■ Flexion and extension. Ask the patient to make a tight fist with each hand, thumb across the knuckles, and then extend and spread the fingers. The fingers should close and open smoothly and easily. At the MCPs, the
fingers may extend beyond the neutral position. Also test flexion and extension at the PIP and DIP joints.
■ Abduction and adduction. Ask the patient to spread the fingers apart (abduction) and back together (adduction). Check for smooth, coordinated movement.
At the thumb, assess flexion, extension, abduction, adduction, and opposition. Ask the patient to move the thumb across the palm and touch the base of the 5th finger to test flexion, and then to move the thumb back across the palm and away from the fingers to test extension.
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