Little Finger Research Articles

7308 A Case of Thyroid Hormone Resistance Associated With a Novel Mutation in the THRA Gene

Abstract Disclosure: J.A. Siddiqui: None. M. Barbosa: None. V. Fettig: None. C.J. Romero: None. Introduction: Thyroid hormone resistance (THR) is a syndrome leading to decreased response of target organs to thyroid hormone. Normal thyroid hormone action is mediated by thyroid hormone nuclear receptors and is essential for normal development and metabolism. Two isoforms are encoded by the thyroid hormone receptor α and β genes (THRA and THRB). Mutations in THRB are commonly reported with limited cases of THRA mutations. We report a 15-month-old and her mother with a pathogenic variant in the THRα receptor leading to thyroid hormone resistance. CASE: A 15-month-old ex-39-week gestation female was born small for gestational age (birth weight: 2450 grams,3rd %ile and birth length: 17 inches,1st %ile). The newborn screen was normal. She presented with macroglossia, low tone and global developmental delay. She had severe constipation complicated by rectal prolapse that required surgical correction. There are multiple relatives (mother, maternal half-brother and maternal grandparents) with neurodevelopmental issues. The mother’s previous genetic evaluation was non-diagnostic. Mother reports a thyroid condition but without treatment. The patient was initially referred to genetics and whole exome sequencing revealed a heterozygous c.1205 T>C p. (L402P) variant in the THRα gene, which was maternally inherited and reported as a variant of uncertain significance. On physical exam, Heart rate was 112 bpm; height <1%ile (Z-score -3.22 SD), weight 3%ile (Z-score -1.89 SD). Patient has a wide anterior fontanelle (4x3 cm), macroglossia and delayed teeth eruption. Other exam findings: non-palpable thyroid and postaxial polydactyly on the 5th digit of the right toe. Thyroid hormone testing: normal TSH 1.829 uIU/mL, low total T4 4.4 mcg/dL, low Free T4 of 0.58 ng/dL and high free T3 of 4.24 pg/mL. Levothyroxine treatment was initiated(25 mcg daily). After 1 month treatment, TSH level was 0.23 uIU/mL, total T4 was 6.1 mcg/dL and low reverse T3 of 5.8 ng/dL. DISCUSSION: Thyroid hormone resistance due to THRα mutations are rare and under-recognized. The main clinical phenotype includes growth retardation, delayed development, decreased muscle tone, delayed tooth eruption and constipation. Unlike patients with THRβ mutations, the hypothalamus-pituitary-thyroid axis in patients with THRα mutations is minimally affected with a normal TSH level. Total T3 levels are elevated with slightly low total T4 and free T4:T3 ratio is low. Treatment with levothyroxine leads to suppressions of TSH levels, therefore confirming intact central T3 feedback loop. Reports, however, show minor clinical improvements with treatment; therefore further research is needed in these patients to explore more effective therapeutic options. We present a case of a novel congenital THRA mutation leading to a clinical phenotype consistent with THR. She continues care in our clinic with hopes to further study her mutation. Presentation: 6/2/2024

Efficacy of Amorolfine in Onychomycosis Treatment: A Mixed‐Effects Models and Multivariate Logistic Regression Analysis

ABSTRACTBackgroundOnychomycosis (OM) is a common nail infection treated with amorolfine hydrochloride nail lacquer in China. Monitoring drug concentrations and using dermoscopy to evaluate treatment efficacy may provide new insights.ObjectiveThe study aims to analyse amorolfine concentrations in nails with mild to moderate OM, assess treatment outcomes using dermoscopy and explore factors influencing drug concentrations and efficacy.MethodsPatients with mild to moderate OM confirmed by fungal microscopy were enrolled. Amorolfine nail lacquer was applied twice weekly for 36 weeks. Monthly nail samples measured amorolfine concentrations using liquid chromatography. Dermoscopy was performed before and after treatment to evaluate responses. Mixed‐effects models and logistic regression analysed factors affecting drug concentrations and outcomes.ResultsNinety‐seven nails were included. Amorolfine concentrations increased over time, with higher levels in females, fingernails, 2nd–5th digits and superficial white OM (p < 0.05). Age was a risk factor, while drug concentration and OM type were protective for clinical efficacy (p < 0.05). Peak concentration correlated with clinical (r = 0.487, p = 0.000) and mycological (r = 0.433, p = 0.000) responses. Dermoscopic features improved significantly in successful cases (p < 0.05).LimitationsIn the assessment of fungal efficacy, only fungal microscopy was used, and fungal cultures were not performed. The study was limited by a small sample size and the lack of a longer follow‐up to assess relapse.ConclusionAmorolfine concentrations vary with patient and nail characteristics, influencing efficacy. Dermoscopy is valuable for monitoring OM treatment.

Resection of 4th-5th Metacarpal Synostosis and Fascial Interposition for Creation of a Functional Grip /Pinch in the Apert Hand.

The 4th-5th metacarpal synostosis, present in over 80% of Apert hands, flattens the metacarpal arch, restricts metacarpal descent, may prevent opposition of border rays, and combined with symphalangism, negates any functional flexion. Ironically, the fifth ray including the digit is the most intact finger within the hand. Restoration of both position and mobility with arthroplasty changes the cardinal plane of flexion and enables both pinch and grip in these compromised hands. This report summarizes the evolution of our technique over five decades. In a cohort of 184 Apert patients (368 hands) the presence, anatomy, and level of the metacarpal synostosis with a classification was determined. The present technique consists of incision along ulnar border of hand, wide excision of the skeletal coalition, release of dorsal structures, soft tissue interposition (with cadaveric fascia lata graft) with the fifth metacarpal flexed and supinated. During the past two decades the fascia was also wrapped around the fifth metacarpal in a subperiosteal plane. No fixation is needed. The arthroplasty was commonly combined with a thumb lengthening procedure, such as opening wedge osteotomy plus autogenous bone graft at 2-6 years or distraction lengthening and bone graft at 11-13 years old. Silicone blocks, silicone sheeting, and autogenous tendon were also used as interpositions early in our experience were not included. Data was generated over a 46 period and consisted of clinical and operative records, serial molds, serial X-rays, and OT records. Follow-up ranged from 3 to 44 years. 80% of the hands (N=147 patients) had bilateral 4-5th metacarpal synostoses, the extent of which correlated with the Apert hand classification3. In 72 patients (144 hands) the synostosis was resected and cadaveric fascia interposed. The 7 hands that had silicone blocks, silicone sheets, or tendon interposition were not included in the final results. Synostosis refusion occurred in 38 hands, all of which were performed early in the series and under the age of 6 years. Despite refusion, the position of the 5th digit was improved and the flat transverse arch tin a more curved or cupped posture. Eight of refused synostoses were re-released, usually in conjunction with thumb distraction lengthening. Distance between the opposing border rays was always improved and a new grip and pinch mechanism created. Aggressive ostectomy of synostosis and fascial interposition places the ulnar side of the hand in a much more functional position. In conjunction with thumb lengthening, opposition between the thumb and fifth finger becomes a clinical reality in Apert children who are born with diminutive thumbs and minimal interphalangeal joint motion.

A rare presentation of cubital tunnel syndrome by accessory anconeus muscle

Cubital tunnel syndrome (Cu TS) is the second most frequent upper extremity compressive neuropathy after carpal tunnel syndrome. Cu TS is idiopathic; however, it has been linked to ulnar nerve vulnerability and anconeus epitrochlearis (AE) muscle hypertrophy. Although there are few studies in the literature that reveal AE muscle as one of the causes of Cu TS, its prevalence is low. The goal of this case report is to raise awareness regarding the existence of AE muscle as a potential cause of Cu TS, as well as the imaging findings of Cu TS in magnetic resonance imaging (MRI). A 17-year-old male patient complained of intermittent pain in the medial aspect of the left elbow and paresthesia in the left hand. Examination revealed hyperextension of meta carpalphalangeal joints and flexion of proximal interphalangeal joints of the 4th and 5th digits, besides the sensory deficit along the ulnar border of the 5th digit. A nerve conduction study revealed non-stimulable sensory and motor components of the right ulnar nerve. MRI with T1-weighted fast spin echo, Fat sat proton density-weighted, and gradient echo T2*-weighted sequence showed AE - on the posteromedial aspect of the elbow. The ulnar nerve within the cubital tunnel appeared thickened and edematous with bright perineural fat signals with maintained fascicular architecture, secondary to compression by the anconeus muscle. This paper reviews imaging findings of ulnar neuropathy secondary to accessory anconeus muscle and explains the importance of MRI imaging for accurate diagnosis. Knowing MRI imaging is vital in the modern imaging era for accurate diagnosis.

Interpretable video-based tracking and quantification of parkinsonism clinical motor states

Quantification of motor symptom progression in Parkinson’s disease (PD) patients is crucial for assessing disease progression and for optimizing therapeutic interventions, such as dopaminergic medications and deep brain stimulation. Cumulative and heuristic clinical experience has identified various clinical signs associated with PD severity, but these are neither objectively quantifiable nor robustly validated. Video-based objective symptom quantification enabled by machine learning (ML) introduces a potential solution. However, video-based diagnostic tools often have implementation challenges due to expensive and inaccessible technology, and typical “black-box” ML implementations are not tailored to be clinically interpretable. Here, we address these needs by releasing a comprehensive kinematic dataset and developing an interpretable video-based framework that predicts high versus low PD motor symptom severity according to MDS-UPDRS Part III metrics. This data driven approach validated and robustly quantified canonical movement features and identified new clinical insights, not previously appreciated as related to clinical severity, including pinkie finger movements and lower limb and axial features of gait. Our framework is enabled by retrospective, single-view, seconds-long videos recorded on consumer-grade devices such as smartphones, tablets, and digital cameras, thereby eliminating the requirement for specialized equipment. Following interpretable ML principles, our framework enforces robustness and interpretability by integrating (1) automatic, data-driven kinematic metric evaluation guided by pre-defined digital features of movement, (2) combination of bi-domain (body and hand) kinematic features, and (3) sparsity-inducing and stability-driven ML analysis with simple-to-interpret models. These elements ensure that the proposed framework quantifies clinically meaningful motor features useful for both ML predictions and clinical analysis.

Enhancing Medical Record Quality via Coding Accuracy

Elements of coding quality in medical records include reliability, completeness, validity, and timeliness. This analytical study, employing a quantitative approach, evaluated medical record files of patients with injuries and external cause cases at Ibnu Sina Hospital, Gresik, from October to December 2022. Using the Slovin formula, 161 samples were randomly selected from a population of 271 records. The study variables were reliability (diagnosis readability), completeness (diagnostic code completeness), and validity (5th digit use, diagnosis code accuracy, and external cause code accuracy). Data were analyzed using SPSS and the Chi-Square test. The study found significant relationships between the validity of diagnosis codes and the quality of medical records (p = 0.0001). Reliability showed no significant impact (p = 0.470), while completeness (p = 0.0001) and the use of the 5th digit (p = 0.0001) were significantly related to diagnosis code accuracy. These findings highlight the critical role of accurate coding in improving medical record quality and suggest targeted improvements in coding practices. Highlight: Significant Link: Diagnosis code accuracy is crucial for medical record quality. Critical Factors: Completeness and 5th digit use are key for accurate coding. Targeted Improvements: Focused coding practice enhancements can boost record quality. Keyword: coding quality, reliability, completeness, validity, medical records

Identifying the Differences in Symmetry of the Anthropometric Parameters of the Upper Limbs in Relation to Manual Laterality between Athletes Who Practice Sports with and without a Ball

Identifying the Differences in Symmetry of the Anthropometric Parameters of the Upper Limbs in Relation to Manual Laterality between Athletes Who Practice Sports with and without a Ball

Cubital Tunnel Syndrome Due to Intraneural Ganglion Cysts of the Ulnar Nerve With Joint-Cyst Connection at the Elbow

BACKGROUND AND OBJECTIVES: The unifying articular theory suggests that intraneural ganglion cysts in the cubital tunnel arise from the elbow joint and are connected to the ulnar nerve through an articular branch. This study aimed to report our clinical experience with these cysts and our surgical findings and outcomes. METHODS: We retrospectively analyzed 13 patients who underwent surgery for cubital tunnel syndrome caused by an intraneural ganglion cyst of the ulnar nerve. Clinical symptoms, physical examination findings, nerve conduction testing electromyography, plain radiography, and ultrasonography were evaluated before and after surgery. MRI was performed in 2 patients. Cyst decompression, disconnection of the articular branch, and ulnar nerve transposition were performed in all. RESULTS: The mean follow-up was 29 months. After surgery, local elbow pain and Tinel sign disappeared in all patients, and the average Numerical Rating Scale dropped from 3.7 (2-5) to 0 (0-0). Two-point discrimination testing was normal (<5.0 mm) in 12 patients. Wartenberg sign and “claw hand” deformity became negative, and muscle function and motor nerve conduction velocity were improved in 12 patients. The Medical Research Council muscle strength grade was M4 or M5 in the flexor carpi ulnaris, flexor digitorum profundus of the 4th and 5th digits, and first dorsal interosseous muscle in 12 patients. Postoperative spontaneous potentials including fibrillation and sharp waves, and motor unit recruitment in the first dorsal interosseous muscle were obviously improved. A cystic articular branch was confirmed during surgery in all patients. No cyst recurred clinically or on follow-up ultrasonography. CONCLUSION: The unifying articular theory of intraneural ganglion cysts applies to those located in the ulnar nerve at the elbow. Surgical disconnection of the articular nerve branch from the ulnar nerve eliminated the pathway for cyst recurrence and achieved good long-term outcomes.

Dynamics and thermal stability of the bypass polymerase, DinB homolog (Dbh).

The DinB homolog polymerase (Dbh) is a member of the Y-family of translesion DNA polymerases that can synthesize using a damaged DNA template. Since Dbh comes from the thermophilic archaeon Sulfolobus acidocaldarius, it is capable of functioning over a wide range of temperatures. Existing X-ray structures were determined at temperatures where the protein is least active. Here we use NMR and circular dichroism to understand how the structure and dynamics of Dbh are affected by temperature (2°C-65°C) and metal ion binding in solution. We measured hydrogen exchange protection factors, temperature coefficients, and chemical shift perturbations with and without magnesium and manganese. We report on regions of the protein that become more dynamic as the temperature is increased toward the functional temperature. Hydrogen exchange protection factors and temperature coefficients reveal that both the thumb and finger domains are very dynamic relative to the palm and little-finger (LF) domains. These trends remain true at high temperature with dynamics increasing as temperatures increase from 35°C to 50°C. Notably, NMR spectra show that the Dbh tertiary structure cold denatures beginning at 25°C and increases in denaturation as the temperature is lowered to 5°C with little change observed by CD. Above 35°C, chemical shift perturbation analysis in the presence and absence of magnesium and manganese reveals three ion binding sites, without DNA bound. In contrast, these bound metals are not apparent in any Dbh crystal structures of the protein without DNA. Two ion binding sites are confirmed to be near the active site, as reported in other Y-family polymerases, and we report a novel ion binding site in the LF domain. Thus, the solution-state structure of the Dbh polymerase is distinct from that of the solid-state structures and shows an unusually high cold denaturation temperature.

Early Rise and Persistent Inhibition of Electromyography during Failed Stopping.

Reactively canceling movements is a vital feature of the motor system to ensure safety. This behavior can be studied in the laboratory using the stop-signal task. There remains ambiguity about whether a "point-of-no-return" exists, after which a response cannot be aborted. A separate question concerns whether motor system inhibition associated with attempted stopping persists when stopping is unsuccessful. We address these two questions using electromyography (EMG) in two stop-signal task experiments. Experiment 1 (n = 24) involved simple right and left index finger responses in separate task blocks. Experiment 2 (n = 28) involved a response choice between the right index and pinky fingers. To evaluate the approximate point of no return, we measured EMG in responding fingers during the 100 msec preceding the stop signal and observed significantly greater EMG amplitudes during failed than successful stopping in both experiments. Thus, EMG before the stop signal differentiated success, regardless of whether there was a response choice. To address whether motor inhibition persists after failed stopping, we assessed EMG peak-to-offset durations and slopes (i.e., rate of EMG decline) for go, failed stop, and successful stop (partial response) trials. EMG peak-to-offset was shorter and steeper for failed stopping compared to go and successful stop partial response trials, suggesting motor inhibition persists even when failing to stop. These findings indicate EMG is sensitive to a "transition zone" at which the relative likelihood of stop failure versus success inverts and also suggest peak-to-offset time of response-related EMG activity during failed stopping reflects stopping-related inhibition.

RadarHand: A Wrist-Worn Radar for On-Skin Touch-Based Proprioceptive Gestures

We introduce RadarHand, a wrist-worn wearable with millimetre wave radar that detects on-skin touch-based proprioceptive hand gestures. Radars are robust, private, small, penetrate materials, and require low computation costs. We first evaluated the proprioceptive and tactile perception nature of the back of the hand and found that tapping on the thumb is the least proprioceptive error of all the finger joints, followed by the index finger, middle finger, ring finger, and pinky finger in the eyes-free and high cognitive load situation. Next, we trained deep-learning models for gesture classification. We introduce two types of gestures based on the locations of the back of the hand: generic gestures and discrete gestures. Discrete gestures are gestures that start at specific locations and end at specific locations at the back of the hand, in contrast to generic gestures, which can start anywhere and end anywhere on the back of the hand. Out of 27 gesture group possibilities, we achieved 92% accuracy for a set of seven gestures and 93% accuracy for the set of eight discrete gestures. Finally, we evaluated RadarHand’s performance in real-time under two interaction modes: Active interaction and Reactive interaction. Active interaction is where the user initiates input to achieve the desired output, and reactive interaction is where the device initiates interaction and requires the user to react. We obtained an accuracy of 87% and 74% for active generic and discrete gestures, respectively, as well as 91% and 81.7% for reactive generic and discrete gestures, respectively. We discuss the implications of RadarHand for gesture recognition and directions for future works.

What's the point? Infants' and adults' perception of different pointing gestures.

Adults and infants as young as 4months old orient to pointing gestures. Although adults are shown to orient faster to index-finger pointing than other hand shapes, it is unknown whether hand shapes influence infants' perception of pointing. In this study, we used a spatial cueing paradigm on an eye tracker to investigate whether and to what extent adults and 12-month-old infants orient their attention in the direction of pointing gestures with different hand shapes: index finger, whole hand, and pinky finger. Furthermore, we assessed infants' and their parents' pointing production. Results revealed that adults showed a reliable cueing effect: shorter saccadic reaction times (SRTs) to congruent than incongruent targets, for all hand shapes. However, they did not show a larger cueing effect triggered by the index or any other finger. This contradicts previous findings and is discussed with respect to the differences in methodology. Infants showed a cueing effect only for the whole hand but not for the index or pinky fingers. The current results suggest that infants' orienting to pointing may be more robust for the whole hand shape in the first year, and tuning in to the social-communicative relevance of the canonical index finger shape may develop later or require additional social-communicative cues.

Establishment of the Common House Gecko, Hemidactylus frenatus (Duméril & Bibron), on Saba, Dutch Caribbean

The Common House Gecko (Hemidactylus frenatus) is recently being reported from multiple islands across the Lesser Antilles: Antigua, Dominica, St. Barthélemy, St. Eustatius, St. Kitts, St. Lucia, and St. Martin (Brisbane et al. 2021, Dewynter et al. 2022, Griffing et al. 2022, Thorpe 2022, Questel et al. 2023, Thibaudier et al. 2023, Lindsay et al. 2023). Here, we report on the establishment of the species on Saba, Dutch Caribbean. On 27 November 2023, between 19.30–20.30 h, we surveyed buildings, walls, rock crevices and piles of wood, brick, concrete, and metal, including building supplies, on the Fort-Bay Road, adjacent to the Fort Bay harbor on Saba (17.61615, -63.25039). We found H. frenatus at eight locations along a 520-meter stretch of road, either on walls, next to the road between rocks, or between aforementioned materials. At each location one animal was captured, totaling four adults and four juveniles. The lamellae on the 4th and 5th digit were used to confirm species identity (Krysko and Daniels 2005). We collected one adult (Figure 1) that has been provided to Naturalis Biodiversity Center, Leiden, The Netherlands, for deposition in their collections. We note that Hemidactylus mabouia was also found at three sites within the 520-meter stretch, but never closer than ~30 meters to Hemidactylus frenatus, which is a known competitor of other gecko species (Petren & Case 1996).

Radiofrequency Ablation of Palmar Digital Branches of Ulnar Nerve in a Patient with Ulnar Neuropathy

Ulnar Tunnel Syndrome (UTS) is ulnar neuropathy at the wrist or hand typically caused by ganglion cysts, lipomas, wrist or hand compression, carpal bone fractures, carpal tunnel syndrome, or anything else that can impinge on the nerve. The symptoms of UTS can be uncomfortable and debilitating, with numbness and tingling of the 4th and 5th digits being the most common. Weakness of the ulnar portion of the hand can lead to decreased grip strength. UTS is typically managed with conservative treatment including anti-inflammatory oral medications, splinting, physical therapy, activity modification, acupuncture, and stretching. Second line treatment includes corticosteroid injections, although these have shown to have little efficacy. Surgery is also an option but may lead to iatrogenic ramifications. Radiofrequency ablation (RFA) is a treatment modality used for chronic pain, which utilizes heat to target nociceptive fibers. Traditionally, RFA is used in treating cervical and lumbar radiculopathy, but it is less studied in peripheral nerve areas. This case report examines a patient who had clinically significant pain relief after RFA to the palmar digital branches of the ulnar nerve. The patient was 63-year-old male who presented with left ulnar neuropathy that had been ongoing for 3 years. Despite conservative management, his symptoms of pain, paresthesia, and weakness persisted. The patient then elected to have a left cubital tunnel release at the elbow with anterior subcutaneous transposition. The surgery provided relief for three months but then led to worsening contractures and pain in the 4th and 5th digits of the left hand. Due to persistent symptoms after conservative management and surgical intervention, he was referred to interventional pain clinic. A decision was made to trial a digital nerve block of the left medial and lateral digital palmar nerves. Following the nerve block, the patient reported 100% improvement in pain and increased range of motion and function. Four weeks later, the patient returned for a radiofrequency ablation of the same nerves. In the week following the procedure, the patient reported that the pain in the little finger was entirely resolved. While radiofrequency ablation has become increasingly popular for the treatment of chronic back pain, its use in peripheral nerve pain has been limited to case reports and few randomized control trials. This case report highlights the successful use of radiofrequency ablation in the treatment of little finger pain and ulnar neuropathy by targeting the median and lateral branches of the palmar digital nerve.

118. Quantitative Assessments of Finger Individuation with an Instrumented Glove

PURPOSE: In clinical and research settings, hand dexterity is often assessed as finger individuation, or the ability to move one finger at a time. Despite its clinical importance, there is currently no standardized, sufficiently sensitive, or fully objective platform for these evaluations. This study aimed to assess the repeatability of quantitative finger individuation metrics using a commercially available instrumented glove. METHODS: Here we developed two novel individuation scores and tested them against a previously developed score from the literature using a commercially available instrumented glove and data collected from 20 healthy adults. Participants performed individuation for each finger of each hand as well as closing their hand into a fist and opening again at two study visits separated by several weeks. Using the three individuation scores, intra-class correlation coefficients (ICC’s) and minimal detectable changes (MDC) were calculated. Individuation scores were further compared to with subjective assessments to assess validity. RESULTS: We found that each score emphasizes different aspects of individuation performance while generating scores on the same scale (0 [poor] to 1 [ideal]). These scores are repeatable, but the quality of these metrics vary by both equation and finger of interest. For example, index finger intra-class correlation coefficients (ICC’s) were 0.90 (<0.0001), 0.77 ([<0.001), and 0.83 (p<0.0001), while pinky finger ICC’s were 0.96 (p<0.0001), 0.88 (p<0.0001), and 0.81 (p<0.001) for each score. Similarly, MDCs also vary by both finger and equation. In particular, thumb MDCs were 0.068, 0.14, and 0.045, while index MDCs were 0.041, 0.066, and 0.078. Furthermore, objective measurements correlated with subjective assessments of finger individuation quality for all three equations (rho=-0.45, p<0.0001; rho=-0.53, p<0.0001; rho=-0.40, p<0.0001). CONCLUSION: This work represents the first healthy participant data set for this translatable and objective measurement and scoring platform. Our finger individuation platform provides objective, quantitative assessments of patients with peripheral nerve and hand injury. Real-time scoring can quantify the extent of recovered finger dexterity both in the operating room and in outpatient follow-up.

Supernumerary digit of bilateral hands: a rare congenital anomaly presented as a case report.

We describe a case of a 29-year-old male with a postaxial supernumerary digit of the ulnar aspect of the bilateral fifth digit. The patient had a growth of 0.5cm over the ulnar aspect of the proximal phalanx of the fifth digit of the right hand and 0.1cm over the ulnar aspect of the proximal phalanx of the fifth digit of the left hand with a broad base. X-rays of bilateral hands were sent. Suture ligation or surgical excision was recommended for the patient, but they were both rejected by the patient. Bilateral hands with supernumerary digits are a rare congenital defect. The differential diagnosis of digital fibrokeratoma should be used by doctors. Simple observation, suture ligation, or excision with skin sutures are examples of potential treatments.

Quantitative assessments of finger individuation with an instrumented glove

BackgroundIn clinical and research settings, hand dexterity is often assessed as finger individuation, or the ability to move one finger at a time. Despite its clinical importance, there is currently no standardized, sufficiently sensitive, or fully objective platform for these evaluations.MethodsHere we developed two novel individuation scores and tested them against a previously developed score using a commercially available instrumented glove and data collected from 20 healthy adults. Participants performed individuation for each finger of each hand as well as whole hand open-close at two study visits separated by several weeks. Using the three individuation scores, intra-class correlation coefficients (ICC) and minimal detectable changes (MDC) were calculated. Individuation scores were further correlated with subjective assessments to assess validity.ResultsWe found that each score emphasized different aspects of individuation performance while generating scores on the same scale (0 [poor] to 1 [ideal]). These scores were repeatable, but the quality of the metrics varied by both equation and finger of interest. For example, index finger intra-class correlation coefficients (ICC’s) were 0.90 (< 0.0001), 0.77 (< 0.001), and 0.83 (p < 0.0001), while pinky finger ICC’s were 0.96 (p < 0.0001), 0.88 (p < 0.0001), and 0.81 (p < 0.001) for each score. Similarly, MDCs also varied by both finger and equation. In particular, thumb MDCs were 0.068, 0.14, and 0.045, while index MDCs were 0.041, 0.066, and 0.078. Furthermore, objective measurements correlated with subjective assessments of finger individuation quality for all three equations (ρ = − 0.45, p < 0.0001; ρ = − 0.53, p < 0.0001; ρ = − 0.40, p < 0.0001).ConclusionsHere we provide a set of normative values for three separate finger individuation scores in healthy adults with a commercially available instrumented glove. Each score emphasizes a different aspect of finger individuation performance and may be more uniquely applicable to certain clinical scenarios. We hope for this platform to be used within and across centers wishing to share objective data in the physiological study of hand dexterity. In sum, this work represents the first healthy participant data set for this platform and may inform future translational applications into motor physiology and rehabilitation labs, orthopedic hand and neurosurgery clinics, and even operating rooms.

Fingerprint patterns in neuropsychological disorder depression among south Indian population.

Depression is a pervasive mental health disorder characterized by persistent sadness and an inability to enjoy activities that were once enjoyable. This study compares the dermatoglyphic patterns of depressed patients with those of healthy, normal individuals in order to determine if dermatoglyphic patterns can be used as biomarkers for early diagnosis and prompt intervention of depression. A total of 100 depressive disorder patients of both sexes between the ages of 18 and 60 were selected for the study. Dermatoglyphic patterns of individual digits were analyzed using the "Ink and Paper" technique. The Whorl, Loop, and Arch patterns, as well as the AFRC, TFRC, and a-b ridge count, were examined using One-Way ANOVA significance and a Chi-Square test using SPSS 20.0. The results showed that the right hand in the depressive diseased group had decreased numbers of Whorls in the 2nd and 5th digits, and decreased numbers of Loops in all five digits. Similarly, decreased numbers of Whorls were found in the 1st, 2nd, 4th, and 5th digits of the left hand, as well as decreased Loops in the 4th digit. However, there were no changes in the Arches of either hand when compared to the control group. The AFRC and TFRC were significantly decreased (p<0.0001), but there was no significant decrease in the a-b ridge count in the depressive diseased group when compared to the control group. Dermatoglyphics, a noninvasive method, can serve as a screening indicator for depressive individuals, the appearance of the decreased count of whorls and loops parameters might be used as an exploratory sign.

Modified radial tongue-shaped flap following stepwise surgical release for Benson type I camptodactyly of the 5th digit

To investigate the outcomes of the modified radial tongue-shaped flap following stepwise surgery release for treating Benson type I camptodactyly of the 5th digit. A retrospective analysis involving patients with Benson type I camptodactyly of the 5th digit was performed. A total of 8 patients with 12 affected digits were included. Extent of surgical release depended on the degree of soft tissue contracture. Skin release, subcutaneous fascial release, and flexor digitorum superficialis tenotomy were performed in all 12 digits, sliding volar plate release in 2 digits, and intrinsic tendon transfer in 1 digit. The mean total passive motion of proximal interphalangeal joint significantly increased from 32.5° ± 16° to 86.3° ± 20.4°, while mean total active motion significantly increased from 22° ± 10.5° to 73.8° ± 27.5° (P < 0.05). Treatment outcomes were excellent in 6 patients, good in 3, moderate in 2, and poor in 1. Scar hyperplasia occurred in 1 patient. The radial tongue-shaped flap allowed for full coverage of the volar skin defect, and was considered aesthetically favorable. In addition, the stepwise surgical approach not only achieved good curative effects, but also allowed for individualization of treatment.

Iatrogenic median and ulnar nerve injuries during carpal tunnel release: clinical, electrodiagnostic, and ultrasound features in 12 patients. Patient series.

Nerve injuries during carpal tunnel release (CTR) are rare. Electrodiagnostic (EDX) and ultrasound (US) studies may be helpful in evaluating iatrogenic nerve injuries during CTR. Nine patients sustained a median nerve injury, and 3 patients experienced ulnar nerve damage. Decreased sensation occurred in 11 patients, and dysesthesia occurred in 1 patient. Abductor pollicis brevis (APB) weakness occurred in all patients with median nerve injury. Of the 9 patients with median nerve injury, the compound muscle action potentials (CMAPs) of the APB and sensory nerve action potentials (SNAPs) of the 2nd or 3rd digit were not recordable in 6 and 5 patients, respectively. Of the 3 patients sustaining ulnar nerve injuries, the CMAPs of the abductor digiti minimi (ADM) and SNAPs of the 5th digit were not recordable in 1 patient; 2 patients showed prolonged latency and decreased amplitude of CMAPs/SNAPs. US studies of 8 patients with a median nerve injury showed a neuroma within the carpal tunnel. One patient underwent surgical repair urgently, and 6 did so after variable intervals. Surgeons should be cognizant of nerve injuries during CTR. EDX and US studies are useful in evaluating iatrogenic nerve injuries during CTR.