Assess flexion, extension, abduction, and adduction of the fingers.

■ Flexion and extension (Fig. 1). For flexion, to test the lumbricals and finger flexor muscles, ask the patient to "Make a tight fist with each hand, thumb across the knuckles." For extension, to test the finger extensor muscles, ask the patient to "Extend and spread the fingers." At the MCPs, the fingers may extend beyond the neutral position.

FIGURE 1. Test finger flexion.

Test the flexion and extension of the PIP and DIP joints (lumbrical muscles). The fingers should open and close easily.

■ Abduction and adduction (Fig. 2). Ask the patient to spread the fingers apart (abduction from dorsal interossei) and back together (adduction from palmar interossei). Check for smooth, coordinated movement.

FIGURE 2. Test finger abduction.

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