Small Finger Research Articles

Stability of steady hand force production explored across spaces and methods of analysis.

We used the framework of the uncontrolled manifold (UCM) hypothesis and explored the reliability of several outcome variables across different spaces of analysis during a very simple four-finger accurate force production task. Fourteen healthy, young adults performed the accurate force production task with each hand on 3 days. Small spatial finger perturbations were generated by the "inverse piano" device three times per trial (lifting the fingers 1cm/0.5s and lowering them). The data were analyzed using the following main methods: (1) computation of indices of the structure of inter-trial variance and motor equivalence in the space of finger forces and finger modes, and (2) analysis of referent coordinates and apparent stiffness values for the hand. Maximal voluntary force and the index of enslaving (unintentional finger force production) showed good to excellent reliability. Strong synergies stabilizing total force were reflected in both structure of variance and motor equivalence indices. Variance within the UCM and the index of motor equivalent motion dropped over the trial duration and showed good to excellent reliability. Variance orthogonal to the UCM and the index of non-motor equivalent motion dropped over the 3 days and showed poor to moderate reliability. Referent coordinate and apparent stiffness indices co-varied strongly and both showed good reliability. In contrast, the computed index of force stabilization showed poor reliability. The findings are interpreted within the scheme of neural control with referent coordinates involving the hierarchy of two basic commands, the r-command and c-command. The data suggest natural drifts in the finger force space, particularly within the UCM. We interpret these drifts as reflections of a trade-off between stability and optimization of action. The implications of these findings for the UCM framework and future clinical applications are explored in the discussion. Indices of the structure of variance and motor equivalence show good reliability and can be recommended for applied studies.

A De Novo POLD1 Mutation Associated With Mandibular Hypoplasia, Deafness, Progeroid Features, and Lipodystrophy Syndrome in a Family With Werner Syndrome.

Background. Mandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a recently recognized genetic disorder comprised of mandibular hypoplasia, deafness, progeroid features, and lipodystrophy. It is caused by an autosomal dominant mutation in the POLD1 gene, with <20 genetically confirmed cases to date. Clinical overlap with other progeroid syndromes including Werner syndrome (WS) can present diagnostic challenges. Case. The proband is a 36-year-old male of Sicilian ancestry who was phenotypically normal at birth. Onset of lipodystrophic and progeroid features began at 18 months, with progressive loss of subcutaneous fat, prominent eyes, and pinched nose. Over the next 2 decades, he developed hearing loss, small fingers, joint contractures, hypogonadism, osteoporosis, and hypertriglyceridemia. Three of his 4 siblings had premature hair graying and loss, severe bilateral cataracts, skin changes, and varying degrees of age-related metabolic conditions, raising suspicion for a genetic progeroid syndrome. Genetic Analysis. A targeted sequencing panel identified a heterozygous WRN mutation in the proband’s genomic DNA. Sanger sequencing further revealed his parents and an asymptomatic brother to be carriers of this mutation, and in his 3 brothers affected with classic WS the mutation was identified in the homozygous state. Whole exome sequencing ultimately revealed the proband harbored the causative de novo in-frame deletion in POLD1 (p.Ser605del), which is the most common mutation in MDPL patients. Conclusion. We report the unusual convergence of 2 rare progeroid disorders in the same family: the proband displayed sporadic MDPL syndrome, while 3 brothers had classical autosomal recessive WS. Whole exome sequencing was invaluable in clarifying the molecular diagnoses in this family.

Testing the Fill‐and‐Spill Model of Subsurface Lateral Flow Using Ground‐Penetrating Radar and Dye Tracing

Core Ideas Lateral flow patterns revealed by dye tracing agreed with time‐lapse GPR data. Lateral flow downslope varied from &lt;1 to 1 m at adjacent sites. 3D radar detected banding in the strike direction but dye fingering did not. Fractured saprock modifies the fill‐and‐spill model by facilitating vertical flow. Preferential flow (PF), which bypasses large portions of the soil or subsurface matrix, is critical in the transport of water and dissolved constituents in the unsaturated zone. To test the “fill‐and‐spill” model of hillslope hydrology that describes the generation and pattern of downslope lateral PF after storms, we used dye tracer and time‐lapse, ground‐penetrating radar (GPR) on a forested hillslope in the Susquehanna–Shale Hills Critical Zone Observatory. We injected 50 L of water mixed with Brilliant Blue dye (4 g L−1) into a shallow trench cut perpendicular to the slope and used GPR to monitor the tracer downslope across a 1.0‐ by 2.0‐m grid. The site was then excavated to the soil–saprock interface and photographed to document the dye pathways. We observed vertical dye fingering near the infiltration trench. Downslope lateral PF at the soil–saprock boundary was limited to ~0.40 m, which is evidence that the soil–saprock interface did not fill‐and‐spill. The extent, depth, and direction of the downslope PF indicated by GPR generally matched the dye staining patterns in the excavation, but the resolution of the 800‐MHz GPR antenna was insufficient to distinguish small fingers of dye. A revised fill‐and‐spill model was proposed for this site that incorporates the PF through fractured saprock before water encounters fresh bedrock surface. This study demonstrates that GPR integrated with dye tracer infiltration can provide a useful means of testing hillslope hydrological hypotheses and unraveling the complexity of PF at the hillslope scale in a field setting.

Spontaneous rupture of the flexor digitorum profundus tendon of the small finger over 20 years after trauma: A case report

Spontaneous rupture of the flexor digitorum profundus tendon of the small finger over 20 years after trauma: A case report

Porokeratosis of Mibelli - An extensive hand involvement

A 50-year-old brown-skinned male presented to the outpatient department of Najran Medical College Hospital in November 2014 with large pink to violaceous non-pruritic patches extending from medial aspect of metacarpophalangeal joint of the small finger of the left hand to involve the whole palmar and dorsal aspect of the hand in an annular and serpigious fashion. The lesion is large-circumscribed patches having hyperkeratotic margin and central atrophy. The raised hyperkeratosis margin contains on its top a furrow along the course of the wall. The surface was verrucous, and many sides of the lesion have serpiginous border. The lesion is hairless and anhidrotic. The onset of the lesion was at the age of 35 years, and the lesion enlarges slowly and progressed to direction in annular fashion. Skin biopsy for histopathology revealed the picture of porokeratosis.

Corrigendum to: Godwin Y, Wheble GAC and Feig C. Assessment of the presence of independent flexor digitorum superficialis function in the small fingers of professional string players: Is this an example of natural selection? J Hand Surg Eur. 2013, 39: 93-100.

The corresponding author details for the above article have been modified. The online version of the article has been updated.

The Effect of Molybdenum Substrate Oxidation on Molybdenum Splat Formation

Disk splats are usually observed when the deposition temperature exceeds the transition temperature, whereas thick oxide layer will reduce the adhesion resulting from high deposition temperature. In present study, single molybdenum splats were deposited onto polished molybdenum substrates with different preheating processes to clarify the effect of surface oxidation on the splat formation. Three substrate samples experienced three different preheating processes in an argon atmosphere. Two samples were preheated to 350 and 550 °C, and another sample was cooled to 350 °C after it was preheated to 550 °C. The chemistry and compositions of substrate surface were examined by XPS. The cross sections of splats were prepared by focus ion beam (FIB) and then characterized by SEM. Nearly disk-shaped splat with small fingers in the periphery was observed on the sample preheated to 350 °C. A perfect disk-shape splat was deposited at 550 °C. With the sample on the substrate preheated to 350 °C (cooling down from 550 °C), flower-shaped splat exhibited a central core and discrete periphery detached by some voids. The results of peeling off splats by carbon tape and the morphology of FIB sampled cross sections indicated that no effective bonding formed at the splat–substrate interface for the substrate ever heated to 550 °C, due to the increasing content of MoO3 on the preheated molybdenum surface.

A Novel Cadaveric Model of the Quadriga Effect.

Introduction:The quadriga phenomenon results from excessive shortening of the flexor digitorum profundus (FDP) tendon to the middle, ring, or small finger.Methods:Five cadaveric specimens were used to create a model for quadriga. The FDP tendons to the middle, ring, and small fingers were shortened in 5-mm increments, and the tip-to-palm (TTP) distance of adjacent fingers was recorded.Results:Shortening of the middle finger FDP by 10 mm resulted in an average TTP distance of 6 mm in the ring finger and 5 mm in the small finger. Shortening the ring finger FDP by 10 mm produced an average TTP distance of 11 mm in the middle finger and 9 mm in the small finger. Shortening of the small finger FDP by 10 mm resulted in an average TTP distance of 14 mm in the middle finger and 10 mm in the ring finger.Discussion:Shortening the FDP by as little as 10 mm produced a significant quadriga effect, which was more pronounced with shortening of the small and ring FDP tendons compared to the middle finger.

Sensory percepts induced by microwire array and DBS microstimulation in human sensory thalamus

BackgroundMicrostimulation in human sensory thalamus (ventrocaudal, VC) results in focal sensory percepts in the hand and arm which may provide an alternative target site (to somatosensory cortex) for the input of prosthetic sensory information. Sensory feedback to facilitate motor function may require simultaneous or timed responses across separate digits to recreate perceptions of slip as well as encoding of intensity variations in pressure or touch. ObjectivesTo determine the feasibility of evoking sensory percepts on separate digits with variable intensity through either a microwire array or deep brain stimulation (DBS) electrode, recreating “natural” and scalable percepts relating to the arm and hand. MethodsWe compared microstimulation within ventrocaudal sensory thalamus through either a 16-channel microwire array (∼400 kΩ per channel) or a 4-channel DBS electrode (∼1.2 kΩ per contact) for percept location, size, intensity, and quality sensation, during thalamic DBS electrode placement in patients with essential tremor. ResultsPercepts in small hand or finger regions were evoked by microstimulation through individual microwires and in 5/6 patients sensation on different digits could be perceived from stimulation through separate microwires. Microstimulation through DBS electrode contacts evoked sensations over larger areas in 5/5 patients, and the apparent intensity of the perceived response could be modulated with stimulation amplitude. The perceived naturalness of the sensation depended both on the pattern of stimulation as well as intensity of the stimulation. ConclusionsProducing consistent evoked perceptions across separate digits within sensory thalamus is a feasible concept and a compact alternative to somatosensory cortex microstimulation for prosthetic sensory feedback. This approach will require a multi-element low impedance electrode with a sufficient stimulation range to evoke variable intensities of perception and a predictable spread of contacts to engage separate digits.

Influence of Wrist Position on the Metacarpophalangeal Joint Motion of the Index Through Small Finger.

The metacarpophalangeal joints exhibit range of motion that is influenced by wrist position. Synergistic motion occurs between the wrist and the metacarpophalangeal joints with different static wrist positions affecting joints' motion capability. The aim of this study was to determine how different wrist positions influence the active range of motion of the index through small finger metacarpophalangeal joints. The active range of motion of the index through small finger metacarpophalangeal joints of 31 healthy subjects was measured in flexion/extension and radial/ulnar deviation in 5 different flexion/extension wrist positions, using biaxial electrogoniometers. There was a difference in range of motion of all fingers depending on the wrist position. The minimum metacarpophalangeal joint range of motion was found in 80° wrist extension, the maximum in neutral wrist position. For the index finger, flexion/extension was 84.7° (±8.6°) to 25.9° (±10.2°) and radial/ulnar deviation was 32.1° (±11.3°) to 22.6° (±12.8°). For the middle finger, flexion/extension was 84.8° (±8.5°) to 25.9° (±10.1°) and radial/ulnar deviation 28.8° (±11.1°) to 22.1° (±8.9). The fourth finger showed a range of motion for flexion/extension of 87.2° (±11.5°) to 22.8° (±11.6°) and radial/ulnar deviation of 8.1° (±5.8°) to 32.3° (±12.4°). The highest range of motion was measured at the fifth finger with flexion/extension of 84.0° (±8.6°) to 32.1°(±16.8°) and radial/ulnar deviation of 15.1° (±12.9°) up to 54.6° (±18.7°). The range of motion of the index through small finger metacarpophalangeal joints was significantly influenced by wrist position. The highest metacarpophalangeal joint range of motion of all fingers was conducted in neutral wrist positions. Apart from ergonomic implications, we conclude that metacarpophalangeal joint motion should be assessed under standardized wrist positions.

Redefining Zone II: Anatomy of the Flexor Digitorum Superficialis Insertion.

Flexor zone II is defined as the region spanning the proximal aspect of the A1 pulley to the insertion of the flexor digitorum superficialis (FDS) tendon. Descriptions of the FDS insertion are inconsistent in the literature, but zones of injury are frequently determined with reference to superficial landmarks. The purpose of this study was to describe the footprint of the FDS insertion and define its relationship to the proximal interphalangeal (PIP) skin crease. The FDS insertion on the index, middle, ring, and small fingers was dissected in 6 matched pairs of fresh-frozen cadaveric hands. A Kirschner wire was used to mark the level of the PIP skin crease on bone before measurements of the FDS footprint and its position relative to the PIP skin crease were made using digital calipers. The radial and ulnar FDS slips inserted a mean distance of 3.22 mm from the distal aspect of the PIP skin crease and varied by digit. The mean distal extent of the FDS insertion was 8.29 mm. The mean length of the insertion of each FDS slip was 5.15 mm and the mean width was 1.9 mm. The radial and ulnar FDS slips insert on average 3.22 mm distal to the PIP skin crease and vary by digit. Knowledge of the FDS insertion is clinically relevant when differentiating between flexor zone I and zone II injuries, planning surgical approaches to the finger, and in guiding patient expectations for surgery given the variability in outcome based on zone of injury.

SIRT7 deacetylates DDB1 and suppresses the activity of the CRL4 E3 ligase complexes.

Cullin 4 (CUL4) and small ring finger protein ROC1 assemble to form E3 ubiquitin ligase (CRL4) complexes. CUL4 interacts with WD-40 proteins through the adaptor protein DNA damage-binding protein 1 (DDB1) to target substrates for ubiquitylation. Very little is known on how the CUL4 and DDB1 interaction is regulated. Here, we show that DDB1 is acetylated and acetylation promotes DDB1 binding to CUL4. We also identify nucleolar sirtuin 7 (SIRT7) as a major deacetylase that negatively regulates DDB1-CUL4 interaction. Following inhibition of nucleolar function by actinomycin D or 5-fluorouracil treatment or knocking down the gene for the RNA polymerase I component UBF, SIRT7 is mobilized from the nucleolus to the nucleoplasm and promotes DDB1 deacetylation, leading to decreased DDB1-CUL4 association and CRL4 activity. This results in the accumulation or activation of CRL4 substrates including LATS1 and p73, which contribute to cell apoptosis induced by actinomycin D and 5-fluorouracil. Our study uncovers a novel regulation of CRL4 E3 ligase complexes.

The Relative Contribution to Small Finger Abduction of the Ulnar Versus Radial Slip of the EDM: Implications for Tendon Transfers.

The extensor digiti minimi (EDM) tendon is commonly divided into a radial slip (EDM-R) and an ulnar slip (EDM-U). To our knowledge, the degree to which each EDM slip concomitantly abducts the small finger with active extension has not been formally tested. This study sought to characterize the comparative contributions of finger abduction inherent to each slip of the EDM to observe the sequelae of active small finger extension following transfer of the contralateral slip. Eighteen fresh-frozen cadaveric hands were used in this study. Starting with the hand in resting position, a controlled traction of 10 N was applied to each slip of the EDM tendon. The range of small finger abduction with respect to the fixed ring finger was recorded utilizing infrared reflective markers tracked through the range of motion using a digital video camera. The mean abduction of the small finger when the radial slip of the EDM tendon was tested was 13.33° (95% confidence interval [CI]: 10.10°-16.55°), which was significantly different ( P ≤ .001) than small finger abduction produced by the ulnar slip of the EDM, with a mean of 23.72° (95% CI: 19.40°-28.04°). Given the fact that the ulnar slip of the EDM tendon is shown to be the major contributor of aberrant abduction with active small finger extension, as traction on this slip produces almost twice as much abduction as the radial slip, the EDM-U is the ideal donor graft with respect to tendon transfers of the EDM.

Abstract: Outcomes of Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws: A Literature Review

INTRODUCTION: Metacarpal fractures are a common occurrence in the United States, making up 33.3% of all hand fractures. The majority can be treated nonoperatively, but surgery is indicated when fractures cannot be reduced or fracture alignment cannot be stabilized using closed methods. In 2010, Boulton et al reported intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture. This method has since been described as an operative technique for displaced, comminuted subcapital, and metacarpal neck and shaft fractures. The purpose of this review is to evaluate the recent studies reporting on the outcomes of intramedullary screw fixation of metacarpal fractures. METHODS: Pubmed, Web of Science, and Cochrane were searched. All outcome data from articles reporting on the use of intramedullary screws for the treatment of metacarpal fractures were combined. RESULTS: A total of five articles, one of which was the original case report, were identified for a total of 115 metacarpal fracture repairs performed using intramedullary screw fixation. The majority (84%) were in the small finger with fracture location in the metacarpal neck (69%). All studies used 2.4mm or 3.0mm screws ranging from 32-50mm in length for fixation. Average follow-up was 14 months with an average MCP flexion of 82 degrees (n=78). One study (n=18) did not record MCP flexion, but reported each digit to have a total active motion >240 degrees. All but one study measured radiographic union as an outcome, and all (n=78) resulted in 100% union at or before the latest follow-up. Additionally, grip strength was assessed in two studies (n=29), which showed an average of at least 98% of the contralateral hand. No serious complications were reported. Only one hardware removal was performed due to radiographic suspicion of intra-articular screw penetration. Of note this was a complication of the Y strutting technique in which two intramedullary screws are placed. CONCLUSION: Intramedullary fixation of metacarpal fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option for metacarpal fractures. Advantages of this technique over previously described methods (intramedullary nail or percutaneous K-wire fixation) include no requirement of K-wire removal and increased rotational stability, thus allowing for earlier mobilization.

Poster 178: Reduction of Residual Limb Pain with Botulinum Toxin Injection Following Small Finger Amputation: A Case Report

PM&RVolume 9, Issue 9S1 p. S189-S189 General Rehabilitation Poster Hall: Case Report Poster 178: Reduction of Residual Limb Pain with Botulinum Toxin Injection Following Small Finger Amputation: A Case Report Eric Chen MD, Eric Chen MD Univ of WA Med CtrSearch for more papers by this authorIleana Howard MD, Ileana Howard MD Univ of WA Med CtrSearch for more papers by this authorJeffrey Heckman DO, Jeffrey Heckman DO Univ of WA Med CtrSearch for more papers by this author Eric Chen MD, Eric Chen MD Univ of WA Med CtrSearch for more papers by this authorIleana Howard MD, Ileana Howard MD Univ of WA Med CtrSearch for more papers by this authorJeffrey Heckman DO, Jeffrey Heckman DO Univ of WA Med CtrSearch for more papers by this author First published: 19 September 2017 https://doi.org/10.1016/j.pmrj.2017.08.119Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume9, Issue9S12017 AAPM&R Annual Assembly AbstractsSeptember 2017Pages S189-S189 RelatedInformation

High efficiency bifacial n-PERT cells with co-plated Ni/Ag contacts for multi-wire interconnection

In this paper we present bifacial n-type PERT cells (n-PERT+) with ultra-thin (< 3 μm) and narrow (< 20 μm) Ni/Ag plated contacts on both the n+ and p+ side of the cell. This cell architecture is designed for multi-wire interconnection and has the potential to deliver low cost of ownership at module level (< 0.30 $/Wp), as it can profit from bifacial gain, a low cost metallization (~ 0.07 $/cell) and reduced shadowing and recombination losses. A self-aligned, fully plated metallization sequence, able to form Ni/Ag electrodes simultaneously on both polarities of the cell with a low specific contact resistance, is demonstrated. We benchmark this novel process to a seed-and-plate sequence where the plating seed is obtained by physical vapor deposition (PVD) of Ni and we show comparable efficiency results. Efficiencies of up to 22.8% for cells featuring this fully plated Ni/Ag metallization sequence have been obtained (Cz, 239 cm2, GridTOUCH measurement). We also report 1-cell laminates assembled using multi-wire foils reaching maximum power of about 5 W (256 cm2 aperture area), which shows that the proposed metallization sequence is well suited for integration with such interconnection technology, despite small finger section and the absence of a highly conductive Cu inter-layer. The 1-cell laminates also exhibit less than 4% power degradation after 400 thermal cycles (-40 ºC to +85 ºC).

The effect of finger spreading on drag of the hand in human swimming.

The effect of finger spread on overall drag on a swimmer's hand is relatively small, but could be relevant for elite swimmers. There are many sensitivities in measuring this effect. A comparison between numerical simulations, experiments and theory is urgently required to observe whether the effect is significant. In this study, the beneficial effect of a small finger spread in swimming is confirmed using three different but complementary methods. For the first time numerical simulations and laboratory experiments are conducted on the exact same 3D model of the hand with attached forearm. The virtual version of the hand with forearm was implemented in a numerical code by means of an immersed boundary method and the 3D printed physical version was studied in a wind tunnel experiment. An enhancement of the drag coefficient of 2% and 5% compared to the case with closed fingers was found for the numerical simulation and experiment, respectively. A 5% and 8% favorable effect on the (dimensionless) force moment at an optimal finger spreading of 10° was found, which indicates that the difference is more outspoken in the force moment. Moreover, an analytical model is proposed, using scaling arguments similar to the Betz actuator disk model, to explain the drag coefficient as a function of finger spacing.

Study of Density Driven Convection in a Hele-Shaw Cell with Application to the Carbon Sequestration in Aquifers

Faster dissolution of CO2 within aquifers plays a crucial role in the optimal storage of carbon dioxide injected into reservoirs. The mixture of CO2 and brine triggers convection currents in the aquifer and creates a remarkable increase of the dissolution rate of carbon dioxide. It is very vital for the risk assessment of leakage to obtain accurate description of the CO2 dissolution rate in the aquifers. In our experiments a series of CO2 solute-driven convection laboratory tests were performed in transparent vertical Hele-Shaw cells with a 1.2 mm gap that contained brine water overlain by gas phase and visualization of convective phenomena was achieved with the help of bromocresol purple completely solved into the brine at first. After CO2-brine film come to existence, small phase fingers caused by density contrast would form and they merge, widen, and penetrate deep into the cell. Much series of images recording the dynamic convection were analyzed. Binarization process can help calculate timescale changes of average/all rich- CO2-area which present mass transfer rate of CO2 into the brine. Effects of such different formation parameters as brine concentration, temperature, high pressure and heterogeneity on the onset and development of convection are investigated in our study. Two time intervals, including onset time and developing time took our most attention. Increasing system Rayleigh number, the formation parameters can greatly strengthen the convective mixing and accelerate the growth of CO2 solution into the test cell. The sodium chloride solution concentration gradient has an obvious influence on the form and development of convection phenomenon in our experiments. Here, only part results are exhibited in this paper and much further work are under way.

Early Results of Surgical Management of Camptodactyly.

We hypothesize that surgery for moderate-to-severe camptodactyly (>50 degrees) results in modest gains in range of motion and improved digital position. A retrospective analysis of patients undergoing surgery for camptodactyly at a tertiary children's hospital between 2000 and 2014 was performed. Surgery was indicated for patients with persistent, functionally limiting flexion contractures despite observation, therapy, and splinting. Data were collected on demographics, clinical history and presentation, nonoperative management, surgery, and clinical follow-up, focusing on range of motion at the involved joint. Total passive motion (TPM) and total active motion (TAM) at the proximal interphalangeal (PIP) joint was calculated at presentation, preoperative visit, first postoperative visit out of the cast, and last follow-up visit. Average postoperative follow-up was 1.4 years. In total, 31 digits in 22 patients were reviewed. There were 13 males; average age at surgery was 9.6 years. There were 7 type I (infantile), 8 type II (adolescent), and 7 type III (syndromic) patients. All cases involved the PIP joint; 55% involved the small finger. All patients underwent sequential release of contracted structures until maximal extension without compromising vascularity or joint stability was obtained. Z-plasty of the volar skin was performed in 68% of digits, flexor digitorum superficialis tenotomy in 77%, volar plate release in 58%, and collateral ligament release in 48%. All patients were casted postoperatively for an average of 31 days, and 71% of digits had temporary transarticular pin fixation. At initial presentation, mean TPM and TAM were 34 and 24 degrees, respectively. TPM and TAM were 32 and 19 degrees immediately preoperatively, 30 and 13 at the first postoperative visit, and 35 and 25 at the final follow-up. Furthermore, the position of PIP arc of motion was in a more extended position postoperatively. Average TPM arc of motion was from 50 to 82 degrees preoperatively and 28 to 63 degrees at final follow-up; average TAM arc of motion was 62 to 81 degrees preoperatively and 30 to 55 degrees at final follow-up. There were no clinically meaningful differences in results based on camptodactyly type, preoperative motion, or age at surgery. There were no cases of wound infection or dehiscence. Two patients with recurrent contractures opted for subsequent PIP arthrodesis. Total motion of the PIP joint was similar both preoperatively and postoperatively following surgical release of camptodactyly. However postoperatively, the digit was in a more extended position over this arc of motion. For patients with functionally limiting flexion contractures, surgical release may be beneficial by providing a more extended position, for improved digital release, hygiene, and esthetics. Level IV.

Hand span influences optimal grip span in adolescents with Down syndrome

The hand grip strength test provides useful and reliable information about overall health. Different studies have investigated the optimal grip span for determining maximal hand grip strength in different populations such as adults, adolescents and children without disabilities. To ascertain whether there is an optimal grip span for determining maximal hand grip strength in adolescents with Down syndrome (DS). Twenty-seven right-handed youths with DS (seven females) aged 15.5 ± 3.6 years were evaluated in this methodological study. Each hand was randomly tested on ten times using five different grip spans, allowing one-minute rest between attempts. The hand span was measured from the tip of the thumb to the tip of the small finger with the hand widely opened. To confirm the usefulness of the optimal grip span, a new group of 15 adolescents with DS were recruited. An optimal grip span was identified for the dominant hand in adolescents with DS. The equation relating grip span as a function of dominant hand span in this group is formulated as follows: y = 0.342x - 1.161 cm (r = 0.63, p < 0.05). In the case of non-dominant hand, a tendency towards a linear association (p = 0.058) was found; the equation is formulated as follows: y = 0,210x + 1.324 cm. It is important to standardize the procedure and increase reliability when measuring hand grip strength in DS population. The values stated in this study are recommended to assess hand grip strength in adolescents with Down syndrome.