China
Africa
Explore chapters and articles related to this topic
Distal Conduction Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The median nerve crosses the ulnary artery, from which it is separated by the deep head of the pronator teres muscle, at the upper part of the forearm. It descends through the forearm lying over the flexor digitorum profundus muscle, until reaching the flexor retinaculum, being accompanied by the median artery (Figures 1.31C, and 1.64). At the lower part of the forearm, it lies between the tendons of the flexor carpi radialis and the flexor digitorum sublimis muscles, behind and slightly lateral to the tendon of the palmaris longus muscle (Figure 1.67).
Upper limb
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
The tendon(s) of which of the following muscles is most likely affected?Flexor carpi radialis.Flexor pollicis longus.Flexor pollicis brevis.Flexor digitorum superficialis.Flexor digitorum profundus.
Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Mohammed Tahir Ansari, Santanu Kar, Devansh Goyal, Dyuti Deepta Rano, Rajesh Malhotra
The donor tendons are tested by activating the muscle and resisted force is given to undo the movement. Simultaneously, the muscle belly is palpated to reconfirm its activation. Most commonly, the donor tendons for tendon transfer for radial nerve palsy are:Pronator teres (PT) – The patient is asked to fully extend the forearm and pronate it. The examiner tries to supinate the forearm, which the patient resists, and pronator teres is palpated at proximal forearm (Video 8A.5).Flexor carpi ulnaris (FCU) – The patient is asked to clench the fist and asked to do palmar flexion and ulnar deviation of the wrist. The muscle belly of FCU is palpated (Video 8A.6).Flexor carpi radialis – The patient is asked to clench the fist and asked to do palmar flexion and radial deviation of the wrist. The tendon of the flexor carpi radialis (FCR) is palpated (Video 8A.6).Palmaris longus (PL) – The patient is asked to touch their little finger and thumb and to do palmar flexion of the wrist against resistance (Video 8A.7). If the wrist is painful then the wrist is supported, and resisted finger flexion is done (Video 8A.8). Both the manoeuvres lead to tenting of the PL in the forearm. The tendon of the PT is absent in 30% of population.Flexor digitorum superficialis (FDS) – This tendon integrity is tested by examination of active flexion of the proximal interphalangeal joint. The patient's hand and forearm are kept flat on the table with the forearm supinated. The examiner stabilizes the other fingers (except the finger to be tested) and the patient is asked to flex the proximal interphalangeal (PIP) joint against resistance and the tendon of the FDS is palpated (Video 8A.9).
The effects of pistol grip power tools on median nerve pressure and tendon strains
Published in International Journal of Occupational Safety and Ergonomics, 2022
Ryan Bakker, Mayank Kalra, Sebastian S. Tomescu, Robert Bahensky, Naveen Chandrashekar
There are limitations to this study. First, factors inherent to cadaveric research can affect the reliability of the results, including the effects of placement of the various sensors and difficulty in maintaining the anatomic alignment of the muscle forces. Second, the muscle forces used for this study were linearly scaled from a model developed for a maximal grip force application and not power tool usage. The distribution of muscle contribution to stabilizing the wrist may be different for power tool usage versus maximal grip. There may have been contributions from additional flexor muscles such as the flexor carpi radialis and flexor carpi ulnaris that were not included in this study. The results are limited to one activity with one set of operational parameters such as torque and grip force. The effects of variations of these parameters are not studied. Third, the effects of active insufficiency on muscle forces in the flexed position were not addressed due to no available muscle force models being found for this position. This position may change the muscle forces and strains through the FDP and FDS, which are known to be actively insufficient in this position.
Patient-reported outcomes following interposition arthroplasty of the basal joint of the thumb
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Rasmus Wejnold Jørgensen, Anders Odgaard, Frederik Flensted, Henrik Daugaard, Claus Hjorth Jensen
The primary outcome of this study shows a significant reduction in pain scores and Quick-DASH scores. A further reduction in pain scores and Quick-DASH scores were seen after 6 months follow up. The improvement in pain scores seen at 6 months further improved marginally but statistically significant at one year follow up. A further improvement might suggest that the full effect of the treatment is seen later than six months following surgery. Werthel et al. showed similar pre- and postoperative DASH values with a mean preoperative value of 49.4 and 22.1 postoperatively in 49 thumbs [15]. These patients were all operated on with ligament reconstruction using the entire flexor carpi radialis tendon. De Smet et al. compared trapeziectomy with or without tendon interposition and found postoperative values of 33 for trapeziectomy in 22 patients and 27 for tendon interposition in 34 patients [4]. One study compared 18 thumb trapeziectomies, 17 trapeziectomies followed by tendon interposition and 28 arthrodesis. Long term postoperative DASH values were 25, 26 and 27, respectively [3]. One randomized single blinded study compared simple trapeziectomy to LRTI suspension and found equal pain scores at follow up but did not report Quick-DASH scores or other PRO [16].
Loss of selective wrist muscle activation in post-stroke patients
Published in Disability and Rehabilitation, 2020
Hanneke van der Krogt, Ingrid Kouwijzer, Asbjørn Klomp, Carel G.M. Meskers, J. Hans Arendzen, Jurriaan H. de Groot
Tests were performed on a haptic wrist manipulator (Wristalyzer®, Moog FCS, Nieuw Vennep, The Netherlands) [30], on which torque and wrist joint angle were recorded. Participants were comfortably seated on a chair in front of a video screen. The forearm of the participant was positioned horizontally with the elbow in 90° flexion. The hand was strapped to an ellipsoidal shaped handle (Figure 1) to prevent finger flexion and hand closure. The skin at the electrode positions was cleansed with alcohol and lightly abraded with skin preparation gel (SkinPure, Nihon Kohden, Japan). EMG activity of the m. flexor carpi radialis (FCR) and m. extensor carpi radialis longus and brevis (together abbreviated as ECR) was recorded by bipolar parallel bar surface electrodes (Bagnoli® DE-2.1, Ag, single differential, interelectrode distance 10 mm; Bagnoli-8 amplifier, Delsys Inc., Boston, USA). FCR and ECR were chosen to reflect overall muscle activity of wrist flexor and extensors. Both muscles are the less pennate muscles of the lower arm, have good accessibility with surface EMG and are therefore likely to suffer less from measurement artifacts. Two bipolar electrodes were placed on each muscle group to ensure that a signal was available and to compensate for spatial alterations in the affected (atrophic) muscle after stroke [31]. Position, force and EMG were sampled at 2048 Hz using a 16 bit analog-to-digital card (USB 6221, National Instruments, Austin, USA) [29].