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Anatomy
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
The median nerve runs between the two bellies of the pronator teres muscle in the forearm. It continues between the flexor digitorum superficialis and profundus muscles to the carpal tunnel. During this course it branches off the anterior interosseous nerve to the m. flexor pollicis longus, the m. flexor digitorum profundus of the index finger and m. pronator quadratus. The median nerve itself innervates the m. flexor carpi radialis, the m. pronator teres, the four mm. flexor digitorum superficialis, the m. palmaris longus and the m. flexor digitorum profundus to the middle finger. At the level of the wrist, the median nerve is located on the ulnar side of the FCR and is covered by the palmaris longus tendon. Distally, the median nerve passes through the carpal tunnel underneath the transverse carpal ligament. The motor branch branches off to the thenar and innervates the m. opponens pollicis, the m. abductor brevis and half of the m. flexor pollicis brevis. Finally the median nerve branches off as a sensory nerve to the thumb, index, middle and radial half of the ring finger.
Introduction
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Significance of the Index FingerThe index finger never does any particular work.The index finger acts as a stabilizer for any external stimulus. Example: Catching a ball where index fingers exert the stabilizing mechanism to minimize ball roll.The index finger is a “navigator” and assists the thumb and most importantly in opposition axis. The thumb is the “pilot” for computation of a hand trajectory towards a target [13,14].In addition to the stabilizing role, the thumb and index finger together have a stronger force production capability compared to the other digits [15,16].
Examination of Pediatric Hand and Wrist
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Mohsina Subair, Satyaswarup Tripathy, Ranjit Kumar Sahu
Ochsner’s clasp test: Ask the child to clasp both hands with the fingers interlocked. The child will be unable to flex the index finger leading to a pointing index. This occurs due to paralysis of the long flexors of the index finger.
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
A 29-year-old female had a palmar oblique amputation with injury type of PNB 455 [18,19] (Figure 2(A)) in the right index finger (Figure 2(B–D)). Replantation was impossible as the distal amputation was unfound. Radiography, tetanus antitoxin, analgesic, antibiotics, biological dressing and laboratory tests were routinely administrated. Sub-emergent reconstructive surgery was performed. A size of 2.5 × 2.0 cm osteo-onychocutaneous free flap was designed preoperatively in the left hallux (Figure 2(E,F)). Composite flap was dissected and checked for blood perfusion by releasing of tourniquet intraoperatively (Figure 2(G)). The donor site was primarily closed with the medial flap strip after flap harvest (Figure 2(H)). After proper flap fixation, the vessels and nerve were repaired. The injured index finger was well reconstructed and reperfusion was robust immediately (Figure 2(I–K)). At follow-up of 16 months, satisfactory shape in the pulp and nail was achieved (Figure 2(L–N)). No obvious morbidity was found in the donor hallux (Figure 2(O,P)). Static 2-PD was approximately 9 mm. Key-pinch strength was 82% of that of the intact left index finger. The highest score, nine points, was recorded for both the donor and recipient sites.
Treatment of cold intolerance following finger pulp amputations: a case comparison between immediate finger replantation and delayed pulp and digital arterial arch reconstruction with flow-through free hypothenar flap
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Ryohei Ishiura, Makoto Shiraishi, Yoshimoto Okada, Kohei Mitsui, Chihena Hansini Banda, Kanako Danno, Mitsunaga Narushima
We report a 51-year-old non-smoking man who presented with left index and middle fingertip amputations. He sustained the injuries while falling from a height when his fingers became entrapped between blocks of a wall in an effort to reach for support. This resulted in volar oblique avulsion of his finger pulps distal to the distal interphalangeal joint crease (Figure 1). There were no fractures and the distal phalanxes were intact. On the day of injury, we performed emergency replantation surgery for both fingers under digital nerve block. A single artery and vein were anastomosed for each fingertip. Index finger replantation was successful, but the middle fingertip underwent necrosis. The patient declined further reconstructive surgery of the middle finger stump. Therefore, debridement and coverage with artificial dermis (Terudermis, Alcare, Japan) were performed instead and the wound healed by secondary intention (Figure 1).
Non-surgical management for air injection injury to the hand, a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
William Pipkin, Alex Frangenberg, Michael Wade, Weston Peine, William F. Pientka
A 54-year-old mechanic presented to the emergency department 5 days after suffering a high pressure air injection injury to the radial base of the index finger through a pre-existing finger laceration. He presented for increased swelling and pain along the hand and forearm. The pressure of the air line and time of exposure to the high pressure were unknown. The patient was hemodynamically stable on arrival. Physical examination demonstrated a 1 cm laceration on the radial aspect of the index finger base with subtle erythema. There was significant stiffness to the index finger. There was also mild swelling on the dorsum of the hand and forearm. The digits, hand, and forearm were neurovascularly intact and there was no evidence of flexor tenosynovitis, compartment syndrome, or carpal tunnel syndrome. There was no obvious subcutaneous emphysema on exam. White blood cell count, erythrocyte sedimentation rate, and C-reactive protein were within normal limits. Radiographs of the left upper extremity (Figure 1) revealed extensive subcutaneous emphysema throughout the hand, wrist, forearm and arm dissecting along fascial planes.