Digits II-V Research Articles

Secondary Repair of Jersey Finger: A Novel Method of Tendon Length Estimation via Measurement of Adjacent Landmarks.

Jerseyfinger describes the rupture of the flexor digitorum profundus (FDP) tendon at its insertion into the distal phalanx. In the absence of an evidence-based approach to tensioning during secondary repair, we aimed to devise a novel method to determine the required tendon length pre/intraoperatively. We measured anatomical landmarks, associated with the FDP tendon, on dissected cadavers, to assess whether these can be used to estimate tendon segment lengths. Eight cadaveric hands were dissected. Three measurements from the distal lumbrical origin to (1) FDP insertion, (2) the distal end of A1 (Annular 1 pulley), and (3) the proximal end of A1 were recorded for digits II-V. Relative ratios for measurement 1were consistent for all digits, compared to digit III. Linear regression analysis confirmed a strong correlation for measurement 1between digit II (R2=0.97) and digit IV(R2=0.97)compared to digit III across all specimens. Digit III distal lumbrical origin to FDP insertion measurements could facilitate the estimation of the required graft length for digit II or IV during secondary repair. This is alevelIV study, providing proofof concept for a novel method of tendon tensioning.

Microcirculatory response to cold stress test in the healthy hand.

Cold sensitivity of the fingers is common in several conditions. It has been linked to digital vasospasm, microvascular dysfunction, and neural mechanisms. This study aimed to investigate the normal digital microvascular response to a cold stress test in healthy individuals using Laser Speckle Contrast Imaging (LSCI). Twenty-six healthy individuals, mean age 31 (SD 9) years were included. Skin perfusion of digits II-V was measured using Laser Speckle Contrast Imaging before and after a standardized cold stress test. Changes in skin perfusion from baseline were analyzed between hands, digits, and sexes. Skin perfusion was significantly (p<0.0001) affected by cold provocation in both the cold exposed and the contralateral hands in all participants of the study. This effect was significantly different between the radial (digit II and III) and the ulnar (digit V) side of the hands (p<0.001). There was a trend towards a larger decrease in perfusion in men (ns), and a faster recovery to baseline values in women (ns). A larger inter subject variability was seen in perfusion values in women. The normal microvascular response to cold provocation may involve both centrally and regionally mediated processes. When exposing one hand to a cold stress test, the contralateral hand responds with simultaneous but smaller decreases in perfusion.

Muscle-tendon arrangement and intramuscular nerve distribution of flexor digitorum superficialis in the siamang (Symphalangus syndactylus), western lowland gorilla (Gorilla gorilla gorilla), western chimpanzee (Pan troglodytes verus), and Japanese macaque (Macaca fuscata).

Flexor digitorum superficialis (FDS) shows diverse muscle-tendon arrangements among primates. The intramuscular nerve distribution pattern is a criterion for discussing the homology of FDS. In this study, the muscle-tendon arrangement and intramuscular nerve distribution of FDS were examined in the siamang, western lowland gorilla, western chimpanzee, and Japanese macaques. The FDS had muscle bellies to digits II-V. FDS had proximal belly and intermediate tendon except for siamang. Distal belly to digit II (in the western lowland gorilla and western chimpanzees) or distal bellies to digits II and V (in Japanese macaque) originated from the intermediate tendon. In all specimens, nerve branches within digit III belly extended into digit IV belly, and nerve branch(es) within digit IV belly extended into digit V belly. This consistent pattern suggested that each muscle belly to digits III-V is interspecifically homologous. The digit II belly in the siamang and the distal belly to digit II in the western lowland gorilla, western chimpanzees, and Japanese macaques could be homologous based on their similar innervating patterns. The proximal belly was innervated by branches from the communicating nerve between median and ulnar nerves in the western lowland gorilla or branches from median and ulnar nerves in western chimpanzees. In the siamang and Japanese macaque, the whole FDS was innervated by median nerve. The proximal belly in the western lowland gorilla, western chimpanzees, and Japanese macaques could be classified into different groups from the other part of the FDS.

MORPHOFUNCTIONAL CHARACTERISTICS OF THE LOWER HINDLIMB AND FOOT MUSCLES OF BORNEAN ORANGUTAN (Pongo pygmaeus)

Orangutan is a great ape that has anatomical and physiological aspects similar to those of gorillas and chimpanzees, although orangutan is more arboreal than other great apes. This research aims to study the morphofunctional characteristics of the lower hindlimb and foot muscles of Bornean orangutan and its relation to the type of locomotion and daily behavior. This research was conducted on the right leg of a male orangutan by observing the morphology of the lower hindlimb and foot muscles and observing the behavior of the Bornean orangutan through video observations. The results showed that digital flexor muscles are more developed than plantar flexor muscles as an adaptation towards arboreal activities that require finger flexor movements such as gripping tree branches. Orangutans have rudimentary hallux, which is related by the less developed intrinsic muscle and indicated by the way orangutan grips tree branches dominantly using digits II-V. At a certain time, male Bornean orangutans are active on terrestrial that causes the digital extensor muscles to have more developed as an adaptation to terrestrial activity. It can be concluded the morphology of the lower hindlimb and foot muscles is in accordance to its function and behavior adaptation in arboreal and terrestrial.

Anatomical disposition of the antebrachial digital flexor muscles in the white footed tamarin (Saguinus leucopus Günther, 1876)

flexor digitorum profundus muscles in the Saguinus leucopus. Methodology: Both thoracic limbs of ten specimens were dissected from superficial to deep; describing the shape, origin, insertion, innervation and arterial supply for these muscles. Main results: The flexor digitorum superficialis muscle originated in the medial epicondyle of the humerus and sent tendons for the digits II-V; and the flexor digitorum profundus muscle had a high development with six heads: two humerals (superficial and deep), one radial, one cubital, and two ulnar (superficial and deep), which form a single tendon that divides distally to the carpus in five tendons to go to each digit. Conclusion: These muscles in Saguinus leucopus are adapted to allow for an adequate grip onto the branches and trunks of the trees, and to release the cortex for the flow of the latex.

Detection of severe digital vasculopathy in systemic sclerosis by colour Doppler sonography is associated with digital ulcers.

Colour Doppler ultrasonography (CDUS) is very important in general vascular diagnostic procedures. Its role in determining the extent of vasculopathy in Systemic Sclerosis (SSc) needs further investigation. The aim of this study was to compare the presence of altered arteries with nailfold capillaroscopy and clinical signs of ischaemia, that is, digital ulcers or pitting scars (DU/PS). A feasible CDUS protocol is provided. Two thousand five hundred and twenty-eight arteries of the fingers, palms and wrists from 79 SSc patients (32 arteries per patient) were examined using CDUS. Furthermore, nailfold capillaroscopy, clinical and laboratory data were evaluated. Narrowed or occluded lumens were seen in 39.8% of all assessable arteries (n = 2489) and 48.9% of all proper palmar digital arteries (n = 1564) but only 15.6% (P < 0.0001) of proximal arteries (n = 924). Fingerwise analyses presented significant coincidence of pathological CDUS findings and DU/PS (P = 0.0009). Pathological CDUS findings were also associated with elevated CRP concentrations, current or past smoking with ⩾20 pack-years, male gender and present or past DU/PS. Receiver operating characteristic curve analysis (area under the curve = 0.727) suggested a cut-off value of ⩾20% pathological vessels (sensitivity: 90.7%; specificity: 47.8%) for the presence of DU/PS. An examination protocol focusing on the right-hand digits II-V (proper palmar digital arteries) revealed similar results (area under the curve = 0.751; sensitivity: 93.0%; specificity: 43.5%). CDUS of hand and finger arteries allows measurement of the extent of SSc vasculopathy, which is associated with clinical signs of chronic malperfusion. A shortened examination protocol of CDUS (right-hand digits II-V; 15 min instead of 45 min examination time) could complement vascular diagnostics in SSc.

FRI0594-HPR Two Different Sets of Handexercises Improved Grip Strength after Eight Weeks in Patients with Arthritis

BackgroundHand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand...

Normal Location Of Thumb/Big Toe may be Related to Programmed Cell Death in the Preaxial Area of Embryonic Limb

The forelimbs and hindlimbs of newborn Polydactyly Nagoya (Pdn) mice were examined to analyze the roles of programmed cell death (PCD) in the preaxial region of the limb. Special attention was paid to the relationship between the PCD in the preaxial area and the location and shape of the first digit (thumb/big toe). Although a large, bifurcated or duplicated thumb/big toe appeared in Pdn/+ mice, digit I (thumb/big toe) in Pdn/+ mice, as in +/+ ones, was located more ventro-proximally than the other four digits. On the other hand, abnormal preaxial digits of the fore/hindlimb in Pdn/Pdn mice lay distally and were aligned at the radial/tibial end of a serial curved plane formed by digits II-V; that is, a thumb and big toe of normal shape and location were not detectable in any preaxial digits of Pdn/Pdn mice. In the limb development of Pdn mouse embryos on Day 11-12, PCD did not occur in the preaxial mesoderm of fore/hindlimb only in one-fourths of all embryos obtained by Pdn/+ x Pdn/+ mating. In addition to digital rays II-V, extra preaxial digital rays appeared in the prominent preaxial expansion of fore/hindlimbs in these embryos on early Day 12. These abnormal limb configurations in embryos were closely similar to those in Pdn/Pdn newborn mice. The present findings suggest that PCD in the preaxial region not only prevents the formation of extra digits but also determines the location of the thumb/big toe for the normal limb morphogenesis.

Digital gene expression tag profiling of bat digits provides robust candidates contributing to wing formation

BackgroundAs the only truly flying mammals, bats use their unique wing - consisting of four elongated digits (digits II-V) connected by membranes - to power their flight. In addition to the elongated digits II-V, the forelimb contains one shorter digit (digit I) that is morphologically similar to the hindlimb digits. Here, we capitalized on the morphological variation among the bat forelimb digits to investigate the molecular mechanisms underlying digit elongation and wing formation. Using next generation sequencing technology, we performed digital gene expression tag profiling (DGE-tag profiling) of developing digits in a pooled sample of two Myotis ricketti and validated our sequencing results using real-time quantitative PCR (RT-qPCR) of gene expression in the developing digits of two Hipposideros armiger.ResultsAmong hundreds of genes exhibiting significant differences in expression between the short and long digits, we highlight 14 genes most related to digit elongation. These genes include two Tbx genes (Tbx3 and Tbx15), five BMP pathway genes (Bmp3, RGMB, Smad1, Smad4 and Nog), four Homeobox genes (Hoxd8, Hoxd9, Hoxa1 and Satb1), and three other genes (Twist1, Tmeff2 and Enpp2) related to digit malformations or cell proliferation. In addition, our results suggest that Tbx4 and Pitx2 contribute to the morphological similarity and five genes (Acta1, Tnnc2, Atp2a1, Hrc and Myoz1) contribute to the functional similarity between the thumb and hindlimb digits.ConclusionsResults of this study not only implicate many developmental genes as robust candidates underlying digit elongation and wing formation in bats, but also provide a better understanding of the genes involved in autopodial development in general.

Ectopic dermal ridge configurations on the interdigital webbings of Hammertoe mutant mice (Hm): Another possible role of programmed cell death in limb development

The mechanism underlying the development of aberrant phalangeal pads and dermal ridge configurations in malformed limbs is not well understood. The forelimbs of Hammertoe (Hm) mutant mouse fetuses were examined sequentially to clarify the relationship between the occurrence of abnormal programmed cell death (PCD) and the formation of phalangeal pads and dermal ridge patterns. Relevant morphological features, with special emphasis on pads and dermal ridge configurations, were inspected on the exposed dermal surface of the forelimbs of adult Hm mutant mice. The forelimbs of Hm mutant mouse fetuses (GD13-18) and newborns were examined histologically. The forelimbs of GD13 fetuses were subjected to Nile blue (NB) vital staining for in situ labeling of PCD. In the forelimbs of +/+ mice, the formation of dermal ridges was confined to pads, while in Hm/+ and Hm/Hm animals, which have interdigital webbing involving digits II-V, dermal ridges were formed also on the ventral side of the webbing, specifically on its lateral margins between the neighboring digits and on the medial margin of the webbing extending toward the palmar pad. PCD was decreased in the interdigital zones II-IV in GD13 Hm/+ and Hm/Hm fetuses. Reduced PCD interdigital tissue of Hm/+ and Hm/Hm fetuses may result in the failure of physiological elimination of interdigital cells and in the persistence of soft tissue webbing between digits. The failure of PCD to occur may also interrupt the interdigital surviving cells to reach the neighboring digits and the distal area of the palm, thereby producing ectopic dermal ridges. It seems that interdigital PCD contributes not only to digit separation but also to the development of digital and palmar pads.

Detailed analyses of periarticular osteoporosis in rheumatoid arthritis.

Periarticular osteopenia is the earliest radiographic sign of rheumatoid arthritis (RA). Recent studies using dual-energy X-ray absorptiometry (DXA) have indicated that the loss of periarticular BMD can be quantified by whole-hand bone mineral density (BMD) measurements. The aim of this study was to analyze periarticular BMD in more detail by DXA and quantitative ultrasound (QUS). In a cross-sectional study 23 women aged 30-76 years with early RA, mean disease duration 26 +/- 19 months, and 18 men aged 42-69 years, mean disease duration 24 +/- 25 months, were examined. All patients received antirheumatic therapy. The reference population consisted of 103 age-matched controls (68 females, 35 males) and young healthy controls. BMD measurements were performed using a DXA Expert XL densitometer (Lunar). BMD of the whole-hand and two subregions was determined: two subchondral regions of interest (S.CH.) were set within the trabecular bone, distal to the proximal interphalangeal joints of digits II and III excluding the dense subchondral bone of the metacarpophalangeal (MCP) joint and two metacarpal regions of interest (MCP) were set including the entire MCP joint of these fingers. QUS measurements at the proximal phalanges of digits II-V were performed using a DBM Sonic (Igea); amplitude-dependent speed of sound (Ad-SoS) was determined. In comparison with whole-hand BMD measurements, bone loss was pronounced in patients with a disease duration of 18-72 months at the subchondral regions of interest in both genders compared with age-matched controls (women: mean BMD loss S.CH. -23%, p<0.001, whole-hand -16%, p<0.001; men: mean BMD loss S.CH. -19%, p < 0.05, whole-hand -12%, p<0.05). The bone changes were also shown by QUS (women: Ad-SOS values of 1950 +/- 90 m/s in RA vs 2137 +/- 35 m/s in young healthy controls (p <0.005); men AD-SOS 1956 +/- 87 m/s in RA vs 2146 +/- 41 m/s in young healthy controls (p <0.05)). These results show that BMD and Ad-SOS values are significantly lowered in patients with early RA and indicate that periarticular osteoporosis in early RA might possibly be better detected using detailed hand scan analyses.

Heritable oligodactyly occurring only in male rats.

Heritable oligodactylism in male rats was discovered in Wistar-derived rats. In this study, external and skeletal features of the limb anomalies were examined to clarify the type of oligodactyly. External observation revealed absence and hypoplasia (with respective percentage incidence) in digits II (100, 0), III (87, 13), and IV (23, 1) of the forefeet and in digits II (26, 34), III (34, 11), and V (0, 3) of the hindfeet. Fusion was also observed in digits IV and V in the forefeet (4%) and in digits I and II in the hindfeet (15%). Skeletal examination disclosed absence of all three (proximal, middle, and distal) phalanges in digits II (97%), III (93%), and IV (67%) and of the middle phalanx in digit V (12%) of the forefeet. In the hindfeet, the missing pattern of phalanges in digits II and III was similar to, but less severe than that in the forefeet; the incidence of absence of the three phalanges in digits II and III was 43% and 45%, respectively. Digit V was more affected than that in the forefeet; absence of the middle phalanx was found at 30%. Although no absence was found in the bones proximal to the phalanges, hypoplasia and/or fusion were detected with various degree and incidences among carpi/metacarpi and tarsi/metatarsi. Based on these observations, the types of limb anomalies in this mutant rat were classified as oligodactyly of digits II-V in the forefeet and II, III, and V in the hindfeet with hypoplasia and/or fusion of the carpi/metacarpi and tarsi/metatarsi.

Ontogeny of knuckle-walking hand postures in African apes

Examination of the ontogeny of hominoid hands indicates that the majority of differences observed among adult bonobos, chimpanzees, and gorillas in the gross proportions of the hand are allometric due to ontogenetic scaling (Inouye, 1992). However, ray segment lengths depart from this pattern, resulting in relatively shorter fingers in the gorilla hand compared to the hands of chimpanzees and bonobos of comparable sizes. Furthermore, as adults and throughout ontogeny the fifth metacarpal is shorter than the second, third and fourth metacarpals in bonobos and chimpanzees, whereas gorillas have metacarpals which are more similar in length (Susman, 1979; Inouye, 1992). In addition, qualitative descriptions of knuckle-walking (Tuttle, 1967, 1969a,b,c; Tuttle & Basmajian, 1978) suggest that chimpanzees and gorillas use different hand postures and appear to bear their weight on different digits. Therefore, ontogenetic, descriptive kinematic data was taken from videotapes of knuckle-walking by chimpanzees, bonobos, and gorillas, and analysed to determine if differences among the African apes in length of the fifth digit was meaningfully correlated with variation in hand positions in load-bearing postures. Results indicate that throughout ontogeny there is no significant change in the frequency of use of digits II-V during knuckle-walking in all the African ape species. During ontogeny, chimpanzees and bonobos use their fifth digits consistently less often than the other digits when knuckle-walking, and comparisons between chimpanzees and bonobos reveal no significant difference in the frequencies of digits used during knuckle-walking. Gorillas, in contrast, use all four digits consistently in knuckle-walking postures throughout ontogeny, and comparative analyses reveal that the gorilla pattern is significantly different from the chimpanzee/bonobo pattern as adults and throughout ontogeny. Thus, metacarpal lengths and the comparative lengths among manual rays of the same hand are not a product of simple ontogenetic scaling between chimpanzees/bonobos and gorillas and instead, appear to be related to interspecific differences in hand postures used during knuckle-walking. These data, when considered with previous allometric data on other postcranial dimensions, indicate that differences between Pan and Gorilla in proportions of the hand may not be related to differences in weight distribution between forelimbs and hindlimbs or to differences in the frequency of knuckle-walking behavior. Rather, differences between Pan and Gorilla hand proportions are more likely related to kinematic differences in knuckle-walking behavior, increased efficiency of knuckle-walking in the latter, or perhaps to other locomotor behaviors, such as climbing.

Anatomical features associated with preaxial duplication (pd): a recessive mutation in the rat.

Preaxial polydactyly of the fore- and hindlimbs was found in Wistar-derived rats in 1978. Genetic analysis indicated that the polydactyly was due to the effects of an autosomal recessive gene (gene symbol; pd). Polydactylous homozygous rats had two or three pollices (six or seven digits) in the forelimbs and one to three preaxial extra digits (six to eight digits) in the hindlimbs. Skeletal examination revealed the presence of the extra carpal, metacarpal, and phalangeal bones that seemed to be complete or incomplete duplication of the navicular, greater multangular, first metacarpal, and phalanges of digit I in the forelimbs. In the hindlimbs, extra tarsal, metatarsal, and phalangeal bones were also observed preaxially. These extra elements seemed to be mirror-image duplications of the talus, navicular, second cuneiform, third cuneiform, cuboid, and metatarsals and phalanges of digits II-V with the absence of the first cuneiform, tibiale, first metatarsal, and phalanges of digit I. In addition, morphological changes were observed in the humerus, radius, and ulna in the forelimbs and femur, tibia, and fibula in the hindlimbs. Especially in the radius and tibia, thickening and bifurcation were found, indicating incomplete duplication of these bones. Based on these findings, the limb anomaly was classified as preaxial carpometacarpal/tarsometatarsal-type polydactyly with incomplete duplication of the radius and tibia. The mutant rats had other associated anomalies such as accessory spleens and cryptorchism. The males are sterile, whereas the females breed normally.

Pachydermodactyly

Pachydermodactyly is a rare distinct form of fibromatosis characterized by dense fibrosis and fibroblastic proliferation around one or more proximal interphalangeal joints. Pachydermodactyly affects the appositional and dorsal aspects of proximal digits II-V. The lateral aspects of the index fingers, the medial aspect of the fifth digits, and the thumbs are usually unaffected. A typical patient was a young adult man with a long history of idiopathic asymptomatic swelling in the fingers. Skin biopsy specimens obtained from three patients with pachydermodactyly showed marked thickening of the dermis with extension of collagenous fibers into the subcutaneous tissues. There was poor demarcation between the papillary and reticular dermis. The cytology of the fibroblasts appeared benign. Isolation of collagen from the involved sites revealed collagen Types I, III, and V in a pattern typical of fibromatoses; i.e. increased Types III and V. Compared with the collagen profile of normal reticular dermis, increased numbers of fine-diameter collagen fibers were notable in electron micrographs.

Metacarpophalangeal flexion forces with respect to age, sex, and exercise habits

Individual finger strengths in digits II-V were examined in terms of metacarpophalangeal (MP) joint flexion forces among a group of 22 senior citizens. Data were collected using a finger force transducer, with each digit splinted so as to allow flexion solely at the MP joint. Findings were evaluated in light of the self-reported exercise habits of the subjects and in comparison with similar data reported in a previous study conducted with college athletes. Patterns of finger strength among the digits and between the sexes were identical for most parameters investigated among the senior citizens as compared to the college athletes. Mean finger strength levels for male and female senior citizens were 10.0% and 10.5% less, respectively, than those of the college athletes of each sex. Correlations between individual estimates of hours spent per week engaged in activity requiring extensive hand utilization and mean finger strength for each subject were r = 0.14 and r = 0.46 for male and female subjects, respectively.