median
Flexion of DIPJ of digits 2 – 5 Flexor digitorum profundus Median and ulnar
Extension of MCPJ of digits 2 – 5 Extensor digitorum, extensor indicis, extensor digiti minimi Radial
Extension of PIPJ and DIPJ of digits 2 – 5 Lumbricals and interossei (extensor digitorum) Ulnar and median
Adduction of digits 2 – 5 Palmar interossei Ulnar
Abduction of digits 2 – 4 Dorsal interossei Ulnar
Abduction of little finger Abductor digiti minimi Ulnar
Opposition of little finger Opponens digiti minimi Ulnar

Table: Movement of the Thumb Joints

Thumb Movements Primary Muscle(s) Nerve Supply
Flexion of thumb at MCPJ Flexor pollicis longus and brevis Median and ulnar
Flexion of thumb at IPJ Flexor pollicis longus Median
Extension of thumb at CMCJ and MCPJ Extensor pollicis longus and brevis Radial
Extension of thumb at IPJ Extensor pollicis longus Radial
Abduction of thumb Abductor pollicis longus and brevis Radial and median
Adduction of thumb Adductor pollicis Ulnar
Opposition of thumb Opponens pollicis Median

Original by By OpenStax [CC BY 4.0 , via Wikimedia Commons

Muscles of the Hand. (Image by OpenStax [CC BY 4.0 , via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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