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Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
The thumb can flex, extend, radially abduct and palmarly abduct. The flexor pollicis longus (median nerve) is the flexor at the thumb interphalangeal joint. The extensor pollicis longus (radial nerve) is the extensor at the interphalangeal joint and also allows the thumb to retropulse. Thumb radial abduction is primarily the action of the abductor pollicis longus (radial nerve) and adduction is the action of the adductor pollicis (ulnar nerve). The thenar muscles (median nerve) are responsible for thumb palmar abduction and opposition. These can all be tested by stabilizing the patient's wrist and asking the patient to move his or her thumb while providing resistance (Figures 12.13 and 12.14).
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The superficial muscles on the anterior aspect of the forearm are the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis, all of which originate from the medial humeral epicondyle at the elbow. These muscles act variously in pronating the forearm and flexing, abducting, and adducting the wrist (see wrist and hand – muscles). The deep anterior muscles of the forearm are the flexor digitorum profundus and flexor pollicis longus, which flex the fingers and thumb respectively. Additionally, pronator quadratus is a deep anterior muscle that pronates the forearm.
The hand
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
If carpal tunnel release is needed, the operation should include a flexor tenosynovectomy. If the flexor tendons are bulky (best felt over the proximal phalanges) and joint movement is limited, then flexor tenosynovectomy should improve movement and, just as important, should prevent tendon rupture. Triggering, likewise, should be treated by tenosynovectomy rather than simple splitting of the sheath. Rupture of flexor digitorum profundus is best treated by distal IP joint fusion. Rupture of flexor pollicis longus (due to attrition against the underside of the distal radius or flexor synovitis) can be treated either by tendon grafting or by fusion of the thumb IP joint.
Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Gavrielle Hui-Ying Kang, Fok-Chuan Yong
The donor median or ulnar nerve and biceps branch of musculocutaneous nerve were identified via the same anterior axillary incision extended distally. (Figure 3) A partial longitudinal epineurotomy was made on the donor nerve for intra-operative nerve stimulation to identify suitable donor fascicles. For the median nerve, suitable donors include the fascicles to wrist or finger flexors (FCR or FDS), or forearm pronator (PT). The suitable donor fascicles for the ulnar nerve would be the fascicles to the FCU. The donor fascicles were identified when strong muscle contractions were observed with nerve stimulation and isolated to the expandable muscle. Fascicles that did not elicit a response to nerve stimulation were assumed to be sensory fascicles and were spared. Fascicles that elicited a motor response to any of the flexor digitorum profundus or flexor pollicis longus on stimulation were spared as well. The chosen fascicles were then isolated with a vessel loop. The nerve fascicle that elicited the stronger muscle contraction was chosen for neurotization to the nerve to the biceps muscle. If the ulnar nerve and median nerve fascicles elicited similarly strong muscle contractions, the ulnar nerve was chosen for neurotization to the nerve to the biceps muscle. The other donor nerve fascicle was then utilized for neurotization to the axillary nerve.
Multilocular lipoma of the left thumb of the hand: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Ahmed Wafiq Wafa, Shabir Wani, Tuqa A. Alsinan, Sarah Alkhonizy
For more investigations, the patient underwent several imaging workups. An MRI of the left thumb was ordered to confirm the findings, which showed a multilocular soft-tissue lesion along the volar aspect of the left thumb. The lesion extends from the level of the mid-distal phalanx to the first metacarpophalangeal joint. The lesion measures 2.2 × 2.8 × 4.3 cm in anteroposterior, transverse, and cranio-caudal diameters respectively. The lesion is surrounding the anterior, medial, and lateral borders of the flexor pollicis longus tendon with no deep extension to the tendon. After contrast administration, there is no definite enhancement. While the tendon of the flexor pollicis longus demonstrates a nonspecific abnormal signal intensity 1 cm above the base of the proximal phalanx. The remaining part of the tendon demonstrates normal signal intensity and thickness (Figure 2(A,B)). The patient was admitted to our institute for excision of the left thumb swelling. Under aseptic precautions and tourniquet control, a rectangular radially based incision was made over the left thumb over the thumb and the flap was raised in order to secure the neurovascular bundle. The mass was excised completely from the left thumb with no immediate or late complications (Figure 3(A–D)).
Primary eccrine porocarcinoma of the thumb with multiple metastases: a case report and review of the literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Connor McGuire, Zahir Fadel, Osama Samargandi, Jason Williams
Follow up initially was unremarkable and the wound healed well. However, four months after the operation the patient had a CT scan demonstrating a seroma in the axilla that required drainage. Seven months after surgery, a suspicious lesion was identified in the scar of the right amputated thumb (Figures 3a,b). Subsequently, the new lesion was excised with clear margins after two operations and histologic examination was positive for recurrent porocarcinoma. During the second excision the plastic surgery team completed a transfer of the flexor pollicis longus tendon to the distal bone stump to help maintain some of the adduction strength of the thumb (Figures 4 a,b). In May of 2018 the patient presented with new subcutaneous lesions. Biopsies of the right chest wall, right anterior axillary line, and right radial wrist revealed metastatic porocarcinoma. The patient received radiation therapy to the right axillary bed. Subsequent discussions with medical and radiation oncology revealed the progressing difficulty of the situation- as metastatic porocarcinoma is so rare, there are few studies investigating treatment protocols. The conversation initially shifted from curative intent to improving quality of life, however after treatments with paclitaxel (175 mg/m2), carboplatin (area under the curve = 5), and intralesional interleukin 2 (IL-2) injections the metastases responded with near complete disappearance of the cutaneous lesions. After one year of follow-up the patient was still responding well to this maintenance treatment.