362 Chapter 9 FLEXION® EXTENSION® uscie NERVE Mcp Pip DP MCP PIP IP Flexor digitorum profundus Median Gnd, 3rd digits), X.—-X |X ‘ulnar (ith Sth digts) Hietcrdigiorum supeciciis Mien x x Flexor digit minim (th digi) Ular x Lambricals Median (Gnd, 3rd digits), X x x ‘ulnar (th, Sth digs) Palmar and dorsal interossei Uinar x x x Extensor digitorum Radial x x x Extensor indicis (second digit) Radial xX xX XxX Extensor digiti minimi (ith digi) Radial x x Xx [Note Bold text indicates the most important muscles, “MCP, metacarpophalangeal joint PIP, proximal interphalangeal join; DIP, distal interphalangeal joint. Simplification: Three Nerves Acting on the Thumb Different thumb muscles are innervated by the radial, ulnar, and median nerves. Its easiest to remember these by the mnemonic RUM (Radial, Uinar, Median), as shown in Figure 9.6. Thumb abduction in the plane of the palm (ab- ductor pollicis longus) is mediated by the Radial nerve, adduction (adductor pollicis) by the Ulnar nerve, and opposition (opponens pollicis) and flexion (lexor pollicis longus and superficial head of the flexor pollicis brevis) by the Median nerve. It should also be recalled that thumb abduction perpendicular to the palm (see Table 3.4; neuroexam.com Video 55) is mediated by the abduc- tor pollicis brevis, which is innervated by the median nerve after it passes through the carpal tunnel. MNEMONIC Intrinsic and Extrinsic Hand Muscles. The intrinsic hand muscles include the muscles of the thenar eminence atthe base of the thumb (opponens pollicis, abductor pollicis brevis, flexor pollicis bre- vis, adductor pollicis), the muscles of the hypothenar eminence at the base of the pinky finger (opponens digiti minimi, abductor digiti minimi, flexor digiti [PR] minim), the lumbricals and the interosse. Intrinsic hand muscles are inner- xe vated by the ulnar nerve, except for the LOAF (Lumbricals I and I, Opponens fanemonic _Pollicis, Abductor pollicis brevis, Flexor pollicis brevis—superficial head) mus- cles, which are innervated by the median nerve after it passes through the carpal tunnel. All intrinsic hand muscles are supplied by €8 and T1 (sce Table 8.1) In addition to the intrinsic hand muscles, extrinsic muscles in the forearm are important for finger movements (see Table 8.1). Intrinsic and extrinsic muscles contributing to flexion and extension at finger joints other than the thumb are FIGURE 9.6 Three Nerves Acting on summarized in Table 9.2. As we have already mentioned, it should be clear from the Thumb ‘The radial nerve abducts this table that the flexor digitorum profundus (median nerve for digits 2 and 3; the thumb inthe plane of the palm. The eee is 4 ee ene oeene balm. Te ulnar nerve for digits 4 and 5) is best tested at the distal interphalangeal joints, planeof the palm, The medion nerve op- since other muscles participate in flexion atthe other joints. Similarly, the ex- poses the thumb. Note also thatthe abs tensor digitorum (radial nerve and C7) is best tested atthe metacarpophalangeal Suctor pollicis brevis (median nerve) joints (See Table 92). This is because other muscles, most notably the lumbricals, abducts the thumb perpendicular to the are predominantly responsible for finger extension at the proximal and distal in- plane ofthe palm (not shown), {exphalangeal joints (median nerve for 2nd and 3rd digits; ulnar nerve for 4th