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PubMed1993

Toe-to-hand transfers in the rehabilitation of frostbite injury.

In our experience digitless hands from frostbite injury are typically seen in young men as a result of an episode of intoxication. Such deformities occur bilaterally in 80% of cases and often lead to total loss of prehensile capability. Because of a uniformly high degree of motivation in this group of patients, toe-to-hand transfer carries an excellent prognosis. Microanastomoses in a frostbitten hand are as reliable as in a mechanically injured hand, provided the ulnar artery and its branches are intact. Because amputations occur at the level of the metacarpal heads, the preferred transplant is the combined second and third toe composite. However, a satisfactory thumb post is essential for proper function of the composite. Well-planned sharing of available toe resources is necessary for establishing optimum bilateral hand function, especially in the face of simultaneous toe frostbite. Squandering valuable foot resources bilaterally on behalf of a single hand makes reconstructing the opposite hand more difficult. Economy may be gained if two separate microvascular toe transfers are taken from the same foot or if a single block of toes may be applied to the hand as an opposable unit. Clinical management is described of 25 digitless patients whose frostbitten hands were treated by microsurgical toe transfer.

Adult↗
PubMed1997

The relation of hand skin-fold thickness to bone mineral density in patients with Crohn's disease.

OBJECTIVES: In healthy postmenopausal women, the association of skin-fold thickness (SFT) with bone mineral density (BMD) is well described, and a low SFT is a useful predictor of osteoporosis. In this study the association between hand SFT and BMD in patients with Crohn's disease was assessed; and the potential for hand SFT as a screening test for osteoporosis evaluated. DESIGN/METHODS: In a cross-sectional study, BMD was measured at the hip and lumbar spine by dual energy x-ray absorptiometry (DEXA). SFT was measured on the dorsum of the right hand using Holtain Tanner Whitehouse calipers. One hundred and seventeen patients (48 male) with Crohn's disease and 50 (25 male) controls were studied. RESULTS: There was a significant correlation between hand SFT and BMD (expressed as t scores) at all four measured sites (lumbar spine r = 0.41, P < 0.0001, 95% CI 0.25-0.55, Ward's triangle r = 0.38, P < 0.0001, 95% CI 0.21-0.53, trochanter r = 0.33, P < 0.0001, 95% CI 0.16-0.48, femoral neck r = 0.38, P < 0.0001, 95% CI 0.21-0.53). On stepwise regression analysis, the association remained significant after correcting for age, weight, menstrual status and current steroid use (P < 0.05). Hand SFT was significantly lower in patients with Crohn's disease than controls (difference in means 0.51 mm, 95% CI 0.3-0.72, P < 0.0001). Mean hand SFT was significantly lower in patients with osteoporosis compared to patients with normal BMD (difference in means 0.74 mm, 95% CI 0.33-1.15, P < 0.001), as was that of osteopenic patients compared to patients with normal BMD (difference in means 0.28 mm, 95% CI 0.01-0.55, P < 0.05). In the diagnosis of osteoporosis, the sensitivity of hand SFT ranged from 29% to 93%, with specificities of 54% to 95%. CONCLUSIONS: Hand SFT is independently associated with BMD in Crohn's disease and is lower than in age-matched healthy subjects. Hand SFT in combination with other easily measurable confounding variables might be useful in screening for osteoporosis in patients with Crohn's disease.

Adult↗
PubMed2006

Coordinative structure of manipulative hand-movements facilitates their recognition.

Manipulative hand movements involve coordinated movements of the fingers to manipulate an object within the hand, and are classified as either simultaneous or sequential. Simultaneous hand movements are characterized by single coordinated patterns of digit movements, while sequential hand movements involve sequences of such patterns. Here, we investigate the extent of the coordination among 15 hand-joints during simultaneous hand movements, and demonstrate that it leads to a concise representation that facilitates movement recognition. Principal component analysis (PCA), performed in the 15-dimensional (15-D) joint-space, indicates that the first principal-component captures more than 98% of the variability in individual hand movements. Consequently, the first principal direction provides a 15-D feature-vector that describes the underlying-coordination and can be used for automatic recognition. We evaluated this recognition strategy on a set of nine simultaneous hand-movements using a database of six users, each performing six sessions. A dedicated classifier for each user resulted in recognition rates of 97.0 +/- 4.7% during testing, while a single generic classifier achieved 95.2 +/- 2.5% recognition rates. We conclude that the suggested feature-vector captures the invariant structure of simultaneous hand-movements, facilitates their recognition, and may provide insight into motor planning.

Artificial Intelligence↗
PubMed2005

Fifteen-year follow-up of hand eczema: predictive factors.

The aim of this study was to identify factors of importance for the long-term prognosis of hand eczema in the general population. In a 15-y follow-up, 868 (78%) individuals with hand eczema, diagnosed and clinically examined in a previous population-based study, answered a postal questionnaire with questions concerning persistence of the disease. In a logistic regression model, the extent of eczema involvement at the initial examination was the strongest negative factor for the prognosis, followed by history of childhood eczema and age below 20 y at onset of hand eczema. These factors significantly influenced both the total time with hand eczema during the 15 y follow-up and occurrence of hand eczema the previous year. The predictive factor for hand eczema 15 y later was doubled for an individual with all three risk factors compared with one without them, 72%vs 35%. Contact allergy to any of the standard allergens also related significantly to current hand eczema. In conclusion, the main determinant for a poor long-term prognosis was widespread hand dermatitis at the initial examination. Other important factors were low age at onset of hand eczema, history of childhood eczema, and contact allergy.

Adult↗
PubMed2004

Cat bites of the hand.

BACKGROUND: Cat bites are the second most common mammalian bites. Cat bites of the hand in particular represent a potentially devastating problem in terms of wound infection and long-term disability if not treated appropriately. The purpose of the present study is to give an overview of demographics, management and follow up of the patients with cat bite injuries of the hand treated at the Royal Hobart Hospital. METHODS: Retrospective and prospective data of all patients with cat bites of the hand seen at the Royal Hobart Hospital for a period of 3 years (January 2000 to April 2003) were collected. Demographics, anatomical site, presentation, assessment, investigations, management and follow up of the patients with this type of injury were analysed. The accuracy of the obtained data was checked by analysing questionnaires returned by our patients. RESULTS: Forty-one patients were treated for cat bites of the hand. Twenty-six were managed in the department of emergency medicine and 15 were admitted and managed by the department of plastic and reconstructive surgery. Five of 15 admitted patients required surgery. Compliance was not a major problem in our study as very few patients were lost to follow up. Almost all patients had close follow up and extensive hand physiotherapy achieving overall good long-term results. Out of 39 patients who were sent questionnaires only one indicated long-term problems with the hand (response rate 46%). CONCLUSION: Appropriate early treatment of cat bites of the hand is the key to success. Treatment with antibiotics, surgical drainage, debridement and copious irrigation, and use of corticosteroids in some cases, proved to be effective. Hand elevation and intensive physiotherapy after a short period of immobilization is critical. We believe that prophylactic antibiotics should be given even in case of a minor infection following cat bites of the hand. Clear guidelines for clinical recognition of infection, hospital admission and management are provided in our study.

Adolescent↗
PubMed1999

A hand immersion test under laboratory-controlled usage conditions: the need for sensitive and controlled assessment methods.

Exaggerated test conditions were frequently used to investigate the cutaneous tolerance of detergent products in the past. As the sensitivity of newly designed biometric methods is steadily improving, the trend towards more realistic test conditions should be encouraged. A hand immersion test under laboratory-controlled usage conditions is presently described, fulfilling such principles. Panelists soaked their hands in 2 different hand dishwashing liquids, 2x daily for 10 min each (with successive in-solution/out-of-solution cycles) for 4 consecutive days. Products were at usual dilution for dishwashing liquids and were randomized between the dominant and non-dominant hands of panelists. Visual scoring of erythema and dryness developing on the whole hands (scoring scales including interdigital areas and joints) during the week did not allow discrimination between the 2 products. However the dominant hands were significantly more susceptible to alterations than the non-dominant hands, regardless of product attribution. In contrast, skin electrical measurements (Corneometer CM800 and Skicon 200) on the dorsum of the hands (muscle mass between thumb and index) and squamometry analysis of tape stripping (harvested from the same site) yielded significant differences between the 2 products. In conclusion, a hand immersion test under realistic conditions has been described, which discriminates between products when sensitive assessment methods are used to explore skin sites partially protected from daily-life skin aggressions.

Allergens↗
PubMed2006

Intentional switches between bimanual coordination patterns are primarily effectuated by the nondominant hand.

Based on indications that hand dominance is characterized by asymmetrical interlimb coupling strength (with the dominant hand exerting stronger influences on the nondominant hand than vice versa), intentional switches between rhythmic bimanual coordination patterns were predicted to be mediated primarily by phase adaptations in the movements of the nondominant hand. This hypothesis was supported for both right-handed and left-handed participants who performed voluntary switches from in-phase to antiphase coordination and vice versa, at four different frequencies. In accordance with previous indications that handedness is expressed less consistently in left-handers, the asymmetry between the hands was less pronounced in left-handed than in right-handed participants. The asymmetry was smaller for switches from in-phase to antiphase coordination (i.e., in the direction opposite to spontaneous transitions) than for switches in the reverse direction, suggesting that (the expression of) the handedness-related asymmetry in coupling strength was weakened by intentional processes associated with these switches.

Adolescent↗
PubMed2006

Occupational and other risk factors for hand-grip strength: the Honolulu-Asia Aging Study.

BACKGROUND: In certain occupations, including farm work, workers are exposed to hazardous substances, some of which are known to be toxic to the nervous system and may adversely affect muscle strength. Measurement of hand-grip strength may be useful for detecting neurotoxic exposure. METHODS: The authors studied 3522 participants of the Honolulu Heart Program and the Honolulu-Asia Aging Study to determine whether occupational exposures to pesticides, solvents, and metals assessed at exam I (1965-68) are associated with hand-grip strength at exam IV (1991-93) and change in hand-grip strength over 25 years. Correlation, analysis of variance and covariance, and linear regression were used to evaluate the associations. RESULTS: At exam IV, participants ranged in age from 71-93 years; mean hand-grip strength was 39.6 kg at exam I and 30.3 kg at exam IV. Over 25 years, the decline in hand-grip strength was an average of 8-9 kg for all exposures. Hand-grip strength was inversely associated with age and glucose but directly associated with cognitive function, BMI, and haemoglobin level. No other exposures were associated with hand-grip strength. CONCLUSION: This study did not provide evidence that occupational exposure to pesticides, solvents, and metals adversely affected hand-grip strength in this population, but confirmed other important associations with hand-grip strength.

Aged↗
PubMed2001

Grasp with hand and mouth: a kinematic study on healthy subjects.

Neurons involved in grasp preparation with hand and mouth were previously recorded in the premotor cortex of monkey. The aim of the present kinematic study was to determine whether a unique planning underlies the act of grasping with hand and mouth in humans as well. In a set of four experiments, healthy subjects reached and grasped with the hand an object of different size while opening the mouth (experiments 1 and 3), or extending the other forearm (experiment 4), or the fingers of the other hand (experiment 5). In a subsequent set of three experiments, subjects grasped an object of different size with the mouth, while opening the fingers of the right hand (experiments 6-8). The initial kinematics of mouth and finger opening, but not of forearm extension, was affected by the size of the grasped object congruently with the size effect on initial grasp kinematics. This effect was due neither to visual presentation of the object, without the successive grasp motor act (experiment 2) nor to synchronism between finger and mouth opening (experiments 3, 7, and 8). In experiment 9 subjects grasped with the right hand an object of different size while pronouncing a syllable printed on the target. Mouth opening and sound production were affected by the grasped object size. The results of the present study are discussed according to the notion that in an action each motor act is prepared before the beginning of the motor sequence. Double grasp preparation can be used for successive motor acts on the same object as, for example, grasping food with the hand and ingesting it after bringing it to the mouth. We speculate that the circuits involved in double grasp preparation might have been the neural substrate where hand motor patterns used as primitive communication signs were transferred to mouth articulation system. This is in accordance with the hypothesis that Broca's area derives phylogenetically from the monkey premotor area where hand movements are controlled.

Adult↗
PubMed1998

Hand and foot growth failure in Rett syndrome.

Growth failure is a major aspect of the developmental arrest in Rett syndrome. Small hands and feet have been reported anecdotally, but the pattern of hand and foot growth has not been studied rigorously. The aims of this study were to characterize the hand and foot growth of 28 girls with Rett syndrome and to examine the relationship between their hand or foot size and height. Median hand length deviated to the 5th percentile at 11 years of age whereas median foot length and height deviated below the 5th percentile at 5.5 years of age. After adjusting for height-age, a greater proportion of foot lengths than hand lengths was less than the 50th percentile. In conclusion, the rate of hand and foot growth of girls with Rett syndrome is slower than that of the normal female. Moreover, the rate of deceleration of foot, but not hand, growth relative to height growth is greater. Thus, many girls with Rett syndrome have "small" feet, but not hands, for their height.

Adolescent↗
PubMed2002

Analysis of EF-hand-containing proteins in Arabidopsis.

BACKGROUND: In plants, calcium (Ca2+) has emerged as an important messenger mediating the action of many hormonal and environmental signals, including biotic and abiotic stresses. Many different signals raise cytosolic calcium concentration ([Ca2+]cyt), which in turn is thought to regulate cellular and developmental processes via Ca2+-binding proteins. Three out of the four classes of Ca2+-binding proteins in plants contain Ca2+-binding EF-hand motif(s). This motif is a conserved helix-loop-helix structure that can bind a single Ca2+ ion. To identify all EF-hand-containing proteins in Arabidopsis, we analyzed its completed genome sequence for genes encoding EF-hand-containing proteins. RESULTS: A maximum of 250 proteins possibly having EF-hands were identified. Diverse proteins, including enzymes, proteins involved in transcription and translation, protein- and nucleic-acid-binding proteins and a large number of unknown proteins, have one or more putative EF-hands. Phylogenetic analysis identified six major groups that contain some families of proteins. CONCLUSIONS: The presence of EF-hand motif(s) in a diversity of proteins is consistent with the involvement of Ca2+ in regulating many cellular and developmental processes. Thus far, only 47 of the possible 250 EF-hand proteins have been reported in the literature. Various domains that we identified in many of the uncharacterized EF-hand-containing proteins should help in elucidating their cellular role(s). Our analyses suggest that the Ca2+ messenger system is widely used in plants and that EF-hand-containing proteins are likely to be the key transducers mediating Ca2+ action.

Arabidopsis↗
PubMed1996

A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys.

In this study we tested a neuroplasticity/learning origins hypothesis for repetitive strain injuries (RSIs), including occupationally induced focal dystonia. Repetitive movements produced in a specific form and in an appropriate behavioral context cause a degradation of the sensory feedback information controlling fine motor movements, resulting in the "learned" genesis of RSIs. Two adult New World owl monkeys were trained at a behavioral task that required them to maintain an attended grasp on a hand grip that repetitively and rapidly (20 msec) opened and closed over short distances. The monkeys completed 300 behavioral trials per day (1,100 to 3,000 movement events) with an accuracy of 80 to 90%. A movement control disorder was recorded in both monkeys. Training was continued until the performance accuracy dropped to below 50%. We subsequently conducted an electrophysiologic mapping study of the representations of the hand within the primary somatosensory (SI) cortical zone. The hand representation in the true primary somatosensory cortical field, SI area 3b, was found to be markedly degraded in these monkeys, as characterized by (1) a dedifferentiation of cortical representations of the skin of the hand manifested by receptive fields that were 10 to 20 times larger than normal, (2) the emergence of many receptive fields that covered the entire glabrous surface of individual digits or that extended across the surfaces of two or more digits, (3) a breakdown of the normally sharply segregated area 3b representations of volar glabrous and dorsal hairy skin of the hand, and (4) a breakdown of the local shifted-overlap receptive field topography of area 3b, with many digital receptive fields overlapping the fields of neurons sampled in cortical penetrations up to more than four times farther apart than normal. Thus, rapid, repetitive, highly stereotypic movements applied in a learning context can actively degrade cortical representations of sensory information guiding fine motor hand movements. This cortical plasticity/learning-based dedifferentiation of sensory feedback information from the hand contributes to the genesis of occupationally derived repetitive strain injuries, including focal dystonia of the hand. Successful treatment of patients with RSI will plausibly require learning-based restoration of differentiated representations of sensory feedback information from the hand.

Animals↗
PubMed2006

Trends in elective hand surgery referrals from primary care.

INTRODUCTION: Two prospective audits of activity in a hand unit were performed, in 1989-1990 and during 2000-2001, to identify trends in elective hand surgery referrals from primary care. PATIENTS AND METHODS: Two 6-month prospective audits of activity in a hand unit were performed, including elective referrals from primary care. Data were collected on all in-district referrals with elective hand disorders. Cross boundary flow was identified to permit assessment of changes in referrals by diagnosis over a decade. RESULTS: There was a 36% increase in health authority referrals for elective hand surgery over the decade (from 289 to 392 per 100,000 of population per year). The number of elective hand surgery operations rose 34% over the decade (from 149 to 199 operations per 100,000 of population per year). Carpal tunnel syndrome (the commonest reason for elective referral) almost doubled (from 59.7 to 112 per 100,000 of population per year). Referrals for ganglion, the second most common elective referral, rose modestly. Referrals for osteoarthritis (commonly basal thumb arthritis) almost trebled over the decade to become the fourth commonest condition referred to the hand unit (from 12.7 to 34 per 100,000 of population per year). Referrals for Dupuytrens disease, trigger finger and rheumatoid arthritis were relatively unchanged over the decade. Congenital hand referrals are uncommon but doubled during the decade. CONCLUSIONS: Hand surgery referrals rose by 36% over the decade. Analysis of the commoner conditions referred reveal a high prevalence within the community with the possibility of increased referrals in years to come.

Carpal Tunnel Syndrome↗
PubMed2002

Validation of the use of the hand for estimating bone mineral density in other skeletal sites by DXA in healthy and osteoarthritic women.

Hand bone mineral density (BMD) by DXA has mainly been used to assess bone loss in rheumatoid arthritis patients. Its use in healthy subjects is limited. The following study was conducted to determine if measurements of hand BMD could estimate ones risk of osteoporosis and predict BMD in other skeletal sites. Subjects consisted of 134 Caucasian females (57-88 yr, 46 with self-reported osteoarthritis and the rest healthy). BMD was measured in the hand, forearm, hip, spine, and total body with the Lunar DPX-MD instrument. Subjects were divided into those with osteoarthritis (OA) and those without and were examined separately, as well as together. Hand BMD correlated significantly with all skeletal sites for the whole population and for each group. Pearson r for the whole population ranged from 0.56 in the lumbar spine to 0.82 in the forearm. Subjects with OA had higher correlations for most sites. Subjects' T-scores, derived from the reference population of young normal adult women, for hip, spine, forearm, and whole body correlated highly with hand BMD. To test how accurately hand BMD could predict BMD in other skeletal sites, we generated regression models from three-fourth of our subjects (n = 102). Based on the resulting regression equations and measured hand BMD, we calculated the predicted values of the BMD in all other skeletal sites for the remaining one-fourth of the subjects (n = 32). The predictive mean square errors, calculated from the observed and predicted values for each skeletal site, were small and below the cutoff values in F-distribution. In conclusion, hand BMD has a potential to establish one's risk for osteoporosis as well as reasonably accurately predict BMD in other skeletal sites. The hand BMD measurement in general, whether a part of DXA or as a separate instrument, might have a potential to be used for mass screening and in prospective studies to determine risk of fractures.

Absorptiometry, Photon↗
PubMed1996

Effects of hand-used on unilateral spatial neglect: a case study.

It was originally claimed that left hand use on line bisection tasks reduced the extent of left neglect by Halligan and Marshall. However, in a following study, the same research group failed to reproduce this left hand amelioration effect if the left hand was initially placed on the right side, and they claimed that spatio-motor cueing was more important in reducing unilateral neglect than the hand used. The present study concerns with the validity of these two theoretical views on modification of unilateral neglect, i.e., hemispheric activation and spatio-motor cueing. A patient with left unilateral neglect and a slight left hemiparesis participated in three experiments. Under conventional testing condition, line bisection performed with the right hand showed more severe left neglect than when performed with the left hand. These hand effects were modified by changing a starting position of the patient's hand when bisecting horizontal lines. However, under body-fixed condition, effects in hand-used as well as starting position were again significant. The results suggest that not only spatio-motor cueing but also differential hemispheric activation can exert a profound effect on unilateral neglect.

Aged↗
PubMed1987

Consistent features of the representation of the hand in area 3b of macaque monkeys.

Multiunit microelectrode recordings were used to explore the responsiveness and somatotopic organization of the representation of the hand in area 3b of anesthetized macaque monkeys. Major findings were as follows: Recording sites throughout the hand representation were activated by low-threshold cutaneous stimulation. Simple, punctate mechanical stimuli were highly effective in activating neurons. Neurons had small, restricted receptive fields. Representations of nearly all skin surfaces of the hand were demonstrated in individual monkeys. The basic topographic pattern found in all monkeys included the following: a large sequential representation of the glabrous digits from thumb to little finger from lateral to medial in cortex, and from proximal to distal hand parts in cortex extending down the caudal bank of the central sulcus; moderately large representations of radial and ulnar pads of the palm in respective lateral and medial cortical locations in the hand representation; and a relatively small, fragmented representation of the dorsal hand and dorsal digits, with the fragments interspersed within the representation of the glabrous hand. The proportions of the proximal, middle, and distal glabrous digits varied, so that the representation of the distal phalanx sometimes approached the dorsal border of area 3b with area 1. A comparison of the present findings with previous results from macaque monkeys indicates that the above-described features have been revealed under a variety of recording and anesthetic conditions. Consistencies in previous and present results strongly support the conclusions that the hand representation in area 3b of macaque monkeys is activated by cutaneous receptors throughout; is composed of neurons with relatively simple, small, cutaneous receptive fields; includes all skin surfaces of the hand; and is somatotopic for the glabrous skin with small, discontinuous, intercalated representations of fragments of the dorsal skin.

Afferent Pathways↗
PubMed2003

Influence of role models and hospital design on hand hygiene of healthcare workers.

We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance.

Anti-Infective Agents, Local↗
PubMed2006

The changes of skin temperature on hands and feet during and after T3 sympathicotomy for palmar hyperhidrosis.

Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers.

Adolescent↗