REIDER PART 159
Hand and Wrist 149
Chapter 4
Figurę 4-78. A, Stability test of the ulnar collater.il ligament of the proximal interphalangeal joint ot' the index finger (arrows indicate the direction of force applied to the middle phalanx). B, Stability testing of the ulnar collateral ligament of the interphalangeal joint of the thumb {arrows indicate the direction of force applied to the distal phalanx).
of the joint remains normal. In morę severe sprains the ulnar side of the joint separates, allowing the joint to angulate 20° or 30°. Complete tears cause the joint to opcn up morę than 30°. The interphalangeal joint of the thumb is testcd in an analogous manner (Fig. 4-78B). Metacarpophalangeal Joints. The collateral iigaments of the MCP joints are a bit morę complicated to test. Because the collateral Iigaments are loose in extension to permit the normal motion of abduction, the Iigaments must be tested with the joint fully flexed so that the collateral Iigaments are under tension.
To test the ulnar collateral ligament of the index finger, for example, the examiner grasps the proximal phalanx of the patients index finger in one hand and the proximal phalanx of the adjacent long finger in the other. The examiner flexes both MCF joints to 90° to tighten the collateral Iigaments and then attempts to separate the two fingers (Fig. 4-79). The examiner feels for any abnormal
Figurę 4-79. Stability testing of the ulnar collateral ligament of the metacarpophalangeal joint of the index finger (arrow indi-cates the direction of the force applied to the index finger). A> Normal subject. B, Ruptured ulnar collateral ligament of the MGR joint of the left index finger
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