Lower median nerve block impairs precision grip

Reach-to-grasp kinematics and kinetics with and without visual feedback in early-stage Alzheimer’s disease

This study aimed to investigate the effects of early-stage Alzheimer’s disease (AD) on the reach-to-grasp kinematics and kinetics with and without visual supervision of the grasping arm and hand. Seventeen patients who had been diagnosed with early-stage AD and 17 age- and gender-matched, cognitive normal (CN) adults participated in the experiment. A mirror operating system was designed to block the visual feedback of their grasping hand and forearms but to virtually show grasped targets. The target for reach-to-grasp kinematics was a reflective marker installed on a base; and the target for reach-to-grasp kinetics was a custom-made apparatus installed with two six-component force/torque transducers. Kinematics and kinetic parameters were used to quantify the reach-to-grasp performances. Results showed that the early-stage AD remarkably decreased the reaching speed, reduced the grasping accuracy and increased the transportation variability for reach-to-grasp kinematics. For kinetic analysis, early-stage AD extended the preload duration, disturbed the grip and lift forces coordination, and increased the feedforward proportion in the grasping force control. The AD-related changes in the reach-to-grasp kinematic and kinetic parameters depended on visual feedback and were associated with nervous system function according to correlation analyses with the neuropsychological testing. These results suggest that the abnormal kinematic and kinetic characteristics may correlate with the neuropsychological status of early-stage AD, and that the reach-to-grasp kinematic and kinetic maneuver could potentially be used as a novel tool for non-invasive screening or evaluation of early-stage AD.

Aging and Bimanual Effects on Finger Center of Pressure during Precision Grip: Different Strategies for Spatial Stability

The purpose of this study was to examine aging and bimanual effects on finger spatial stability during precision grip. Twenty-one older and 21 younger adults performed precision grip tasks consisting of a single task (grip and lift an object with the thumb and index finger) and a dual task (the grip-lifting task with one hand and a peg board task with the other hand). The center of pressure (COP) trajectory and the grip force were evaluated using a pressure sensor with a high spatial resolution. In the COP trajectory, the main effects of age for the thumb (F_1,140 = 46.17, p < 0.01) and index finger (F_1,140 = 22.14, p < 0.01) and task difficulty for the thumb (F_1,140 = 6.47, p = 0.01) were significant based on ANCOVA. The COP trajectory was statistically decreased in the older adults. The COP trajectory was also decreased in the dual task, regardless of age. The results suggest the existence of a safety strategy to prioritize the spatial stability in the elderly group and in the dual task. This study provides new insights into the interpretation of the COP trajectory.

Fine adaptive precision grip control without maximum pinch strength changes after upper limb neurodynamic mobilization

Before and immediately after passive upper limb neurodynamic mobilizations targeting the median nerve, grip (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$G_F$$\end{document}GF) and load (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_F$$\end{document}LF) forces applied by the thumb, index and major fingers (three-jaw chuck pinch) were collected using a manipulandum during three different grip precision tasks: grip-lift-hold-replace (GLHR), vertical oscillations (OSC), and vertical oscillations with up and down collisions (OSC/COLL/u, OSC/COLL/d). 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Sensation thresholds at index and thumb were reduced (p = 0.001, p = 0.008). Precision grip adaptations observed after the mobilizations could be partly explained by changes in cutaneous median-nerve pressure afferents from the thumb and index fingertips.

Force-stabilizing synergies can be retained by coordinating sensory-blocked and sensory-intact digits

The present study examined the effects of selective digital deafferentation on the multi-finger synergies as a function of total force requirement and the number of digits involved in isometric pressing. 12 healthy adults participated in maximal and sub-maximal isometric pressing tasks with or without digital anesthesia to selective digits from the right hand. Our results indicate that selective anesthesia paradigm induces changes in both anesthetized (local) and non-anesthetized (non-local) digits’ performance, including: (1) decreased maximal force abilities in both local and non-local digits; (2) reduced force share during multi-finger tasks from non-local but not local digits; (3) decreased force error-making; and (4) marginally increased motor synergies. These results reinforce the contribution of somatosensory feedback in the process of maximal voluntary contraction force, motor performance, and indicate that somatosensation may play a role in optimizing secondary goals during isometric force production rather than ensuring task performance.

Effect of Sensory Deprivation on Maximal Force Abilities from Local to Non-local Digits

The present study investigates the effect of sensory deprivation of the index and middle finger on motor function of all digits during maximal voluntary force production tasks. A total of 27 subjects performed maximal isometric pressing tasks by using different instructed finger combinations. Subjects completed the same tasks in two visits: a control visit when they had normal sensory feedback in all fingers, and an anesthesia visit when digital nerve blocks were performed on their right index and middle fingers. We evaluated three aspects of motor adaptation on both local (anesthetized) and non-local (non-anesthetized) digits during maximal force production: (1) task-relevant and overall force magnitude, (2) force directional application, and (3) digital individuation and force sharing. Our results indicate that selective digital anesthesia resulted in decreased maximal force magnitude, changed direction of force production, and significant changes extended to non-local digits. The motor weakness and inefficiency revealed in the non-local digits implies that sensory information from each digit can be shared across the digits to assist motor execution within the same hand.

Carpal tunnel syndrome impairs index finger responses to unpredictable perturbations

The fine-tuning of digit forces to object properties can be disrupted by carpal tunnel syndrome (CTS). CTS' effects on hand function have mainly been investigated using predictable manipulation tasks; however, unpredictable perturbations are commonly encountered during manual tasks, presenting situations which may be more challenging to CTS patients given their hand impairments. The purpose of this study was to investigate muscle and force responses of the index finger to unpredictable perturbations in patients with CTS. Nine CTS patients and nine asymptomatic controls were instructed to stop the movement of a sliding plate by increasing index finger force following an unexpected perturbation. The electrical activity of the first dorsal interosseous muscle and forces exerted by the index finger were recorded. CTS patients demonstrated 20.9% greater muscle response latency and 12.0% greater force response latency compared to controls (p<0.05). The duration of plate sliding was significantly different between groups (p<0.05); the CTS group's duration was 142.2±5.8ms compared to the control group's duration of 133.1±8.4ms. Although CTS patients had increased muscle and force response durations comparatively, these differences were not statistically significant. Findings from this study suggest CTS-induced sensorimotor deficits interfere with accurate detection, processing and response to unpredictable perturbations. These deficits could be accounted for at multiple levels of the peripheral and central nervous systems. Delayed and decreased responses may indicate inefficient object manipulation by CTS patients and may help to explain why CTS patients tend to drop objects.

Temporary Nerve Block at Selected Digits Revealed Hand Motor Deficits in Grasping Tasks

Peripheral sensory feedback plays a crucial role in ensuring correct motor execution throughout hand grasp control. Previous studies utilized local anesthesia to deprive somatosensory feedback in the digits or hand, observations included sensorimotor deficits at both corticospinal and peripheral levels. However, the questions of how the disturbed and intact sensory input integrate and interact with each other to assist the motor program execution, and whether the motor coordination based on motor output variability between affected and non-affected elements (e.g., digits) becomes interfered by the local sensory deficiency, have not been answered. The current study aims to investigate the effect of peripheral deafferentation through digital nerve blocks at selective digits on motor performance and motor coordination in grasp control. Our results suggested that the absence of somatosensory information induced motor deficits in hand grasp control, as evidenced by reduced maximal force production ability in both local and non-local digits, impairment of force and moment control during object lift and hold, and attenuated motor synergies in stabilizing task performance variables, namely the tangential force and moment of force. These findings implied that individual sensory input is shared across all the digits and the disturbed signal from local sensory channel(s) has a more comprehensive impact on the process of the motor output execution in the sensorimotor integration process. Additionally, a feedback control mechanism with a sensation-based component resides in the formation process for the motor covariation structure.

Changes in the Spinal Neural Circuits are Dependent on the Movement Speed of the Visuomotor Task

Previous studies have shown that spinal neural circuits are modulated by motor skill training. However, the effects of task movement speed on changes in spinal neural circuits have not been clarified. The aim of this research was to investigate whether spinal neural circuits were affected by task movement speed. Thirty-eight healthy subjects participated in this study. In experiment 1, the effects of task movement speed on the spinal neural circuits were examined. Eighteen subjects performed a visuomotor task involving ankle muscle slow (nine subjects) or fast (nine subjects) movement speed. Another nine subjects performed a non-visuomotor task (controls) in fast movement speed. The motor task training lasted for 20 min. The amounts of D1 inhibition and reciprocal Ia inhibition were measured using H-relfex condition-test paradigm and recorded before, and at 5, 15, and 30 min after the training session. In experiment 2, using transcranial magnetic stimulation (TMS), the effects of corticospinal descending inputs on the presynaptic inhibitory pathway were examined before and after performing either a visuomotor (eight subjects) or a control task (eight subjects). All measurements were taken under resting conditions. The amount of D1 inhibition increased after the visuomotor task irrespective of movement speed (P < 0.01). The amount of reciprocal Ia inhibition increased with fast movement speed conditioning (P < 0.01), but was unchanged by slow movement speed conditioning. These changes lasted up to 15 min in D1 inhibition and 5 min in reciprocal Ia inhibition after the training session. The control task did not induce changes in D1 inhibition and reciprocal Ia inhibition. The TMS conditioned inhibitory effects of presynaptic inhibitory pathways decreased following visuomotor tasks (P < 0.01). The size of test H-reflex was almost the same size throughout experiments. The results suggest that supraspinal descending inputs for controlling joint movement are responsible for changes in the spinal neural circuits, and that task movement speed is one of the critical factors for inducing plastic changes in reciprocal Ia inhibition.

Coordination of digit force variability during dominant and non-dominant sustained precision pinch

This study examined the effects of handedness on the inter-digit coordination of force variability with and without concurrent visual feedback during sustained precision pinch. Twenty-four right-handed subjects were instructed to pinch an instrumented apparatus with their dominant and non-dominant hands, separately. During the pinch, the subjects were required to maintain a stable force output at 5 N for 1 min. Visual feedback was given for the first 30 s and removed for the second 30 s. Coefficient of variation and detrended fluctuation analysis were employed to examine the amount and structural variability of the thumb and index finger forces. Similarly, correlation coefficient and detrended cross-correlation analysis were applied to quantify the inter-digit correlation of force amount and structural variability. Results showed that, compared to the non-dominant hand, the dominant hand had higher inter-digit difference in the amount of digit force variability. Without visual feedback, the dominant hand exhibited lower digit force structural variability but higher inter-digit force structural correlation than the non-dominant hand. These results implied that the dominant hand would be more independent, less flexible and with lower dynamic degrees of freedom than the non-dominant hand in coordination of the thumb and index finger forces during sustained precision pinch. The effects of handedness on inter-digit force coordination were dependent on sensory condition, which shed light on higher-level sensorimotor mechanisms that may be responsible for the asymmetries in coordination of digit force variability.

Carpal tunnel syndrome impairs sustained precision pinch performance

OBJECTIVE

The purpose of this study was to investigate effects of carpal tunnel syndrome (CTS) on digit force control during a sustained precision pinch.

METHODS

Eleven CTS individuals and 11 age- and gender-matched healthy volunteers participated in the study. The subjects were instructed to isometrically pinch an instrumented apparatus for 60s with a stable force output. Visual feedback of force output was provided for the first 30s but removed for the remaining 30s. Pinch forces were examined for accuracy, variability, and inter-digit correlation.

RESULTS

CTS led to a decrease in force accuracy and an increase in amount of force variability, particularly without visual feedback (p<0.001). However, CTS did not affect the structure of force variability or force correlation between digits (p>0.05). The force of the thumb was less accurate and more variable than that of the index finger for both the CTS and healthy groups (p<0.001).

CONCLUSIONS

Sensorimotor deficits associated with CTS lead to inaccurate and unstable digit forces during sustained precision pinch.

SIGNIFICANCE

This study shed light on basic and pathophysiological mechanisms of fine motor control and aids in development of new strategies for diagnosis and evaluation of CTS.

Cross recurrence quantification analysis of precision grip following peripheral median nerve block

Background

Precision grip by the thumb and index finger is vulnerable to sensorimotor deficits. Traditional biomechanical parameters offer limited insight into the dynamical coordination between digits during precision grip. In this study, the thumb and index finger were viewed as “coupled systems”, and a cross recurrence quantification analysis (CRQA) was used to examine the changes of interdigit dynamics and synchronization caused by peripheral median nerve block.

Methods

Seven subjects performed a precision grip by holding an instrumented handle before and after median nerve block at the wrist. The forces and the torques at each digit-handle interface were recorded with two six-component transducers. For CRQA, the percentage of recurrence rate (%RR), percentage of determinism (%DET), longest diagonal line (Lmax) and percentage of laminarity (%LAM) were computed for the force, torque and center of pressure (COP) signals. Phase synchronization of the thumb and index finger was examined based on the τ-recurrence rate. Paired t-tests and Wilcoxon signed-rank tests were used for statistical comparisons. The twin-surrogate hypothesis test was used to examine phase synchronization.

Results

Nerve block led to significant increases (p < 0.05) for %DET, Lmax and %LAM in all components of force, torque, and COP. Only the normal force met the conditions of phase synchronization for all successfully completed pre- and post-block grasping trials. The probability of synchronization with larger time lags (τ > 0.1 s) increased after nerve block. The percentage of trials that the thumb led the index finger increased from 52% (pre-block) to 86% (post-block).

Conclusions

Nerve block caused more deterministic structures in force, torque and COP when the thumb interacted with the index finger. A compensatory mechanism may be responsible for this change. Phase synchronization between the opposite normal forces exerted by the thumb and index finger would be an essential dynamical principle for a precision grip. The nerve block resulted in an increased interdigit phase delay and increased probability that the thumb leads the index finger. The CRQA provides an effective tool to examine interdigit coordination during precision grip and has the potential for clinical evaluation of hand dysfunction.

Effects of task complexity on grip-to-load coordination in bimanual actions

We investigated within- and between-hand grip and load force coordination in healthy young subjects during bimanual tasks involving realistic manual actions. Actions involving disparate actions of the two hands (bimanual asymmetry) were expected to result in lower overall measures of within- and between-hand measures of grip and load force coordination. As dissociation between two hands performing disparate actions may be expected, it was also hypothesized that increased task asymmetry would result in a shift toward higher within-hand force coordination. Features such as object rotation were found to reduce some, but not all indices of both within- and between-hand force coordination. The action of connecting two independent objects was associated with declines in all indices of within- and between-hand force coordination. Evidence of task-specific differences in force application timing and a trend toward within-hand grip-load coordination differences in the current data set suggest that individual hand specification emerges naturally in everyday bimanual prehension tasks, independent of the action role of the assigned to the dominant and non-dominant hands.

Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent

Carpal tunnel syndrome (CTS) impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips) or a combination of CTS-affected and non-affected digits ('mixed' grips), we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS-affected and non-affected digits.

Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object texture

OBJECTIVE

The ability to adapt digit forces to object properties requires both anticipatory and feedback-driven control mechanisms which can be disrupted in individuals with a compromised sensorimotor system. Carpal tunnel syndrome (CTS) is a median nerve compression neuropathy affecting sensory and motor function in a subset of digits in the hand. Our objective was to examine how CTS patients coordinate anticipatory and feedback-driven control for multi-digit grip force adaptation.

METHODS

We asked CTS patients and healthy controls to grasp, lift, and hold an object with different textures.

RESULTS

CTS patients effectively adapted their digit forces to changes in object texture, but produced excessive grip forces. CTS patients also produced larger peak force rate profiles with fewer modulations of normal force prior to lift onset than did controls and continued to increase grip force throughout the lift whereas forces were set at lift onset for the controls.

CONCLUSIONS

These findings suggest that CTS patients use less online sensory feedback for fine-tuning their grip forces, relying more on anticipatory control than do healthy controls.

SIGNIFICANCE

These characteristics in force adaptation in CTS patients indicate impaired sensorimotor control which leads to excessive grip forces with the potential to further exacerbate their median nerve compression.

Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation

The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS), a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g) for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

Impact of precision grip tasks on cervical spinal network excitability in humans

Motor skill acquisition in the lower limb may induce modifications of spinal network excitability. We hypothesized that short-term motor adaptation in precision grip tasks would also induce modifications of cervical spinal network excitability. In a first series of experiments, we studied the impact of two different precision grip force control tasks (a visuomotor force-tracking task and a control force task without visual feedback) on cervical spinal network excitability in healthy subjects. We separately tested the efficacy of two key components of the spinal circuitry: (i) presynaptic inhibition on flexor carpi radialis (FCR) Ia terminals, and (ii) disynaptic inhibition directed from extensor carpi radialis (ECR) to FCR. We found that disynaptic inhibition decreased temporarily after both force control tasks, independently of the presence of visual feedback. In contrast, the amount of presynaptic inhibition on FCR Ia terminals decreased only after the visuomotor force tracking task. This temporary decrease was correlated with improved tracking accuracy during the task (i.e. short-term motor adaptation). A second series of experiments confirmed these results and showed that the visuomotor force-tracking task resulted also in an increase of the Hmax/Mmax ratio and the slope of the ascending part of the H-reflex recruitment curve. In order to address the role of presynaptic inhibition in the motor adaptation process, we conducted a third series of experiments during which presynaptic inhibition was recorded before and after two consecutive sessions of visuomotor force tracking. The results showed that (i) improved tracking accuracy occurred during both sessions, and (ii) presynaptic inhibition decreased only after the first session of visuomotor force tracking. Taken together, these results suggest thus that the nature of the motor task performed has a specific impact on the excitability of these cervical spinal circuits. These findings also suggest that early motor adaptation is associated with a modulation of presynaptic Ia inhibition in the upper limb.

Dependence of safety margins in grip force on isometric push force levels in lateral pinch

This study examined the relationship between safety margin and force level during an isometric push task in a lateral pinch posture. Ten participants grasped an object with an aluminium- or rubber-finished grip surface using a lateral pinch posture and exerted 20%, 40%, 60%, 80% and 100% of maximum push force while voluntary grip force was recorded. Then minimum required grip force was measured for each push force level. Mean safety margin, the difference between voluntary and minimum required grip forces, was 25% maximum voluntary contraction (MVC) when averaged for all push levels. Safety margin significantly increased with increasing push force for both grip surfaces. Grip force used during maximum push exertion was only 74% lateral pinch grip MVC. Possible underlying mechanisms for increasing safety margin with increasing push force are discussed as well as the implication of this finding for ergonomic analysis. This study demonstrates that ergonomic analyses of push tasks that involve friction force should account for safety margin and reduced grip strength during the push. Failure to consider these can result in overestimation of people's push capability.

Variability of precision pinch movements caused by carpal tunnel syndrome

PURPOSE

Carpal tunnel syndrome (CTS) impairs the performance of fine motor tasks of the hand, leading to clumsiness. Precision pinch by the thumb and index finger is a frequent task that requires the fine control of each digit as well as the coordination of the 2 digits. The purpose of this study was to examine the performance of precision pinch movements impaired by CTS.

METHODS

Sixteen CTS subjects and 16 gender- and age-matched control subjects were instructed to repetitively perform the precision pinch movement with the thumb and index finger. A marker-based motion analysis method was used to obtain the kinematic data of the thumb and index finger during the precision pinch movements. Pinch performance was quantified by the variability of tip positions, joint angles, and tip distance at the pinch closures in the repeated movements.

RESULTS

The CTS subjects performed the precision pinch movements less consistently compared with performance of the control subjects. The inconsistency was demonstrated by the increased variability of the tip positions of the 2 digits and the joint angles of the index finger. However, the variability of thumb joint angles was not significantly different between the 2 groups. The tip-to-tip distance, an indicator of thumb and index finger coordination, was relatively reproducible for both groups. Still, the CTS subjects showed a 50% greater variability of the tip distance compared with that of the control subjects.

CONCLUSIONS

Carpal tunnel syndrome impairs the performance of precision pinch movement as indicated by the increased variability. The results correlate with the observed clumsiness or lack of dexterity for patients with CTS.

Peripheral median nerve block impairs precision pinch movement

OBJECTIVE

The objective of this study was to investigate the effects of a simulated peripheral median nerve lesion on precision pinch movement by the thumb and index finger.

METHODS

A median neuropathy was created by blocking the median nerve at the wrist using an anesthetic. The subjects (n=5) were asked to perform pulp-to-pulp precision pinch movements before and after the nerve block. Digit motion data was obtained with a marker-based motion analysis system.

RESULTS

The radial offset of the thumb tip, as defined by the minimum distance of the thumb tip to the flexion-extension plane of the index finger, showed an increase of 11.2mm after the nerve block. For the thumb, the nerve block caused a decrease in the range of motion at the metacarpophalangeal (MCP) joint, and a compensatory increase in the range of motion at the interphalangeal (IP) joint. The range of motion ratio (MCP:IP) changed from 1:4.8 (pre-block) to 1:1.0 (post-block). The maximum flexion angle at the MCP joint increased from 18.8 degrees (pre-block) to 33.7 degrees (post-block), and maximum flexion angle at the IP joint decreased from 42.6 degrees (pre-block) to 18.8 degrees (post-block). For the index finger, the nerve block caused a decrease in the range of motion at the MCP joint, and compensatory increases in the ranges of motion at the proximal and distal interphalangeal (PIP and DIP) joints. The range of motion ratio (MCP:PIP:DIP) changed from 1:1.1:0.7 (pre-block) to 1:2.4:1.8 (post-block). The maximum flexion angle at the MCP joint decreased from 56.8 degrees (pre-block) to 34.6 degrees (post-block), and the maximum flexion angle at the PIP joint increased from 51.2 degrees (pre-block) to 76.0 degrees (post-block), but the change at the DIP joint was insignificant.

CONCLUSIONS

The median nerve block caused remarkable degradation of the pinch performance as quantified by an inaccurate pulp-to-pulp contact of the thumb to the index finger and an alteration of joint motion of the digits.

SIGNIFICANCE

Many fine manual tasks require accurate pulp-to-pulp positioning of the thumb to the index finger. Within the hand, the median nerve is critical to the fine sensorimotor function due to the motor supply and the sensory endings to the thumb and index finger. People with median neuropathies (for example, carpal tunnel syndrome) experience clumsiness while performing simple manual tasks. The current approach to the examination of precision pinch movement may be utilized to quantify the apparent hand clumsiness observed in individuals with peripheral neuropathy such as carpal tunnel syndrome.