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Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
The palmar thenar muscles are a group of muscles at the base of the thumb and are used for thumb movement. Inspect the base of the thumb for muscle bulk. A well-defined thenar eminence will appear as a mound at the base of the thumb. The thenar muscles can be palpated using the same technique described above for muscle engagement. While the patient is holding their thumb pressed against the other four fingerpads, palpate the base of the thumb on the palmar side to assess the musculature. Well-nourished patients will have adequate muscle bulk between the metacarpal bones and thumb base with no apparent depressions. In severely malnourished patients, an apparent depression will be seen between the metacarpal bones and the base of the thumb. Lack of muscle bulk can also be felt on palpation. See Figures 6.14–6.16.
Anatomy
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Intrinsic muscles are those whose origin and insertion are located within the hand. Located in the thenar eminence are three muscles that together provide opposition (m. opponens pollicis), abduction (m. abductor pollicis brevis) and flexion of the first MCP joint (m. flexor pollicis brevis). The muscles of the hypothenar consist of the m. opponens digiti minimi, m. abductor digiti minimi and the flexor digiti minimi. The thumb is adducted towards the palm by the adductor pollicis, palpated best on the dorsal side of the hand. Located between the metacarpal bones are the mm. interossei. The palmar interossei, three in total, adduct the fingers in the direction of the middle finger. The dorsal interossei, four in total, abduct the fingers away from the middle finger (Figure 2.5). Last but not least the hand contains the mm. lumbricales, which originate from the FDP tendons and insert onto the extensor aponeurosis at the proximal phalangeal level. These lumbrical muscles tighten the extensors such that the fingers can remain extended during the flexion of the MCP joints.
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
Palmar surface (Figure 7.1a): Thenar eminence: On the thumb side; formed by intrinsic muscles of the thumb.Hypothenar eminence: On the little finger side, formed by intrinsic muscles of the little finger.Palmar creases: Longitudinal and transverse creases are present.Kaplan’s cardinal line: Transverse line from the apex of first web space to the pisiform bone running parallel to the proximal palmar crease.2 Used as a surface guide during carpal tunnel surgery (Figure 7.2). The intersection of Kaplan’s line with a perpendicular line along the radial border of the middle finger corresponds to the recurrent motor branch of the median nerve and superficial palmar arch (Figure 7.2).The intersection of Kaplan’s line with a perpendicular line along the ulnar border of the ring finger corresponds to the distal margin of the transverse carpal ligament (Figure 7.2).
Facing symptoms and limitations: A qualitative study of women with carpal tunnel syndrome
Published in Scandinavian Journal of Occupational Therapy, 2023
Paloma Moro-López-Menchero, Margarita Inés Cigarán-Méndez, Lidiane L. Florencio, Javier Güeita-Rodríguez, César Fernández-de-las-Peñas, Domingo Palacios-Ceña
Carpal tunnel syndrome (CTS) is a neuropathic pain condition characterised by signs and symptoms associated to compression of the median nerve. The clinical presentation consists of pain and/or paresthesia within the area innervated by the median nerve that worsens at night, loss of strength and, in severe cases, atrophy of the thenar eminence musculature. It is estimated that between 4 and 5% of the world population suffers from CTS, with incidence rates of 9.2% in women and 6% in men. The most affected age group is between 40 and 60 years old [1]. In Spain, the incidence of CTS is 4.2 cases per 100,000 workers, of which 62.8% are women [2]. Potential risk factors for CTS include obesity, pregnancy, autoimmune diseases (rheumatoid arthritis), diabetes, hypothyroidism, and renal and cardiac insufficiency, together with mechanical factors such as constant wrist activity with wrist flexion or extension positions, or exposure to vibration [1,3].
Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John W. Lyng, Francis X. Guyette, Michael Levy, Nichole Bosson
Using a two-hand mask hold is superior to one-hand technique and is the best way to optimize mask seal (28–30). Classic BVM technique involves holding the mask to the face with the rescuer’s fingers in the “E-C” configuration. However, an alternate two-handed technique uses the thenar eminence to grip the mask. While a matter of personal preference, the two-handed thenar eminence technique may have advantages for those with smaller hands or in patients for whom achieving adequate seal is challenging. Gerstein et al. found the two-handed thenar eminence grip to be superior to E-C technique in novice operators (32). Otten et al. found that women achieved better seal using the two-handed thenar eminence hold; a difference that may be related to rescuer hand size relative to the mask (30). Soleimanpour demonstrated successful ventilation using a combination of the two holds (33).
Development and testing of a wearable wrist-to-forearm posture measurement system for hand-tool design evaluation
Published in International Journal of Occupational Safety and Ergonomics, 2021
Michail Karakikes, Dimitris Nathanael
The presented findings combined with direct observation can be used to directly inform tool design with the following recommendations: Longer and narrower handles tend be held so that they lie diagonally across the entire palm; the thenar eminence forcing a diversion from the axis of the forearm. This causes postural compensation by ulnar deviation of the wrist, leading to higher discomfort.Shorter and wider handles tend to be held so that the head of the handle rests inside the palm, with less deviation from the axis of the forearm. However, this resting causes constant wrist extension in order to apply the required force for screwdriving.The aforementioned hold true both for the horizontal and for the vertical screwing task, signifying that there is no benefit in differentiating handle design for these two typical screwing directions.Based on SD values of P/S, it is evident that the forearm rotational displacement which is employed by the participants is independent of the screwdriver design. Hence, handle width, while desirable for minimizing tissue pressure, was not found to affect the rotational amplitude per turn.