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At least 145 records · Page 8Linked to original sources
PubMed2006

[Thumb reconstruction with skin and soft tissue expansion].

OBJECTIVE: To evaluate a new reconstruction method for grades V and VI defect with flap by skin soft tissue expansion technique. METHODS: From May 1998 to September 2003, 8 cases of serious thumb defect were treated, including 6 males and 2 females, aging 18-27 years. The defect was caused by crush injury of machine in 6 cases and hot crush injury in 2 cases (5 cases of grade V and 3 cases of grade VI). The expander was placed under the tenor skin and soft-tissue. And then normal saline was infused to expand the skin and soft tissue gradually till it was available for thumb reconstruction. Iliac autograft was fixed to residual thumb stump and covered with flap produce by expanded skin and soft-tissue. Postoperative rehabilitation was carried out. RESULTS: All reconstructed thumbs were alive. After 3-24 months follow-up, all reconstructed thumbs were with good sensation, appearance and durable. Two-point discrimination was less than 5 mm. The functions of opposition, extend, abduction and endoduction were better in grade V thumb defect than in grade VI thumb defect. Bone union was achieved within 3 to 4 months. CONCLUSION: It is a convenient-to-operate and reliable method for thumb reconstruction. It is an alternative new reconstruction method for grades V and VI, thumb defect.

Adolescent↗
PubMed1985

Congenital thumb deformities.

The congenital deformities that affect the thumb are reviewed in terms of the clinical problem, the type of inheritance involved, the associated abnormalities seen with the particular deformity, and the indications for surgical treatment. The thumb is often the key to establishing the diagnosis of many rare syndromes. The congenital thumb may be classified for easy identification by pediatricians, family doctors, and hand surgeons as follows: inadequate thumb, fingerlike thumb, contracted thumb, crooked thumb, extra thumb, and unusual thumb.

Amniotic Band Syndrome↗
PubMedDate not supplied

Extension splint for trigger thumb in children.

Sixty-two reducible trigger thumbs in 50 children with age from 0 to 4 years (mean, 1 year 11 months) were reviewed to study the effect of splinting. Thirty-one thumbs in 24 children received splinting for a mean of 11.7 weeks. The other 31 thumbs in 26 children were only observed. The results were categorized as cured, improved, or nonimproved. Follow-up was conducted after a mean of 20 months (age, 43 months). Result in the splinted group showed cured in 12 thumbs, improved in 10 thumbs, and nonimproved in 9 thumbs, whereas in the observed group, result showed 4, 3, and 24, respectively. Splinting results in 71% trigger thumbs cured or improved that is better than observation alone. The subsequent surgical release for the nonimproved trigger thumbs after splinting still had excellent results. Because surgical release for trigger thumb is not urgent, we suggest extension splinting to be a treatment option before the elective surgery.

Child, Preschool↗
PubMed1999

Aniseikonia quantification: error rate of rule of thumb estimation.

PURPOSE: To find the error rate in quantifying aniseikonia by using "Rule of Thumb" estimation in comparison with proven space eikonometry. METHODS: Study 1: 24 adult pseudophakic individuals were measured for anisometropia, and astigmatic interocular difference. Rule of Thumb quantification for prescription was calculated and compared with aniseikonia measurement by the classical Essilor Projection Space Eikonometer. Study 2: parallel analysis was performed on 62 consecutive phakic patients from our strabismus clinic group. RESULTS: Frequency of error: For Group 1 (24 cases): 5 ( or 21 %) were equal (i.e., 1% or less difference); 16 (or 67% ) were greater (more than 1% different); and 3 (13%) were less by Rule of Thumb calculation in comparison to aniseikonia determined on the Essilor eikonometer. For Group 2 (62 cases): 45 (or 73%) were equal (1% or less); 10 (or 16%) were greater; and 7 (or 11%) were lower in the Rule of Thumb calculations in comparison to Essilor eikonometry. Magnitude of error: In Group 1, in 10/24 (29%) aniseikonia by Rule of Thumb estimation was 100% or more greater than by space eikonometry, and in 6 of those ten by 200% or more. In Group 2, in 4/62 (6%) aniseikonia by Rule of Thumb estimation was 200% or more greater than by space eikonometry. CONCLUSION: The frequency and magnitude of apparent clinical errors of Rule of Thumb estimation is disturbingly large. This problem is greatly magnified by the time and effort and cost of prescribing and executing an aniseikonic correction for a patient. The higher the refractive error, the greater the anisometropia, and the worse the errors in Rule of Thumb estimation of aniseikonia. Accurate eikonometric methods and devices should be employed in all cases where such measurements can be made. Rule of thumb estimations should be limited to cases where such subjective testing and measurement cannot be performed, as in infants after unilateral cataract surgery.

Adult↗
PubMed1994

Bilateral thumb amputation.

Seventy-one patients with thumb amputations, 45 complete and 26 incomplete nonviable, have been treated at the Microsurgical Unit of the Department of Orthopaedic Surgery at the University of Ioannina Medical School over the past 15 years. Of these thumb amputations, which included crush, avulsion, and guillotine injuries, three cases involved amputation of both thumbs. The three patients with complete bilateral thumb amputations are presented. Because of the importance of the thumb, microsurgical replantation efforts were made which proved successful for two of the patients. Replantation efforts in the third patient, who had severe crush injuries of both thumbs, were not successful. Bilateral thumb amputation is a serious and disabling injury. When replantation is attempted by a team of surgeons well trained in microsurgery, the final result can be impressive, with exceptionally good function of the replanted thumbs.

Adolescent↗
PubMed1998

Movement detection at the distal joint of the human thumb and fingers.

To determine whether proprioceptive acuity is the same at all digits, particularly when postured as in a 'grasp', we imposed 10 degrees movements at the distal joint of the thumb, index and ring finger, at three velocities; 1.25 degrees/s, 2.5 degrees/s and 5 degrees/s. The test joint was initially flexed by 25 degrees and the joints proximal to the test joint were maintained in a standard posture for each study. When in a grasp posture that disengaged the extensor muscles at the distal joint of the finger, movement detection at the thumb was superior to that at the fingers for all velocities. However, when the fingers were positioned so that all proprioceptive inputs were able to contribute (i.e. cutaneous, joint and both flexor and extensor muscle afferents), proprioceptive acuity was similar for the three digits. Loss of local cutaneous (and joint) inputs by digital anaesthesia significantly impaired performance at all digits, suggesting a critical role for cutaneous input in normal proprioceptive sensibility at all distal joints of the digits. Anaesthesia of the extensor muscle afferents innervating the thumb did not affect its proprioceptive acuity. Thus, for the thumb, the extensor muscle afferents do not provide critical information. The greater change in muscle fascicle length for the thumb's long flexor muscle (3% per 10 degrees) compared with that in the finger flexor muscles (e.g. 0.1% per 10 degrees) could contribute to the thumb's performance. There appears to be less redundancy of muscle and non-muscle signals for the fingers than for the thumb, because a reduction in either cutaneous or muscle input significantly impaired acuity at the fingers. Overall, when the hand is in a grasping posture, irrespective of the contribution of local cutaneous inputs, the long flexor acting on the thumb may contribute more to its proprioceptive acuity than the long finger flexors contribute to acuity at the fingers.

Adolescent↗
PubMed2001

Conservative treatment for trigger thumb in children.

Conservative treatment was performed for 60 trigger thumbs (19 right, 17 left, 12 bilateral) in 48 children (19 boys, 29 girls); the age at initial diagnosis ranged from 0 to 48 months old (mean 26 months). In this approach, only passive exercise of the affected thumb was performed by the mother. As a result, two patients (two thumbs) dropped out of treatment. Fifty-six thumbs out of 58 showed a satisfactory result (96%). Sixteen thumbs (in stage 2) and eight thumbs (in stage 3) showed completely recovery. Four thumbs (in stage 3) have not yet improved. In conclusion, we suggest that conservative treatment is effective for trigger thumbs in stage 2, while surgical therapy was thought to be indicated for stage 3 before the age of 3 years to avoid flexion deformity.

Child↗
PubMed2005

Normative values for thumb length, girth, and width in the pediatric population.

PURPOSE: To determine the normal relative length, girth, and nail width of the pediatric thumb with respect to the index finger in children ages 1 through 18 years. METHODS: Measurements of relative thumb length, girth, and nail width were performed on 546 hands in 273 volunteers ages 1 through 18 years. At least 22 hands were included for each age group. The data were analyzed by age, gender, and hand, with the thumb compared with the index finger for all measurements. RESULTS: The adducted thumb tip reached an average of 70% of the length of the index finger proximal phalanx and 32% of the length of the index finger from the metacarpophalangeal joint to its tip. The thumb girth and nail width as a percentage of corresponding levels of the index finger girth and nail width were 133% and 105%, respectively. Relative thumb size remained constant with no significant difference in length, width, or girth between age groups. CONCLUSIONS: The relative size of the thumb remains constant during growth. These normative data will allow a more objective assessment of thumb size and appearance.

Abstracting and Indexing↗
PubMed2006

Twelve weeks of nightly stretch does not reduce thumb web-space contractures in people with a neurological condition: a randomised controlled trial.

QUESTION: What is the effectiveness of 12 weeks of nightly stretch in reducing thumb web-space contracture in people with neurological conditions? DESIGN: Assessor-blinded, randomised controlled trial. PARTICIPANTS: Forty-four (one dropout)community-dwelling patients with a neurological condition (14 stroke, 7 traumatic brain injury, 23 spinal cord injury) who had uni or bilateral thumb web-space contractures (60 thumbs). INTERVENTION: The experimental thumbs were splinted into a stretched,abducted position each night for 12 weeks. The control thumbs were not splinted. OUTCOME MEASURES: Thumb web-space was measured as the carpometacarpal angle during the application of a 0.9 Nm abduction torque before and after intervention. RESULTS: The mean increase in thumb web-space after 12 weeks was 1 deg (95% CI, -1 to 2). CONCLUSION: Intensive stretch administered regularly over three months does not reduce thumb web-space contractures in neurological conditions.

Adult↗
PubMed2003

Towards a realistic biomechanical model of the thumb: the choice of kinematic description may be more critical than the solution method or the variability/uncertainty of musculoskeletal parameters.

A biomechanical model of the thumb can help researchers and clinicians understand the clinical problem of how anatomical variability contributes to the variability of outcomes of surgeries to restore thumb function. We lack a realistic biomechanical model of the thumb because of the variability/uncertainty of musculoskeletal parameters, the multiple proposed kinematic descriptions and methods to solve the muscle redundancy problem, and the paucity of data to validate the model with in vivo coordination patterns and force output. We performed a multi-stage validation of a biomechanical computer model against our measurements of maximal static thumbtip force and fine-wire electromyograms (EMG) from 8 thumb muscles in each of five orthogonal directions in key and opposition pinch postures. A low-friction point-contact at the thumbtip ensured that subjects did not produce thumbtip torques during force production. The 3-D, 8-muscle biomechanical thumb model uses a 5-axis kinematic description with orthogonal and intersecting axes of rotation at the carpometacarpal and metacarpophalangeal joints. We represented the 50 musculoskeletal parameters of the model as stochastic variables based on experimental data, and ran Monte Carlo simulations in the "inverse" and "forward" directions for 5000 random instantiations of the model. Two inverse simulations (predicting the distribution of maximal static thumbtip forces and the muscle activations that maximized force) showed that: the model reproduces at most 50% of the 80 EMG distributions recorded (eight muscle excitations in 5 force directions in two postures); and well-directed thumbtip forces of adequate magnitude are predicted only if accompanied by unrealistically large thumbtip torques (0.64+/-0.28Nm). The forward simulation (which fed the experimental distributions of EMG through random instantiations of the model) resulted in misdirected thumbtip force vectors (within 74.3+/-24.5 degrees from the desired direction) accompanied by doubly large thumbtip torques (1.32+/-0.95Nm). Taken together, our results suggest that the variability and uncertainty of musculoskeletal parameters and the choice of solution method are not the likely reason for the unrealistic predictions obtained. Rather, the kinematic description of the thumb we used is not representative of the transformation of net joint torques into thumbtip forces/torques in the human thumb. Future efforts should focus on validating alternative kinematic descriptions of the thumb.

Adult↗
PubMed2002

[Thumb arthritis yesterday and today. Epidemiologic comparison in an ancient population].

The aim of the study was to assess the rate of thumb osteoarthritis in an ancient population (before the industrial revolution) according to the age, the sex and the side affected, and to compare the results to the current epidemiologic data. This study was performed in bones from the convent graveyard of the Soeurs Grises de Beauvais (15th to 18th century). The rate of thumb osteoarthritis was assessed in 73 adult individuals (34 men and 39 women) divided into 2 age groups: 35-49 and over 50. The rates of thumb osteoarthritis in each group were compared according to different factors (age, sex, side affected). The statistical study showed a higher rate of thumb osteoarthritis in elder people in general, and in male but not in female individuals. The rate of bilateral thumb osteoarthritis was higher in women. However, no difference was found between both sides of human body whatever the age or sex. As for the female population, the results were identical those of the current data. However, there was a higher rate of thumb osteoarthritis in men of any age group. A functional fatigue could provide a higher rate of secondary thumb osteoarthritis since the women in this series (nuns), who were less affected by overwork, had a rate of primary thumb osteoarthritis identical to the rate found in the current literature.

Adult↗
PubMed1990

Thumb duplication: surgical treatment and analysis of sequels.

Between 1978 and 1988, 50 thumb duplications were operated upon at either the orthopedic department of Hôpital Trousseau (Paris) or at l'Institut Français de la Main (Paris). Following Wassel's classification, we observed a large incidence of types IV, II and VII (in that order). There was a 30% incidence of associated anomalies. The average age at operation was 15 months. We were able to review 30 patients (31 thumbs) with a mean follow-up of 30.9 months. We divided our series into two groups depending on the operative protocol. Group A: 19 patients (20 thumbs), operated on between 1978 and 1982 and reviewed at 33 months on average. Group B: 11 patients (11 hands) operated on between 1983 and 1988 and reviewed with a mean follow-up of 28.5 months. All of the children were evaluated following Wassel's and Tuch's criteria. In groupe A, only five thumbs could be considered normal, or near normal upon this reexamination. All the others were affected by various sequels, which were essentially esthetic. Only two thumbs had a functional deficit, due to instability of the MP joint in one case, and stiffness of the two joints of the thumb in the other. These poor objective results were, however, not shared by the children and their parents, since 16 of them declared themselves satisfied with the appearance and the function of the thumb. 6 patients required further surgery with an average of 2.5 operations per patient. These secondary operations gave imperfect results: out of 6 such patients, we obtained 3 fair results, and three remained poor. This relatively high proportion of sequels in our patients in group A led us to change our treatment protocol in 1983. Our revised attitude was to treat all deformities at once, and especially axial deviation with a corrective osteotomy if soft tissue surgery alone did not afford perfect realignment of the thumb. Thus, among the 11 reviewed patients of group B, 6 results could be considered to be good, 4 suffered from slight sequels, and one patient required a secondary surgery (tenolysis of the extensor apparatus) to correct an inadequate active extension of the IP joint. This result was functionally good on review. The optimal age for operation is between 12 and 18 months. Il seems to us that bad results are apparent early, after 6 to 12 months, because they are mainly due to inadequate treatment. Conversely, good short-term results seem to persist with growth, but there is an overall paucity of studies in this field.

Classification↗
PubMed2000

The occurrence rate and correlation factors of thumb-in-palm posture in newborns.

Bilateral fisting of hands, including adduction and infolding of the thumbs (cortical thumbs), is an expected finding in term infants. Clinically, the cortical thumb position is a transient and normal, but not general, hand posture in newborns. The aim of this study was to analyze the rate of occurrence and the factors possibly affecting the cortical thumb (thumb-in-palm) posture in term newborns. We enrolled 197 low-risk term newborns and observed the posture of their hands once daily from the day of birth for 3 consecutive days. The occurrence rates of the thumb-in-palm posture of the right hand on the first, second, and third days were 62.8%, 60.9%, and 50%, respectively, and those of the left hand were 60.3%, 55.8% and 53.2%, respectively. There was a significant reduction on a day-to-day basis in the right hand and an insignificant reduction in that of the left hand. Factors including sex, gestation age, birth weight, method of delivery, and alertness were analyzed, and no relationship was evident between these factors and the occurrence rates of the cortical thumb posture. Our observations suggest that the cortical thumb posture is indeed a predominant hand posture in our hospital, yet it is not a general phenomenon in all term newborns.

Age Factors↗
PubMedDate not supplied

The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.

Splinting for the common osteoarthritis of the carpometacarpal (CMC) joint of the thumb is infrequently described in the literature, but the few splints that are described include one or both adjacent joints. This paper describes the design and biomechanics of a custom-molded thumb CMC immobilization splint that excludes the thumb metacarpophalangeal and wrist joints. The problem of the imbalance of extrinsic extensor/abductor forces against the intrinsic flexor/adductor forces is described. The accompanying weakening of the thumb CMC capsule allows dorsal shifting of the proximal end of the metacarpal, producing pain. The splint described in this paper 1) prevents motion of the first metacarpal in relation to the other metacarpals, 2) prevents tilting (flexion) of the first metacarpal during pinch, and 3) allows unrestricted thumb metacarpal and wrist joint motion. Attention to detail during construction is required for an accurate pattern, precise positioning of the CMC joint during molding, accurate molding around the first metacarpal, and well-distributed pressure. This design may also be used for protection following thumb CMC arthroplasty or thumb CMC sprain or strain and as a base for thumb metacarpophalangeal and/or interphalangeal mobilization splinting.

Activities of Daily Living↗
PubMed2002

[Cup and cone arthrodesis of the thumb in palliative surgery for tetraplegia. Retrospective study of 57 cases].

INTRODUCTION: The cup and cone technique, first described by Carrol and Hill is very simple. It affords excellent contact between bones, and allows all possible adjustments of the arthrodesis in three planes before its final fixation. MATERIAL AND METHODS: Fifty seven cup and cone arthrodesis of the thumb were performed in 41 adult tetraplegic patients. Level of arthrodesis was i.p. in 28 cases, TM in 25 cases and MP in 4 cases. Distribution in Giens classification was 3 group 1, 14 group 2, 9 group 3, 23 group 5, 2 group 6, 1 group 7, 2 group 10. Mean follow-up was 51 months. Three criteria were retrospectively studied: the clinical strength of arthrodesis, its position, and the potential existence of complications. RESULTS: Clinical fusion was obtained in 8 week in all cases, without any infection. No delayed union was observed. In only one case, a surgical revision was required, due to initial bad setting of TM arthrodesis and an intermetacarpal arthrodesis was performed with a bony graft. In all other cases, position of arthrodesis was correct. In a few cases, only minor or non specific drawbacks were observed: TM arthrodesis were sometimes painful during the first 6 months postoperatively; transient dystrophy of the thumb nail occurred two times in i.p. arthrodesis; the worst drawback was the shortening of the thumb, which impaired the key-grip in cases where the thumb was preoperatively short. DISCUSSION: In tetraplegic patients, stabilization of the thumb can be obtained either by split distal FPL tenodesis or by an arthrodesis at TM, MP or i.p. level of the thumb. When the provided thumb length is adequate arthrodesis is preferred. The cup and cone technique is very simple and effective. It is fit particularly in tertraplegic patients, whatever the level of the thumb arthrodesis.

Adult↗
PubMed2001

Specific somatosensory processing in somatosensory area 3b for human thumb: a neuromagnetic study.

OBJECTIVES: We examined the relation between somatosensory N20m primary responses and high-frequency oscillations (HFOs) after thumb and middle finger stimulation. METHODS: Somatosensory evoked fields (SEFs) from 12 subjects were measured following electric stimulation of the thumb and middle finger. SEFs were recorded with a wide bandpass (3-2000 Hz) and then N20m and HFOs were separated by subsequent 3-300 and 300-900 Hz bandpass filtering. RESULTS: The N20m peak-to-peak amplitude did not differ significantly between thumb and middle finger SEFs. In contrast, HFOs had a significantly larger number of peaks and were higher in the maximum amplitude and the total amplitude after thumb stimulation than after middle finger stimulation. CONCLUSIONS: Our present data demonstrate a different relation between N20m and HFOs after thumb and middle finger stimulation. In view of the fact that the human thumb has uniquely evolved functionally and morphologically, the somatosensory information from the thumb will be processed differently for a fine motor control. We speculate that HFOs are generated by inhibitory interneurons in layer 4 in area 3b. Thus, enhanced activity of interneurons reflected by high amplitude HFOs exerts stronger inhibition on downstream pyramidal cells in area 3b for thumb stimulation.

Adolescent↗
PubMed1995

Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography.

We evaluated possible differential effects of vecuronium on the thumb and great toe using two types of neuromuscular transmission monitor. Train-of-four stimuli were simultaneously applied to the ulnar nerve and tibial nerves using cutaneous electrodes. The responses were quantified with accelographs (thumb and left great toe) and an electromyograph (right great toe). Twenty ASA 1 or 2 patients received, by random allocation, one of two types of anaesthesia: neuroleptanaesthesia or sevoflurane-based anaesthesia. With both techniques, the shortest time to maximum block after vecuronium 0.1 mg.kg-1 occurred in the thumb as measured by accelography. The average (SD) values with neuroleptanaesthesia were: 173(23) s for thumb using accelography; 220(16) s for great toe using accelography; 205(44) s for great toe using electromyography. The average (SD) value(s) with sevoflurane-based anaesthesia were: 137(15) for thumb using accelography; 179(21) for great toe using accelography; 153(23) for great toe using electromyography. The differences between the thumb and great toe were statistically significant during both types of anaesthesia when measured with the accelograph (p < 0.01). The time from completion of maximal block to 25% recovery of twitch height in the thumb was significantly longer than that of the great toe as measured by accelography during both types of anaesthesia (p < 0.05). In contrast, there were no statistically significant differences between time to maximum block and 25% recovery of twitch height of the thumb as measured by accelography compared to the values measured for the great toe using electromyography during either anaesthetic technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Effect of thumb anaesthesia on weight perception, muscle activity and the stretch reflex in man.

1. We have confirmed the results of Gandevia & McCloskey (1977) on the effect of thumb anaesthesia on perception of weights lifted by the thumb. Weights lifted by flexion feel heavier and weights lifted by extension feel lighter. 2. The change in size of the long-latency stretch reflex in flexor pollicis longus or extensor pollicis longus after thumb anaesthesia cannot explain the effect on weight perception by removal or augmentation of the background servo assistance to muscular contraction. 3. During smooth thumb flexion, thumb anaesthesia increases e.m.g. activity in flexor pollicis longus and extensor pollicis longus for any given opposing torque. 4. During smooth thumb extension the opposite occurs: e.m.g. activity in both extensor and flexor pollicis longus decreases. 5. Clamping the thumb at the proximal phalanx to limit movement solely to the interphalangeal joint reduces or abolishes the effect of anaesthesia on both weight perception and e.m.g. activity during both flexion or extension tasks. 6. Gandevia & McCloskey's findings on the distorting effects of thumb anaesthesia on weight perception cannot be used to support the hypothesis of an efferent monitoring system of the sense of effort. Our results emphasize the close functional relationship between cutaneous and joint afferent information and motor control.

Anesthesia, Local↗