Dr.Ihsanullah Orthopedic & Spine Clinic

Dr.Ihsanullah Orthopedic & Spine Clinic Dr Ihsanullah
MD, MBBS Special For Only Orthopedic & Spine Patient

Crossed-Finger Test and Ulnar Nerve Function — QuizThe crossed-finger test, commonly recognized as the “good luck” sign,...
17/08/2026

Crossed-Finger Test and Ulnar Nerve Function — Quiz

The crossed-finger test, commonly recognized as the “good luck” sign, requires the patient to cross the middle finger over the index finger. Which nerve is primarily being evaluated by this maneuver?

A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Musculocutaneous nerve

Correct Answer: B. Ulnar nerve

Explanation:
The crossed-finger test evaluates the ulnar-innervated interossei muscles. The interossei control finger abduction and adduction—dorsal interossei abduct (DAB) and palmar interossei adduct (PAD). More specifically, crossing the middle finger over the index depends particularly on the first palmar interosseous and second dorsal interosseous muscles.

When examining a patient for ulnar neuropathy, the crossed-finger test should be part of the examination rather than used alone. Other findings may include weak finger abduction/adduction, wasting or weakness of the first dorsal interosseous, decreased sensation of the fifth finger and ulnar half of the ring finger, a positive Froment sign, Wartenberg sign, and a positive Tinel sign over the cubital tunnel when the lesion is at the elbow.

How reliable is the crossed-finger test?
The original 1980 description characterized it as a reliable and easy bedside test of ulnar motor function. However, later reviews emphasize that it is best regarded as a screening test; good modern sensitivity and specificity data for the crossed-finger test itself have not been established, and additional empirical studies are needed. Therefore, a positive test demonstrates interosseous/ulnar motor dysfunction, but it does not by itself localize the lesion or determine its severity.

Pakistani flag is a symbol of our pride, unity, and freedom. Its respect is the duty of every citizen. Pakistan Humesha ...
13/08/2026

Pakistani flag is a symbol of our pride, unity, and freedom. Its respect is the duty of every citizen.
Pakistan Humesha Zindabad Inshallah 🇵🇰

Bryant/Gallow’s traction :It is mainly used for femoral shaft fractures in young children, particularly those
12/08/2026

Bryant/Gallow’s traction :

It is mainly used for femoral shaft fractures in young children, particularly those

Calcium Metabolism
26/07/2026

Calcium Metabolism

Why the Posterior Flap is the Gold Standard in Transtibial AmputationTo my fellow surgeons in training: we often focus h...
14/07/2026

Why the Posterior Flap is the Gold Standard in Transtibial Amputation

To my fellow surgeons in training: we often focus heavily on the bone cuts and vascular control, but the true longevity of an amputation lies in the soft tissue envelope.

While the "fish mouth" closure is a technique we all learn, there is a reason the Long Posterior Flap (Burgess technique) remains the preferred approach for proximal and mid-level transtibial amputations. From a senior perspective, here is

why we lean this way:

Superior Vascularity: The posterior flap is supplied by the robust posterior compartment musculature and its associated blood supply. In patients with peripheral arterial disease (the most common indication for these procedures), this vascular reliability is critical for primary healing.

The "Durable" End-Bearing Surface: By bringing the thicker, well-padded posterior tissue anteriorly, we position the suture line away from the pressure-sensitive areas of the distal tibia. This significantly reduces the risk of skin breakdown under a prosthesis.

Optimal Biomechanics: The posterior flap provides a superior cushion over the bone ends, leading to improved outcomes in prosthetic fitting and patient comfort our ultimate goal in limb salvage/reconstruction.

The fish mouth technique has its place in specific distal scenarios, but when you are operating in the proximal/mid-third of the leg, prioritize the posterior flap. It’s a small technical detail that makes a world of difference for your patient’s future mobility.
Have you mastered your flap planning yet? Let’s discuss in the comments.

The Case for the Extended Elbow (EE) Cast in Pediatric Proximal Forearm Fractures:For young orthopedic surgeons, managin...
14/07/2026

The Case for the Extended Elbow (EE) Cast in Pediatric Proximal Forearm Fractures:

For young orthopedic surgeons, managing proximal-third forearm fractures in pediatric patients can be a clinical challenge. While we are trained to prioritize elbow flexion for immobilization, evidence suggests that for proximal-third fractures, an extended elbow (EE) cast may provide superior stability.

Why Extension Can Outperform Flexion in These Cases:

Instability in Flexion: In young children, the proximal radius and ulna can be unstable when the elbow is flexed. Muscle groups (such as the biceps and supinator) pull on the proximal fracture fragments, leading to displacement when the arm is held in the conventional 90-degree flexed position.

Loss of Three-Point Fixation: Standard casting relies on "three-point fixation" (or three-point molding) to maintain the alignment of the bone fragments. When the fracture is in the proximal third, the anatomy of the short, "fat" forearm in young children can make it impossible to achieve the necessary three-point pressure points while the elbow is flexed.

Stability in Extension: Clinical observation has shown that for these specific, unstable proximal fractures, the fragments often become stable when the elbow is placed in full extension. By casting the arm in this extended position, the surgeon can achieve the necessary three-point fixation that was previously unattainable in flexion.



Clinical Tip: If you find that a proximal forearm fracture is unstable in a standard flexed position, consider assessing the stability of the fracture in extension. The EE cast offers a reliable, evidence-based alternative to maintain reduction without immediately resorting to surgery.

Technique of Ponseti casting for clubfoot correction. A, First cast; note positioning of forefoot to align with heel, wi...
11/07/2026

Technique of Ponseti casting for clubfoot correction.
A, First cast; note positioning of forefoot to align with heel, with outer edge of foot tilted even farther downward because of Achilles tendon tightness.

B, Second cast is applied with outer edge of foot still tilted downward and forefoot moved slightly outward.

C, Third cast; Achilles tendon is stretched bringing outer edge of foot into more normal position as forefoot is turned farther outward.

D, Final cast; Achilles tendon is stretched more with foot pointed upward.

Acute Flexion Ap.View Jones' View
04/07/2026

Acute Flexion Ap.View
Jones' View

💊 انٹیگ ڈی سیرپ (Intig D Syrup) کیا ہے؟انٹیگ ڈی سیرپ (SAMI Pharmaceuticals) ایک غذائی سپلیمنٹ (Dietary Supplement) ہے جس...
28/06/2026

💊 انٹیگ ڈی سیرپ (Intig D Syrup) کیا ہے؟

انٹیگ ڈی سیرپ (SAMI Pharmaceuticals) ایک غذائی سپلیمنٹ (Dietary Supplement) ہے جس میں وٹامن ڈی (Vitamin D) اور اوسیئن منرل کمپلیکس (Ossein Mineral Complex) شامل ہوتے ہیں۔ یہ جسم میں کیلشیم کے جذب (Calcium Absorption) کو بہتر بناتا ہے اور ہڈیوں کی مضبوطی کے لیے ضروری معدنیات فراہم کرتا ہے۔ یہ ہڈیوں کی مختلف بیماریوں جیسے آسٹیوپوروسس (Osteoporosis)، آسٹیومیلیشیا (Osteomalacia) اور رکٹس (Rickets) کی روک تھام اور علاج میں مددگار ثابت ہوتا ہے۔

✅ اہم فوائد

🦴 ہڈیوں کو مضبوط بناتا ہے اور دانتوں کی صحت بہتر رکھنے میں مدد دیتا ہے۔

🩺 وٹامن ڈی اور کیلشیم کی کمی (Vitamin D Deficiency & Hypocalcemia) کو پورا کرنے میں مددگار ہے۔

💪 ہڈیوں کے درد، جوڑوں کی اکڑن اور کمزوری میں آرام پہنچانے میں معاون ہے۔

🤰 حمل اور دودھ پلانے کے دوران جسم کی بڑھتی ہوئی کیلشیم اور منرلز کی ضرورت پوری کرنے میں مدد دیتا ہے۔

🩹 ہڈی ٹوٹنے (Fracture) کی صورت میں دیگر علاج کے ساتھ استعمال کرنے سے ہڈی کے جڑنے کے عمل میں معاون ثابت ہو سکتا ہے۔

💊 عمومی خوراک

بچے:

عموماً 1 سے 2 چائے کے چمچ روزانہ، کھانے سے پہلے۔

بالغ:

عموماً 2 سے 4 چائے کے چمچ روزانہ، کھانے سے پہلے۔

> نوٹ: خوراک ہمیشہ ڈاکٹر کی ہدایت کے مطابق استعمال کریں۔

⚠️ احتیاط

ڈاکٹر کے مشورے کے بغیر تجویز کردہ مقدار سے زیادہ استعمال نہ کریں۔

اگر گردوں کی بیماری، گردے کی پتھری، یا خون میں کیلشیم کی مقدار زیادہ ہو تو استعمال سے پہلے ڈاکٹر سے مشورہ کریں۔

بچوں کی پہنچ سے دور رکھیں۔

اگر کسی قسم کی الرجی یا غیر معمولی علامات ظاہر ہوں تو دوا بند کرکے ڈاکٹر سے رجوع کریں۔

Baker CystA Baker cyst is a fluid-filled swelling behind the knee. It usually develops when excess joint fluid escapes i...
20/06/2026

Baker Cyst

A Baker cyst is a fluid-filled swelling behind the knee. It usually develops when excess joint fluid escapes into a small pocket at the back of the knee.

In adults, a Baker cyst is often a sign of an underlying knee problem, most commonly arthritis or a meniscal tear. Patients may notice a lump, tightness, stiffness, or discomfort behind the knee, especially with bending or straightening the knee.

Treatment is directed at the underlying cause. If the arthritis or meniscal tear is treated, the cyst often improves. Large or painful cysts may be drained, but they can return if the source of the excess fluid is not addressed.

Address

Mardan Cantonment
23201

Opening Hours

Monday 09:00 - 17:00
Tuesday 09:00 - 17:00
Wednesday 09:00 - 17:00
Thursday 09:00 - 17:00
Friday 09:00 - 17:00
Saturday 09:00 - 17:00

Telephone

+923219196991

Website

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