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Contracture of Muscles of the Upper Limb: Severe Volkmann's Ischaemic Contracture of The Forearm
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
The contracted atrophied flexor muscles were excised, and tendons of the flexor digitorum superficialis were also excised. The tendons of the flexor digitorum profundus were tenolysed to get passive finger flexion. The passive wrist extension improved, and the wrist could be brought to the neutral position after this softtissue release. The hand was splinted in maximum correction.
Upper Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo
The part of the muscle that inserts onto the second digit is distinct from origin to insertion (Bergman et al. 1988; Standring 2016). When completely distinct, it forms flexor indicis profundus (Macalister 1875; Knott 1883a; Bergman et al. 1988). The tendon to the third digit may be absent (Bergman et al. 1988). Flexor digitorum profundus is frequently joined by slips from other structures including flexor digitorum superficialis, flexor pollicis longus, the medial epicondyle, the coronoid process, or the radius (Macalister 1875; Mori 1964; Akita and Nimura 2016b; Standring 2016). Other variations of flexor digitorum profundus described by Macalister (1875) include the distinct separation of flexor indicis profundus, accessory slips to and from other structures, and cases in which other forearm or hand muscles arose from this muscle or its tendons. Linburg-Comstock variation is described as a tendinous connection between flexor pollicis longus and the digit two slip of flexor digitorum profundus, or the tendons of these muscles (Linburg and Comstock 1979). Flexor digitorum profundus is also associated with Gantzer’s muscle (see the entry for this muscle).
Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
J Terrence Jose Jerome, Dafang Zhang
The motor examination of a high median nerve injury should focus on deficits in the median nerve innervated muscle groups, and the examiner should assess forearm pronation, wrist flexion, finger flexion, thumb flexion and thumb opposition. The motor examination of an isolated high median nerve injury can be complicated by redundant innervation patterns from an intact ulnar nerve [1]. Deficits in the flexor carpi radialis and palmaris longus are well compensated for by a functioning flexor carpi ulnaris. Deficits in flexor digitorum superficialis to the ring finger and small finger are compensated for by a functioning flexor digitorum profundus.
A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Xianyu Zhou, Di Sun, Fei Liu, Wen Jun Li, Chuan Gu, Ling Ling Zhang
During the surgery, non-viable tissue and local scar were removed from the traumatized digits. The distal dorsal branch or the distal branch of proper palmar digital artery, the distal branch of proper palmar digital nerve, and 1–2 superficial dorsal digital veins were deliberately dissected. The flexor digitorum superficialis tendon and the distal insertion of flexor digitorum profundus on the distal phalanx were left intact. As a general principle, the non-dominant foot, mostly the left one, was chosen as the donor hallux. The nail width (W1), the nail length (L1) and the digital tip circumference (C1) in the intact contralateral thumb and fingers were measured. Similarly, W2, L2 and C2 indicated those parameters in the traumatized digits. ΔW (W1–W2) indicated the difference between W1 and W2, and so were the same as the ΔL and ΔC. The sizes of the mini neurovascular osteo-onychocutaneous flaps were calculated preoperatively as follows: W=ΔW + 0.2 cm; L=ΔL + 0.2 cm; C=ΔC + 0.5 cm, and then marked on the donor hallux (Figure 1).
Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis
Published in Disability and Rehabilitation, 2022
Takatoshi Hara, Masachika Niimi, Naoki Yamada, Yusuke Shimamoto, Go Masuda, Hiroyoshi Hara, Masahiro Abo
BoNT-A was administered to the patients based on the guidelines of Sheean et al. [18]. The maximum dose for the upper limb was 240 units. Botulinum Neurotoxin A (OnabotulinumtoxinA) was diluted with saline to a concentration of 25 U/mL. A team consisting of two physicians, an occupational therapist, and a nurse observed the degree of upper limb paresis, degree of muscle contraction, the extent of dysfunction due to paresis and spasticity, and affected activities of daily living. On the basis of these observations, the team planned the sites and dosage of injection by estimating the possibility of upper limb functional improvement due to the reduction of muscle contraction. Injections of all patients were performed by the same physician. For the biceps, flexor digitorum superficialis, and flexor digitorum profundus, ultrasonography was used. At the time of Botulinum Neurotoxin A injections, the patient was in the supine position. The probe was positioned in the transverse view and perpendicular to the upper limb surface. Then, the needle was inserted into the target muscle at an angle of 30° with respect to the probe [19]. For all other muscles, anatomical landmarks were used to guide Botulinum Neurotoxin A injections. The sites of injection and the dosages are summarized in Table 1.
Functional reconstruction of a hand that was severely deformed due to Jaccoud’s arthropathy
Published in Modern Rheumatology Case Reports, 2021
Kei Funamura, Hajime Ishikawa, Rika Kakutani, Asami Abe, Hiroshi Otani, Kiyoshi Nakazono, Akira Murasawa
Surgery was performed in two stages. In the first stage, radio-lunate arthrodesis was performed at the radially rotated radiocarpal joint, fusion was performed at the CM and IP joints of the thumb, and finger joint replacement was performed at the MP joint using a silicone implant (Swanson). (Figure 3). In the second stage, finger joint replacement was performed at the MP joint of the index finger, but in the middle, ring, and little fingers, myostatic contracture and shortening of the finger flexor muscles were extremely severe, and sufficient space for the implant could not be made. After cutting the flexor digitorum superficialis (FDS) tendon, the flexor digitorum profundus (FDP) tendon was still tight. Therefore, the metacarpal head was excised about 2 cm in length, and fusion was performed at the MP joint. By reducing the dislocated MP joint, the swan-neck deformity in the index through ring fingers was automatically corrected. The remaining hyperextension at the PIP joint of the little finger was fused in a 30° flexed position. Since the cutaneous contracture was not very severe, Z-plasty with skin grafting was not required.