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Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Nikhil Agrawal, Chaitanya Mudgal
Froment's sign specifically looks at the function of the adductor pollicis muscle. The examiner should ask the patient to tightly grasp an object between their index finger and thumb. When the examiner attempts to pull the object away, in a normal hand the patient will use the adductor pollicis and firmly hold on to the object without any associated flexion of the interphalangeal joint of the thumb. However, in a patient with ulnar nerve injury, the patient will oppose and flex the thumb as they will be unable to initiate contraction of the adductor pollicis. This is best observed by the flexion of the interphalangeal joint (IPJ) of the thumb when it is compared to the contralateral side [17]. The object should be the size of a narrow book, as a sheet of paper will result in most individuals using opposition and flexion on the normal side as well (Figure 8C.6) (Video 8C.4). Jeanne's sign is less often mentioned but refers to MP hyperextension when performing the manoeuvre.
Electricity and Magnetism
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
80% of the neuromuscular receptors must be blocked to paralyse the diaphragm. Recovery of the diaphragm from neuromuscular block occurs quicker than that of the adductor pollicis muscle. Therefore, if this muscle is used to monitor neuromuscular blockade, overestimation of the blockade of the diaphragm can occur
The spastic thumb
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
The most common operation performed for an adducted thumb is the release of the adductor pollicis from its origin.2 An incision is made in the thenar crease and the adductor pollicis muscle can be identified simply by retracting medially the flexor tendon to the index finger. The muscle is erased from its origin on the shaft of the third metacarpal bone and the flexor retinaculum (Figure 66.2).
Low Food Consumption Interferes with the Nutritional Status of Surgical Patients with Neoplasia of the Gastrointestinal Tract
Published in Nutrition and Cancer, 2022
Anieli Golin, Caroline Zucchetto Freitas, Mairin Schott, Bruna Pessoa Alves, Juliana Ebling Brondani, Silvia Cercal Bender, Juliana Fleck, Edson Irineu Müller, Clandio Timm Marques, Elisângela Colpo
Anthropometric assessment of triceps skinfold thickness (TST), subscapular skinfold thickness (SST), mid-upper arm circumference (MUAC), adequacy percentage of the mid-upper arm circumference (%MUAC), calf circumference (CC), midarm muscle circumference (MAMC), adequacy percentage of the midarm muscle circumference (%MAMC), and corrected arm muscle area (CAMA) were performed by using a tape measure and Cescorf© scientific plicometer. In the preoperative period, the Body Mass Index (BMI) was assessed according to the respective classifications for adults (18) and the elderly (19). BMI was not assessed in the postoperative period, as most patients had edema. The adductor pollicis muscle (APM) thickness was measured by using a Cescorf© scientific plicometer to verify possible depletion of the skeletal muscles (male = 12 mm; female = 10 mm). Afterwards, the percentage adequacy of APM (%APM) was classified as follows: absence of depletion (100%), mild depletion (90% to 99%), moderate depletion (60% to 90%), and severe depletion (<60%) (20).
Precision Neuromuscular Block Management for Neural Monitoring During Thyroid Surgery
Published in Journal of Investigative Surgery, 2021
I-Cheng Lu, Sheng-Hua Wu, Pi-Ying Chang, Pi-Yang Ho, Tzu-Yen Huang, Yi-Chu Lin, Dipti Kamani, Gregory W. Randolph, Gianlorenzo Dionigi, Feng-Yu Chiang, Che-Wei Wu
A reinforced EMG endotracheal tube (internal diameter (ID) 6.0 mm for female and 7.0 mm for male patients, respectively) (Medtronic, Jacksonville, FL) was placed by the UEScope (UE Medical Devices, Newton, MA). The EMG tube was then advanced under video guidance until the surface electrodes were in optimal contact with vocal cords (Figure 1). Proper tube depth and invisible tube rotation were then visually verified by video image and anesthesia was maintained with sevoflurane combined with propofol target-controlled infusion. The precision anesthesia protocol (Group S) included anesthesia depth and NMB management: At 10 minutes after operation starting, an intravenous bolus of sugammadex 0.5 mg/kg was administrated to partially reverse NMB (Figure 2). No additional rocuronium was given intraoperatively to any patient. Train-of-four (TOF) ratio derived via neuromuscular transmission (NMT) monitor (Aestiva/5; Datex-Ohmeda, FL) was used to continuously assess NMB degree of the adductor pollicis muscle. The train of four (TOF) stimulation was setup as (constant 50 mA current, four twitches at every 0.5 second over 2 seconds). Anesthesia depth was monitored by Bispectral index (BIS) monitor (Medtronic, MN). Target anesthesia depth was controlled via titration by inhaled sevoflurane to keep Bispectral index (BIS) monitor between 40% and 50%.
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.