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PubMed1998

Drawing with the non-dominant hand: implications for the study of construction.

BACKGROUND: Constructional impairment following left vs. right hemisphere damage has been extensively studied drawing tasks. A confounding factor in these studies is that right-handed patients with left hemisphere damage (LHD) are often forced by weakness to use their non-dominant (left) hand or hemiparetic dominant hand. Qualitative differences in the drawing characteristics of left and right hand drawings by normal subjects have not previously been characterized. The present study was undertaken to determine the qualitative differences between left and right hand drawings of normal subjects. METHODS: Thirty right-handed, elderly subjects without a history of neurological disease were asked to draw, from memory, seven objects using the right and left hand. Half of the subjects were randomly assigned to draw with the left hand first, and half the right hand first. Right and left hand drawings were compared using a standardized scoring system utilized in several previous studies of drawing in focal and diffuse neurological disease. Each drawing was scored on eighteen criteria. Right and left hand drawing scores were then compared using the t-test for paired samples or the Wilcoxon matched-pairs test. RESULTS: Drawings made using the left hand were found to be significantly simpler, more tremulous and of poorer overall quality than drawings made by the same subjects using the right hand. CONCLUSIONS: The deficits found in left versus right hand drawings of normals are similar to those found in patients with LHD, suggesting that much of the drawing impairment seen following LDH is due to an elementary motor disturbance related to use of the non-dominant hand.

Aged↗
PubMed1996

Localization of unique functional determinants in the calmodulin lobes to individual EF hands.

We have investigated the functional interchangeability of EF hands I and III or II and IV, which occupy structurally analogous positions in the native I-II and III-IV EF hand pairs of calmodulin. Our approach was to functionally characterize four engineered proteins, made by replacing in turn each EF hand in one pair by a duplicate of its structural analog in the other. In this way functional determinants we define as unique were localized to the component EF hands in each pair. Replacement of EF hand I by III reduces calmodulin-dependent activation of cerebellar nitric oxide synthase activity by 50%. Replacement of EF hand IV by II reduces by 60% activation of skeletal muscle myosin light chain kinase activity. There appear to be no major unique determinants for activation of these enzyme activities in the other EF hands. Replacement of EF hand III by I or IV by II reduces by 50-80% activation of smooth muscle myosin light chain kinase activity, and replacement of EF hand I by III or II by IV reduces by 90% activation of this enzyme activity. Thus, calmodulin-dependent activation of each of the enzyme activities examined, even the closely related kinases, is dependent upon a distinct pattern of unique determinants in the four EF hands of calmodulin. All the engineered proteins examined bind four Ca2+ ions with high affinity. Comparison of the Ca2+-binding properties of native and engineered CaMs indicates that the Ca2+-binding affinity of an engineered I-IV EF hand pair and a native I-II pair are similar, but an engineered III-II EF hand pair is intermediate in affinity to the native III-IV and I-II pairs, minimally suggesting that EF hands I and III contain unique determinants for the formation and function of EF hand pairs. The residues directly coordinating Ca2+ ion appear to play little or no role in establishing the different Ca2+-binding properties of the EF hand pairs in calmodulin.

Amino Acid Sequence↗
PubMed2004

A possible methodological flaw in comparing dominant and nondominant sided lumbar spine muscle responses without simultaneously considering hand dominance.

STUDY DESIGN: Different factorial designs analyzing the same data were compared for consistent interpretation. OBJECTIVE: To assess hand dominance as an explanatory factor when comparing dominant and nondominant side back muscle response time delay and fatigability. SUMMARY OF BACKGROUND DATA: A number of studies have evaluated lumbar spinal muscle responses to sudden load and fatigue. Although the dominant side of the back is usually determined by considering hand dominance, few studies explicitly consider hand dominance as part of the explanatory model and assume that right- and left-handed patients are not unique cohorts. METHODS.: The erector spinae and multifidi lumbar muscle groups in patients with chronic low back pain (CLBP) were investigated. For the response time to a sudden load, the biceps brachii muscle was compared with erector spinae and multifidi muscles to understand any compensatory upper extremity movement patterns. For fatigue, the erector spinae and multifidi muscle median frequency (MF) and its slope (MFS) were measured during a 1-minute isometric back extension maneuver. RESULTS: Altogether, 46 patients with CLBP were studied. Right- and left-handed subjects did not differ in reported disability based on the Oswestry Disability Index, (F1, 44 = 2.11, P < 0.153). The dominant and nondominant side response times were significantly different for left-handed patients but not for right-handed patients. The nondominant side back muscles, located on the contralateral side of the dominant hand, were faster for the right-hand dominant patients and slower for the left-hand dominant patients. In the muscles on the nondominant side of the back, the left-hand dominant patients demonstrated significantly more fatigue than right-hand dominant patients. However, in the muscles on the dominant side of the back, neither set of patients demonstrated fatigability. CONCLUSIONS: When examining differential lumbar muscle responses, failing to consider hand dominance explicitly in conjunction with the side assessed resulted in confounding effects. The results of the study indicated a delayed back muscle response time on the nondominant side. This delayed response time raises the possibility that unbalanced muscle activity could prompt a decreased, uncoordinated, asymmetric bracing effect, thereby increasing the risk of lumbar segment buckling. Further studies are needed to investigate the characteristics of the back muscles on the same side of the dominant hand and the factors mediating neuromuscular differences in patients with CLBP. Understanding the effects of hand dominance on fatigue in certain back muscles should lead to better treatments thereby improving neuromuscular control in patients with CLBP.

Adult↗
PubMed2002

Comparison of hand assisted and standard laparoscopic radical nephroureterectomy for the management of localized transitional cell carcinoma.

PURPOSE: Hand assisted laparoscopy affords the surgeon tactile sensation and blunt dissection, which are currently limited using the standard laparoscopic technique. Therefore, we compared standard and hand assisted laparoscopic radical nephroureterectomy for localized upper tract transitional cell carcinoma. MATERIALS AND METHODS: The medical records of 27 patients who underwent standard (11) or hand assisted (16) laparoscopic radical nephroureterectomy between April 1998 and January 2001 were retrospectively reviewed. The parameters of efficacy, efficiency, safety and convalescence were compared. RESULTS: Mean patient age was 64 and 66 years (p = 0.72) in the standard and hand assisted groups, and the mean American Society of Anesthesiologists score was 2.5 and 2.7 (p = 0.64), respectively. All standard and 15 of the 16 hand assisted (94%) procedures were successfully completed via laparoscopy. Total operative time was more than 1 hour shorter for hand assisted than for laparoscopic radical nephroureterectomy (4.9 versus 6.1 hours, p = 0.055). Mean estimated blood loss was similar in the standard and hand assisted groups (190 and 201 ml., p = 0.78). In each group 1 patient required blood transfusion. Mean specimen weight was significantly higher in hand assisted cases (576 versus 335 gm., p = 0.036). Mean time to oral intake was similar in patients who underwent standard and hand assisted laparoscopic radical nephroureterectomy (13 and 20 hours, respectively, p = 0.45). The mean analgesic requirement was also similar (29 and 33 mg. morphine sulfate, respectively, p = 0.83). Mean hospital stay in uncomplicated cases was similar for standard and hand assisted surgery (2.9 and 2.5 days, respectively). Overall hospital stay in the 2 cohorts was also similar (3.3 and 4.5 days, respectively, p = 0.59). Four patients per group experienced postoperative complications. There were no deaths in the standard group but 1 patient (6%) in the hand assisted group died postoperatively. Mean time to partial and complete convalescence in the standard and hand assisted groups was 2.4 and 5.2, and 3.5 and 8.0 weeks, while mean followup was 27.4 and 9.6 months, respectively. CONCLUSIONS: Compared with standard laparoscopy hand assisted laparoscopy decreases operative time without significantly altering short-term parameters of convalescence. However, long-term convalescence after hand assisted laparoscopic radical nephroureterectomy is 1 to 3 weeks longer (p = 0.27). Longer followup in the hand assisted cohort is necessary to determine whether there are any differences in the 2 methods in regard to cancer control.

Aged↗
PubMed2003

Assessment of individual hand performance in box trainers compared to virtual reality trainers.

Training residents in laparoscopic skills is ideally initiated in an inanimate laboratory with both box trainers and virtual reality trainers. Virtual reality trainers have the ability to score individual hand performance although they are expensive. Here we compared the ability to assess dominant and nondominant hand performance in box trainers with virtual reality trainers. Medical students without laparoscopic experience were utilized in this study (n = 16). Each student performed tasks on the LTS 2000, an inanimate box trainer (placing pegs with both hands and transferring pegs from one hand to another), as well as a task on the MIST-VR, a virtual reality trainer (grasping a virtual object and placing it in a virtual receptable with alternating hands). A surgeon scored students for the inanimate box trainer exercises (time and errors) while the MIST-VR scored students (time, economy of movements, and errors for each hand). Statistical analysis included Pearson correlations. Errors and time for the one-handed tasks on the box trainer did not correlate with errors, time, or economy measured for each hand by the MIST-VR (r = 0.01 to 0.30; P = NS). Total errors on the virtual reality trainer did correlate with errors on transferring pege (r = 0.61; P < 0.05). Economy and time of both dominant and nondominant hand from the MIST-VR correlated with time of transferring pegs in the box trainer (r = 0.53 to 0.77; P < 0.05). While individual hand assessment by the box trainer during 2-handed tasks was related to assessment by the virtual reality trainer, individual hand assessment during 1-handed tasks did not correlate with the virtual reality trainer. Virtual reality trainers, such as the MIST-VR, allow assessment of individual hand skills which may lead to improved laparoscopic skill acquisition. It is difficult to assess individual hand performance with box trainers alone.

Clinical Competence↗
PubMed2005

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study.

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.

2-Propanol↗
PubMed2005

Change of facilitation during voluntary bilateral hand activation after stroke.

BACKGROUND AND PURPOSE: The relearning of daily activities after stroke also involves performance of bimanual tasks. This raises the possibility that concurrent activation of the healthy hemisphere interferes with reorganization processes in the affected hemisphere due to inhibitory pathways between homologous motor cortex representations. This study investigated the effect of voluntary, simultaneous activation of both hands upon the non-dominant (healthy subjects) or affected (stroke patients) hemisphere. METHODS: Eleven healthy subjects and 16 stroke patients were investigated using transcranial stimulation (TMS). TMS was applied over the non-dominant/affected hemisphere during performance of an isometric pinch grip at different force levels (10% or 50% of maximal voluntary contraction) with the contralateral hand. The ipsilateral hand had to perform the pinch grip at various force levels (10%, 50%, or 100% of maximal voluntary contraction) simultaneously. Peak-to-peak amplitudes of motor evoked potentials (MEPs) were compared to assess differences in motor cortex excitability. RESULTS: Unilateral activity of either hand alone exerted a facilitatory effect upon the non-dominant or affected hemisphere. In healthy subjects, the activation of the ipsilateral hand simultaneously with the contralateral hand did not produce any significant change of the MEP amplitudes compared to unilateral activation of the contralateral hand. In patients, however, the additional activation of the ipsilateral hand caused an additional increase of the peak-to-peak amplitudes. CONCLUSION: In healthy subjects voluntary activation of the ipsilateral hand does not change the excitability of the motor cortex of the non-dominant hemisphere, when the contralateral hand is simultaneously activated. The facilitation of the contralateral hand seems to gate further facilitation by the ipsilateral hand. However, in stroke patients simultaneous activation of both hands causes an additional facilitation compared to activation of the affected hand alone.

Adult↗
PubMed2004

Brain activation during manipulation of the myoelectric prosthetic hand: a functional magnetic resonance imaging study.

Neuroimaging data, particularly functional magnetic resonance imaging (fMRI) findings, have not been reported in users of the myoelectric or electromyographic (EMG) prosthetic hand. We developed a virtual EMG prosthetic hand system to eliminate mutual signal noise interference between fMRI imaging and the EMG prosthesis. We used fMRI to localize activation in the human brain during manipulation of the virtual EMG prosthetic hand. Fourteen right-handed normal subjects were instructed to perform repetitive grasping with the right hand with eyes closed (CEG); repetitive grasping with the right hand with eyes open to obtain visual feedback of their own hand movement (OEG); and repetitive grasping with the virtual EMG prosthetic hand with the eyes open to obtain visual feedback of the prosthetic hand movement (VRG). The specific site activated during manipulation of the EMG prosthetic hand was the right ventral premotor cortex. Both paradigms with visual feedback also (OEG and VRG) demonstrated activation in the right posterior parietal cortex. The center of activation of the right posterior parietal cortex shifted laterally for visual feedback with the virtual EMG prosthetic hand compared to a subject's own hand. The results suggest that the EMG prosthetic hand might be recognized in the brain as a high-performance alternative to a real hand, being controlled through a "mirror system" in the brain.

Action Potentials↗
PubMed2002

Risk assessment of hand washing efficacy using literature and experimental data.

This study simulated factors that influence the levels of bacteria on foodservice workers' hands. Relevant data were collected from the scientific literature and from laboratory experiments. Literature information collected included: initial bacterial counts on hands and water faucet spigots, bacterial population changes during hand washing as effected by soap type, sanitizing agent, drying method, and the presence of rings. Experimental data were also collected using Enterobacter aerogenes as a surrogate for transient bacteria. Both literature and experimental data were translated into appropriate discrete or probability distribution functions. The appropriate statistical distribution for each phase of the hand washing process was determined. These distributions were: initial count on hands, beta (2.82, 2.32, 7.5); washing reduction using regular soap, beta (3.01, 1.91, -3.00, 0.60); washing reduction using antimicrobial soap, beta (4.19, 2.99, -4.50, 1.50); washing reduction using chlorhexidine gluconate (CHG), triangular (-4.75, -1.00, 0); reductions from hot air drying, beta (3.52, 1.92, -0.20, 1.00); reduction from paper towel drying, triangular (-2.25, -0.75, 0); reduction due to alcohol sanitizer, gamma (-1.23, 4.42) -5.8; reduction due to alcohol-free sanitizer, gamma (2.22, 5.38) -5.00; and the effect of rings, beta (8.55, 23.35, 0.10, 0.45). Experimental data were fit to normal distributions (expressed as log percentage transfer rate): hand-to-spigot transfer, normal (-0.80, 1.09); spigot to hand, normal (0.36, 0.90). Soap with an antimicrobial agent (in particular, CHG) was observed to be more effective than regular soap. Hot air drying had the capacity to increase the amount of bacterial contamination on hands, while paper towel drying caused a slight decrease in contamination. There was little difference in the efficacy of alcohol and alcohol-free sanitizers. Ring wearing caused a slight decrease in the efficacy of hand washing. The experimental data validated the simulated combined effect of certain hand washing procedures based on distributions derived from reported studies. The conventional hand washing system caused a small increase in contamination on hands vs. the touch-free system. Sensitivity analysis revealed that the primary factors influencing final bacteria counts on the hand were sanitizer, soap, and drying method. This research represents an initial framework from which sound policy can be promulgated to control bacterial transmission via hand contacts.

Bacteria↗
PubMed1995

Is hand washing really needed in an intensive care unit?

OBJECTIVES: To determine whether a rigorous antiseptic hand washing of bare hands with 4% chlorhexidine and alcohol reduced fingertip microbial colonization as compared with the use of boxed, clean, nonsterile latex gloves. In addition, to investigate if aseptic donning technique and/or a prior hand washing would reduce the level of glove contamination. DESIGN: Prospective, randomized, crossover design, with each subject serving as his/her own control. SETTING: University intensive care unit. SUBJECTS: Forty-three intensive care nurses. INTERVENTIONS: The fingertips of 20 nurses were cultured before and after a strict antiseptic hand washing and before and after the routine and aseptic donning of sterile gloves. Subsequently, the fingertips of 43 nurses were cultured before and after the casual donning of nonsterile gloves over unwashed hands and before and after a strict antiseptic hand washing. Fingertip cultures were plated directly on agar, incubated for 24 hrs, and counted and recorded as the number of colony-forming units (cfu) for each hand. Different colony types were then subcultured. MEASUREMENTS AND MAIN RESULTS: Hand washing with antiseptic reduced colonization from 84 to 2 cfu (p < .001). The proportion of cases with > or = 200 cfu/hand was reduced from 30% to 9%. Aseptic or casual donning of sterile gloves, with or without prior antiseptic hand washing, resulted in consistently low glove counts between 0 and 1.25 cfu. Nonsterile gloves casually donned over washed or unwashed bare hands diminished the bioburden to 2.17 and 1.34 cfu, respectively. No qualitative difference was found in the microorganisms recovered from gloved or bare hands. CONCLUSIONS: Antiseptic hand washing and the use of nonsterile gloves over unwashed hands confer similar reductions in the number of microorganisms. There is no additional benefit with the use of aseptic donning technique, prior antiseptic hand washing, or the use of individually packaged sterile gloves.

Asepsis↗
PubMed1991

Is there a preferred coordinate system for perception of hand orientation in three-dimensional space?

The purpose of this experiment was to determine the preferred coordinate system for representation of hand orientation in 3-dimensional space. The ability of human subjects to perceive angles of the hand in 3-dimensional space (elevation, yaw, roll angles-extrinsic coordinate system) was compared to their ability to perceive hand angles relative to the proximal upper limb segments (wrist joint angles, forearm pronation-intrinsic coordinate system). With eyes closed, subjects performed a matching task in which the experimenter positioned the left arm, forearm and hand and the right arm and forearm. Subjects were then told to match an angle in one of the two coordinate systems by moving only the right hand at the wrist or the forearm as in pronation or roll matching. Absolute constant error (ACE), variable error (VE) and normalized variable error (NVE-normalized to tested range of motion) of matching were quantified for each subject for each of the six angles matched. It was hypothesized that matching angles in a preferred coordinate system would be associated with lower ACE, VE and NVE. Overall, ACE and VE were lower for matching hand angles in the intrinsic coordinate system. This suggests that the preferred coordinate system involved specification of hand angles relative to forearm and arm angles (joint angles) rather than the hand angles relative to axes external to the upper limb. However, matching of pronation angles was associated with larger VE and NVE than roll angle matching. There were no significant differences in ACE between pronation and roll matching. In a second experiment subjects with their forearms constrained at different elevations matched hand elevation and wrist flexion angles. Thus, errors in matching the angles in the non-preferred coordinate system were predictable if the subjects were biased toward matching angles in the preferred coordinate system. Trends in the data suggested that subjects preferred matching hand elevation angles but these trends were not consistent within or between subjects. Thus a preferred intrinsic coordinate system for wrist flexion matching was not observed in this experiment. We suggest that matching angles when proximal limb segments are constrained is a simpler task for the subjects (VE lower than in the first experiment) and may bias the matching toward the extrinsic coordinate system. Thus, hand orientation in 3-dimensional space may be perceived as follows: wrist flexion and abduction angles together with forearm elevation and yaw are used to specify hand elevation and yaw; these together with hand roll angle, completely specify the hand angle in 3-dimensional space.

Adult↗
PubMed2006

Serial correlation in lateralized choices of hand and target.

We investigated how lateralized choices of hand and target are influenced by previous behavior. Three monkeys retrieved food pellets following cues indicating the location of available food pellet targets, and the hand that could be used to acquire a target. In pseudo-randomized trials, the monkeys could retrieve food pellet targets only on their right side, only on their left side, or their choice of either right or left side, using only their right hand, only their left hand, or their choice of either hand. We examined separately the patterns of serial correlation in target choices and hand choices. Although individual monkeys showed overall laterality preferences, instead of repeatedly using the preferred hand, we found that the monkeys tended to switch hands in successive trials. This serial correlation in hand choice was stronger and more robust than serial correlation in target choice. Furthermore, the pattern of serial correlation for target choice closely resembled that of serial correlation for hand choice when the animal was allowed to choose both target and hand, but only when the target cue was presented before the hand cue. These results suggest that when cued to choose a hand first, the monkeys tended to make a separate decision as to whether to switch their target choices or not, whereas their decisions to switch hands and targets were linked more tightly if the animal was cued to choose a target first.

Analysis of Variance↗
PubMed2006

Hand-grip strength of young men, women and highly trained female athletes.

Hand-grip strength has been identified as one limiting factor for manual lifting and carrying loads. To obtain epidemiologically relevant hand-grip strength data for pre-employment screening, we determined maximal isometric hand-grip strength in 1,654 healthy men and 533 healthy women aged 20-25 years. Moreover, to assess the potential margins for improvement in hand-grip strength of women by training, we studied 60 highly trained elite female athletes from sports known to require high hand-grip forces (judo, handball). Maximal isometric hand-grip force was recorded over 15 s using a handheld hand-grip ergometer. Biometric parameters included lean body mass (LBM) and hand dimensions. Mean maximal hand-grip strength showed the expected clear difference between men (541 N) and women (329 N). Less expected was the gender related distribution of hand-grip strength: 90% of females produced less force than 95% of males. Though female athletes were significantly stronger (444 N) than their untrained female counterparts, this value corresponded to only the 25th percentile of the male subjects. Hand-grip strength was linearly correlated with LBM. Furthermore, both relative hand-grip strength parameters (F (max)/body weight and F (max)/LBM) did not show any correlation to hand dimensions. The present findings show that the differences in hand-grip strength of men and women are larger than previously reported. An appreciable difference still remains when using lean body mass as reference. The results of female national elite athletes even indicate that the strength level attainable by extremely high training will rarely surpass the 50th percentile of untrained or not specifically trained men.

Adult↗
PubMed2004

The effects of test variables on the efficacy of hand hygiene agents.

BACKGROUND: Hand hygiene is essential to interrupting disease transmission in health care facilities. Multiple hand hygiene agents are currently available for use in the health care setting. To evaluate the utility of these agents, both the user acceptability and the efficacy need to be evaluated. Different hand hygiene test methodologies have been used to measure the efficacy of these agents, but efficacy results vary depending on variations to key parameters in these methodologies. The purpose of this study was to evaluate the effect of test variables on the efficacy of hand hygiene agents. METHODS: Both a comprehensive literature review and original hand hygiene efficacy studies were undertaken. The literature review was conducted using a Medline search, and hand hygiene efficacy studies were conducted under the American Society for Testing and Materials (ASTM). E 1174 Standard Test Method for Evaluation of the Effectiveness of Health Care Personnel Handwash Formulation. RESULTS: The literature review and our original data showed that the following variables affected the hand hygiene efficacy measurements: hand jewelry, experimental contamination versus normal flora, method of application of test organism, hand hygiene agent, concentration of active ingredient, volume of hand hygiene agent, duration of application of hand hygiene agent, method of application of hand hygiene agent, and study method (human challenge trial versus in vitro suspension test). CONCLUSIONS: Although many methodological variables affect efficacy results, infection control professionals in their analysis of product information should always assess the results in light of the following key variables: concentration and type of active ingredient, duration of exposure to hand hygiene agent, volume of hand hygiene agent applied, test organism, and study method (ie, human challenge vs. in vitro suspension test).

Anti-Infective Agents, Local↗
PubMed2004

Anatomic study of variations of hypothenar muscles and arborization patterns of the ulnar nerve in the hand.

PURPOSE: To show the variations in the hypothenar muscles and the arborization patterns of the ulnar nerve and to investigate the relationship between the hypothenar muscles and the ulnar nerve. METHODS: We performed an anatomic study of 35 hands from embalmed cadavers. After dissecting the ulnar side of the hand we recorded the number of hypothenar muscles and their variations, the site of the hiatus for the deep branch of the ulnar nerve, and the branching patterns of the ulnar nerve in each hand. We then investigated the relationship between the variations in the hypothenar muscles and the arborization patterns of the ulnar nerve. RESULTS: The abductor digiti minimi (ADM) had 1 belly in 6 hands, 2 bellies in 28 hands, and 3 bellies in 1 hand. The flexor digiti minimi brevis was absent in 8 hands, had 1 belly in 24 hands, and had 2 bellies in 3 hands. The opponens digiti minimi had 2 layers of origin and the deep branch of the ulnar nerve passed between these 2 layers in all hands. We classified the structural patterns of the hiatus into 3 types, the arborization patterns of the ulnar nerve into 5 types, and the branching patterns of the motor branch to the ADM into 4 types according to their morphologic characteristics. We found variations of the arborization pattern in which the deep branch originated from the ulnar trunk of the ulnar nerve distal to bifurcation in 3 hands, a communicating branch was present between the 2 sensory branches to the fingers in 3 hands, and the ulnar sensory branch pierced the ADM in 2 hands. CONCLUSIONS: We confirmed that the anatomic relationship between the ulnar nerve and the hypothenar muscle is complex and that the formation of the hiatus varies. This knowledge can assist the surgeon in the diagnosis and treatment of conditions associated with the ulnar aspect of the hand.

Aged↗
PubMed2002

Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis.

BACKGROUND: Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick-leave periods and need for changes of work and re-training put an economic burden on society, and there is an interest in developing cost-effective epidemiological surveillance instruments such as a screening questionnaire. OBJECTIVES: In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self-reported signs. METHODS: Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist ('gold standard') were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. RESULTS: Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the 'gold standard'. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0.62 and a specificity of 0.87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0.87 and a specificity of 0.79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a kappa-value of 0.65 (95% CI 0.55-0.75), and the poorest was for papules with 0.47 (95% CI 0.32-0.62). CONCLUSIONS: It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking 'Do you have hand eczema?' had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.

Adolescent↗
PubMed1997

Two feet-one hand syndrome: a retrospective multicenter survey.

BACKGROUND: The two feet-one hand syndrome is not uncommon; however, there have only been a few reports on this condition. This study was undertaken to obtain a better understanding of the epidemiology of the two feet-one hand syndrome. METHODS: A retrospective chart review was conducted of all the patients seen in our practices over the past 15 years with the diagnosis of two feet-one hand syndrome. RESULTS: A total of 80 patients with mycologically confirmed disease were identified (men, 72 (90%); women, 8 (10%); 77 (96%) Caucasian; 3 (4%) African-American; age (mean +/- standard error (SE)), 55.9 +/- 2.1 years). The mean age of the patients when the physician was first seen for the condition was 51.3 +/- 2.0 years. The mean ages when the symptoms first developed on the feet and hand were 37.1 +/- 2.4 years and 45.7 +/- 2.2 years, respectively. Tinea pedis was found to occur at an earlier age than tinea manuum (t(65) = 6.92, P < 0.01). There was a significant relationship between the hand in which tinea manuum developed, the hand used to excoriate the soles of feet (chi 2(4) = 14.82, P < 0.01), and the hand used to pick toenails (chi 2(4) = 14.82, P < 0.01); however, there was no significant relationship between handedness and the development of tinea manuum in the dominant hand. The occupation of the patient at the time of development of the two feet-one hand syndrome was categorized according to whether the intensity of hand use was high, moderate, or low. Patients with a high intensity of hand use in their jobs were significantly more likely to develop tinea pedis/onychomycosis (r = -0.27, F(1,61) = 4.77, P < 0.05) and tinea manuum (r = -0.30, F(1,62) = 6.31, P < 0.05) at an earlier age. The best multiple predictors of the age at which medical attention was sought were the age of onset of tinea manuum and a family history of tinea infection (r = 0.86, F(2,59) = 86.9, P < 0.01). The age of onset of tinea manuum was the best single predictor, with a correlation of 0.85. CONCLUSIONS: In the two feet-one hand syndrome, the development of tinea pedis/onychomycosis generally preceded the development of tinea manuum. Tinea manuum usually developed in the hand used to excoriate the feet or pick toenails. Patients whose occupation involved a high intensity of use of the hands were more likely to develop the disease at an earlier age. Patients were more likely to seek attention once tinea manuum had developed, particularly if there was a family history of tinea infection.

Adolescent↗
PubMed2000

Hand osteoarthritis patients characteristics according to the existence of a hormone replacement therapy.

BACKGROUND: Hand osteoarthritis (hand OA) mostly occurs in women around the time of menopause, but its relationship with sexual hormones remains a controversial issue. The eventual influence of hormone replacement therapy (HRT) on the incidence and progression of hand OA is still debated. OBJECTIVE: To assess whether HRT influences the occurrence and disease activity of hand OA. METHODS/PATIENTS: Epidemiological prospective cross-sectional study. PATIENTS: Menopausal women, aged 50-75, consulting for painful hand OA, for another rheumatic condition with hand OA or controls (no disease of the upper limbs). ELIGIBILITY CRITERIA: hand OA [American College Rheumatology (ACR) criteria] with X-ray evidence. PATIENTS with 'painful' hand OA defined by a Dreiser's functional index score > or = 6 and pain on VAS > or = 35 mm. Study parameters: Demographics, personal histories and gynaecologic data for patients and controls including the administration of HRT (+) or not (-). For patients, description and symptom activity of hand OA. STATISTICS: Descriptive analysis in the studied population and in subsets taking into account treatment and disease activity factors. RESULTS: 711 women were studied: 238 with 'painful' hand OA, 240 with 'quiescent' and 233 controls. Baseline characteristics were similar for patients and controls except for age (patients were older). HRT+ patients were younger (-5 years) (P < 0.0001), slightly taller (P < 0.0045) and more often cigarettes smokers (P < 0.012) than HRT- patients. They did not differ in gynecologic characteristics with the exception that the women in the HRT+ group had been menopausal for a shorter period of time, probably because of their younger age. There were no differences between HRT+ and HRT- patients, whatever the symptom activity, on the characteristics of hand OA: Dreiser's index scores were, respectively, 11.3 +/- 3.8 vs 12.3 +/- 4.5 in 'painful' patients, 3.6 +/- 2.5 vs 3.7 +/- 2.7 in 'quiescent' patients. Pain on VAS showed no difference between the two groups. CONCLUSION: Few differences were found between hand OA patients receiving HRT or not. HRT did not seem to influence the severity or the symptom activity of hand OA. Further prospective studies are required in order to evaluate the exact effect of HRT on hand OA.

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