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Bottle Feeding↗
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Motion and morphology of the thumb metacarpophalangeal joint.
PURPOSE: To determine the variability in the flexion/extension motion of the thumb metacarpophalangeal (MCP) joint in a normal volunteer population and to determine any correlation between the shape of the thumb metacarpal head, gender, age, thumb interphalangeal (IP) joint range of motion (ROM), and thumb MCP joint ROM in a population of fresh-frozen cadaver arms. METHODS: The ROM of the thumb MCP joints of 100 volunteers (200 thumbs) was measured. The thumb MCP joints of 70 fresh-frozen cadaver arms were examined. Posteroanterior and lateral radiographs were taken of 64 MCP joints. Passive flexion and extension at the MCP and IP joints were measured with a standard goniometer starting at neutral (0 degrees ) with the metacarpal, proximal, and distal phalanges axially aligned. The distance from the volar to the dorsal edge of the articular surface (A) and the radius of curvature of the articular surface (r) of the metacarpal head were measured on the lateral view. The shape of the metacarpal head was given a value using the A/r ratio. Regression analysis was used to determine the correlation between the head shape and joint motion. The thumbs were categorized into a round group (A/r ratio > 1.7) or a flat group (A/r ratio of < 1.7) to facilitate statistical analysis. RESULTS: The volunteer population mean thumb MCP maximum flexion was 77 degrees range, 40 degrees -126 degrees ). Range of motion in hyperextension varied from 0 degrees to 72 degrees, with a mean of 35 degrees. Total ROM was from 55 degrees to 176 degrees, with a mean of 110 degrees. In the cadaver population studied the average MCP joint ROM was 94 degrees (mean flexion, 70 degrees; mean extension, 24 degrees ). The A/r ratio had a range of 1.1 to 2.2. There were 37 round and 27 flat thumb metacarpal heads. Regression analysis showed a significant correlation between metacarpal head shape and ROM; MCP joints with rounder metacarpal heads had greater motion. Round and flat metacarpal heads had significantly different motion arcs averaging 106 degrees and 77 degrees, respectively. Female gender was associated both with significantly greater MCP joint ROM (99 degrees women/87 degrees men) and a significantly higher incidence of round metacarpal heads (66% of women/36% of men). No significant correlation existed between specimen age, MCP, and/or IP joint ROM. CONCLUSIONS: There is a wide range in the magnitude of the thumb MCP joint ROM and the normal shape (round vs flat) of the thumb metacarpal head. A rounder thumb metacarpal head has greater thumb MCP joint ROM than a flatter thumb metacarpal head. Clinically we have found this information helpful in predicting posttraumatic recovery of thumb MCP joint ROM and selecting candidates for and predicting patient satisfaction with thumb MCP joint arthrodesis.
Adolescent↗
Posttraumatic thumb reconstruction.
LEARNING OBJECTIVES: After reading this article, the reader should be able to: 1. Discuss the critical anatomic features of the thumb as they affect on reconstructive decision making. 2. Define the goals of reconstruction. 3. Discuss an algorithm for thumb reconstruction according to the level of amputation. 4. Understand the role of prosthetics in thumb reconstruction. BACKGROUND: The function of the thumb is critical to overall hand function. Uniquely endowed with anatomic features that allow circumduction and opposition, the thumb enables activities of pinch, grasp, and fine manipulation that are essential in daily life. Destruction of the thumb secondary to trauma represents a much more significant loss than would result from loss of any other digit. Therefore, significant effort has been focused on thumb reconstruction. Numerous techniques have been described, ranging from simple osteoplastic techniques to complex microsurgical procedures. With an appreciation of the unique anatomic properties of the thumb, the hand surgeon is better able to understand the goals of thumb reconstruction and to develop an algorithm for thumb reconstruction. With such an understanding, an individualized reconstructive plan can be developed for each patient. METHODS: A great many options are available for posttraumatic thumb reconstruction. Optimal results are obtained by pursuing an organized and logical approach to reconstruction based upon the level of tissue loss. Reconstruction methods depend on the location of the amputation and range from homodigital and heterodigital flaps to partial-toe transfer or a great-toe wrap-around flap to first-web-space deepening using Z-plasties, a dorsal rotation flap, or a distant flap, to distraction osteogenesis, lengthening of the thumb ray, spare parts from another injured digit in the acute setting for pollicization or heterotopic replantation, and microvascular toe transfer. RESULTS: Amputations in the distal third of the thumb are generally well-tolerated. The primary reconstructive issues are the restoration of a padded and sensate soft-tissue cover, as well as aesthetic considerations. First-web-space deepening will generally provide excellent results for amputations at the distal half of the middle third. In the proximal half of the middle third, lengthening of the thumb ray is generally required. Distraction lengthening of the first metacarpal is a useful and reliable technique that provides up to 3 cm of length without requiring complex microsurgical methods. Spare parts from another injured digit may be used in the acute setting for pollicization or heterotopic replantation. Microvascular toe transfer is an excellent option for elective reconstruction. However, other options also are available and may be more appropriate in some cases. Less ideal options include the various types of osteoplastic reconstruction. CONCLUSIONS: The reconstruction of posttraumatic thumb defects is a challenging and rewarding surgical endeavor. The value of a functioning thumb is immense, and its reconstruction is worthy of considerable effort. Despite the elegant reconstructive options available, the best results are obtained with replantation or revascularization whenever possible. Finally, the treatment plan always must be derived from a careful assessment of each patient's posttraumatic function and specific reconstructive needs.
Algorithms↗
Incidence and development of trigger thumb in children.
PURPOSE: Whether trigger thumb is congenital or acquired remains controversial. The purpose of this study was to identify whether trigger thumb is present at birth and to clarify whether trigger thumb represents a developmental condition. METHODS: We examined 1,116 babies born at Yamagata Prefectural Nihonkai Hospital within 14 days after birth. All patients were examined by the author (N.K.), a hand surgeon. Patients were followed up to determine whether trigger thumb would present later even though it was not present at birth. We informed parents about the development of trigger thumb by providing informational sheets for neonatal screenings after hospital discharge. They were asked to check their child for a year or more to see if any flexion deformity of the interphalangeal joint of the thumb occurred. After discharge from the hospital, the family was responsible for noticing trigger thumb in their infant and seeking medical treatment. RESULTS: Trigger thumb was not identified in any patient at birth. Responses were obtained from 601 families. Trigger thumb manifested in 2 thumbs of 2 children in the screening group at 8 and 11 months after birth; however, 3 additional children developed trigger thumb at 15, 21, and 30 months of age. CONCLUSIONS: The incidence of acquired trigger thumb in children 1 year of age was 3.3 per 1,000 live births. It is unlikely that this study identified all cases of trigger thumb in patients older than 1 year in the primary screening group. The results of this follow-up study, however, suggest that trigger thumb is not present at birth but develops with postnatal growth.
Child, Preschool↗
Flexor pollicis longus abductor-plasty for spastic thumb-in-palm deformity.
Seven patients with thumb-in-palm deformity due to spasticity of the flexor pollicis longus (FPL) were treated by transferring the tendon of the FPL to the radical side of the proximal phalanx of the thumb and stabilizing the interphalangeal (IP) joint in 15 degrees of flexion by tenodesis or arthrodesis. Surgery was not performed unless: (1) the affected limb was used spontaneously for bimanual activities, (2) there was functional disability due to the thumb-in-palm deformity, (3) the thumb could be passively extended and abducted with the wrist palmar flexed, or (4) the thumb could be actively adducted and the metacarpophalangeal joint flexed with the wrist palmar flexed. Neither low intelligence nor sensory deficit was considered an absolute contraindication to treatment. After the operation, there was improved appearance in the hands of all seven patients. The thumb was no longer held clenched in the palm. Each patient was able to use the operated hand for assistive grasp; however, ability to use the hand for manipulation of small objects and for pinch was not improved. In fact, one patient had decreased small object manipulative ability postoperatively and required subsequent tendon transfer to restore thumb adduction. Release of the FPL from its insertion, stabilization of the IP joint of the thumb, and transfer of the FPL to the radical side of the thumb can achieve improved thumb balance and function in patients with spastic FPL thumb-in-palm deformity who have functioning adductor pollicis and thumb extensors. The operation lessens thumb flexion and adduction and improves thumb extension and abduction.
Adult↗
Triphalangeal thumb without associated abnormalities: clinical characteristics and surgical outcomes.
Thirty-four triphalangeal thumbs of 23 patients, who had no associated anomaly in their ipsilateral hand, were reviewed to clarify the characteristics of an isolated triphalangeal thumb and its surgical outcome. There were 13 type 1 thumbs, 21 type 2 thumbs, and no type 3 thumbs. The existence of an accessory phalanx caused ulnar bending at the interphalangeal joint. Thirteen type 1 thumbs were operated on by excising an accessory phalanx. Corrective osteotomy at the epiphysis was performed on four type 2 thumbs, and partial excision of the epiphysis was performed on 11 type 2 thumbs. At follow-up examination, the average interphalangeal joint motion was 54 degrees in type 1 thumbs and 53 degrees in type 2 thumbs. More than 10 degrees of lateral bending remained in one type 1 thumb and six type 2 thumbs. Good results were observed when an early excision of the accessory phalanx with a securing collateral ligament was performed on type 1 thumbs. For type 2 thumbs, partial excision of the epiphysis provided relatively better correction than osteotomy. For good adaptation of interphalangeal joints, surgery should be performed when the patient is between the ages of 1 and 2, when the epiphysis is visible on x-rays.
Child, Preschool↗
Surgical treatment for the thumb-in-palm deformity in patients with cerebral palsy.
BACKGROUND: Thumb-in-palm deformity in patients with spastic cerebral palsy is a deformity that impairs the ability to use the thumb and thus severely limits hand function. From the variety of operative procedures that have been described, it may be clear that there is no consensus on the surgical treatment of thumb-in-palm deformity. OBJECTIVES: To review the efficacy of surgical interventions for the thumb-in-palm deformity in patients with spastic cerebral palsy; to review the selection criteria to surgically treat thumb-in-palm deformity in these patients; and to review the outcome assessment used in these studies. SEARCH STRATEGY: We identified studies for inclusion from searches of several electronic databases: the Cochrane Central Register of Controlled Trials (Issue 4, 2003), MEDLINE (1966 to December 2004), EMBASE (1980 to December 2004) and CINAHL (1982 to December 2004). We also cross-checked the reference lists of these studies to identify additional studies. SELECTION CRITERIA: We considered a trial eligible for inclusion when it met the following criteria. 1) It was described as a randomized clinical trial, clinical controlled trial or prospective study that compared pre-operative- with post-operative outcome assessment. 2) It concerned patients with thumb-in-palm deformity affected by spastic cerebral palsy. There was no restriction in age. 3) It compared or described any surgical intervention to the thumb. 4) It followed subjects for at least six months. 5) Outcomes described included one or more of the following items: rate of success; functional improvement; active and passive range of motion of the thumb; grasp and release; pinch grip; complications and side effects; and quality of life. DATA COLLECTION AND ANALYSIS: Two authors assessed each study using a scoring system. Meta-analysis was not possible because the selected studies were poorly designed, and the results were presented in an incompatible form. Therefore, we compiled a descriptive summary of the results of the individual studies. We did not attempt to acquire the raw data for re-analysis. MAIN RESULTS: We identified 14 prospective studies that compared preoperative and postoperative outcomes as eligible for inclusion in this review. We found no randomized clinical trials or controlled clinical trials. The studies with the best available evidence were prospective studies that compared pre- with post-operative assessment. After assessment, we ultimately included nine studies. Participants In all the included studies the participants were more or less homogeneous regarding the most important prognostic indications. The nine included studies treated 234 patients. Age at operation ranged from 4-48 years (Median approximately 11 years). Interventions Twenty-four different specific interventions were performed, or combined, aiming to 1) stabilize the first metacarpophalangeal joint, 2) weaken the spastic thumb adductors, and 3) augment thumb abduction and extension. Outcome measures All of the included studies assessed whether the thumb had stayed out of the palm at follow-up. Additional outcome measures varied among studies. Selection criteria There was no consensus on the selection criteria for eligibility for surgical treatment. There was also considerable variety in the use of methods of assessment among the studies. There is no standardized method to evaluate the pre- and post-operative data, and most of the assessment methods were not validated. It was impossible to compare the outcomes among studies. Judgement about the effectiveness of one particular surgical intervention was not possible, because different surgical interventions and co-interventions were used within most studies. Nonetheless, generally, the outcome of surgical treatment of thumb-in-palm deformity was considered satisfactory to both patients and to surgeons in all studies. AUTHORS' CONCLUSIONS: Because the methodological quality of the studies is poor, it is impossible to provide a reliable judgement of the role of surgery for thumb-in-palm deformity. This review has demonstrated the need for randomized clinical trials or controlled clinical trials on the surgical treatment of thumb-in-palm deformity. Surgical reconstruction appears to improve hand function, to facilitate hygiene, and to improve the appearance and quality of life. For patient selection, a validated classification system should be developed to determine the type and extent of the cerebral palsied hand. The influence of age, intelligence, and voluntary muscle control still needs to be investigated. Investigators should focus on one particular surgical intervention or a specific group of interventions to find out which procedures produce the best functional improvement.
Cerebral Palsy↗
Factors related to thumb pain in physiotherapists.
The aim of this study was to determine whether differences exist between physiotherapists with work-related thumb pain and physiotherapists without thumb pain. Twenty-four physiotherapists with work-related thumb pain (Pain Group) and 20 physiotherapists without thumb or wrist pain (Non-pain Group), who were working at least 20 hours per week in an outpatient musculoskeletal setting, were compared on a number of attributes: generalised joint laxity, hand and thumb strength, height, weight, working environment, hand position and force applied during mobilisation, mobility at individual thumb joints, extent of osteoarthritis at the thumb and radial-sided wrist joints, and demographic data including age, gender and years of experience. All physiotherapists in the Pain Group reported their thumb pain was related to and initially caused by the performance of manual techniques, and 88% had altered their manual techniques because of pain in the thumb. There was extreme variability in hand position and force applied during mobilisation, and a slightly high prevalence of osteoarthritis (22.7%) considering the mean age of the total sample (38.6 years). Statistically significant differences between groups included increased right carpometacarpal joint laxity (6.4%, 95% CI 0.19 to 12.6), decreased right tip pinch strength (0.84 kg, 95% CI 0.01 to 1.68), and lower body mass index (2.0, 95% CI 0.11 to 3.9) for the Pain Group. Other factors were not statistically different between groups. These results indicate that work-related thumb pain affects physiotherapists ability to administer manual treatments, and suggest that decreased stability and strength of the thumb may be associated with work-related thumb pain.
Adult↗
Classification of ulnar deficiency according to the thumb and first web.
Fifty-five ulnar-deficient upper extremities in 45 patients treated at the St. Louis Shriner's Hospital were reviewed in order to evaluate the hand abnormalities. Thumb and first-web abnormalities were noted in 73% of hands. The majority of operations (28 of 53) were recommended to improve functional deficits associated with abnormalities of the thumb and first web. A classification of the ulnar-deficient hand based upon the characteristics of the thumb and first web is presented. When used in combination with any of the six current forearm/elbow classification schemes, this classification more completely describes ulnar deficiency of the upper extremity. Four classification types are proposed based upon progressive involvement of the thumb and first web. In type A, the thumb and first web are normal; in type B, the first web space has mild deficiency and the thumb has mild involvement. Extrinsic tendon function is intact and opposition function is present. In type C, the thumb has varying degrees of involvement. The first web has moderate to severe deficiency, including thumb-index syndactyly, and is often associated with malrotation of the thumb into the plane of the other digits, loss of opposition, and dysfunction of the extrinsic tendons. In type D, the thumb is absent. Previous classifications of ulnar deficiency neglect the radial hand anomalies that have been noted by several authors in a high percentage of affected extremities. Our premise for this classification is that the thumb and first-web abnormalities are related to the complexity of the hand problem and that the frequently noted radial hand abnormalities require the majority of surgical procedures. Such a classification based on the thumb and first-web deformities will focus the surgeon's attention on those deficiencies that are most important for the restoration of function. It is proposed that ulnar deficiency be classified by one of the classification schemes that describes the anatomy of the forearm and/or elbow supplemented by the hand classification type.
Elbow Joint↗
Long-term results of cemented Steffee arthroplasty of the thumb metacarpophalangeal joint.
A retrospective evaluation of the Steffee metacarpophalangeal (MCP) thumb joint prostheses was performed to determine the long-term outcome and survivorship of the prosthesis. Fifty-four primary thumb arthroplasties (49 patients) were performed for pain, weakness, or instability involving the thumb MCP joint secondary to arthritis. Underlying etiology included rheumatoid (49 thumbs), psoriatic (1 thumb), scleroderma (2 thumbs), and degenerative (2 thumbs) arthritis. Thirty-one thumbs had concomitant interphalangeal joint instability and underwent interphalangeal joint fusions. At an average follow-up period of 57 months, the average motion of the MCP joint was 21 degrees (range, 0 degrees to 40 degrees ), with a significant improvement in position and stability. Thumb axis length was maintained or increased in 98%. Although there was not a consistent long-term improvement in grip or pinch strength, 87% of the patients reported subjective improvement in strength and function as a result of surgery. Pain was relieved in all thumbs with preoperative pain. Complications included a periprosthetic fracture, 2 late infections, and 1 gross loosening of the implant. The survivorship of the implant was 93% survivorship at 5 years and 89% survivorship at 10 years, with only 4 failures in 54 thumbs. The Steffee thumb MCP arthroplasty resulted in excellent long-term survivorship, patient satisfaction, and functional outcome.
Adult↗
['Trigger thumb' in 38 children: good short-term and long-term results from surgery].
OBJECTIVE: To determine the direct and long-term effectivity of incision of the pulley in a trigger thumb (tendovaginitis stenosans). DESIGN: Retrospective study with follow-up. METHODS: In the period 1984-1995, 38 children (24 boys and 14 girls) were diagnosed and operated on 45 trigger thumbs in the Onze Lieve Vrouwe Gasthuis (Amsterdam) and Medisch Centrum Alkmaar, the Netherlands. Data were obtained from notes, operation reports and review in follow-up, at least 2 years after the operation. RESULTS: The mean age of the children at the moment of surgery was 3 years and 2 months (range: 11 months-10.33 years). 39 out of 45 thumbs were reviewed. Four thumbs had limited postoperative function. Two of these had a revision operation. There was 1 thumb with a postoperative superficial infection. At follow-up all thumbs had maximal function. The nodule in the tendon, which was palpable in 43 out of 45 thumbs preoperatively, had (almost) disappeared in all 39 thumbs at follow-up. There was a family history of trigger thumb in 33% of the 33 patients with follow up. 18% had bilateral involvement of the thumbs. The 6 digits not included in follow-up had a normal function according to the last notes. CONCLUSION: The results of surgery in the short term are good, in the long term excellent. Few complications occur. Based on the findings, it seems advisable to operate on children with a trigger thumb if there is no spontaneous recovery within half a year. Trigger thumb is the result of a congenital tight pulley.
Child↗
Is the thumb a fifth finger? A study of digit interaction during force production tasks.
We studied indices of digit interaction in single- and multi-digit maximal voluntary contraction (MVC) tests when the thumb acted either in parallel or in opposition to the fingers. The peak force produced by the thumb was much higher when the thumb acted in opposition to the fingers and its share of the total force in the five-digit MVC test increased dramatically. The fingers showed relatively similar peak forces and unchanged sharing patterns in the four-finger MVC task when the thumb acted in parallel and in opposition to the fingers. Enslaving during one-digit tasks showed relatively mild differences between the two conditions, while the differences became large when enslaving was quantified for multi-digit tasks. Force deficit was pronounced when the thumb acted in parallel to the fingers; it showed a monotonic increase with the number of explicitly involved digits up to four digits and then a drop when all five digits were involved. Force deficit all but disappeared when the thumb acted in opposition to the fingers. However, for both thumb positions, indices of digit interaction were similar for groups of digits that did or did not include the thumb. These results suggest that, given a certain hand configuration, the central nervous system treats the thumb as a fifth finger. They provide strong support for the hypothesis that indices of digit interaction reflect neural factors, not the peripheral design of the hand. An earlier formal model was able to account for the data when the thumb acted in parallel to the fingers. However, it failed for the data with the thumb acting in opposition to the fingers.
Adult↗
Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting.
PURPOSE: There have been few prospective studies evaluating the results of nonsurgical treatment of a well-defined patient cohort with symptomatic basal joint osteoarthritis of the thumb. This prospective study uses a validated outcome instrument to examine the effectiveness of a single steroid injection and 3 weeks of splinting in patients with osteoarthritis in Eaton stages 1 to 4 with a minimum of 18 months of follow-up evaluation. METHODS: Thirty consecutive patients (30 thumbs) were studied prospectively to evaluate the efficacy of a single injection of corticosteroid into the trapeziometacarpal joint, followed by immobilization in a thumb spica splint for 3 weeks. All patients answered an outcome-based questionnaire (Disabilities of the Arm, Shoulder, and Hand) and were examined before injection, 6 weeks after injection, and at final follow-up examination (minimum, 18 months). Eaton radiographic stage was recorded by 3 independent observers. RESULTS: At 6 weeks 13 patients had improvement in pain intensity and 17 patients reported no symptomatic improvement. Twelve of those with relief at 6 weeks continued to have relief at long term follow-up evaluation (mean, 25 months). Of patients with long-term relief average grip strength of the affected thumb was 95% of contralateral side, whereas those without relief had grip strength values that were 60% of contralateral side. For those patients without relief at 6 weeks there was no improvement seen at later follow-up evaluation. Five patients with Eaton stage 1 disease had an average of 23 months of relief with nonsurgical treatment. In stage 2 and stage 3 disease 7 thumbs improved at 6 weeks after injection and 6 thumbs had long-term relief. In stage 4 disease, 6 thumbs had neither short-term nor long-term relief with the injection. Disease side, handedness, and smoking did not affect outcomes. At final follow-up evaluation 12 thumbs had had surgical treatment. CONCLUSIONS: Steroid injection with splinting for the treatment of basal joint arthritis of the thumb provided reliable long-term relief in thumbs with Eaton stage 1 disease but provided long-term relief in only 7 of 17 thumbs with Eaton stage 2 and stage 3 basal joint arthritis.
Adult↗
The prevalence of thumb problems in Australian physiotherapists is high: an observational study.
QUESTION: What is the lifetime and current prevalence of thumb problems in Australian physiotherapists and what are the factors associated with thumb problems? DESIGN: Survey of a random cross-section of physiotherapists. PARTICIPANTS: 1562(approximately 10% of the total) registered Australian physiotherapists. OUTCOME MEASURES: General questions covered demographic information, area of practice, hours worked per week, and years worked as a physiotherapist. Specific questions about thumb problems covered thumb affected, symptoms, onset of symptoms, treatment sought, relevance of work-related factors, and joint hypermobility. RESULTS: 1102 (71%) questionnaires were returned and 961 (68%) completed. The lifetime prevalence of thumb problems was 65% and the current prevalence was 41%. Factors that were significantly associated with thumb problems included: working in orthopaedic outpatients (OR 3.2, 95% CI 1.8 to 5.8); using manual therapy (OR 2.3 to 3.4, 95% CI 1.7 to 5.1), trigger point therapy (OR 2.3, 95% CI 1.7 to 3.0) and massage (OR 2.1, 95% CI 1.6 to 2.8); having thumb joint hypermobility (OR 2.2 to 2.6, 95% CI 1.4 to 4.5); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (OR 4.2, 95% CI 2.9 to 5.9). Of those respondents who reported thumb problems, 19% had changed their area of practice and 4% had left the profession as a result of their thumb problems. CONCLUSION: The prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers.
Adult↗
Anatomy, physiology, and functional restoration of the thumb.
The essential prehensile nature of the human hand rests on the presence of a mobile, sensate thumb with adequate stability and length. The true significance of the thumb-to-hand function is variable and dependent on a person's vocation, expectations, and needs. The frequently stated opinion that the thumb represents 40% of hand function is too exacting and does not allow for flexibility in evaluating a patient's requirements after thumb injury or loss. It is our approach to consider each patient's specific needs for individualized planning of thumb reconstruction. The patient can often offer useful information regarding need for strength vs. precision, width of hand vs. requirements for fine motor function, and concern for the aesthetic nature of an abnormal thumb vs. the variable deformities resultant from thumb reconstruction. We offer a review of the basic anatomy and physiology of the human thumb, with emphasis on hand-and-thumb function. We present the alternatives for thumb reconstruction, the advantages and disadvantages, and the relationships to a specific patient's needs. Clinical examples of various methods of thumb reconstruction, including metacarpal lengthening, phalangization, osteoplastic reconstruction, pollicization, and toe-to-hand transfer are provided.
Amputation, Traumatic↗
Retrospective study of open versus percutaneous surgery for trigger thumb in children.
BACKGROUND: Percutaneous release for trigger finger in adults is well established, but this is not so for trigger thumb in children. The traditional treatment for trigger thumbs in children, if conservative treatment has failed, is open surgery. The authors' aim is to recommend that percutaneous release may be more appropriate in the treatment of trigger thumb in children. METHODS: The authors performed a retrospective study of open versus percutaneous release for trigger thumb in children with a mean age of 2.4 years from December of 1984 to March of 2003. The 61 patients with 72 trigger thumbs included 35 boys and 26 girls. Thirty-two trigger thumbs were treated using open surgery before February of 1989. More recently, 40 trigger thumbs were treated using percutaneous surgery. The authors recommended a new manipulation to examine whether the A1 pulley had completely released, while the sensitive patients were operated on under general anesthesia. RESULTS: The percutaneous procedure yielded up to a 90 percent successful release of trigger thumb in children without recurrence. The outcome of releasing trigger thumbs using these two surgical techniques showed no statistically significant difference. Thirty-seven trigger thumbs treated with percutaneous re-lease were able to achieve full extension and flexion without any residual deformity. CONCLUSIONS: The authors developed a special manipulation to ensure complete release of the A1 pulley when general anesthesia is necessary in the cases of sensitive children and parents. The results suggest that percutaneous release for trigger thumb in children is a satisfactory alternative to open release.
Anesthesia, General↗
Coordination of three-joint digit movements for rapid finger-thumb grasp.
Human thumb and index finger kinematics were examined for multiple repetitions of a simple grasp task as a means to evaluate motor planning and execution of these important hand movements. Subjects generated a rapid (approximately 90-ms duration) pinch movement of the index finger and thumb from an open-hand position. Approximately 400 repetitions were obtained from four naive subjects. The two-dimensional trajectory of the fingertip and the angular positions of the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints of the index finger were recorded along with the angular position of the thumb interphalangeal joint (TH). Individual joint angular positions were transduced using planar electrogoniometers of an exoskeletal linkage design. Except for consistent single-peaked joint angle and digit trajectory velocity profiles, most kinematic features of the grasp varied considerably across trials, including fingertip spatial position at contact, specific finger paths, finger and thumb path distances, finger and thumb peak tangential velocities, and 5) individual joint rotation magnitudes and peak velocities. However, this kinematic variability was not random. Variable TH angular positioning was paralleled by complementary two-dimensional variations in the finger path. These fingertip adjustments were accomplished by actively controlled, reciprocal angular positioning of the MP and PIP joints. Specifically, with natural reductions in thumb flexion, MP flexion was greater while PIP flexion was reduced and vice versa. These adjustments acted to minimize variations in the point contact of the finger on the thumb and yielded a robust and seemingly natural preference for finger-thumb contact at the more distal surfaces of the digits. The kinematic variability was not due to the finger and thumb movements being controlled independently of digit contact. The variable appositional movements of the finger and thumb and the associated contact force were generated as a single action. This was indicated by an absence of kinematic or force adjustments after contact, smooth digit trajectories with a single peak in their tangential velocities, and finger-thumb contact that consistently occurred well after peak velocity. Likewise, because the variability in the kinematics of the grasp was systematic, it apparently was not due simply to sloppiness or noise in motor execution.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Thumb polydactyly as a part of the range of genetic expression for thenar hypoplasia.
Attempts to study the genetics of human thumb polydactyly have been hampered by lack of awareness of the extremely varied expression of upper limb preaxial anomalies. It has been appreciated that thumb polydactyly could range from a broadened distal phalanx to complete duplication of the entire thumb. Most cases are sporadic and unilateral, but rare familial cases with wide variability and occasional nonpenetrance have been described. Four unrelated families are described who have thumb polydactyly as part of the range of expression for a dominant gene that is frequently associated with absence of thenar intrinsic muscles and flexor pollicis longus with inability to flex the thumb across the palm (the Fromont anomaly). These families and previous literature reports suggest that expression of the gene can range from thumb hypoplasia (most commonly the Fromont anomaly) to triphalangeal thumb or thumb polydactyly. As a consequence of this experience, we urge that parents, siblings, and other close relatives of patients born with thumb polydactyly be carefully examined for mild degrees of thumb hypoplasia or any other thumb anomaly, and that these findings be considered when providing recurrence risk counseling.
Adolescent↗