Wrist Crease Research Articles

Effects of 830 nm continuous wave laser diode irradiation on median nerve function in normal subjects

The presence, magnitude, and nature of the effect that low intensity laser irradiation has on nerve function, growth, and repair constitute a contentious area of research. We have addressed one aspect of this controversy by systematically examining the influence of 830 nm laser radiation on median nerve function. In particular, we investigated median nerve motor and sensory distal latencies, action potential amplitudes, action potential areas, and conduction velocities as well as dorsal hand skin temperatures in 33 normal subjects in a double-blinded, randomized controlled study. All subjects received identical treatment: 30 seconds of "irradiation" at 10 points over the course of the right median nerve (five sites on the forearm and five sites distal to the wrist crease) with either an active (1.2 J/point) or inactive (0 J/point) 40 mW 830 nm continuous wave IR laser diode. Latencies, conduction velocities, amplitudes, areas, and skin temperatures were collected bilaterally at a baseline immediately prior to irradiation and at intervals of 1, 5, 10, 15, 20, and 30 minutes following treatment. Analysis of the results reveals that motor and sensory distal latencies were decreased in the treated limbs of the laser-treated group relative to the control group by 3-4% (P < .016 and .046, respectively, rank sum test). No significant differences in these quantities were found between the limbs within either group. Similarly, no alterations of action potential amplitudes, action potential areas, forearm conduction velocities, or skin temperatures were detected within or between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Bilateral Carpal Tunnel Release at One Operation

The division of the transverse carpal ligament for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s. The surgical technique, however, is controversial, and the literature is rife with individual preferences and biases. This report describes our results in 228 tensor fasciae patients who underwent a bilateral carpal ligament release in one procedure that used a small transverse incision in the wrist crease. When the patients' responses to a questionnaire, records of postoperative visits, and follow-up phone calls were analyzed, 216 patients (94.7%) had a satisfactory outcome. One hundred fifty-five patients were working before surgery, with 88.3% back to work in 6 weeks or less. There were no major complications.

Bilateral carpal tunnel release at one operation: report of 228 patients.

The division of the transverse carpal ligament for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s. The surgical technique, however, is controversial, and the literature is rife with individual preferences and biases. This report describes our results in 228 tensor fasciae patients who underwent a bilateral carpal ligament release in one procedure that used a small transverse incision in the wrist crease. When the patients' responses to a questionnaire, records of postoperative visits, and follow-up phone calls were analyzed, 216 patients (94.7%) had a satisfactory outcome. One hundred fifty-five patients were working before surgery, with 88.3% back to work in 6 weeks or less. There were no major complications.

Anthropometric data for describing the kinematics of the human hand.

The major goal of this investigation was to collect statistically-based anthropometry describing the kinematics of the human hand and to model this anthropometry as a function of external hand measurements, so that it may be predicted noninvasively. Joint centres were anatomically estimated as the centre of curvature of the head of the bone proximal to the given joint. Joint centres determined using Reuleaux's method for PIP and DIP were within 1.4 mm of this anatomical estimate. Models using bone length as the independent variable explain more than 97% of the variability in the anatomically estimated joint centre position along the mid-line of the bone. Models for estimating the lengths of the kinematic segments using external hand length as the independent variable account for between 49 and 99% of the variability in segment length. Models for estimating the axial location of the finger MCP and thumb CMC joints with respect to the distal wrist crease using external hand length as the independent variable account for between 82 and 96% of the variability in these locations. Models for estimating the radio-ulnar location of the finger MCP and thumb CMC joints with respect to the long axis of the third metacarpal using external hand breadth as the independent variable account for between 30 and 74% of the variability in these locations.

Tenosynovial injection for carpal tunnel syndrome

Although local steroid injection into the tenosynovium is a frequent treatment for carpal tunnel syndrome, it involves some risk and is not always effective. We simulated injection on 16 fresh cadaver forearms, instilling 1 ml (group 1) or 2 ml (group 2) of methylene blue at 1 cm or 3 cm proximal to the most distal wrist crease. Passive flexion and extension were simulated 2 minutes after injection by application of traction to the appropriate digital tendons. Specimens were dissected under loupe magnification from midpalm to midforearm, dye diffusion was quantified and photographed, sections of the carpal tunnel and contents were graded for presence of dye, and average values were determined for each of the four groups. Diffusion of dye was best in group 2B in which 2 ml was injected 3 cm proximal to the distal wrist flexion crease.

Neurophysiological assessment of the early phases of carpal tunnel syndrome with the inching technique before and during operation

In 14 patients with early carpal tunnel syndrome, the diagnostic sensitivity of the measurement of the segmental sensory nerve conduction velocity at 1 cm. steps (“inching”) was compared with the distal sensory latency and the pre-operative wrist-digit and wrist-palm S.C.V. and with similar measurements made at operation immediately after surgical decompression of the nerve. Before operation, distal sensory latency and wrist-digit S.C.V. were normal in all cases, while wrist-palm S.C.V. was pathological in five patients and inching in all 14 patients. Moreover, inching allowed us to determine the site of the slowing across the carpal tunnel, this being between 1–2 cm. from the distal wrist crease in 57% and between 2–3 cm. in 21% of cases. Focal slowing disappeared immediately after decompression in five patients, as is evident from the intra-operative recordings. Inching is, therefore, the most sensitive diagnostic method in early carpal tunnel syndrome.

Median nerve neuralgia caused by a fibrovascular band in the distal forearm

A 67-year-old woman had experienced exquisite focal pain and tenderness for more than 1 year in the distal forearm 4.5 cm proximal to the distal wrist crease. Surgical exploration showed a venous fibrovascular band adherent to and transversing the epineurium of the median nerve precisely at the point of maximal tenderness. Resection of the fibrovascular band completely relieved the symptoms of focal pain and tenderness.

An anatomical study of the palmar cutaneous branch of the median nerve.

We present an anatomical study of the palmar cutaneous branch of the median nerve emphasizing its frequency, origin, perforation point at the transverse carpal ligament, point of emergence in the palm, width, length, divisions and innervation territory. For this purpose, fifty cadaver hands were dissected under a stereomicroscope and/or magnifying glass. The origin of the palmar cutaneous branch (PCB) was on the average 4.56 cm proximal to conventionally named "zero point" on the most distal transverse volar wrist crease. Perforation of the aponeurosis occurred on average 0.79 cm from the mentioned point and its emergence in the palm at 0.76 cm. The nerve had an average length of 5.24 cm. PCB's divisions in the palm resulted in a medial branch in 42%, a lateral branch in 92% and an intermediate branch in 100% of the hands studied. In six specimens PCB presented a deep branch which was directed toward the thenar eminence or made communication with the superficial branch of the palmar digital nerve or still penetrated between the first or second metacarpal. In 4% of the cases there was a communicating branch between the superficial branch of the radial nerve and the PCB. These anatomical results should be considered in the evaluation of the best surgical techniques for decompression of the median nerve in the carpal tunnel.

Ulnar nerve entrapment neuropathy in the forearm

A 74-year-old male attorney developed rapidly progressive weakness of the fourth and fifth digits of the right hand with impairment of his grip and ability to perform cursive writing. Lancinating pain occurred spontaneously and was triggered by pressure along the ulnar border of the forearm about 5 cm proximal to the wrist crease. Nerve conduction studies revealed a complete electrical block to stimulation at a point 5 cm proximal to the wrist crease when recording from the abductor digiti minimi. Distal to this point, responses of normal amplitude and latency were recorded. Surgical exploration disclosed two fibrovascular bands coursing from the ulnar artery to the distal belly of the flexor carpi ulnaris, entrapping and grooving the ulnar nerve. Release of these bands resulted in reversal of the electrical block, complete relief of pain, and a full neurologic recovery during the ensuing six months.

A Review of H.I.T.: A Manual for the Classification, Filing and Retrieval of Palmprints

Abstract The H.I.T. manual for filing, classifying, and retrieving palmprints appears to have been researched fairly well. The author breaks the palm into three separate areas, the hypothenar, interdigital, and thenar areas. From these areas a three-part classification formula is arrived at. This formula is used for filing and retrieving the palmprints much as a classification formula is used with fingerprints. The hypothenar is the area below the upper palm crease (distal transverse crease) and to the little-finger side of the center palm crease (radial longitudinal crease). The interdigital area is the part of the palm bounded on the top by the lowest finger joint creases (metacarpophalangeal creases) and on the bottom by the distal transverse crease. The thenar area is that part of the palm located to the thumb side of the radial longitudinal crease, bounded on the bottom by the wrist crease (carpal crease). From these three areas the author uses a standard fingerprint-sized card on which are located an area for personal descriptors, an area to code in the type of pattern that appears in each of the palm areas (H. for hypothenar, I. for interdigital, and T. for the thenar area), and an area for references to each of the H.I.T. sections

True Aneurysm of the Radial Artery: Report of a Case with Long‐Term Follow‐Up

Reports on aneurysm of the arteries of the wrist and hand are relatively rare. Presented here is a case of true aneurysm of the radial artery in a 41-year-old-man. The patient had an enlarging painful swelling on the volar aspect of the left wrist, of six months' duration. Under local anesthesia, a transverse incision over the wrist crease revealed an arterial aneurysm. The aneurysm was excised, followed by end-to-end anastomosis. The patient recovered uneventfully and was discharged nine days after the operation. A follow-up arteriogram, five days later, showed a patent radial artery with good blood flow. This is an excellent example of a successful reconstructive surgical procedure involving a small artery.

The anatomy and function of the palmar fascia

The palmar fascia is a prolongation of the deep fascia of the forearm and continues out into the fingers to join Cleland's ligament. It is firmly fixed to the palmar aspect of the skin from the distal wrist crease to the distal palmar crease. It basically protects the flexor tendons, lumbricals, and neurovascular structures, and separates these by thick paratendinous bands.

Cutaneous Larva Migrans -A Case Report

A case of cutaneous larva migrans came to the dermatology outdoor of Rajshahi Medical College Hospital with the complaints of migratory cutaneous itching lesion on her right hand. At the onset she had papules with mild itching on ventral aspect of her right hand. The papular eruption turned into a raised linear line progressed with tortuous course and finally ended at the medial aspect of right thenar eminence about one inch below the wrist crease. The lesion looked like a thin, raised serpiginous line with mild erythema. Complete blood picture shows high eosinophilic count, with mild anaemia and histopathology shows features of chronic dermatitis. But no larva was present in the lesion. Stool for routine examination shows eggs of Ancylostoma duodenale. The patient was diagnosed as cutaneous larva migrans . The patient was prescribed tab. Albendazole DS 400 mg. twice daily for 3 days and tab. Cetrizine 10mg. once daily for 10 days. The dose of Albendazole was repeated after 14 days. doi: 10.3329/taj.v18i1.3305 TAJ 2005; 18(1): 49-50

Stature estimation using regression equations from hand dimensions among hausa neonates of kano state, Nigeria

Introduction: Stature (ST) (or height) of an individual is useful information for making forensic identifications. Before estimating ST, one must determine the race, sex, and age of the individual as ST varies with these variables. Most ST estimation has been reported on adults, but there is a paucity of data in the subadult group. Objectives: Firstly, the study aimed at finding the relationship (correlation) between ST and hand dimensions (hand length [HL] and hand breadth [HB]). Secondly, is to form linear regression equations that can be used to estimate ST among the Hausa neonates. Materials and Methods: A total of 549 Hausa neonates (0-28 days) were involved in the study. HL was measured from the mid-point of the distal wrist crease, to the tip of the middle finger, while HB was measured from the head of the fifth to the head of second-metacarpal bone. ST was also measured as the projective distance between the highest point on the head (vertex), and the most posterior projecting point of the heel. Results: A significant positive correlation was found between ST and hand dimensions. Regression equations were formed for each of the measured parameters for both sexes. Conclusions: The result showed that hand dimensions can be used to estimate ST in Hausa neonates of Kano State, Nigeria.

Ulnar Compression in the Loge de Guyon

JEAN CASIMIR FELIX GUYON was a French surgical pathologist (later professor of genitourinary surgery) who noticed in 1861 that digital pressure over the proximal hypothenar region of his own hand produced a bulge still more proximally at the volar wrist crease.¹The evanescent swelling was initially considered to be synovial thickening, but cadaver dissection proved it to be a fibrofatty mass arising from an intra-aponeurotic space. Although Dr. Guyon was intrigued primarily by the lump of fibrofatty tissue residing in this "loge" (lodge), he described the course of the ulnar artery and nerve through the region and predicted that compressive difficulties might be clinically anticipated. Isolated ulnar-nerve motor paralysis in the hand due to occupational trauma was first clearly reported by Ramsey Hunt²in 1908. Seddon³and Brooks,⁴in 1952, independently drew attention to occult carpal ganglia often being the pressure-producing culprit. In an excellent article

Ulnar compression in the loge de Guyon

JEAN CASIMIR FELIX GUYON was a French surgical pathologist (later professor of genitourinary surgery) who noticed in 1861 that digital pressure over the proximal hypothenar region of his own hand produced a bulge still more proximally at the volar wrist crease.¹The evanescent swelling was initially considered to be synovial thickening, but cadaver dissection proved it to be a fibrofatty mass arising from an intra-aponeurotic space. Although Dr. Guyon was intrigued primarily by the lump of fibrofatty tissue residing in this "loge" (lodge), he described the course of the ulnar artery and nerve through the region and predicted that compressive difficulties might be clinically anticipated. Isolated ulnar-nerve motor paralysis in the hand due to occupational trauma was first clearly reported by Ramsey Hunt²in 1908. Seddon³and Brooks,⁴in 1952, independently drew attention to occult carpal ganglia often being the pressure-producing culprit. In an excellent article

Infant's Handprint: A Clue to Rubella Sequelae?

Hidden sequelae of in utero rubella exposure often are mirrored in abnormal features of an infant's handprint, New York investigators report. At least one of three uncommon patterns has been found in a number of rubella-exposed infants studied at the State University of New York's Downstate Medical Center in Brooklyn. Since an estimated 50% of newborn congenital defects remain undetected at initial examinations, handprinting shortly after birth may be an important diagnostic index, said Ruth Achs, MD. The three types of unusual patterns most commonly seen, singly or in combination are: Fusion of ordinarily transverse creases in the palm into a single "simian line"; Elevation of the "axial triradius" skin ridge pattern above its normal position near the wrist crease on both hands; Presence of "radial loops" facing the thumb on other than the second finger. Such abnormalities, Dr. Achs and colleagues point out, most probably develop

Carpal Tunnel Syndrome During Pregnancy

To the Editor:— The pregnant patients with upper extremity paresthesias described in the Aug 17 Questions and Answers section have the typical symptom complex now recognized as the result of median nerve compression in the carpal tunnel. Pain and numbness, often nocturnal, sometimes spreading proximally to the elbow and shoulder, precede thenar muscle weakness, which may rarely progress to severe atrophy. Phalen's sign (exacerbation of symptoms produced by hyperflexing the wrist for two or three minutes with the elbow extended) is helpful in differentiating carpal tunnel syndrome from other entrapment neuropathies. Most patients benefit from injection of 1 or 2 cc of corticosteroid suspension (hydrocortisone acetate or prednisolone tertiary-butylacetate) into the carpal tunnel, just medial to the palmaris longus at the level of the proximal wrist crease. In more severe or stubborn cases, surgical division of the deep transverse carpal ligament produces uniformly gratifying results. The pathological cause is still