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Oliveira BM, Fernandes CH, Nakachima LR, Dos Santos JBG, Hirakawa CK, Faloppa F. Prevalence of Absence of Function of the Flexor Digitorum Superficialis Muscle Tendons in the Fourth and Fifth Fingers of the Hand in the Brazilian Population. Rev Bras Ortop 2020; 55:448-454. [PMID: 32904755 PMCID: PMC7458732 DOI: 10.1055/s-0039-3402458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/15/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives
To evaluate the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in the Brazilian population
Methods
Prospective study performed at the orthopedics and traumatology department of a university hospital. The study was conducted from October 2017 to April 2018. The sample consisted of volunteers with no history of upper limb trauma, surgery or any other condition. This study included both male and female individuals over 18 years old. The flexor digitorum superficialis muscle tendons of the fourth and fifth fingers were evaluated through clinical tests by three independent examiners. The data were analyzed using GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, USA).
Results
A total of 2,016 hands from 1,008 volunteers were analyzed. The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fourth finger was 0.56% at the right hand and 0.99% at the left hand. At the right hand, this prevalence was higher in females compared to males (
p
= 0.0328). No difference between genders was noted in the left hand (
p
= 0.7562). The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fifth finger was 34.53% in the right hand and 30.06% in the left hand. This prevalence was higher in females compared to males, both at the right hand (
p
= 0.0001) and the left hand (
p
= 0.0003).
Conclusion
Even though there are studies performed separately in different ethnic groups, there were no data in the literature regarding the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in a multiethnic population such as the Brazilian one.
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Affiliation(s)
- Bruno Macêdo Oliveira
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Luis Renato Nakachima
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Celso Kiyoshi Hirakawa
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Abstract
The anatomy of the wrist and hand is complex and contains numerous small structures. Magnetic resonance imaging (MRI) is often an ideal imaging modality in the assessment of various traumatic and pathologic conditions of this region, and it is frequently performed after initial radiographs. In this manuscript we describe the normal anatomy, imaging techniques, and MRI findings of various traumatic and pathologic conditions of the wrist and hand including occult fractures, osteonecrosis, ligamentous and tendon injuries, and entrapment neuropathies.
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Johnson CC, Vutescu ES, Miller TT, Nwawka OK, Lee SK, Wolfe SW. Ultrasound determination of presence, length and diameter of the palmaris longus tendon. J Hand Surg Eur Vol 2018; 43:948-953. [PMID: 29879859 DOI: 10.1177/1753193418778990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Inadvertent median nerve harvest is a devastating complication of palmaris longus harvest. Accurate assessment of palmaris longus presence and dimensions preoperatively would minimize this risk and assure safe harvest. We hypothesized that ultrasound would accurately predict palmaris longus presence, length and diameter. Seventeen cadaveric forearms were studied using a LOGIQ-E9 ultrasound. Two radiologists assessed palmaris longus presence and dimensions. Each wrist was explored, and the tendon was harvested and measured. Inter-rater reliability and agreement between measurements was assessed. The palmaris longus was present in 13 of 17 forearms. Both radiologists correctly identified the tendon and its absence (sensitivity and specificity, 100%). Ultrasound assessment of palmaris longus dimensions significantly correlated with surgical measurements. Intraclass correlation coefficient between radiologists was 0.97. We conclude that ultrasound can determine palmaris longus presence and dimensions with excellent accuracy and inter-observer reliability. Ultrasound is useful for preoperative evaluation of the palmaris longus and its use will increase patient safety.
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Affiliation(s)
| | | | | | | | - Steve K Lee
- Hospital for Special Surgery, New York, NY, USA
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4
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A rare variation of intrinsic and extrinsic hand muscles represented by a bi-ventered first lumbrical extending into the carpal tunnel combined with bilateral fifth superficial flexor digitorum tendon regression. Morphologie 2018; 102:294-301. [PMID: 30266563 DOI: 10.1016/j.morpho.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/21/2022]
Abstract
A rare unilateral variation of the first left lumbrical muscle was discovered in a female Caucasian cadaver dissected during a first year anatomy course at the Paracelsus Medical University - Nuremberg, Germany. The muscle possessed two venters with the first originating near the medial epicondyle of the humerus together with the intramuscular tendon of the superficial flexor digitorum tendon, and the second presenting as a regular first lumbrical muscle with radial palmar origin from first tendon of the deep flexor digitorum muscle. Both muscle bellies were connected by a 1.42mm thick tendon that passed beneath the median nerve and ran through the carpal tunnel. The second belly was enlarged and entered the distal part of the carpal tunnel. Interestingly, the donor revealed further rare variations such as a bilateral regression of the fifth superficial flexor tendons to an obviously non functional connective tissue strand, lack of both palmaris longus muscles, a discoid lateral meniscus in the left knee, and reduction of the plantaris muscle to a fascia-like structure on the right leg. Lumbrical muscle variations extending into the carpal tunnel, especially those associated with auxiliary tendons, have significant clinical relevance due to their association with carpal tunnel syndrome.
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Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol 2018; 129:2658-2679. [PMID: 30309740 DOI: 10.1016/j.clinph.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Over the last two decades, dozens of applications have emerged for ultrasonography in neuromuscular disorders. We wanted to measure its impact on practice in laboratories where the technique is in frequent use. After identifying experts in neuromuscular ultrasound and electrodiagnosis, we assessed their use of ultrasonography for different indications and their expectations for its future evolution. We then identified the earliest papers to provide convincing evidence of the utility of ultrasound for particular indications and analyzed the relationship of their date of publication with expert usage. We found that experts use ultrasonography often for inflammatory, hereditary, traumatic, compressive and neoplastic neuropathies, and somewhat less often for neuronopathies and myopathies. Usage significantly correlated with the timing of key publications in the field. We review these findings and the extensive evidence supporting the value of neuromuscular ultrasound. Advancement of the field of clinical neurophysiology depends on widespread translation of these findings.
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Affiliation(s)
- Francis O Walker
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Katharine E Alter
- Department of Rehabilitation Medicine, National INeurolnstitutes of Health, Bethesda, MD 20892, USA.
| | - Leo H Visser
- Departments of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA.
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Piazzale Rodolfo Morandi, 6, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Universita Cattolica del Sacro Cuore, Rome, Italy.
| | - Jeffery A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; OhioHealth McConnell Spine, Sport and Joint Center, Columbus, OH, USA.
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Einar Wilder-Smith
- Department of Neurology, Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, Kantonsspital Lucerne, Switzerland; Department of Neurology, Inselspital Berne, Switzerland.
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Canada.
| | - Jeremy D P Bland
- Deparment of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Craig M Zaidman
- Division of Neuromuscular Medicine, Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Box 8111, St. Louis, MO 63110, USA.
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Yammine K, Erić M. Agenesis, functional deficiency and the common type of the flexor digitorum superficialis of the little finger: A meta-analysis. HAND SURGERY & REHABILITATION 2018; 37:77-85. [PMID: 29449159 DOI: 10.1016/j.hansur.2017.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/05/2017] [Accepted: 11/09/2017] [Indexed: 12/11/2022]
Abstract
Agenesis, functional deficiency and the common type of the flexor digitorum superficialis of the little finger are reported in the literature to be highly variable with significant discrepancy between clinical and cadaveric frequencies. The aim of this systematic review was to generate overall clinical and cadaveric weighted frequencies, along with ancestry-based, side-based, sex-based and laterality-based frequencies. A systematic literature search identified 34 studies including 12,213 forearms/hands that met the inclusion criteria. Functional deficit of the FDS tendon of the little finger was significantly more prevalent among Iranian and Caucasian populations as compared to Indian, East African and Chinese populations. The weighted "clinical" frequency of functional absence of the FDS tendon of the little finger was 7.45%, while prevalence of the common type was 37.5%. The weighted "cadaveric" prevalence of muscle absence of the FDS-5 in the forearm was 2.5% while tendon absence in the hands was nil. An expanded examination technique proved to be the most accurate test for FDS function. In case of injury, inadequate knowledge of different connections or substitutions of the FDS-5 could lead to a total loss of flexion of the little finger. These findings support the hypothesis of a dual origin of the FDS-5 where the muscle portion originates in the forearm, while the tendon portion originates in the hand.
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Affiliation(s)
- K Yammine
- The Center for Evidence-Based Anatomy, Sport and Orthopedic Research, Jdeideh highway, Fouad Yammine boulevard, 1st floor, Beirut, Lebanon; The Foot & Hand Clinic, Baushrieh, Jdeideh, Beirut, Lebanon.
| | - M Erić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova, 3, 21000 Novi Sad, Serbia.
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Pękala PA, Henry BM, Pękala JR, Skinningsrud B, Walocha JA, Bonczar M, Tomaszewski KA. Congenital absence of the palmaris longus muscle: A meta-analysis comparing cadaveric and functional studies. J Plast Reconstr Aesthet Surg 2017; 70:1715-1724. [PMID: 28917934 DOI: 10.1016/j.bjps.2017.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/07/2017] [Accepted: 08/06/2017] [Indexed: 11/16/2022]
Abstract
The aim of our paper was to provide comprehensive data on the prevalence of absence of palmaris longus muscle (PLM) and its anatomical characteristics and conduct two separate meta-analyses comparing cadaveric and functional studies while identifying variation among different ethnic groups. An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included prevalence of absence of PLM among subjects, ethnicity, laterality, side, and gender. Our main findings revealed that the absence of PLM is more frequently reported in functional studies. Moreover, functional tests likely overestimated the absence of PLM and recommend future studies to assess the validity of functional tests and use an imaging assessment prior to excluding the use of a palmaris longus tendon graft in patients in whom a function test identified the absence of PLM.
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Affiliation(s)
- Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Bendik Skinningsrud
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Mansoor S, Siddiqui M, Mateen F, Saadat S, Khan ZH, Zahid M, Khan HH, Malik SA, Assad S. Prevalence of Obesity in Carpal Tunnel Syndrome Patients: A Cross-Sectional Survey. Cureus 2017; 9:e1519. [PMID: 28959514 PMCID: PMC5613927 DOI: 10.7759/cureus.1519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common compressive entrapment neuropathy caused by the compression of the median nerve at the wrist space known as the carpal tunnel. The epidemiologic factors related to CTS include genetic, medical, social, vocational, and demographic factors. The common symptoms experienced include pain, paresthesia, and numbness in the median nerve distribution. If left untreated, it can lead to irreversible median nerve damage, causing a loss of hand function. Body mass index (BMI) has been attributed as a risk factor for the development of CTS. We planned to determine the frequency of obesity among CTS patients in the neurophysiology department of a tertiary care center in Islamabad, Pakistan. The survey was designed as a cross-sectional descriptive study from March 2016 to August 2016 using a consecutive nonprobability sampling technique. A total of 112 patients with a mean age of 54 ± 5 years were included in the study. In the study population, 39 patients (35 percent) were males and 73 were females (65 percent). Based on BMI, 74 patients (66 percent) had a normal weight and 38 (34 percent) were obese. The frequency of obesity in our study was 34 percent, excluding the other comorbid conditions, which is quite high. Targeted therapy in those with CTS should also include weight reduction measures because obesity poses a cause-and-effect relationship for both the severity and the pathogenesis of CTS.
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Affiliation(s)
- Salman Mansoor
- Neurology, Registrar Neurology, Cork University Hospital
| | - Maimoona Siddiqui
- Consultant Neurologist, Department of Neurology, Shifa International Hospital, Islamabad, Pakistan
| | - Farrukh Mateen
- Department of Neurology, Shifa International Hospital, Islamabad, Pakistan
| | - Shoab Saadat
- Department of Nephrology, Shifa International Hospital, Islamabad, Pakistan
| | - Zarak H Khan
- Department of Medicine, Shifa College Of Medicine
| | - Mehr Zahid
- Internal Medicine, University of Lahore, Lahore, Pakistan
| | - Hamza H Khan
- Graduate, Shifa International Hospital, Islamabad, Pakistan
| | - Shuja A Malik
- Internal Medicine, Nawaz Sharif Medical College, University of Gujrat
| | - Salman Assad
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
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Shakeri Bavil A, Mirfakhraei A, Tayebi Khosroshahi H, Chokhachizadeh Moghadam R, Fouladi DF. The inability of an early post-transplantation intrarenal resistive index to predict renal allograft function at 12 weeks after engraftment in young adults. Acta Radiol 2016; 57:1402-1408. [PMID: 26013023 DOI: 10.1177/0284185115587321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The intrarenal resistive index (RI) is a promising tool for predicting renal graft outcomes. Due to the complexity of graft function and the presence of diverse contributing factors, however, the available data are inconclusive. Purpose To examine the performance of the RI 1 week after transplant in predicting allograft function at week 12, with an emphasis on the type of intrarenal artery used in the examination. Material and Methods A total of 58 first-time living-donor kidney-allograft-transplantation patients aged less than 50 years underwent Doppler ultrasonography (US) of the intrarenal arteries 1 week after engraftment. The RI was calculated for both the segmental (RI-C) and interlobar-arcuate (RI-P) arteries. Serum creatinine level and the creatinine reduction ratio (CRR) were determined at weeks 1 and 12 post transplantation. Results While the RI did not correlate with serum creatinine level and CRR at week 1, significant correlations were present between the RI and serum creatinine level (r = 0.28, P = 0.03 for both RI-C and RI-P) and CRR (r = -0.25, P = 0.05 for both RI-C and RI-P) at week 12. The sensitivity, specificity, positive predictive value, and negative predictive value of using RI-C in predicting abnormal 12-week serum creatinine level were 51.2%, 52.9%, 72.4%, and 31.3%, respectively; and 53.7%, 47.1%, 70.9%, and 29.6% for RI-P, respectively ( P > 0.99 for all comparisons). Conclusion Early post-transplantation RI correlates significantly with both serum creatinine level and creatinine reduction ratio 12 weeks after engraftment with intermediate predictive accuracy.
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Affiliation(s)
- Abolhassan Shakeri Bavil
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alirezal Mirfakhraei
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Tayebi Khosroshahi
- Department of Nephrology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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