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Geriatric Assessment and the Physical Examination of the Older Adult
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Osteoarthritis and cervical spondylosis often impair the elderly patient’s neck mobility. Caution is recommended in hyperextending the neck of people with rheumatoid arthritis due to the involvement of the odontoid process. Wasting of the interosseous muscles of the hand can provide an indirect clue about cervical myelopathy malnutrition or diabetic neuropathy.
Topography of the deep branch of the ulnar nerve between genders: a cadaveric study with potential clinical implications
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Alfio Luca Costa, Konstantinos Natsis, Marco Romeo, Maria Piagkou, Franco Bassetto, Cesare Tiengo, Bruno Battiston, Paolo Titolo, Nikolaos Papadopulos, Michele Rosario Colonna
Several authors agree with the statement that the anatomy of the deep branch of the ulnar nerve (DUN) is complex and often little known; even hand surgeons often find it difficult to understand its three-dimensional arborization pattern [1,2]. This branch runs in a space between the flexor digitorum profundus (FDP) tendons and the interosseous muscles in the hand, an area that a microsurgeon rarely sees in clinical practice, except for hand trauma or rare elective pathologies [3–8]. Besides this, although the anatomy of this branch can also be found in the more common hand surgery atlas, its arborization patterns were unclear until a few years ago [1–2]. This poor anatomical knowledge in clinical practice can lead to a delay in diagnosis or misdiagnosis of the DUN lesion. Several noxae, such as cysts, penetrating trauma, displaced fractures, flexor injuries in zone III, can be associated with a DUN injury [3–8]. Surgeons often relate loss of fine hand movement and pinching and grasping force to the trauma itself, to a reduction in flexor tendon function, or poor rehabilitation of the patient following trauma rather than injury to the DUN or its terminal branches [9]. Atkins first and Gil later clarified the anatomy with radiographic landmarks [1,2]. However, no data exists concerning the nerve identification in relation to a precise anatomical landmarks, as well as possible gender variability in DUN position and course. Aim of this study is to define the position of the arc of the DUN relative to a clear and well-known reference point on the surface of the hand, the Kaplan line, a well-known landmark in hand surgery for carpal tunnel release [10].