Wrist Area Research Articles

Embryological considerations on the bilateral reversed palmaris longus muscle: a case report in human

AbstractThis study describes a rare case of bilateral reversed palmaris longus muscle. An unusual variation was observed during the male cadaver dissection (60-year-old White). According to the literature, a reversed palmaris longus muscle may cause a compartment syndrome in the wrist area, carpal tunnel, and Guyon's syndrome. Moreover, this particular variation of the reversed palmaris longus muscle is rarely reported and has the potential to cause compression of both the median and ulnar nerves. Thus, the described variation is also useful to the hand surgeon, as the anomalous muscle is an anatomical landmark for operations at this area. Morphological variability and clinical significance are reviewed.

The effect of dexmedetomidine on propofol injection pain.

Propofol causes pain during vascular injection. Dexmedetomidine, an α2-adrenoceptor agonist, has an analgesic effect as well as a sedative effect. Several studies have examined whether the analgesic effect of dexmedetomidine can reduce pain associated with propofol injection [1], but these studies were not helpful in clarifying the appropriate dosage of dexmedetomidine for minimizing hemodynamic changes from the drug while maximizing the reduction of propofol injection pain. In this study, we evaluated the efficacy of dexmedetomidine in reducing pain and hemodynamic changes during propofol injection. The study was approved by the Institutional Review Board of our hospital, and informed consent was obtained from the subject patients after sufficient explanation regarding general anesthesia and our study. One hundred sixty American Society of Anesthesiologists physical status 1 or 2 patients (20 to 60 years old) who were scheduled for elective surgery were enrolled. They were randomly divided into four groups; group 1 (propofol 120 mg and normal saline, n = 40), group 2 (propofol 120 mg and dexmedetomidine 0.25 μg/kg, n = 40), group 3 (propofol 120 mg and dexmedetomidine 0.5 μg/kg, n = 40), and group 4 (propofol 120 mg and dexmedetomidine 0.75 μg/kg, n = 40). The volume of the drug mixture 1% propofol (long-chain triglyceride) and saline or dexmedetomidine was 15 ml in all patients. Injection pain was graded using a 4-point scale. A 20 gauge catheter was mounted on the dorsal hand or wrist area. The drug mixture was injected for 25 seconds through the catheter in order to induce anesthesia. From the start of the injection until the loss of consciousness, each patient was asked, “Does it hurt?” every 5 seconds to measure the degree of pain. The pain was evaluated as 0 when there was no discomfort in the injection area (no pain), 1 when the patient simply answered “Yes” without any change in behavior (slight), 2 when there was a change in behavior or voluntary complaint of pain (intermediate), and 3 when the patient made a loud sound, grimaced, withdrew his or her arm, or shed tears (severe). SAS 9.2 (SAS Institute Inc., Cary, NC, USA) was used to perform a one way ANOVA for age, height, weight, and hemodynamic changes. The degree of pain was analyzed with a χ 2 -test, and the results were considered statistically significant

Bipartite os Centrale Carpi in a Patient with the First Metacarpal Bone Fracture

Bipartite os Centrale Carpi in a Patient with the First Metacarpal Bone Fracture

High‐Resolution Median Nerve Sonographic Measurements

To study relationships between median wrist and forearm sonographic measurements and median nerve conduction studies. The study population consisted of a prospective convenience sample of healthy adults. Interventions included high-resolution median nerve sonography and median motor and sensory nerve conduction studies. Main outcome measures included median motor nerve compound muscle action potential amplitude, distal latency, and conduction velocity; sensory nerve action potential amplitude and distal latency; and sonographic median nerve cross-sectional area. Median motor nerve and sensory nerve conduction studies of the index finger were performed using standard published techniques. A second examiner blinded to nerve conduction study results used a high-frequency linear array transducer to measure the cross-sectional area of the median nerve at the distal volar wrist crease (carpal tunnel inlet) and forearm (4 cm proximally), measured in the transverse plane on static sonograms. The outer margin of the median nerve was traced at the junction of the hypoechoic fascicles and adjacent outer connective tissue layer. Fifty median nerves were evaluated in 25 participants. The compound muscle action potential amplitude with wrist stimulation was positively related to the cross-sectional area, with the area increasing by 0.195 mm(2) for every millivolt increase in amplitude in the dominant hand (95% confidence interval, 0.020, 0.370 mm(2); P < .05) and 0.247 mm(2) in the nondominant hand (95% confidence interval, 0.035, 0.459 mm(2); P < .05). There was no significant linear association between the wrist median cross-sectional area and median motor and sensory distal latencies. Conduction velocity through the forearm was not significantly linearly associated with the forearm area or forearm-to-wrist area ratio (tapering ratio). The wrist area was inversely related to the sensory nerve action potential amplitude. Although associations were found between median nerve conduction study amplitudes and sonographic nerve measurements, they were not found for other parameters. Studying these relationships may increase our understanding of when to best use these procedures.

The OMERACT-RAMRIS Rheumatoid Arthritis Magnetic Resonance Imaging Joint Space Narrowing Score: Intrareader and Interreader Reliability and Agreement with Computed Tomography and Conventional Radiography

To test the intrareader and interreader reliability of assessment of joint space narrowing (JSN) in rheumatoid arthritis (RA) wrist and metacarpophalangeal (MCP) joints on magnetic resonance imaging (MRI) and computed tomography (CT) using the newly proposed OMERACT-RAMRIS JSN scoring method, and to compare JSN assessment on MRI, CT, and radiography. After calibration of readers, MRI and CT images of the wrist and second to fifth MCP joints from 14 patients with RA and 1 healthy control were assessed twice for JSN by 3 readers, blinded to clinical and imaging data. Radiographs were scored by the Sharp/van der Heijde method. Intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated, and the performance of various simplified scores was investigated. Both MRI and CT showed high intrareader (ICC ≥ 0.95) and interreader (ICC ≥ 0.94) reliability for total (wrist + MCP) assessment of JSN. Agreement was generally lower for MCP joints than for wrist joints, particularly for CT. Intrareader SDD for MCP/wrist/MCP + wrist were 1.2/6.1/6.4 JSN units for MRI, while 2.7/8.3/9.9 JSN units for CT. JSN on MRI and CT correlated moderately well with corresponding radiographic JSN scores (MCP 2-5: 0.49 and 0.56; wrist areas assessed by Sharp/van der Heijde: 0.80 and 0.95), and high ICC between scores on MRI and CT were demonstrated (MCP: 0.94; wrist: 0.92; MCP + wrist: 0.92). The OMERACT-RAMRIS MRI JSN scoring system showed high intrareader and interreader reliability, and high correlation with CT scores of JSN. The suggested JSN score may, after further validation in longitudinal studies, become a useful tool in RA clinical trials.

The correlation between viscosity, elasticity and the cross-sectional area of wrist- and finger-flexor muscles—A study of the NeuroFlexor®

Introduction: The NeuroFlexor® is an apparatus that estimates the viscosity, elasticity and the neural component of the resistance in the wrist and finger flexor muscles when the wrist is passively extended. Only the neural component has been validated, and the device has not been used in children. It is proposed that viscosity and elasticity increase with increased muscle cross-sectional area. The aim of the study was to correlate the cross-sectional areas ofwrist and finger flexormuscleswith viscosity and elasticitymeasured with the NeuroFlexor®, and with grip strength. Patients/materials and methods: 15 typically developed subjects, 8–18 years old and one subject with cerebral palsy (CP), 17 years old, were testedwith theNeuroFlexor®. Ultrasoundwas used to obtain the cross-sectional areas of the flexor carpi radialis and flexor digitorum superficialismuscles. Grip strengthwasmeasured with the Grippit®. Results: There were moderate correlations between the viscosity and the cross sectional areas of the flexor carpi radialis (rrho=0.57; p=0.03) and the flexor digitorum superficialis (rrho=0.57; p=0.03). There were no correlations between elasticity and the flexor carpi radialis (rrho=0.30; p=0.28) and flexor digitorum superficialis (rrho=0.28; p=0.33). Discussion and conclusions: The current pilot study suggests that the NeuroFlexor® estimates viscosity correctly. The NeuroFlexor® has the potential to become a useful tool for treatment evaluation in children with CP and contribute to the understanding of contractures.

A comparative evaluation of the AOFAS Ankle-Hindfoot Scale and the Foot Function Index using the Oxford Foot Model

Introduction: The NeuroFlexor® is an apparatus that estimates the viscosity, elasticity and the neural component of the resistance in the wrist and finger flexor muscles when the wrist is passively extended. Only the neural component has been validated, and the device has not been used in children. It is proposed that viscosity and elasticity increase with increased muscle cross-sectional area. The aim of the study was to correlate the cross-sectional areas ofwrist and finger flexormuscleswith viscosity and elasticitymeasured with the NeuroFlexor®, and with grip strength. Patients/materials and methods: 15 typically developed subjects, 8–18 years old and one subject with cerebral palsy (CP), 17 years old, were testedwith theNeuroFlexor®. Ultrasoundwas used to obtain the cross-sectional areas of the flexor carpi radialis and flexor digitorum superficialismuscles. Grip strengthwasmeasured with the Grippit®. Results: There were moderate correlations between the viscosity and the cross sectional areas of the flexor carpi radialis (rrho=0.57; p=0.03) and the flexor digitorum superficialis (rrho=0.57; p=0.03). There were no correlations between elasticity and the flexor carpi radialis (rrho=0.30; p=0.28) and flexor digitorum superficialis (rrho=0.28; p=0.33). Discussion and conclusions: The current pilot study suggests that the NeuroFlexor® estimates viscosity correctly. The NeuroFlexor® has the potential to become a useful tool for treatment evaluation in children with CP and contribute to the understanding of contractures.

133 Results of a Myotonometrical Muscle Study in Patients with Work-Related Hand Overload Disorder

IntroductionImplementation of the new myotonometrical diagnostic method in occupational medicine enables non-invasive, easy and quick evaluation of the functional state of muscles.AimsUse of the myotonometrical method to study hand muscles...

Hand Washing Quality among Biosafety Level 2 Research Laboratory Workers

Soap and water hand washing (HW) is recommended as the standard microbiological practice for removing transient microbes from laboratory workers' hands. The effectiveness of HW in preventing pathogen transmission depends largely on the technique used by the individual, but little is known about laboratory workers' compliance with recommended HW protocols. This study evaluated the quality of HW performed by research workers (N = 93) in 21 biosafety level 2 (BSL-2) laboratories at a large university. Study personnel measured the quality of workers' HW by direct observation while subjects performed their regularly assigned work tasks. Five HW quality indicators as well as hand and wrist jewelry use were measured using an existing tool designed for use in the healthcare setting and modified for this study. A total of 49 soap and water washes were measured during 118 hours of observation. Duration of scrubbing was 9 seconds or less in 41 (84%) cases. Soap was used in 45 (92%) washes, but in 25 (51%) cases where soap was used, lathering was not visible to the observer. Subjects covered dorsal, wrist, palm, and interdigital areas as recommended in only 16 (33%) cases. In 29 (59%) HW events subjects turned off the faucet with bare hands. Hand or wrist jewelry was worn by 60 (65%) participants while in the containment lab. In this study, four of five HW quality indicators were poorly performed. Poor quality HW may result in low reductions of transient pathogens on workers' hands, and may explain many laboratory-associated infections where the route of transmission is otherwise unknown.

Non-cryogenic ultra-low field MRI of wrist–forearm area

Ultra-low field (ULF) MRI as an alternative to high field MRI can find some niche applications where high field is a liability. Previously we demonstrated hand images with a non-cryogenic ULF MRI system, but such a system was restrictive to the size of the imaging objects. We have modified the previous setup to increase the imaging volume and demonstrate the image of human hand near the wrist area. One goal for the demonstration is the evaluation of quality of larger bone structure to project image quality to other parts of extremities, such as elbows, shoulders, and knees. We found that after 12min of acquisition, the image quality was quite satisfactory. To achieve this image quality, several problems were solved that appeared in the new system. The increase in the imaging volume size led to an increase in transient time and various measures were taken to reduce this time. We also explored a method of overcoming the artifacts and image quality reduction arising from field drifts present in the system due to heating of the coils. We believe that our results can be useful for evaluation of diagnostic capability of non-cryogenic ULF MRI of extremities and other parts of the body. The system can be also applied to image animals and tissues.

PREVALENCE OF MUSCULOSKELETAL PROBLEMS AMONG FULL TIME LADY SERVANTS IN DOQQI AREA, CAIRO

Introduction: Musculoskeletal disorders (MSDs) have been identified as a major health concern affecting sizeable segments of the general and working populations. A limited number of studies have particularly explored the prevalence and causes of MSDs among full-time lady servants who routinely perform housework. Aim of work: To estimate the prevalence and pattern of musculoskeletal disorders among randomly selected lady servants and to identify potential factors associated with self-reported musculoskeletal disorders (MSD) among full-time lady servants in Doqqi area, Cairo. Materials and Methods: It is a cross-sectional study included randomly selected female servants in Doqqi area, Cairo. Nordic Musculoskeletal Questionnaire (NMQ) was used to study frequency of MSD and possible risk factors associated with it. Results: The study revealed that all the studied population are female, illiterate (70.4%), unmarried (57.8%), and 43.7% of them have ≥ 3children. As well as 76.1% of lady servants are working using repetitive movements and 69% taking awkward positions during domestic work. Eighty four percent (84.5%) of the study group had musculoskeletal troubles during past 12 months, mostly in lumbar region (63.3%) and 36.6% of servants have evidence of stress. Conclusions: A major finding of this study was musculoskeletal disorders (84.5%) that mainly affected lumbar area followed by knee, wrist and hand areas. Also, 56.3% of servants had mental stress and the most important risk factors that affect the MSDs were awkward positions and repetitive movements.

Study of Multimedia Technology in Posture Training for the Elderly

Wrist diseases, also known as “mama hand”, “mouse hand” or “keyboard hand”, are commonly seen and easily overlooked symptoms in daily life. The diseases are mostly related to incorrect exercise or excessive force imposed on hands, leading to tenosynovitis or carpal tunnel syndrome. To alleviate the symptoms or even to recover, besides drug treatment, supplementary rehabilitation training is necessary. The rehabilitation process forces the affected wrist area to continually exercise in order to stimulate the self-repair signals sent to the affected area for partial restoration, if not all, of the supposed functions. In modern world, using information technology to improve the rehabilitation environment with better approaches has become a trend. In this study, software programs coded in C# and Flash are developed to work on the Bluetooth ball hardware to facilitate the rehabilitation. The basic principle is to use the reaction from the Bluetooth ball’s swaying or swinging to drive the movement of the objects on the computer screen, making the supposedly boring rehabilitation much more fun and vivid in the interactive multimedia environment, thus gaining better treatment effect. Also, RFID, Internet and databases can be integrated into this facility to provide patient identification and data storage for references in making rehabilitation training programs.

Transplantation of a full-cut upper limb (in wrist): A cases study

Background: Complete traumatic amputation of upper limb in wrist area is relatively rare. During the past years thanks to advances in scientific and microscopic methods peripheral nerve surgery has increased the success rate of such surgeries. Case Presentation: An 18 year old man with his wrist has been cut for about 6 hours in an accident was referred to emergency Ward of Taleqani Hospital of Kermanshah. The patient suffered from complete cut of left wrist in car accident in 2008. The patient was really agitated and restless. His Blood pressure was 50/90 mm ​​Hg and pulse rate was 120 per minute. Cut hand has been pressed and contaminated with soil and was wrapped in cloth and sent to the medical center. At first radius and ulnar bones were fixed by pin and articular capsule was sutured. In the second stage muscles were sutured. Arteries and veins in the third stage were anastomosed. Vessels were anastomosed end-to-end. Median, radial and ulnar nerves were restored by microscopic surgery after blood supply of hand has been flown. Finally, fasciotomy of organ was done to prevent compartment syndrome. Conclusion: Two years later it was realized that the patients' sense of touch, heat and pressure of hand was remarkably good in transplanted hand and the surgery was really successful.

Analysis of temperature on the surface of the wrist due to repetitive movements using sensory thermography

This study examines changes in body temperature generated in the wrist area through sensory thermography technique because of highly repetitive movements, proving with this technique that there is a decreased ability to perform muscular work, and thereby assess possible pathologies of Cumulative Trauma Disorders (CTDs). Two healthy right-handed individuals, who performed repetitive work, emulating an operation of the textile industry for three days, generated DTA in the area of the wrist. The evaluation time was of 3 hours 30 minutes in a controlled temperature between 20 and 25°C, 20 minutes stabilization time at the beginning and end of the operation. The maximum temperatures reached were on the right wrist (RW) of 35. 078°C over a period of 1 hour 41 minutes 52 seconds; and on the left wrist (LR), 34.663°C over a period of 2 hours 42 minutes 51 seconds, detected discomfort in their right shoulder and wrist in the time range which identified the highest temperatures. It was shown that the data does not fit a normal distribution for RW and LW; the data fit the three- parameters Weibull distribution for WR and LW with a correlation coefficient between 0.93 to 0.99.

Procedure-Oriented Sectional Anatomy of the Wrist and Hand

This is the third in a series of papers related to procedure-oriented joint anatomy. This article reviews the anatomy of the wrist and hand and its relationship to procedures in the clinical setting with or without ultrasound/electromyography (EMG) guidance. Anatomically correct axial and coronal schematics allow injections to be envisioned relative to clinically important anatomy for common wrist and finger procedures. Cross-sectional schematics for the wrist and hand were drawn as they appear in imaging projections. The levels and planes of cross section were selected to highlight important anatomic landmarks for injection. It is hoped that these schematics allow for safer and more accurate needle procedures in the wrist and hand area.

Quantitative MRI analysis of idiopathic carpal tunnel syndrome

The aim of this study was to try to find parametric ratios for the diagnosis and pathophysiology of carpal tunnel syndrome using MR. Dominant side wrist MRI examinations of 27 female carpal tunnel patients and 21 normal females were compared. The carpal tunnel contents area / carpal tunnel cross section area ratio was defined, analysed and discussed with the literature. Carpal tunnel contents / wrist area ratios of the carpal tunnel patients were measured and compared with the control group. This comparison revealed that the proportion of the contents of the carpal tunnel is increased in the carpal tunnel syndrome patients. Palmar bowing was found to be increased and median nerve cross section area was found to be increased at the proximal entrance of the carpal tunnel. As Phalen has postulated, the volume of the contents of the carpal tunnel were found to be increased in the carpal tunnel syndrome patients. Carpal tunnel cross section areas remained the same with the control group. This increase can be demonstrated by MRI imaging which can provide an evidence for the pathophysiology of carpal tunnel syndrome.

Functional recovery following motor cortex lesions in non-human primates: experimental implications for human stroke patients.

This review discusses selected classical works and contemporary research on recovery of contralesional fine hand motor function following lesions to motor areas of the cerebral cortex in non-human primates. Findings from both the classical literature and contemporary studies show that lesions of cortical motor areas induce paresis initially, but are followed by remarkable recovery of fine hand/digit motor function that depends on lesion size and post-lesion training. Indeed, in recent work where considerable quantification of fine digit function associated with grasping and manipulating small objects has been observed, very favorable recovery is possible with minimal forced use of the contralesional limb. Studies of the mechanisms underlying recovery have shown that following small lesions of the digit areas of primary motor cortex (M1), there is expansion of the digit motor representations into areas of M1 that did not produce digit movements prior to the lesion. However, after larger lesions involving the elbow, wrist and digit areas of M1, no such expansion of the motor representation was observed, suggesting that recovery was due to other cortical or subcortical areas taking over control of hand/digit movements. Recently, we showed that one possible mechanism of recovery after lesion to the arm areas of M1 and lateral premotor cortex is enhancement of corticospinal projections from the medially located supplementary motor area (M2) to spinal cord laminae containing neurons which have lost substantial input from the lateral motor areas and play a critical role in reaching and digit movements. Because human stroke and brain injury patients show variable, and usually poorer, recovery of hand motor function than that of nonhuman primates after motor cortex damage, we conclude with a discussion of implications of this work for further experimentation to improve recovery of hand function in human stroke patients.

Preclinical diagnosis of diabetic nephropathy in children and adolescents with type 1 diabetes

Aim. To evaluate the diagnostic and prognostic value of hemodynamic characteristics and endothelial function (EF), viz. endothelium-dependent vasodilation (EDVD) and vasoconstriction (EDVC), during development of diabetic nephropathy (DN). Materials and methods. A total of 155 children and adolescents aged 9-17 years (residents of Volgograd) with type 1 diabetes mellitus (DM1) from 1 to 14 years in duration were examined at the Endocrinological Department of the Regional Childrens Clinical Hospital. The patients were divided into 3 groups depending on DM1 duration. EF and arteriolar tone (AT) were determined by the rheovasographic method. AT was calculated from vascular distension by a pulse wave based on tetrapolar rheovasography of the shoulder and its first derivative. Rheograms were registered using the Valenta software-hardware system. EF was evaluated in a reactive (working) hyperemia test with occlusion of blood vessels in the arm for 4 min followed by decompression; these procedures resulted in an abrupt acceleration of blood flow and endothelium response to shear stress by EDVD. EDVC was determined by occlusion of blood flow in the wrist area that caused its steady decline in the brachial artery and a decrease of its diameter suggesting enhanced vascular tone. Rheovasography was performed during occlusion. Results. Children with DM1 showed enhanced EDVC and impaired EDVD diagnosed before manifestation of microalbuminurea (MAU) characteristic of early DM1. Conclusion. Changes of EF determined from AT, EDVD and EDVC in children with DM1 before manifestation of microalbuminurea make it possible to identify patients at risk of vascular complications.

Subthreshold corticospinal control of anticipatory actions in humans

Previous findings suggest that, by influencing the subthreshold state of motoneurons, the corticospinal pathways can set and reset the threshold position at which wrist muscle recruitment begins. Here we assumed that the corticospinal system can change the threshold position in a similar way before anticipated perturbation to pre-determine an appropriate emerging response to it. We first analyzed motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) applied to the wrist area of motor cortex before unloading of preloaded wrist flexors, i.e. before the subsequent involuntary wrist motion to another position (natural unloading). Subjects then learned to diminish the post-unloading movement extent without activating antagonist (extensor) muscles before unloading or making intentional movement corrections after unloading (adjusted unloading). Although activity levels of wrist muscles before unloading were similar, MEPs of extensor but not pre-loaded flexor muscles were higher before adjusted unloading. We also applied TMS in combination with a torque pulse that shortened extensor muscles such that the MEP occurred when the motoneuronal excitability was minimized. Although diminished following muscle shortening, MEPs before adjusted unloading were still higher than before natural unloading. Results suggest that the corticospinal system, possibly together with other descending systems participated in the tonic subthreshold facilitation of antagonist motoneurons before adjusted unloading, which appears sufficient in modifying motor commands and motion leading to adjusted unloading. This study reinforces previous findings that descending systems, in particular, the corticospinal system can employ threshold position control during and after learning a novel action.

Stress Fatigue and Ergonomics in Dentistry

The objective of this study was to evaluate the intensity of pain suffered by Dental personnel, identify the variables related to the occurrence of musculoskeletal symptoms, and establish possible preventive measures for such disorders. A cross-sectional study was made among students and faculty members from different postgraduate courses of various dental hospitals between March and April 2009. A total of 74 dentists (54 postgraduate students and 20 faculty members) were asked to complete an anonymous questionnaire containing 19 questions. Most of the dentists (79.8%) had experienced some kind of musculoskeletal pain in the last 6 months. On comparing the different locations of pain, the neck was found to be the most commonly affected location (58%of all subjects). A higher frequency of intense pain involving cervical, lumbar, dorsal and wrist area was seen in women (p 0.05). The implementation of preventive measures is necessary, in view of the high incidence of these disorders.