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Anatomy
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Intrinsic muscles are those whose origin and insertion are located within the hand. Located in the thenar eminence are three muscles that together provide opposition (m. opponens pollicis), abduction (m. abductor pollicis brevis) and flexion of the first MCP joint (m. flexor pollicis brevis). The muscles of the hypothenar consist of the m. opponens digiti minimi, m. abductor digiti minimi and the flexor digiti minimi. The thumb is adducted towards the palm by the adductor pollicis, palpated best on the dorsal side of the hand. Located between the metacarpal bones are the mm. interossei. The palmar interossei, three in total, adduct the fingers in the direction of the middle finger. The dorsal interossei, four in total, abduct the fingers away from the middle finger (Figure 2.5). Last but not least the hand contains the mm. lumbricales, which originate from the FDP tendons and insert onto the extensor aponeurosis at the proximal phalangeal level. These lumbrical muscles tighten the extensors such that the fingers can remain extended during the flexion of the MCP joints.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
To test adductor pollicis, ask the patient to squeeze a piece of paper between the base of the thumb and the index finger. If the adductor pollicis is weak, the interphalangeal joint of the thumb flexes due to the use of the median-innervated flexor pollicis longus to hold onto the paper (Froment's sign).
Biochemical Contributors to Exercise Fatigue
Published in Peter M. Tiidus, Rebecca E. K. MacPherson, Paul J. LeBlanc, Andrea R. Josse, The Routledge Handbook on Biochemistry of Exercise, 2020
Arthur J. Cheng, Maja Schlittler, Håkan Westerblad
The decline in contractile force during fatiguing exercise is reversible, although it may take several hours to days for complete recovery. Recovery of contractile force in fatigued muscle can be tested with electrical stimulation in vivo and in vitro. Such tests have revealed that during recovery, the reduction in contractile force is typically more pronounced at low (10–20 Hz) than at high (>70 Hz) stimulation frequencies. This phenomenon was first described in human adductor pollicis muscles (26) and has since been observed in numerous in vivo and in vitro studies (2, 67). It was originally named “low frequency fatigue,” but this term has become imprecise because it has been used for many different conditions. Thus, most prefer using the term “prolonged low frequency force depression” (PLFFD). In general, PLFFD can be explained by long-lasting decreases in SR Ca2+ release and/or myofibrillar Ca2+ sensitivity (2, 67).
Deep versus moderate neuromuscular block in laparoscopic bariatric surgeries: effect on surgical conditions and pulmonary complications
Published in Egyptian Journal of Anaesthesia, 2019
Mohamed M. Abu Yazed, Sameh Abdelkhalik Ahmed
Quantitative neuromuscular function was monitored using an acceleromyograph (TOF-watch-SX, MSD BV, Oss, Netherlands) that measures the adductor pollicis muscle response. Two electrodes were placed over the course of the ulnar at the radial side of the flexor carpi ulnaris muscle 1 cm proximal to the wrist joint. The contractions of the ipsilateral adductor pollicis muscle (causing adduction of the thumb) were detected by attaching a sensor to the tip of the thumb and placing it in a flexible adaptor to generate preload. TOF-watch-SX was calibrated and stabilized after induction of general anesthesia and before rocuronium administration, according to manufacturer specifications. Neuromuscular block was assessed after endotracheal intubation at 15-second intervals.
Comparison of vecuronium or rocuronium for rapid sequence induction in morbidly obese patients: a randomized study
Published in Egyptian Journal of Anaesthesia, 2020
Mohamed M. Abu Yazed, Sameh Abdelkhalik Ahmed
The neuromuscular functions were monitored by acceleromyography (TOF-watch-SX, MSD BV, Oss, The Netherlands); the response of the adductor pollicis muscle was detected by two electrodes placed over the path of the ulnar nerve: the first was placed over the lateral side of the flexor carpi ulnaris muscle, and the second was placed 1 cm proximal to the wrist joint. A sensor was placed on the tip of the thumb to detect the contractions of the ipsilateral adductor pollicis muscle. The thumb was placed in a flexible adapter to generate preload while the rest of the hand was fixed. Calibration of the train-of-four monitor was carried out after the induction of anesthesia but before the injection of the muscle relaxants.
Surgical management of hand deformities in patients with recessive dystrophic epidermolysis bullosa
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Xianyu Zhou, Yan Zhang, Mengmeng Zhao, Yuluo Jian, Jinny Huang, Xusong Luo, Jun Yang, Di Sun
Next, transverse volar or Z-plasty incisions at the level of flexion creases in the flexion contractures fingers were made. Contracted scars in the skin and subcutaneous tissues were released using scissors. While performing deep incisions, attempts were made to avoid the direct exposure of bilateral neurovascular bundles. If exposure was inevitable due to intraoperative tendon readjustments, local fat flaps or skin flaps were designed to cover those neurovascular bundles. In severe cases, if the thumb adduction contracture involved the adductor pollicis brevis and the first dorsal interosseous muscle, the hand function would be largely restricted and the adducted thumbs must be thoroughly released. This requires a long incision from the base of the web at the level of the thenar eminence and mid-palm up to the dorsal palm. To separate the metacarpal muscle head of the first dorsal interosseous muscle, an exterior manual force was used to lengthen the adductor pollicis brevis and flexor policis brevis muscle, thus creating a new first web space. To completely release and lengthen the severely contracted second to fifth digits, it was necessary to cut off the musculus flexor digitorum superficialis. Additional releases of the palm prints and the medial margin of the hypothenar eminence were necessary if the patients had severe palm flexed contracture (Figure 1(B)). The Kirschner wires (Smith & Nephew Company, Memphis, TN) were used to secure and maintain the fingers in specific position: the thumb was fixed in an opposed position and the other digits were fixed in the functional position crossing the IP joints. In four patients, wire fixation was unnecessary because their digit flexion contracture was not severe enough.