REIDER PART 1
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94 Chapter 3 F-lbow and Forearm

Figurę 3-49. Long Finger flexion test.

forearm, wrist flexion may be unaffccted. Finally, if the injury is at the wrist, only the muscles of the thenar emi-nence, most easily tested by evaluating thumb opposition, are affected.

A high median nerve palsy may produce a Benediction hand. In this casc, the patient s attempt to make a fist results in a hand position reminiscent of the Papai blessing, with an inability to flex the thumb, indcx finger, and (partially) the long finger but fuli flexion of the ring and little fingers. (Fig. 3-50)

Anterior Interosseous Nerve Syndrome. Anterior interosseous nerve syndrome may occur spontaneously or secondary to a number of causes including trauma, forearm masses, or anomalous muscles. Its prcsentation is quite similar to that of pronator syndrome, with aching pain in the proximal forearm. In morę severe cases of anterior interosseous ncrve syndrome, weakness of the flexor pollicis longus and flexor digitorum profundus to the index finger may be present. To test the strength of these muscles, the patient is instructed to make a tight O by opposing the tips of the thumb and index finger. The examiner then hooks each of his or her own index fingers within the O and attempts to separate the patients thumb and index finger (Fig. 3-51). Comparison with the patient s opposite hand should be used to assess whether weakness of the muscles innervated by the anterior interosseous nerve may be present. Weakness of the pronator quadratus, which is also innervated by the anterior interosseous nerve, may be looked for by testing pronator strength with the elbow fully flcxed. As noted, there is no sensory deficit associatcd with anterior interosseous nerve syndrome.

Provocative Tests for Tendinitis Resistive testing of the biceps and triceps, already described, can be used as provocative tests to elicit the symptoms of tendinitis involving those two tendons at the elbow. In most cases, combining resistance testing of

Figurę 3-50. Benediction hand deformity.

Figurę 3-51. Testing flexor pollicis longus and flexor digitorum profundus strength for anterior interosseous nerve syndrome.