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Hand infections
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Exploration and drainage must be carried out as a matter of urgency. The patient should receive intravenous antibiotics. There are four potential localizations of an abscess:The interdigital space. This will cause the fingers to be abducted due to swelling.Midpalmar space. The concavity of the palm has disappeared and the mobility of the middle and ring fingers are painful and limited. The infection can quickly spread to the forearm to the space of Parona, located between the mm. FDP and the m. pronator quadratus.Thenar space. Causes a swelling over the thenar region and the first interdigital space.Hypothenar space. This is rare. There will be a swelling of the hypothenar.
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
Pronator quadratus is in close proximity to several supernumerary muscles. Radiocubitocarpien (radialis internus brevis biceps) has an ulnar head and radial head and ends on the wrist (Calori 1870; Bergman et al. 1988; Akita and Nimura 2016b). Tensor capsulae radiocubitalis (inferioris) originates from the distal radius and courses over the anterior surface of pronator quadratus to insert onto the radioulnar capsule (Bergman et al. 1988; Akita and Nimura 2016b). Ulnocarpus brevis (flexor carpi ulnaris brevis or cubitocarpeus) originates from the distal end of the ulna and inserts onto the pisiform, hamate, fourth metacarpal, fifth metacarpal, capsule of carpal articulations, or abductor digiti minimi (Knott 1883a; Mori 1964; Bergman et al. 1988; Akita and Nimura 2016b).
Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
J Terrence Jose Jerome, Dafang Zhang
Patients with high median nerve palsies have diminished pinch and grasp strength, due to deficits in the median nerve-innervated thenar muscles. High median nerve palsies uniformly result in a lack of distal interphalangeal joint flexion in the thumb and index finger. While the middle finger flexor digitorum profundus is thought to be innervated by the anterior interosseous nerve. Bertelli et al., have shown that deficits in middle finger flexion are not functionally observed in isolated high median nerve palsies, likely due to redundant innervation from the ulnar nerve. Moreover, while the strength and excursion of forearm pronation can be limited, pronation function is largely preserved in these injuries, despite paralysis of the pronator teres and pronator quadratus. The drivers of this pronation are unclear but may result from a concerted effort from the brachioradialis, ulnar nerve-innervated flexor digitorum profundus, extensor carpi ulnaris and extensor digiti minimi [7].
Dorsal dry needling to the pronator quadratus muscle is a safe and valid technique: A cadaveric study
Published in Physiotherapy Theory and Practice, 2023
Albert Pérez-Bellmunt, Carlos López-de-Celis, Jacobo Rodríguez-Sanz, César Hidalgo-García, Joseph M. Donnelly, Simón A Cedeño-Bermúdez, César Fernández-de-las-Peñas
The pronator quadratus (PQ) is a deep flat muscle covering the distal ends of the ulna and radius anteriorly. It originates from the anterior surface of the distal ulna and inserts onto the distal aspect of the anterior surface of the radius proximal to the wrist (Standring, 2016). This muscle is an important pronator of the forearm and also contributes to stability of the distal radio-ulnar joint. Therefore, due to its function, this muscle is susceptible to repetitive overload that may lead to development of myofascial pain. In fact, patients with TrPs in the PQ clinically report difficulty in using scissors for cutting heavy cloth, handling tools while gardening, or using tools that require stability and a forceful grasp. Similarly, injuries in the lower portion of the forearm, e.g., distal radius fracture, could also affect the PQ muscle (Donnelly, 2019). Interestingly, the pain referral pattern from the PQ muscle was not described by Simons, Travell, and Simons (1999). The pain referral pattern from the PQ was described by Hwang, Kang, and Kim (2005) in an experimentally induced pain model. These authors reported that PQ muscle referred pain pattern spreads both proximally and distally along the medial aspect of the forearm mimicking ulnar or median nerve sensory distributions (Hwang, Kang, and Kim, 2005).
An investigation of dynamic ulnar impingement after the Darrach procedure with ultrasonography
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Kuan-Jung Chen, Jung-Pan Wang, Hui-Kuang Huang, Yi-Chao Huang
The patients received surgery under general anesthesia. An incision was made on the dorsal side of the wrist, medial to the extensor carpi ulnaris (ECU). Anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN) neurectomy were routinely performed, excising the distal 1–2 cm section. The extensor retinaculum, periosteum, and the distal part of the pronator quadratus (PQ) muscle were elevated to expose the distal ulna. Then ulnar osteotomy was made in a long-sloped shape, and parallel to the contour of the opposing radius. The edges of the ulnar cut were beveled with the saw. The detached distal part of the PQ muscle was transferred dorsally and sutured onto the periosteum sleeve of the ulnar stump, forming an interposition (Figure 2). In the cases with an attritional tear of the extensor tendons, the tendons were explored and reconstructed using the same incision.
Twenty years’ follow-up of radiocarpal arthrodesis for rheumatoid wrists
Published in Modern Rheumatology, 2021
Ryo Okabayashi, Hajime Ishikawa, Asami Abe, Hiroshi Otani, Kei Funamura, Rika Kakutani, Satoshi Ito, Youichi Kurosawa, Shunsuke Sakai, Kiyoshi Nakazono, Motohiro Suzuki, Yukihiro Matsuyama, Akira Murasawa
The distal 1.5 to 2.0 cm of the ulna was resected, and proliferative synovium in the wrist joint was removed. The lunate fossa of the radius and proximal articular surface of the lunate were exposed with the wrist in flexion by inserting an elevator into the notch at the origin of the RSL ligament. Degenerated cartilage and sclerotic bone were removed from the lunate fossa and proximal articular surface of the lunate with a bur. Bone chips harvested from the resected ulnar head were packed into the lunate fossa, and the lunate was moved into its neutral position. Two parallel 1.2-mm Kirschner wires (K-wires) then were inserted from the triquetrum obliquely through the lunate into the radius. Two staples with a leg width × length of 13 × 15 mm were inserted between the lunate and radius with a staple gun or manually, and the K-wires were removed. Recently, we have begun to use a Double Threaded Screw, Japan (DTJ) screw (MEIRA Cooperation, Nagoya, Japan) to achieve stable fixation. If the MC joint had fibrously fused, we resected the capitate head, and the space was replaced with a tendon ball harvested from the palmaris longus [17]. RLT arthrodesis was performed, when the lunate was collapsed by 50% or more and it was difficult to insert a screw or a staple to the lunate. RSL arthrodesis was performed only if the radioscaphoid joint was severely deteriorated. The scaphoid was excluded from the fusion site as much as possible, because the range of extension/flexion after fixation became significantly worse. The pronator quadratus was then raised as a flap and sutured to the dorsal periosteum and fascia around the ulnar stump. If dorsal subluxation of the distal radius remained, a distal based strip of one half of the flexor carpi ulnaris tendon was used as a stabilizer by passing it through a drill hole made in the ulnar stump [21,22]. A short arm cast was applied for four weeks, and an elastic wrist support was then applied for a further four weeks after these procedures.