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Anatomy

Upper Limb

Question 66 of 234

A 54 year old carpenter has sustained a laceration to his left hand with a stanley knife. He is unable to flex the proximal interphalangeal joint of his middle finger which is held in extension. Which of the following structures has most likely been injured:

Answer:

The flexor digitorum superficialis is primarily responsible for flexion at the proximal interphalangeal joint and thus separation of this tendon from its attachment on the middle phalanx of the finger will result in loss of this movement. The flexor digitorum profundus flexes the distal interphalangeal joint. Flexion at the metacarpophalangeal joint is primarily produced by the lumbrical muscles with assistance from the interossei and the flexor digitorum profundus and superficialis. Abduction and adduction of the fingers at the metacarpophalangeal joint is produced by the interossei.

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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