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At least 775 records · Page 43Linked to original sources
PubMed2000

Experience with the pedicled latissimus dorsi flap for finger reconstruction.

The pedicled latissimus dorsi flap was used for the reconstruction of finger function in 12 patients with severely disabled hands. The fascial origin of the muscle was sutured directly to finger flexors in 6 patients, and to extensors in the other 6 patients in the forearm without severing the neurovascular pedicle. Voluntary contraction of the muscle was obtained in all patients. Useful tendon gliding was achieved in 6 patients, thereby providing total active motion of fingers of >100 degrees. In the remaining 6 patients, however, several problems such as stiff finger joints prevented appropriate tendon gliding, resulting in total active motion of <60 degrees. When these problems are overcome, the pedicled latissimus dorsi muscle can yield satisfactory excursion for extrinsic tendons of the fingers. In contrast to free muscle transplantation, early and predictable recovery of function can be obtained using this particular technique without any risk of denervation of the muscle.

Adolescent↗
PubMed1995

Extensor physiology in the hand and wrist.

The Physiology of finger extension is complex because of the various components of the extensor tendon mechanism. This article discusses the role each component plays in finger extension. Tendon excursion, strength, and electromyographic activity of the extensors are discussed.

Finger Joint↗
PubMed1979

A hand infection from A. calcoaceticus (M. polymorpha).

Acinetobacter calcoaceticus (Mima polymorpha) is not a well known organism, and its identification can be confusing due to its variable morphology and sensitivity pattern. In a joint infection, delay in identification or appropriate treatment can result in added morbidity. An A. calcoaceticus (Mima) infection in the hand seems not to have been previously reported. The present case involving a finger joint infection illustrates the pathogenicity of A. calcoaceticus (Mima) and problems of treatment. Minocycline is recommended as the drug of choice in subsequent A. calcoaceticus (Mima) and (Herella) infections.

Acinetobacter↗
PubMed1988

Injury to collateral ligament of the metacarpophalangeal joint of a finger.

Twenty-two patients with injury to the collateral ligament of the metacarpophalangeal (MP) joint of a finger are reported. Thirteen cases were acute injuries and nine cases were chronic injuries. In all cases arthrography was performed. The arthrographic findings correlated with the grade of joint stability. Arthrographics of the unstable joint gave useful information for elucidating the mechanism of injury and deciding whether surgical treatment was indicated. At exploratory surgery, a Stener lesion was identified in one case in which the ruptured end of the ligament was trapped by the proximal portion of the expansion hood and sagittal band.

Adult↗
PubMed2003

Neurological presentation of Ehlers-Danlos syndrome type IV in a family with parental mosaicism.

Ehlers-Danlos syndrome type IV (EDS-IV) is an autosomal-dominant disorder caused by a defect of type III collagen which leads to ruptures of arteries and hollow organs. Neurological presentation with muscle involvement and flexion contractures of the finger joints is uncommon. We clinically characterized seven members of a family with EDS-IV. The index patient, a young woman with an acrogeric face, suffered chronic muscle pain and cramps, Achilles tendon retraction, finger flexion contractures and seizures. The mother had similar features and had experienced an ischemic stroke. Biochemical study in cultured fibroblasts and molecular analysis of the COL3A1 gene led to the diagnosis of EDS-IV. A glycine substitution, p.G883V, within the triple helix of the alpha 1(III) chain, was found in the index patient and in the mother. The maternal grandfather and an aunt each had an abdominal aortic aneurysm, the rupture of which was the cause of death in the latter, at 40 years of age. Surprisingly, we found the mutation, as a mosaic, in the asymptomatic maternal grandmother. This expands the clinical spectrum of EDS type IV and confirms that in some families mosaicism can be identified as the source of the mutation.

Adult↗
PubMed1995

Design methodology for a multifunctional hand prosthesis.

The first part of this paper reviews different approaches to define the motion of the fingers and the thumb in order to obtain prehension. The last part presents the design of a hand prosthesis based on a new plane of action for the thumb and on proposed design specifications and functional characteristics. The design methodology consists of two steps: the morphology design of the hand prosthesis and the 4-bar mechanism design for each finger. A 3-D computer-aided design (CAD) interactive program was used as a design tool to obtain the hand morphology. This CAD technique was also used to check the geometry, the relative motions of the fingers, and the possibility of interference for the proposed model with two prehension patterns (tridigital and lateral). It is noted that identical flexion angles of the finger joints were obtained for these two prehension patterns, the difference being in the inclination angle of the thumb's plane of flexion. This finding greatly simplified the design of the internal mechanisms of the fingers. CAD was a powerful tool in the design process of this hand prosthesis and will be more and more useful in the future.

Artificial Limbs↗
PubMed1987

[Fibrinogen glue in osteochondral fractures with small fragments of the upper limb].

Fibrin sealant presents a satisfactory possibility for reconstruction of the joint surface, especially in cases of little osteochondral fragments. Our experience in 16 patients is detailed. The patients average age was 23 years. 34 osteochondral fragments had been glued in these 16 cases, 10 times at the finger joints, 4 times at the caput radii and 2 times at the trochlea humeri. The patients, who had been operated on from June 1979 to December 1984 have been followed up at an average of 2,1 years after the fibrin gluing. This method can avoid an early arthrodesis or oversized osteosynthetic material.

Adolescent↗
PubMed1993

Treatment of porokeratosis of Mibelli with CO2 laser vaporization versus surgical excision with split-thickness skin graft. A comparison.

BACKGROUND: Porokeratosis of Mibelli has been treated with many topical surgical modalities in the past, including cold steel surgical excision and CO2 laser excision. We report a patient with an 8 x 10 cm2 plaque of porokeratosis on the dorsum of his hand, fingers, and web spaces. OBJECTIVE: To compare the treatment results of CO2 laser vaporization versus cold steel surgical excision with split-thickness skin graft placement. METHOD: The portions of the lesion overlying the metacarpophalangeal joints, fingers, and web spaces were treated with CO2 laser vaporization. The remainder of the lesion covering the dorsum of the hand was excised with cold steel, followed by placement of a split-thickness skin graft over that area. RESULTS: The portion of the porokeratosis lesion treated with CO2 vaporization healed with results cosmetically and functionally superior to the grafted area. CONCLUSION: Carbon dioxide laser vaporization, a more superficial treatment modality than CO2 laser excision, should be the preferred treatment modality for porokeratosis lesions.

Aged↗
PubMed1993

A quantitative assessment of limited joint mobility in patients with diabetes. Goniometric analysis of upper extremity passive range of motion.

OBJECTIVE: The syndrome of limited joint mobility is a common but not widely recognized musculoskeletal complication of diabetes. The purpose of this study was to further characterize this syndrome using quantitative goniometric measures. METHODS: Cross-sectional analysis of a sample population was performed to establish the prevalence, location, and severity of limited joint mobility and to determine its relationship to extraarticular manifestations and complications of diabetes. Passive range of motion of both upper extremities was measured by goniometry in 70 adult patients with insulin-dependent diabetes mellitus and 70 nondiabetic controls who were group-matched for age, sex, and general activity level. Joint mobility was assessed by both individual joint motions and a composite scoring technique. RESULTS: Analysis of individual joints and composite scores revealed significant differences between dominant and nondominant extremities in both the control and the diabetic groups. Diabetic patients were generally less flexible than nondiabetic subjects throughout the arm, especially in shoulder and finger joints. In the full study population, multivariate analysis revealed that advanced age, male sex, and the presence of diabetes were associated with decreased passive range of motion for a majority of joints (P < 0.05). In the diabetes group, passive range of motion was significantly correlated (P < 0.05) with age, sex, duration of diabetes, and to a variable extent, glucose control, but was not correlated with the presence of clinically significant neuropathy, retinopathy, nephropathy, or peripheral vascular disease, with activity level, or with hand dominance. Stepwise regression analysis failed to identify single key joint motion(s) to serve as possible screening tests in predicting generalized limited joint mobility of the upper extremity. Finally, the effect of limb usage on range of motion in flexion may differ in diabetic and nondiabetic subjects. CONCLUSION: Limited joint mobility is a generalized phenomenon occurring throughout the upper extremities of many diabetic patients. It is significantly related to age, sex, and to a variable extent duration of diabetes and glucose control. It is not related to the standard complications of diabetes as defined in this study.

Adult↗
PubMed2005

Estimation of finger muscle tendon tensions and pulley forces during specific sport-climbing grip techniques.

The present work displayed the first quantitative data of forces acting on tendons and pulleys during specific sport-climbing grip techniques. A three-dimensional static biomechanical model was used to estimate finger muscle tendon and pulley forces during the "slope" and the "crimp" grip. In the slope grip the finger joints are flexed, and in the crimp grip the distal interphalangeal (DIP) joint is hyperextended while the other joints are flexed. The tendons of the flexor digitorum profundus and superficialis (FDP and FDS), the extensor digitorum communis (EDC), the ulnar and radial interosseus (UI and RI), the lumbrical muscle (LU) and two annular pulleys (A2 and A4) were considered in the model. For the crimp grip in equilibrium conditions, a passive moment for the DIP joint was taken into account in the biomechanical model. This moment was quantified by relating the FDP intramuscular electromyogram (EMG) to the DIP joint external moment. Its intensity was estimated at a quarter of the external moment. The involvement of this parameter in the moment equilibrium equation for the DIP joint is thus essential. The FDP-to-FDS tendon-force ratio was 1.75:1 in the crimp grip and 0.88:1 in the slope grip. This result showed that the FDP was the prime finger flexor in the crimp grip, whereas the tendon tensions were equally distributed between the FDP and FDS tendons in the slope grip. The forces acting on the pulleys were 36 times lower for A2 in the slope grip than in the crimp grip, while the forces acting on A4 were 4 times lower. This current work provides both an experimental procedure and a biomechanical model that allows estimation of tendon tensions and pulley forces crucial for the knowledge about finger injuries in sport climbing.

Adult↗
PubMed2005

Laryngeal involvement in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane, which causes joint damage and bone destruction. Extra-articular manifestations are numerous, involving multiple organ systems. Rheumatoid nodules are common extra-articular findings occurring in 20% RA patients. They develop most commonly in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and others. Furthermore, RA affects the ear, nose, and throat, causing various otorhinolaryngological symptoms. In this report we describe two patients with RA and laryngeal involvement, mostly rheumatoid nodule formation, with a review of the literature.

Aged↗
PubMed2000

Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls.

OBJECTIVE: To introduce dynamic magnetic resonance imaging (MRI) as an indicator of inflammatory activity in the metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) or early unclassified polyarthritis, and to compare the results with a healthy control group. MATERIALS AND METHODS: We examined 42 RA and 23 early unclassified polyarthritis patients, and 12 healthy controls in a cross-sectional study. Dynamic MRI (repeated FLASH-MR images after injection of a contrast agent) was performed through the 2nd to the 5th MCP joint. Two methods for identification of the enhancing synovial membrane were compared: 1) outlining of enhancing synovial membrane on subtraction images and 2) automated recognition by principal component analysis (PCA). The early enhancement (EE) rate was calculated on the basis of the first method. RESULTS: Method 1) and 2) were closely associated (P<0.00001). From the healthy control group, an upper limit (mean+2SD) of normal enhancement was established for the 2nd to 5th MCP joints, which served to identify abnormal EE rates in the corresponding joints of patients. The patients had higher EE rates in the 2nd to 5th MCP joints than had the healthy controls (P<0.01). There were no significant differences between the two patient groups (P>0.09). CONCLUSION: PCA seems to be a promising method for automated identification of enhancing tissue. EE rates of the finger joints may be useful in the assessment of the inflammatory activity in the joints of patients with RA and early unclassified polyarthritis and may reflect other aspects of disease activity than clinical evaluation.

Adult↗
PubMed1977

Pseudotumoral aspect of posttraumatic digital synovitis.

A case of posttraumatic subacute synovitis with pseudotumor of the digit with bone lesions on plain film is reported. Arteriography showed a pattern of hypervascularity that did not appear malignant and evoked a benign tumor of the synovial. Biopsy helped establish diagnosis of common subacute synovitis. Swelling disappeared spontaneously during subsequent months. Diagnosis of villonodular synovitis is difficllt when proliferation of histiocytes is present.

Angiography↗
PubMed1995

A two-dimensional kinematic model of the lumbrical in the human finger.

The functioning of the lumbrical muscle in the human finger is difficult to visualise. This is mainly due to the fact that the origin and insertion of the lumbrical is on tendons of other motors (the deep flexor and the extensor assembly, respectively), instead of on bone. In this paper the functioning of the lumbrical in the human finger is kinematically investigated by explicitly considering the slackness or tautness of tendon parts which are in parallel or in series with the lumbrical, and by deriving from a standard finger model equivalent representations from which the functioning of the lumbrical is visually more clear. These models are used to review and interpret the results of previous studies. Further, it is indicated that the lumbrical is in an ideal position to contribute to the control of certain fast movements, as may be of importance for the musician, and that its role in other fast movements may be limited because of its large displacements (contraction speed).

Algorithms↗
PubMed1995

Safety and efficacy of percutaneous trigger finger release.

Twenty-five A1 pulleys in 5 fresh cadaveric hands and 13 trigger fingers in 11 patients were released percutaneously with a 19 gauge needle, as described by Eastwood et al., to determine the efficacy and safety of the technique. Over 90% of the length of each individual finger and thumb A1 pulley were successfully released in the cadaveric digits with no injuries to the A2 pulley, nerves, or vessels. Superficial abrasions were noted in four superficialis tendons. In our surgical series, complete clinical release (eradication of triggering) was achieved in each digit. In 8 of 13 digits, the A1 pulley was found to be completely divided on open exploration. In five digits, while triggering was eliminated, some of the A1 pulley remained intact. There were no complications. Because of the proximity of digital nerves, we do not perform percutaneous release in the index finger or thumb.

Adult↗