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At least 37 records · Page 2Linked to original sources
PubMed2000

[The metacarpal ligament of the thumb. Topography and functional significance of a heretofore unknown fiber tract of the thumb and its anatomic relationship to the internal interosseus muscle].

During cadaver dissections of the thenar muscles of 81 human hands, we found a distinct ligament at the palmar side of the first metacarpal in 58% ([symbol: see text] 47 hands). This not previously described ligament crosses the princeps pollicis artery regularly. The ligament arises from the base of the first metacarpal bone in 83%. Sometimes (in 15%) it arises from the trapezium or from the middle portion of the first metacarpal bone in one case. The primary insertion of this ligament is the ulnar sesamoid. We have named these fibres "metacarpal ligament of the thumb". It could be classified into five different types. We think that this ligament is helpful in the stabilisation of the ulnar sesamoid. Besides it fixes the princeps pollicis artery to the metacarpal bone and therefore it is possible that it could compress the artery. Maybe the "metacarpal ligament of the thumb" is a rudiment of the interosseous muscles of the thumb or of the deep head of the flexor pollicis brevis muscle or of the oblique head of the adductor pollicis muscle. There is a very close topographic relationship between this ligament and the "internal interosseous muscle" of the thumb which was described by Schmidt and Lanz (1992) and which was mentioned by Henle (1858), who named it "M. interosseus volaris primus" for the first time. We could isolate this muscle in 69%.

Aged↗
PubMedDate not supplied

The use of a neoprene "thumb-sock" to prevent trauma in a thumb-sucking child with intractable epilepsy.

A nine-year-old girl with spastic quadriplegia, mental retardation, poor vision, a gastrostomy, and intractable epilepsy was referred by her pediatrician for a dental assessment with a view to extracting her anterior teeth as a means of preventing repeated damage to the skin over the proximal phalanx of her left thumb, which she sucked at night. This was the time of day when the frequency of her epileptic seizures was highest. A simple solution to the problem was developed by a dentist and an occupational therapist in which nylon-coated 3-mm neoprene sheeting (wet-suit material) was formed into a "thumb-sock" with a simple Velcro fastening around the wrist. No trauma to the thumb from epileptic seizures has occurred since the "thumb-sock" was fitted 24 months ago.

Child↗
PubMed1994

Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb).

OBJECTIVE: The ulnar collateral ligament bridges the ulnar aspect of the first metacarpal and the proximal phalanx and functions as a major stabilizer of the first metacarpophalangeal joint. Acute or chronic injury of this ligament is referred to as gamekeeper's thumb. The objectives of this study were to (1) determine the MR appearance of the ulnar collateral ligament of the thumb in cadavers and volunteers and (2) analyze the MR findings in patients with gamekeeper's thumb, especially with regard to the value of MR in detecting clinically significant displacement of the ligament (Stener lesion). MATERIALS AND METHODS: MR imaging of the first metacarpophalangeal joint was performed in three volunteers, two cadaveric specimens, and 11 patients with acute injury. In the patients, the mechanism of injury was an abrupt abductive force on the thumb resulting in rupture of the ulnar collateral ligament. The diagnosis was confirmed by surgery in five patients and by clinical follow-up in the remaining six. Cryomicrotome sectioning of the cadaveric tissue blocks was performed to correlate pathologic and MR findings. Images were interpreted by one radiologist. RESULTS: MR images showed rupture of the ulnar collateral ligament in all 11 patients. Prospectively, Stener lesions (n = 3) could be differentiated from non-Stener lesions (n = 8) in eight of 11 patients. Retrospectively, the correct diagnosis could be made in all 11 patients once the importance of determining the position of the ulnar collateral ligament relative to the adductor aponeurosis was understood. CONCLUSION: MR imaging of the first metacarpophalangeal joint depicts the ulnar collateral ligament and adductor aponeurosis to good advantage. It can also accurately show tears of the ulnar collateral ligament and thus be used to differentiate a rupture without significant retraction from a Stener lesion. This information is important in determining whether surgical or conservative management is indicated.

Collateral Ligaments↗
PubMed2005

A modified thumb spica splint for thumb injuries in the ED.

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.

Emergency Medicine↗
PubMed1998

Association between hyperflexibility of the thumb and an unexplained bleeding tendency: is it a rule of thumb?

A bleeding tendency manifested by petechiae and ecchymoses is one of the most common causes for referral of patients to haematology clinics. Vessel wall pathology is not usually considered to be a cause for deranged haemostasis, although coexistence of increased capillary fragility and joint hypermobility have been reported. We determined the frequency of thumb hyperextensibility and scored the findings in a series of 44 patients referred because of ecchymoses and petechiae, as well as 261 control children and their mothers. All 44 patients had normal coagulation studies. Thumb flexibility score was +4 in 30 patients, +3 in eight patients, +2 in five patients and +1 in one of the index patients. In the control group, only one of 261 had a +4, and three had a +3 score, and two of 260 mothers had a +4 score. Ecchymoses were not observed in any of these subjects, nor in the +1 patients. Based on clinical presentation and normal coagulation studies, we suggest that our patients had an underlying subtype of Ehlers-Danlos syndrome. In view of the dramatically high occurrence of thumb hyperextensibility in patients with unexplained mild bleeding tendency, costly haemostatic and coagulation studies on such patients may not be necessary.

Child↗
PubMed2005

The true triplication of the thumb: a case of unclassified thumb polydactyly.

A child with true triplication of the thumb is reported. Each thumb has a well-developed metacarpal, and one of them is biphalangeal; the remaining 2 are triphalangeal. Satisfactory result was obtained from a functional and esthetic point of view. Our surgical approach to this interesting anomaly and the necessity of a new group under the Wassel classification for the categorization of different forms of thumb triplications is discussed.

Child↗
PubMed1990

Arthrodesis of the metacarpophalangeal joint of the thumb in children and adults. Adjunctive treatment of thumb-in-palm deformity in cerebral palsy.

A hypermobile hyperextension or hyperflexion deformity of the metacarpophalangeal (MCP) joint associated with thumb-in-palm deformity in 90 patients affected by cerebral palsy was treated by arthrodesis with or without soft-tissue procedures. Twenty-two of these patients were adults with closed physes, and 68 were children or adolescents with open growth plates. The MCP joint fusion was usually accompanied by intrinsic muscle lengthening and/or extrinsic tendon transfer, but occasionally it was the only procedure performed to diminish the thumb-in-palm position. Even in four-year-olds, joint fusion was a predictable procedure to establish stability of that joint without disturbing longitudinal or circumferential growth. Measurable function was improved to a mild or moderate degree in 44 of the 50 children who were followed to maturity. Eighteen of the 68 children were unavailable for follow-up evaluation. Six of the 50 followed patients showed no functional improvement, although arthrodesis of the MCP joint occurred in four of the six. The other two patients were operated on when they were 12 years of age and developed a fibrous union that was painless and stable when they were adults. Even those patients who had no functional improvement did have improved appearance and easier control of the affected hand when it was manipulated by the opposite hand. The children were followed to maturity with age-matched cerebral palsy control patients. There was no significant disturbance in growth of those thumbs that had MCP joint fusion when the physes were open.

Adolescent↗
PubMedDate not supplied

[Rupture of the ulnar, collateral ligament of the metacarpophalangeal joint of the thumb, so-called 'wobbly thumb'].

A stable metacarpophalangeal joint of the thumb is indispensable for a normal grip function of the hand. The joint is stabilized by collateral ligaments. A rupture of the ulnar, collateral ligament is often caused by a sports trauma, as indicated by the denominations "skiërs duim", "goalkeeper's thumb" and "baseball thumb". Many surgeons are not familiar with the phenomenon of an insufficient collateral ligament, also called "wackeldaum". In the period 1981-1985 a consecutive series of 35 patients with a ruptured ulnar collateral ligament was operated in the De Wever hospital Heerlen (Netherlands). On the basis of our own patients, attention is given to the diagnosis, therapy and results of the operative treatment of these lesions.

Adolescent↗
PubMed1993

[Forum: reconstruction of the traumatised thumb. Covering losses of cutaneous substance of the thumb].

The authors proposed their preferential indications to repair cutaneous loss of the thumb. The choice of the flap depend on localisation: to repair a frontal amputation, a triangular volar flap (Atazoy) performed, to repair a tangential distal amputation, a neurovascular island flap (O'Brien-Moberg) was used. To repair a tangential palmar amputation, a flap with advancement and rotation (Hueston) was performed--Free toe to finger tip neurovascular flap was necessary to restore sensation after complete avulsion of pulp. The island kite flap transfer from the dorsum of the index to the thumb (Foucher) was used to repair loss of dorsal and palmar side of the first phalanx. For tangential dorsal amputation, cross finger and free toe to thumb "custom-made" transfer were possible. The authors explained why they preferred these flaps.

Amputation, Traumatic↗
PubMed1993

[Forum: reconstruction of the traumatic thumb. Reconstruction of the thumb by osteocutaneous flaps of the forearm].

The authors present different techniques of thumb reconstruction using osteocutaneous retrograde island forearm flaps. They describe an original thumb reconstruction technique by using the anterior interosseous osteocutaneous retrograde island flap and present two clinical cases. The advantages and disadvantages as well as the indications of this kind of thumb reconstruction procedure are discussed.

Adult↗
PubMed1993

[Forum: reconstruction of the traumatic thumb. The thumb in hand mutilations. Indications for reconstructive surgery].

The indications for reconstruction of the thumb in traumatic mutilations of the hand are presented in relation to the various conventional and microsurgical techniques. Several clinical situations are distinguished according to the severity of the hand mutilation and the number of severed fingers. Paucidigital amputations (one or two fingers including the thumb) should be treated by pollicisation or other techniques (Matev, osteoplastic reconstruction, second toe or "custom-made" transfers) depending on whether or not the other fingers need to be preserved. Pluridigital amputations (the thumb and two or three long fingers) require transfer of the 2nd toe or "custom-made" transfers avoiding a further reduction of the digital capital of the hand. Amputations of the five fingers create oblique, transverse or convex sections which, when they are proximal, require elongation of one, two or three digits depending on whether surgery is designed to restore a bipod or tripod pinch grip. Lastly, complex mutilations require a combination of digital reconstruction and palmo-commissural skin repair by neurovascular free flaps from the foot. Nonsurgical management should also be discussed in every case.

Amputation, Traumatic↗
PubMed1993

[Forum: reconstruction of the traumatic thumb. Esthetics and post-traumatic reconstruction of the thumb].

The authors deal with the aesthetic problems of traumatic thumb reconstructions from two complementary points of view: surgical and psychoanalytical. From the surgical point of view, they discuss the aesthetic factors of repair ("aesthetics equals function") in the hand and in the donor site. The features of a "good" reconstructed thumb are recalled, together with the ways of achieving this result, taking into account several imperatives related to the various techniques: the residual scar, the proportions of the thumb (length and diameter) and the appearance of the nail. The morphological sequelae at the principal donor sites (hand, forearm and foot) are also evaluated. Although sacrifice of the great toe is not longer justified, that of the second toe should be weighted up against the limited sequelae of "custom-made" great toe flaps. In the second, psychoanalytical approach to the aesthetic problem, the deep motivations underlying the patient's request are examined. In order to satisfy the patient's demand, it is essential to clearly define the indications and contraindications related to the patient's psychological make-up, the importance of the aesthetic role of his or her hand and the psychological impact of both the initial trauma and the secondary sequelae of surgery, bearing in mind that psychological factors change with time, just as the body image also varies continuously. Finally, the dual, surgical and psychoanalytical approach should allow the surgeon to satisfy the hand injury patient's functional and aesthetic demands under the best possible conditions.

Amputation, Traumatic↗
PubMed1994

The thumb's knuckle. Flexibility in the thumb subdomain of T7 RNA polymerase is revealed by the structure of a chimeric T7/T3 RNA polymerase.

We have solved the structure of a chimeric T7/T3 RNA polymerase (RNAP) in an orthorhombic crystal by molecular replacement with the T7 RNAP structure determined from a monoclinic crystal. The structure of the protruding "thumb" subdomain of the polymerase appears very different in these two crystals apparently because of differences in packing contacts made by the thumb subdomain. These observations support the proposal that the thumb subdomain is flexible and can wrap around bound template to obstruct polymerase: template dissociation during processive synthesis.

Amino Acid Sequence↗
PubMed1986

Breakdancer's thumb--partial rupture of the ulnar collateral ligament with a fracture of the proximal phalanx of the thumb.

Breakdancing is an acrobatic dance that involves spinning on various parts of the body including the head, dorsal spine and hand. Three cases are reported of partial rupture of the ulnar collateral ligament (UCL) of the thumb, associated with a fracture of the base of the proximal phalanx which occurred as a result of torsional forces applied to the abducted and hyperextended thumb. It appears to be a distinct clinical entity. In all cases, open reduction was required and led to excellent functional recovery.

Adolescent↗
PubMed1986

Conservative treatment for a ruptured extensor tendon on the dorsum of the proximal phalanges of the thumb (mallet thumb).

Of 35 patients with mallet thumb, 25 received conservative coil-splint immobilization treatment. Those who received treatment were able to extend the interphalangeal joints to at least 0 degrees with the exception of four patients. The number of patients who did not respond to the treatment was greater in those 30 years of age or older compared with those 29 years old or younger, but there was no statistically significant difference. Satisfactory extension was observed in 12 patients who received treatment within 2 weeks after sustaining injuries. Four of 10 patients who received treatment 2 weeks or later after the injuries demonstrated poor results. The preferred treatment for mallet thumb is primary surgical repair. However, conservative treatment should be the first choice if there is no skin wound or the conditions at first consultation are not appropriate for surgery.

Adolescent↗
PubMed2000

Simultaneous avulsion fracture of the insertion of the ulnar and radial collateral ligaments of the metacarpophalangeal joint of the thumb.

We present a case of simultaneous avulsion fracture of the insertion on the volar base of the proximal phalanx of the ulnar and radial collateral ligaments of the metacarpophalangeal joint of the thumb. To our knowledge this combination has never been published before. The mechanism of this injury is not clearly understood. (c) 2000 Harcourt Publishers Ltd Copyright 2000 The British Association of Plastic Surgeons DOI: 10.1054/bjps.1999.3227.

Journal Article↗