Thumb Nail Research Articles

Pigmented onychomatricoma may originate from a childhood trauma: A case report

Pigmented onychomatricoma (OM) is a very rare benign fibroepithelial tumor of the nail matrix. We report the case of a 23-year-old Lebanese man with 15-year history of nail plate dystrophy with longitudinal ridging, yellowish discoloration, excessive transverse curvature and late-onset melanonychia along the medial third of the right thumb nail. Excisional biopsy was performed and confirmed OM. We outline the clinical history, radiological and histopathological findings as well as the surgical and reconstructive technique of this unusual case of OM. The age group, history of crush injury, and pigmentation of the nail plate make of this rare form of ungual tumor an interesting case report.

Altered cerebral pain processing of noxious stimuli from inflamed joints in rheumatoid arthritis: An event-related fMRI study

ObjectiveTo our knowledge, this is the first study assessing brain activation in response to painful stimulation over disease-relevant (finger joint) vs. neutral area (thumb nail) in patients suffering from rheumatoid arthritis (RA) compared to healthy controls (HC). MethodThirty-one RA patients and 23 HC underwent functional magnetic resonance imaging (fMRI) while stimulated with subjectively calibrated painful pressures corresponding to a pain sensation of 50 mm on a 100 mm VAS scale (P50) at disease-affected finger joint and thumbnail (left hand), and corresponding sites in HC. ResultsCompared to controls, RA patients had significantly increased pain sensitivity (lower P50) at the inflamed joints but not at the thumbnail. RA patients exhibited significantly less activation in regions related to pain- and somatosensory processing (S1, M1, anterior insula, S2, SMG and MCC) during painful joint stimulation, compared to HC. No group difference in cerebral pain processing was found for the non-affected thumbnail. Within RA patients, significantly less brain activation was found in response to painful stimulation over disease-affected joint compared to non-affected thumbnail in bilateral S1, bilateral S2, and anterior insula. Further, RA patients exhibited a right-sided dlPFC deactivation, psycho-physiologically interacting (PPI) with the left dlPFC in response to painful stimulation at disease-affected joints. ConclusionThe results indicate normal pain sensitivity and cerebral pain processing in RA for non-affected sites, while the increased sensitivity at inflamed joints indicate peripheral/spinal sensitization. Brain imaging data suggest that disease-relevant pain processing in RA is marked by aberrations and a failed initiation of cortical top-down regulation.

Penicillium brasilianum Fungal Infection of Thumb Nail in a Patient Living with HIV-1

Penicillium brasilianum Fungal Infection of Thumb Nail in a Patient Living with HIV-1

Measurement of thumb nail strain during key pinch

Measurement of thumb nail strain during key pinch

A diagnostic instrument to help field graders evaluate active trachoma

ABSTRACTThe SAFE strategy (Surgery for trichiasis, mass treatment with Antibiotics to clear ocular Chlamydia trachomatis infection, and Facial cleanliness and Environmental improvement to reduce transmission) is being used to eliminate trachoma as a public health problem. Decisions on whether or not to implement the A, F, and E components of SAFE are made on the basis of the prevalence of trachomatous inflammation—follicular (TF) in 1–9-year-olds. TF has a precise definition: at least five follicles, each of which is at least 0.5-mm diameter, in the central part of the upper tarsal conjunctiva. Determining whether a follicle has a diameter ≥0.5mm is difficult using magnifying loupes alone. We have developed an ultra-low-cost solution: a follicle size guide that takes the form of a durable printed adhesive sticker which can be fixed to graders’ thumb nails for direct size comparison. This tool will be made available to health ministries free of charge. It is anticipated to simplify grader training, increase grader trainee pass rates, and prevent in-service diagnostic drift after training is complete.

Atypical presentation and management of a subungual glomus tumor in the pediatric population

The glomus tumor is a rare vascular neoplasm that accounts for less than 2% of all soft tissue tumors of the hand. This is the first case study to describe the presentation and curative resection of a subungual glomus tumor in the pediatric population. The glomus tumor is classically described as a solitary subungual mass in women aged 30–50 who present with the triad of pain, temperature sensitivity, and point tenderness. However, given an infrequent and inconsistent presentation, the typical time from onset of symptoms to the correct diagnosis is 7 years, resulting in significant functional and cosmetic morbidity for patients. Here we describe an unusual case of a 6-year-old boy who presented with 3 years of pain and progressive, nontraumatic deformity of his left thumb nail. The patient underwent a left thumb nail plate removal, excision of the subungual mass, and nail bed repair. The diagnosis of subungual glomus tumor was confirmed on pathology. Glomus tumors are rare in the pediatric population but should be considered in patients presenting with nail pain and deformity. Keywords: glomus tumor, pediatric hand tumor, subungual

Finite element analysis of strain distribution on the thumb nail in deformation of the thumb pulp

Finite element analysis of strain distribution on the thumb nail in deformation of the thumb pulp

Vestibular Rehabilitation for the Patients with Intractable Vestibular Neuritis

Objective: To clarify whether vestibular rehabilitation is effective in improving spontaneous nystagmus in patients with intractable vestibular neuritis. Methods: The subjects were 8 patients (6 females and 2 males) with vestibular neuritis who revealed long-lasting (more than 2 months since the onset) horizontal spontaneous nystagmus toward the healthy side. We used thumbs-up head shaking for vestibular rehabilitation. This exercise involves active head shaking (1 Hz) while staring at one’s thumb nail. One set is 10 cycles. We asked the patient to do 3 sets (morning, afternoon, and night) every day. Results: The mean value of the slow-phase velocity of spontaneous nystagmus before treatment was 4.1°/s, and that 3 months after vestibular rehabilitation was 4.1°/s. No improvement was observed. Conclusion: Vestibular rehabilitation is not always effective in improving spontaneous nystagmus in patients with intractable vestibular neuritis. Therefore, clinicians should consider the possibility of long-term incomplete central compensation.

Evaluation of Babinski Reflex in Neonates

Babinski reflex (BR) is one of the infantile reflexes. Most newborn babies are not neurologically mature and therefore show a BR. Upon stimulation of the sole, they dorsiflex the great toe smaller toe will fan out. Objective of our study was to evaluate the Babinski reflex in neonates. Study was conducted on 458 neonates, babies of either sex which were categorised as preterm 120, Term SGA 123, Term AGA 215. Their plantar response was assessed using thumb nail drag method. The response was graded as flexor, extensor, equivocal and asymmetrical. Plantar response was recorded as in preterm AGA extensor 75%, flexor 5%, equivocal 8.3% and asymmetrical 11.7%. In term SGA extensor 61.8%, flexor 9.8%, equivocal 13%, asymmetrical 15.4%. In term AGA extensor 61.9%, flexor 12.1%, equivocal 14.9%, asymmetrical 11.2%. Study showed predominant extensor response in neonates. p value was 0.11.

Special issue on complex aerodigestive endoscopy

Over the past two decades, general thoracic surgery has moved away from large, debilitating thoracotomy, to minimally invasive approaches, with thumb nail sized incisions and the use of high definition cameras for optimal visualization.

3D Printing Technology in Planning Thumb Reconstructions with Second Toe Transplant

To report preoperative planning using 3D printing to plan thumb reconstructions with second toe transplant. Between December 2013 and October 2015, the thumbs of five patients with grade 3 thumb defects were reconstructed using a wrap-around flap and second toe transplant aided by 3D printing technology. CT scans of hands and feet were analyzed using Boholo surgical simulator software (www.boholo.com). This allowed for the creation of a mirror image of the healthy thumb using the uninjured thumb. Using 3D images of the reconstructed thumb, a model of the big toe and the second toe was created to understand the dimensions of the donor site. This model was also used to repair the donor site defect by designing appropriate iliac bone and superficial circumflex iliac artery flaps. The polylactic acid model of the donor toes and reconstructed thumb was produced using 3D printing. Surgically, the wrap-around flap of the first dorsal metatarsal artery and vein combined with the joint and bone of the second toe was based upon the model donor site. Sensation was reconstructed by anastomosing the dorsal nerve of the foot and the plantar digital nerve of the great toe. Patients commenced exercises 2 weeks after surgery. All reconstructed thumbs survived, although partial flap necrosis occurred in one case. This was managed with regular dressing changes. Patients were followed up for 3-15 months. The lengths of the reconstructed thumbs are 34-49 mm. The widths of the thumb nail beds are 16-19 mm, and the thickness of the digital pulp is 16-20 mm. The thumb opposition function was 0-1.5 cm; the extension angle was 5°-20° (mean, 16°), and the angle of flexion was 38°-55° (mean, 47°). Two-point discrimination was 9-11 mm (mean, 9.6 mm). The reconstructed thumbs had good appearance, function and sensation. Based on the criteria set forth by the Standard on Approval of Reconstructed Thumb and Finger Functional Assessment of the Chinese Medical Association, the results were considered excellent for four cases and good for one case. The success rate was 100%. When planning a wrap-around flap and second toe transplant to reconstruct a thumb, both the donor and recipient sites can be modeled using 3D printing. This can shorten the operative time by supplying digital and accurate schematics for the operation. It can also optimize the function and appearance of the reconstructed thumb while minimizing damage to the donor site.

Modeling and estimation of focused ultrasound radiation force for modal excitation

To date, conventional excitation techniques such as impact hammer or mechanical shaker excitations are commonly used in experimental modal testing. However, these excitations require that the excitation device be in direct contact with test articles, resulting in measurement distortions, particularly for small structures like MEMS cantilever. In addition, it is physically difficult or even impossible to apply these contact type excitations to certain structures, for example, biological tissues and thumb nail sized turbine blade. Moreover, these conventional excitations have limited bandwidth, usually below than 10 kHz, and thus not applicable for structures with interest in higher frequency modes. Focused ultrasound radiation force, having a much broader frequency bandwidth, has recently been used to excite structures with sizes ranging from micro to macro-scale. Therefore, it can potentially be used as an alternative non-contact excitation method for experimental modal analysis. Yet, this force remains to be quantified in order to obtain the force-response relationship, i.e., the frequency response functions (FRFs) of test articles. The dynamic focused ultrasound radiation force is modeled and estimated using the calibrated sound pressure fields generated by a spherically focused ultrasonic transducer (UT) driven by amplitude modulated signals. Its application for modal excitation is to be discussed.

Normative study of paediatric hand in an Indian population and a novel method of measurement of first web space arc radius

The aesthetic appearance of the thumb hasn’t been analysed to a similar extent as thumb function which would aid during reconstructive surgeries of the thumb and first web space and analyse its outcome. The purpose of this study is to determine the relative length, girth, nail width of thumb with respect to the index finger and intermetacarpal distance. Measurement of the 1st web space arc radius has been done to tackle the problem of webbing which is not addressed by IMD and palmar abduction angles. A total of 482 hands in 241 subjects were studied to measure the relative length of the thumb with respect to the index finger, the relative nail width of thumb with respect to index finger, the relative girth of IP joint of thumb with respect to PIP joint of index finger and Intermetacarpal distance was calculated. The 1st web space arc radius was calculated by the “best arc fit” with the thumb in maximum radial abduction using a radius gauge. The data collected was analysed by age, gender, laterality of the hand and the height and weight of the child. Hands of subjects of which with a mean age of years were analysed. The relative Thumb length, girth and nail width remained independent of age. It has been observed that the reliability of the measurements between the right and left web space arc radius measurement is significant [ICC– p value

The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery.

Internal lengthening nail (ILN) is a recent development in limb lengthening and deformity correction specialty. The ILN has the distinct advantage of combining acute deformity correction with gradual lengthening of bone. While using ILN, the short metaphyseal bone fragment may develop a deformity at the time of osteotomy and nail insertion or during bone lengthening because of the wide medullary canal. These deformities are typically predictable, and blocking screws (Poller screws) are helpful in these situations. This manuscript describes the common deformities that occur in femur and tibia with osteotomies at different locations while using ILN in antegrade and retrograde nailing technique. Also, a systematic approach to the appropriate use of blocking screws in these deformities is described. In addition, the “reverse rule of thumb” is introduced as a quick reference to determine the ideal location(s) and number of blocking screws. These principles are applicable to limb lengthening and deformity correction as well as fracture fixation using intramedullary nails.

Outcome of index finger pollicisation

Pollicisation of the index finger for absence or severe hypoplasia of the thumb has been reported as a good procedure to recreate a new 'thumb' with good cosmesis and acceptable function. The purpose of this study is to evaluate the outcome of our series from different viewpoints. Seventeen patients with 24 involved hands were willing to come back for evaluation. The mean age at operation was 12 months. In 8 hands there was also a radial club hand. Buck Gramcko's technique was used with slight modifications. The mean follow-up time was 53 months (ranging from 6 to 142). The outcome was determined in a variety of ways: the functional assessment, cosmesis (objectivated with measurement of thumb length, girth and nail size) and a subjective evaluation of function and aspect done with a patient/parent questionnaire and a visual analogue score. The mean functional score was: one excellent, eleven good, five fair and five poor results. The mean length was 96% the width was 93%, the nail width was 85%. There was no significant different outcome in the syndrome related thumbs versus the isolated cases, unilateral versus bilateral cases. A significant worse outcome was seen for function and subjective evaluation in the radial club hand associated thumbs and for the functional score for the more severe Blauth group. The general outcome for non radial club hand associated thumb reconstructions was satisfying. There was good correlation between the different scoring systems.

Median nail dystrophy involving the thumb nail

Median canaliform dystrophy of Heller is a rare entity characterized by a midline or a paramedian ridge or split and canal formation in nail plate of one or both the thumb nails. It is an acquired condition resulting from a temporary defect in the matrix that interferes with nail formation. Habitual picking of the nail base may be responsible for some cases. Histopathology classically shows parakeratosis, accumulation of melanin within and between the nail bed keratinocytes. Treatment of median nail dystrophy includes injectable triamcinalone acetonide, topical 0.1% tacrolimus, and tazarotene 0.05%, which is many a times challenging for a dermatologist. Psychiatric opinion should be taken when associated with the depressive, obsessive-compulsive, or impulse-control disorder. We report a case of 19-year-old male diagnosed as median nail dystrophy.

Median Canaliform Dystrophy of Heller occurring on thumb and great toe nails

Median Canaliform Dystrophy of Heller is a rare but morphologically striking habit tic deformity of thumb nails characterized by midline longitudinal furrow with multiple transverse parallel lines. The proposed etiopathogenesis is repetitive trauma to the nail plate and cuticle, however some case reports have suggested familial occurrence and use of oral retinoids in its causation. Treatment is often prolonged and unsatisfactory, though some topical agents have been used successfully. We report a case of a young male patient presenting with Median Dystrophy of Heller affecting both Great thumb and toe nails simultaneously.

Comparative Evaluation between Diameter Difference of the Thumb and Asymmetry of Lateral Cerebral Ventricles in Children with Developmental Delay: A New Finding.

Anthropometry (measurement of body dimensions) has been used for clinical diagnosis of growth and developmental disorders during pregnancy and after birth. Different brain volumes have also been shown in abnormal developmental disorders. This study compares the different horizontal diameters of the left- and right-hand thumbnails and asymmetry of lateral cerebral ventricles in children with developmental delays. This retrospective case control study was carried out in the Pediatric Neurologic Outpatient of a university hospital in Tehran, Iran (2009-2011). Twenty-eight patients with motor developmental disorders (case) and 28 healthy individuals (control) had brain MRIs and volume of lateral cerebral ventricles size had been studied. The maximum horizontal diameters of the left and right thumbnails were measured by calipers during physical and neurological exams by a pediatric neurologist. Finally, we compared and analyzed different horizontal diameters of the left and right hand thumbnails and asymmetry of lateral cerebral ventricles. There was a significant correlation between asymmetry of brain lateral ventricles size and mean difference of horizontal diameter of thumb nails (P = 0.0001). A meaningful relation between brain hemispheres asymmetry and developmentaldelay (P = 0.04) was seen. The asymmetry of thumbnails can be a marker for asymmetry of lateral ventriclesand child developmental delays.

Ultrasonographic characterization of the nails in patients with psoriasis and onychomycosis

ObjectiveThe study aimed at assessment of ultrasound (US) in diagnosing nail psoriasis and onychomycosis. MethodsOne hundred subjects were included: the psoriatic patients group (n=25), the onychomycosis patients group (n=25) and the control group (n=50). Nail psoriasis severity index (NAPSI) score and onychomycosis severity index were used to assess the patients, in addition to performing nail culture. The thickness of right index and thumb nail plate (NP) and nail bed (NB) was measured by US. The following parameters were also assessed: contour and echogenicity of the NP, NB focal lesions, interpolate space, distal interphalangeal joint (DIJ) changes, proximal nail fold (PNF) changes and distance between proximal NP and DIJ. ResultsThumb NP thickness in psoriasis, onychomycosis and control groups was 0.80±0.14mm and 0.77±0.21mm, and 0.61±0.09mm respectively. The thumb NB thickness in psoriasis, onychomycosis and control groups was 2.05±0.32mm, 2.13±0.32mm, and 1.79±0.23mm respectively. Psoriatic nails show preserved interplate space and DIJ changes. Onychomycotic nails show loss of interplate space proximally, swollen PNF and decreased Plate/DIJ distance. ConclusionUS nail measurements and characters can differentiate between psoriasis and onychomycosis.

Squamous cell carcinoma of the nail bed: a case report

Squamous cell carcinoma of the nail bed is rare and commonly diagnosed late. Presentation is not specific and diagnosis rests on biopsy of the lesion. This condition can be easily misdiagnosed, especially if there is preceding trauma. We are also reporting such case involving the thumb. A 70 years old male patient presented at OPD with complaints of pain and ulcer over left thumb since last 4 months. Patients had lost his thumb nail 6 month back and since then was treated on Ayurvedic treatment. Patient does not give a history of trauma. Biopsy of the ulcer revealed Squamous Cell Carcinoma. His X-ray did not reveal any infiltration and hence a distal phalanx amputation of thumb was performed. Patient had an uneventful post-operative course and on 9 months follow up showed no recurrence. Rare still subungual squamous cell carcinoma should be considered early in lesions around the nail that fail to resolve after adequate conservative management. Early detection helps change surgical treatment from amputation to more preserving techniques like Moh’s or wide local flap reconstruction.