The range of motion of the fingers includes movements at the distal interphalangeal joint, the proximal interphalangeal joint, and the metacarpophalangeal joints of the fingers and the thumb.
Ask the patient to make a fist with the thumb across the knuckles and then extend and spread the fingers. Normally, the fingers should flex to the distal palmar crease. The thumb should oppose to the distal metacarpal head. Each finger should extend to the zero position in relation to its metacarpal.
Tenosynovitis of the thumb abductors and extensors is known as de Quervain's disease. The patient complains of weakness of grip and pain at the base of the thumb that is aggravated by certain movements of the wrist. To confirm the diagnosis, ask the patient to flex the thumb and close the fingers over it. You should now attempt to move the hand into ulnar deviation. Excruciating pain will accompany this maneuver if de Quervain's tenosynovitis is present.
The most common symptom of disorders of the spine is pain. Pain from the thoracic spine often radiates around the trunk along the lines of the intercostal nerves. Pain from the upper lumbar spine may be felt in the front of the thighs and knees. Pain originating in the lower lumbar spine can be felt in the coccyx, hips, and buttocks, as well as shooting down the back of the legs to the heels and feet. The pain is often intensified by movement. Patients with her-niated vertebral discs may complain of pain that is exacerbated by sneezing or coughing. Determine whether there is associated numbness or tingling in the lower extremity, which is related to nerve root lesions.
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