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Ulnar claw hand usually occurs when the ulnar nerve is damaged distally. Claw hand deformity is characterized by metacarpophalangeal hyperextension and interphalangeal flexion, making it impossible to oppose the fingers and thumb. Bouvier’s test is used to guide the procedure. Palliative surgery requires prior preparation of paralytic hands. In case of a positive Bouvier's test, Zancolli’s lasso technique is preferred because of its effectiveness. Capsuloplasty with anteroposterior transosseous fixation is used if the bone is strong enough and when flexor digitorum profondus muscle is inactive and does not allow flexor digitorum superficialis tendon transfer. In case of a negative Bouvier’s test with interphalangeal extension deficit of 45 degrees of less, direct interossei muscle restoration techniques by active transfers are performed. If the interphalangeal extension deficit is more than 45 degrees, proximal interphalangeal arthrodesis is indicated. Wartenberg first described actively irreducible abduction of the little finger. Wartenberg’s sign is seen when ulnar paralysis occurs, and during ulnar nerve regeneration. Treatment of isolated Wartenberg's sign consists of re-routing the extensor digiti minimi. Among the other techniques, Belmahi's "tie lasso" is preferred when flexible claw hand is associated with Wartenberg’s sign.

We aimed to determine the surface locations of the nerve fascicles that innervate the lumbricals and interossei, re-examine the branching pattern of the deep branch of the ulnar nerve (dUN), and provide a clear description of their course. Eleven fresh-frozen adult cadaver hands were investigated. Nerve fascicles that innervate the lumbricals, interossei, and surface landmarks including the distal wrist crease and 2-5 proximal finger creases were marked by radio opaque fibers and subjected to X-ray. We analyzed the images and set a quadrant-linked hand surface. Subsequently, we measured the lengths of both axes and the coordinates of the branch locations in the quadrant. The surface locations of branches that innervated the lumbricals and interossei were clearly quantified. The branches of dUN exhibited a 4-group distribution pattern. Novel methods for quantitatively locating the surface anatomy of these branches and demonstration of a 4-group branching pattern of the dUN were established.

To compare the amplitude changes in motor evoked potentials (MEP) with reversal of residual neuromuscular blockade using sugammadex or placebo in patients with cervical myelopathy. In this prospective randomized double-blind, placebo-controlled crossover trial, 38 patients with cervical myelopathy undergoing posterior cervical decompression and fusion were randomized to either sugammadex (2mg/kg) or placebo. The primary outcome measure was the increase in amplitude of the MEP in the first dorsal interossei (FDI) muscle at 3 min. Mann-Whitney U test was used to analyze the primary outcome measure. There was a significant increase in the amplitude of MEP at 3 min with sugammadex when compared to placebo group. The median (IQR) increase in MEP amplitude (μV) at 3 min from the left FDI in sugammadex and placebo group was 652.9 (142:1650) and 20.6 (−183.5:297.5) (p

A 52-year-old gentleman presented with acute onset quadriparesis of ten days duration after a trivial fall. Both extremities had grade-2 power. Bilateral hand grip was poor with interossei weakness. The sensation was reduced below C6 with positive Lhermitte’s sign. Deep tendon reflexes were exaggerated except absent bilateral biceps jerk. The bowel and bladder had urgency and frequency. Neck movements were terminally painful. CT and MRI showed a floating bony spicule adjacent to left C5-6 facet joint encroaching the spinal canal causing cord compression. A focal left C5 hemi-laminectomy and foraminotomy were performed. A onecm floating bony spicule adjoining to left C5-6 facet joint was excised. Biopsy ruled out osteochondroma and synovial cyst. The power improved to grade-4 in both extremities with moderate grip and he became dependent ambulatory within three months of surgery. At the end of two years, he recovered almost completely with residual mild left-hand grip weakness.

This study aimed to inspect anatomical variations in the insertion of the peroneus longus tendon (PLT) using a large sample of cadavers. In total, 104 legs from 52 Japanese cadavers were used. The PLT was identified behind the lateral malleolus and carefully followed up to its insertion in the foot. All insertion slips of the PLT were located and documented. Mainly, the PLT was inserted to the base of the first metatarsal (1MT) in all 104 ft. Attachment to the medial cuneiform was present in 20.2%, and the first dorsal interossei was present in 36.5%. The anterior frenular ligament was observed in 31.7%, and attachment to the flexor digiti minimi brevis and opponens digiti minimi was present in 31.7%. The posterior frenular ligament was observed in 5.8%. An additional band was observed in 3.9%, and the adductor hallucis consisting of a caput obliquum was present in 3.9%. No statistically significant differences in the PLT were observed between genders or laterality (right vs. left). These findings suggest that the main function of the PLT is resisting the varus force on the 1MT; however, as the PLT has various attachment sites, it may also be involved in the stabilizing action of the longitudinal and transverse arches. Therefore, these variations and functions appear to be associated with a difficult diagnosis at the first clinical evaluation.

Highlights • This report describes a new electrophysiological pattern of MGA. • The mid-palm recording provides a broader view in terms of innervation of MGA. • This technique is not complicated and can be added into the investigation of MGA., Introduction Median and ulnar motor nerve conduction study recording from median-innervated 2nd lumbrical and ulnar-innervated 1st palmar and 2nd dorsal interossei is designated in electrodiagnostic evaluation of carpal tunnel syndrome. In this technique, both responses are recorded by the same surface recording electrode placing over their shared motor point in mid-palm. To the best of our knowledge, this technique has never been utilized in demonstration of Martin-Gruber anastomosis. Case reports By applying this technique to the conventional CMAP comparison method, the authors accordingly demonstrated Martin-Gruber anastomosis in four cases. Three presented with focal mononeuropathies of the upper limbs, including a severe carpal tunnel syndrome, a mild to moderate carpal tunnel syndrome, and an ulnar neuropathy. One was a normal individual. Significance This report described a new electrophysiological pattern of MGA. Adding the mid-palm recording to conventional CMAP comparison method provides a broader view in terms of innervation of MGA. This technique is not complicated and can be added to the electrophysiological investigation for complete studying of the innervated muscles in MGA.

Adhesions between lumbricales and interossei muscles are known as “saddle deformities.” Clinical diagnosis of saddle deformities of the hand requires a high index of clinical suspicion; this specific injury is often missed or remains undiagnosed using conventional X-ray or MRI techniques. Although the “gold standard” for treatment is surgical release of the adhesions, ultrasound-guided steroid injections at the site of adhesions could be considered a promising treatment option prior to surgical management and, as illustrated in this case, is shown to provide adequate pain relief and positive outcomes for the patient.

An 18-year-old woman was referred to a neuromuscular clinic for neuropathy and tremors. She had been born full-term and had mildly delayed walking at 14 months. She was a toe-walker, clumsy, and when running, had difficulty keeping up with her peers. She was diagnosed with attention-deficit/hyperactivity disorder (ADHD) at age 7 and was found to have high arches and difficulty with heel-walking. EMG and nerve conduction studies (NCS) were performed, showing demyelinating neuropathy (table e-1, [doi.org/10.5061/dryad.876r5m5][1]). With her history and EMG/NCS findings, she was diagnosed with Charcot-Marie-Tooth (CMT) disease. Symptoms progressed over the next few years, characterized by tripping, occasional falls, and continued difficulty running. She could climb stairs without the use of a handrail, but was very cautious going down the stairs. She also developed tremors in the hands (left > right), which would worsen when she approached objects. There was no loss of sensation, paresthesias, bladder or bowel problems, or hearing or visual symptoms. She graduated from high school and was accepted into college. Family history was negative for neurologic disorders. Neurologic examination showed normal mental status and cranial nerves. There were no abnormal eye movements or corticobulbar findings (no brisk jaw jerk, gag reflex, dysarthria, or pseudobulbar palsy). She had ankle contractures and pes cavus. She had mild lower limb spasticity without atrophy or fasciculations, and 5−/5 weakness of distal extremity muscles, including bilateral abductor digiti minimi, first dorsal interossei, tibialis anterior, and extensor hallucis longus. Tendon reflexes were 2+ in the upper extremities and brisk (3+) in the lower extremities; plantars were extensor. Sensation was intact to light touch, pain, temperature, and proprioception, but vibration was mildly reduced at the toes. She had cerebellar intention tremors (left > right) and mild dysmetria on finger-to-nose testing without appreciable dysdiadochokinesia. Her gait was mildly wide-based and tandem gait was impaired. [1]: https://doi.org/10.5061/dryad.876r5m5

Background Intraneural ganglion (IG) cysts have been considered curiosities and their pathogenesis remains controversial. Objective To clarify ulnar nerve at the elbow (UNE) pathogenesis and long-term surgical outcomes by presenting 9 rare cases of IG of the UNE. Methods Surgical treatment of IG was performed. Clinical symptoms, physical examinations, and electromyogram were evaluated pre- and postoperatively. At least 4 yr of follow-up was performed. Results The Tinel's sign became negative and local elbow pain disappeared in all 9 patients after surgery, and the average visual analog scale/score dropped from 4.9 (3-8) to 0 (0-0) after 6.2 d (2-10) on average. Two patients retained positive Froment test, "claw hand" and paresthesias with the 2-point discrimination much different from the contralateral little finger. Postoperative the UK Medical Research Council muscle strength score (MRC) grades of the flexor carpi ulnaris and the flexor digitorum profundus muscle of the fourth and fifth digits recovered to M4-M5 from M0-M2 in all 9 patients. The postoperative MRC grades of the third to fourth lumbrical muscles, the interossei, and the hypothenar recovered to M3-M5 from M0-M2 in 7 patients. Cystic articular branch (CAB) was found in all 9 patients intraoperatively. No symptomatic recurrence of IG was seen. The mean motor nerve conduction velocity of ulnar nerve across the elbow recovered from 5.3 to 41.2 m/s. Conclusion A unifying articular theory is responsible for the pathogenesis of IG of UNE and disconnection of the CAB would prevent recurrence. The long-term outcome is good after surgical treatment of IG of UNE.

Introduction Knowledge of anatomical variations in the origin and in the course of the dorsal metatarsal arteries (DMTAs) is valuable for many procedures, including reconstructive surgeries and flap selection. However, there is a paucity of data on these arteries among black Africans. Materials and Methods The present study studied the origin and the location of DMTAs in 30 formalin-fixed cadaveric feet of adult black Kenyans at the Department of Human Anatomy of the University of Nairobi, Nairobi, Kenya. Results Dorsal metatarsal arteries were present in all of the cases. Of the right dorsalis pedis artery (DPA), in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the 2nd to 4th DMTAs were given off as branches from the arcuate artery (AA). On the left feet, in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the rest were given off as branches from the AA. In relation to the dorsal interossei muscles, all of the the arteries were either within the muscle fibers (53%) or beneath them (47%), on the right side. On the left side, the 1st DMTA was above the muscles in 40% of the cases; within the muscles in 53%; and beneath the muscles in 7%. The 2nd and 3rd DMTAs were above the muscles in 57% and in 53% of the cases, respectively. Conclusion These results reveal that the DMTAs show variation in their origin and position relative to the dorsal interossei muscles. These variations display bilateral asymmetry.

Due to difficulty of obtaining accurate quantitative data on foot muscles, relatively little has been done to study foot muscle function in non-human apes. Gorilla feet are known to be similar in bony proportions and mechanics to those of humans, hence are key to understanding human foot evolution and its ecological context. We present the first 3D musculoskeletal computer model of a western lowland gorilla foot, giving muscle torques about the tarsometatarsal, metatarsophalangeal and interphalangeal joints of digits 2–5. Peak flexor torque around the fifth metatarsophalangeal joint occurs at a highly flexed position, suggesting an ability to maintain flexed postures around lateral metatarsophalangeal joints, useful for grasping vertical supports. For distal interphalangeal joints, flexor torques peaked the more medial the digit at relatively flexed postures. We report, for the first time, interossei acting upon proximal and distal interphalangeal joints. All these facilitate maintenance of flexed positions around distal interphalangeal joints, likely used for grasping of small supports/objects. Humans lack these features, suggesting that semi-arboreal early hominins made less use of the peripheral canopy than gorillines. Information here could be used in gorilla enclosure design to encourage wild-type locomotor repertoires in captivity.

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function. Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20min identical leap motion video games after 40min traditional occupational therapy (OT). The control group received traditional OT for 60min. Both groups received interventions 2 days a week for 4 months. A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann-Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate. We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p

We demonstrate a technique that allows an unprecedented level of dexterity in electrical muscle stimulation (EMS), i.e., it allows interactive EMS-based devices to flex the user's fingers independently of each other. EMS is a promising technique for force feedback because of its small form factor when compared to mechanical actuators. However, the current EMS approach to flexing the user's fingers (i.e., attaching electrodes to the base of the forearm, where finger muscles anchor) cannot flex one finger alone at the metacarpophalangeal (MCP) joint, they always induce unwanted actuation to adjacent fingers. To tackle the lack of dexterity, we propose a new electrode layout that places the electrodes on the back of the hand, where they stimulate the interossei/lumbricals muscles in the palm, which have never received attention with regards to EMS. We demonstrate the improved dexterity with a series of EMS-assisted music applications for playing piano, drums, and guitar.

We propose a technique that allows an unprecedented level of dexterity in electrical muscle stimulation (EMS), i.e., it allows interactive EMS-based devices to flex the user's fingers independently of each other. EMS is a promising technique for force feedback because of its small form factor when compared to mechanical actuators. However, the current EMS approach to flexing the user's fingers (i.e., attaching electrodes to the base of the forearm, where finger muscles anchor) is limited by its inability to flex a target finger's metacarpophalangeal (MCP) joint independently of the other fingers. In other words, current EMS devices cannot flex one finger alone, they always induce unwanted actuation to adjacent fingers. To tackle the lack of dexterity, we propose and validate a new electrode layout that places the electrodes on the back of the hand, where they stimulate the interossei/lumbricals muscles in the palm, which have never received attention with regards to EMS. In our user study, we found that our technique offers four key benefits when compared to existing EMS electrode layouts: our technique (1) flexes all four fingers around the MCP joint more independently; (2) has less unwanted flexion of other joints (such as the proximal interphalangeal joint); (3) is more robust to wrist rotations; and (4) reduces calibration time. Therefore, our EMS technique enables applications for interactive EMS systems that require a level of flexion dexterity not available until now. We demonstrate the improved dexterity with four example applications: three musical instrumental tutorials (piano, drum, and guitar) and a VR application that renders force feedback in individual fingers while manipulating a yo-yo.

OBJECTIVE The objective of this prospective randomized study was to compare ulnar nerve decompression and anterior subfascial transposition with versus without supercharged end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer for advanced cubital tunnel syndrome, to describe performing the nerve transfer through a small incision, and to investigate predictive factors for poor recovery following the procedure. METHODS Between January 2013 and October 2016, 93 patients were randomly allocated to a study group (n = 45) and a control group (n = 48). Patients in the study group were treated with supercharged motor nerve transfer via a 5-cm incision following decompression and anterior subfascial transposition. Patients in the control group were treated with decompression and anterior subfascial transposition alone. Postoperative pinch strength and compound muscle action potential amplitude (CMAPa) were assessed. Function of the limb was assessed based on the Gabel/Amadio scale. Between-group data were compared, and significance was set at p < 0.05. Potential risk factors were collected from demographic data and disease severity indicators. RESULTS At the final follow-up at 2 years, the results of the study group were superior to those of the control group with regard to postoperative pinch strength (75.13% ± 7.65% vs 62.11% ± 6.97%, p < 0.05); CMAPa of the first dorsal interossei (17.17 ± 5.84 mV vs 12.20 ± 4.09 mV, p < 0.01); CMAPa of abductor digiti minimi (11.57 ± 4.04 mV vs 8.43 ± 6.11 mV, p < 0.01); and excellent to good results (0.67 for the study group vs 0.35 for the control group, p < 0.05). Multivariate analysis showed that the advanced age (OR 2.98, 95% CI 2.25–4.10; p = 0.003) in the study group was related to unsatisfactory outcome in the patients. CONCLUSIONS In the treatment of advanced cubital tunnel syndrome, additional supercharged end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer may produce a better function of the hand. The authors also found that cases in the elderly were related to unsatisfactory postoperative results for these patients and that they could be informed of the possibility of worsening surgery results.

Background Magnetic resonance imaging (MRI) features are typical findings in Hirayama disease (HD) and are useful diagnostic entities but may not be present in all patients. Case presentation We present the case of a 22-year-old Nepalese man who presented with insidious onset of weakness of his right upper limb of more than 5 years duration. His weakness was progressive for the first 3 years, and then remained static. On examination, weakness of the interossei, thenar, hypothenar, flexor, and extensor muscles were present in his right upper limb, power was normal in his left upper and bilateral lower limbs. Minipolymyoclonus was present in both upper limbs, less prominent on the left side. Electrophysiological findings showed motor axonal neuropathy in his right upper limb, neurogenic discharges and fibrillations, and fasciculations in both upper limbs. Contrast magnetic resonance imaging (MRI) of his cervical spine in flexion was normal. Our patient was diagnosed with HD based on clinical and electrophysiological findings. Our patient was advised to use a cervical collar and regular physiotherapy and was found to have subjective benefit. Conclusion A normal cervical MRI does not rule out HD and the diagnosis can also be made based on clinical and electrophysiological studies. Progressive distal upper limb weakness or tremor in young patients should be evaluated for HD, because early diagnosis and intervention might halt the progression.

A 75-year-old man previously diagnosed with multiple sclerosis presented with a 20-year history of therapy-resistant progressive upper and lower limb weakness and sensory deficits. Examination found hand interossei muscle wasting, thickened radius and ulna nerves, and reduced distal lower limb strength. Neurophysiology revealed a sensorimotor polyneuropathy with demyelinating features. MRI showed hypertrophic nerves and nerve roots in the lumbosacral plexus (figure). Charcot-Marie Tooth disease (CMT) and chronic inflammatory demyelinating polyneuropathy (CIDP) are the leading causes of hypertrophic polyneuropathy. Other causes include leprosy, neurofibromatosis and amyloid deposition. In this case, genetic screening was negative for CMT, suggesting probable CIDP.

This paper presents a tendon-driven robotic finger with its inspiration derived from the human extensor mechanism. The analytical model presented relates the contractions of the intrinsic muscles of the human hand to abduction-adduction and coordinated motion of proximal and distal interphalangeal joints. The design presented is simplified from the complex webs of fibers appearing in prior works, but preserves the dual role the interossei have of abducting/adducting the finger and flexing it at the metacarpal-phalangeal joint with the finger outstretched. The anatomical feature in our design is that the proximal interphalangeal joint passes through a set of lateral bands as the finger flexes. We discovered that by including a mechanical stop that causes the lateral bands to 'fold' at large enough flexion aids coordinated movements of the two interphalangeal joints as the finger flexes. Because it involves engineering running and sliding fits, this finger admits a concise kinematic model, which accurately predicts the tendon excursions from a known pose. In this work, however, we evaluate what happens when the model is used to search for a sequence of tendon excursions corresponding to a desired movement. We perform several such sequences of tendon excursions experimentally and present the poses that result using motion capture. We also demonstrate executing several types of grasps on an underactuated robotic hand that incorporates this finger design.

Purpose Targeted muscle reinnervation (TMR) transfers cut the nerve endings to the motor nerves of the nearby muscles to reduce neuroma pain and/or enhance prosthetic function. To guide surgeons, anatomic "roadmaps" describe nerve transfer options for TMR at various locations. This study aimed to landmark and measure motor entry points (MEPs) to the hand interossei muscles in the context of TMR for digital nerve neuroma management. Methods Ten fresh-frozen cadaveric hands were dissected to describe the innervation arising from the deep branch of the ulnar nerve to the dorsal interossei (DIs) and palmar interossei (PIs) muscles. The location of MEPs relative to the bone and soft tissue landmarks and the size of the target nerves were measured. Results The MEPs for the DIs and PIs were found in the central third of the metacarpal. The MEPs to the PIs averaged 23.3-24.7 mm from the median nerve. The length of nerve proximal to the MEP was limited, ranging between 6.5 ± 2.6 mm for the first PI and 10.5 ± 2.7 mm for the second PI. Similarly, minimal nerve proximal to the MEP of the DI was available for mobilization. Access to the first PI innervation required substantial release of the thenar musculature. Motor nerve diameter averaged 0.85-0.97 mm. Conclusions In considering TMR for the management or prevention of digital nerve neuromas, the motor branches to the second and third PIs are the most accessible and best approached volarly, whereas motor branches to the DIs take more direct routes into the muscle, making volar exposure difficult. Nerve length proximal to the MEP is short, requiring that most of the nerve length for neurorrhaphy comes from the digital nerve. Size mismatch at the neurorrhaphy site is favorable compared to more proximal TMR. Clinical relevance Targeted muscle reinnervation in the hand is technically feasible for a patient with a symptomatic neuroma after digital amputation.

A 15-year-old boy presented with progressive left to bilateral hand weakness and cold paresis over 1 year. Examination revealed atrophy of upper limb musculature, especially bilateral dorsal interossei muscle. Neutral MRI showed cord thinning and intramedullary hyperintensity at C5–C7 levels. Neck flexion MRI demonstrated bilaterally symmetric spinal cord compression due to dural sac anterior shifting (figure), suggestive of Hirayama disease (HD). HD mimics amyotrophic lateral sclerosis–like symptoms and features an expansion of the dural sac on neck flexion MRI.1 The majority of HD is unilateral or asymmetric but bilateral symmetric involvement is reported in 10% of patients and indicates more severe affliction.2

Background and Purpose: The purpose of the study is to determine whether the clinical profile of patients with carpal tunnel syndrome (CTS) has been same over the years with the help of routine and comparative electrodiagnostic tests. Methods: A prospective study of 100 patients with suspected CTS was conducted without controls. Three provocative maneuvers were performed. Routine and comparison nerve conduction tests were performed, i.e., second lumbrical interossei motor latency difference (2 LIMLD), digit 4 median-ulnar sensory latency difference (D4MUSLD), palm wrist distal sensory latency difference (PWDSLD), and digit 1 median-radial sensory latency difference (D1MRSLD). Data entry, analysis, and statistical evaluation were done using International Business Machines Corporation Statistical Package for the Social Sciences statistics package (IBM, SPSS). Results: A total of 195 hands of 100 patients met the criteria for CTS. Forty-three percentage of patients were homemakers. Considering the rapidly changing communication technology, we observed 84% patients had aggravation of symptoms with continuous long-term daily mobile phone use (>30 min per session per day). We noted positive Tinel's sign in only 25%. Phalen's sign was positive in 53 right hands with mean duration of 11.49s (standard deviation [SD] ± 2.54 s) and was positive in 26 left hands with mean being 10.4 s (SD ± 1.91 s). The mean motor distal latency of median was 4.67 ms (SD ± 1.71 ms) and mean sensory distal latency of median was 3.24 ms (SD ± 1 ms). On internal comparison testing, mean difference in 2 LIMLD was 0.7 ± 0.3 ms, in D4MUSLD was 0.81 ± 0.32, in PWDSLD was 0.71 ± 0.20, and in D1MRSLD was 0.76 ± 0.32. Conclusion: Further analysis of clinical profile needs to be done, and new risk or provoking factors should be analyzed in patients with CTS.

In Brazil, there are two species of tapirs, the largest land mammals in Brazil, which belong to the order Perissodactyla, as do horses. Our aim was to describe the bone and muscular anatomy of the forearm and hand in T. terrestris and to propose adaptive functions. We used five anatomical specimens donated from a breeder to the Laboratory for Teaching and Research on Wild Animals of the Federal University of Uberlandia after death with no trauma. The bones were analyzed, the muscles dissected, and both described. The bones of the forearm and hand of the tapir are the ulna, radius, Os. metacarpalia, Os. carpi, phalanx and Os. sesamoideum. The muscles are M. extensor carpi radialis, M. ulnaris lateralis; M. flexor carpi radialis; M. extensor radialis communis; M. extensor digitorum longus II, III, IV and V, M. extensor digitorum lateralis; M. extensor digitorum; M. abductor longus; M. flexor digiti superficialis; M. flexor digitalis; M. flexor carpi ulnaris; M. flexor carpi obliquus; and M. interossei and M. lumbricales. Characteristics of bone and muscle structure are adapted to the development of the animal’s niche. Existem duas espécies de anta brasileira, os maiores mamíferos terrestres do Brasil, as quais pertencem à ordem dos Perissodactyla, assim como os equinos. Objetivou-se descrever a anatomia óssea e muscular do antebraço e mão de Tapirus terrestris e fazer considerações adaptativas. Foram utilizadas cinco peças anatômicas doadas por um criadouro ao Laboratório de Ensino e Pesquisa em Animais Silvestres da Universidade Federal de Uberlândia (LAPAS-UFU), após óbito sem traumas. Os ossos foram analisados, os músculos dissecados, e ambos descritos. Os ossos que constituem o esqueleto do antebraço e mão da anta são a ulna, rádio, metacarpos, carpos, falanges e sesamoides. Os músculos são: M. extensor carpo radial, M. ulnar lateral, M. flexor carpo radial, M. extensor radial comum, M. extensor longo dos dedos II, III, IV e V, M. extensor digital lateral, M. abdutor longo, M. flexor digital superficial, M. flexor digital profundo, M. flexor carpo ulnar, M. flexor oblíquo do carpo, M. interósseos e M. lumbricais. Os acidentes ósseos e a estrutura muscular estão adaptados para o desenvolvimento do nicho do animal.

Purpose To assess the efficacy of nerve transfer versus nerve grafting in restoring motor and sensory hand function in patients with complete, isolated high ulnar nerve injuries. Methods A retrospective chart review was performed, at a minimum 2 years of follow-up, of 52 patients suffering complete, isolated high ulnar nerve injury between January 2006 and June 2013 in one specialized hand surgery unit. Twenty-four patients underwent motor and sensory nerve transfers (NT group). Twenty-eight patients underwent sural nerve grafting (NG group). Motor recovery, return of sensibility and complications were examined as outcome measures. The Medical Research Council scale was applied to evaluate sensory and motor recovery. Grip and pinch strengths of the hand were measured. Results Twenty of 24 patients (83.33%) in the NT group regained M3 grade or greater for the adductor pollicis, the abductor digiti minimi, and the medial 2 lumbricals and interossei, compared with only 16 of 28 patients (57.14%) in the NG group. Means for percentage recovery of grip strengths compared with the other healthy hand were significantly higher for the NT group than the NG group. Sensory recovery of S3 or greater was achieved in more than half of each group with no significant difference between groups. Conclusions Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand. Type of study/level of evidence Therapeutic IV.

Intensive use of the thumbs for text entry on smartphones may contribute to discomfort, pain, or musculoskeletal disorders. This study investigated the effect of twenty-five button positions (5 rows × 5 columns) on a soft keyboard for two-thumb entry. Two experiments measured muscle activity, touch time, and discomfort as a function of the button positions. In Phase I, the muscle activities of two intrinsic (abductor pollicis brevis and first dorsal interossei) and two extrinsic (abductor pollicis longus and extensor digitorum communis) muscles associated with thumb motions were observed for ten college students (age: 24.2). In Phase II, touch time and discomfort were measured for 40 college students (age: 23.6). The results demonstrated that the %MVCs of the intrinsic muscles significantly increased when the thumbs flexed and abducted. Also, the button positions near the rest positions of the thumbs resulted in significantly shorter touch times (0.66 s) and lower discomfort ratings (0.70 pt) than their peripheral buttons (0.76 s; 2.29 pt).

A 63-year-old woman presented with marked, progressive worsening of lower extremity spasticity and decreased upper extremity strength. In 1980, she developed lower extremity paresthesias and was found to have an intramedullary hemorrhagic lesion at T3. She underwent a laminectomy at T1–T4 and partial resection of a cavernous malformation (CM). Apart from a single, transient worsening of lower extremity sensory symptoms in 1985 (due to CM rebleeding), she did not experience any further exacerbations. At the time of evaluation at our institution, she had noticed worsening leg spasms and difficulty with her gait, as well as decreased muscle bulk, most pronounced in the quadriceps. These symptoms had developed over several months. She also reported worsening strength and endurance in the upper extremities, difficulties with fine motor movements, and dysphagia. She did not report new sensory deficits in her upper extremities or bowel or bladder dysfunction. On examination, she had a spastic gait but was able to walk with a cane. She had mild weakness, Medical Research Council grade 4, in the lower extremities and normal strength in the upper extremities, except for mild weakness, about 4/5 strength, in finger and wrist extension, in the interossei, and proximally. She had 3+ patellar and ankle reflexes, normal reflexes in the upper extremities, and extensor plantar responses bilaterally. Jaw jerk was not assessed. She had marked spasticity in the lower extremities with normal tone in the upper extremities. She had a T5 sensory level to temperature.

We propose a framework based on high-density surface electromyography (HD-sEMG) to identify the neural drive to muscles controlling the human hand. High-density (320 channels) sEMG signals were recorded concurrently from intrinsic (the four dorsal interossei and thenar) and extrinsic (forearm) hand muscles and then decomposed into the constituent trains of motor unit (MU) action potentials. The participants performed pinch tasks with simultaneous activation of the thumb and one of the other fingers with sinusoidal force variations. The common drive among MUs across different muscles was extracted via principal component analysis (PCA) of the smoothed MU discharge rates. The first principal component of the smoothed discharge rates of all identified motor neurons explained 48.7 ± 15.4% of the total variance across all pinching tasks, indicating a common neural input shared by different muscles of the forearm and the hand.. When considering only the MUs extracted from extrinsic and intrinsic muscles, the percent of variance explained was 48.3 ± 15.3% and 57.1 ± 15.5%, respectively. This framework is conceived to use motor neuron activity for a proportional myoelectric control and rehabilitation technologies. A wearable adaptation of the framework is proposed for future perspectives.

A man in his late 40s presented to his general practitioner with a history of skin changes and two lumps in his left hand, which had been present for several years. He thought the symptoms were from repeated trauma after carrying heavy buckets as part of his job. The nodular lumps had recently increased in size. In the months before referral, the patient began to experience a severe burning sensation in the nodules in his hand, which interrupted his sleep. Examination of the hand revealed an area of skin tethering with a palpable thickening deep to it in the palm over the hypothenar eminence (fig 1, fig 2). Two small erythematous lumps were found, one proximal to the main lesion at the wrist crease and another on the ulnar border of the hypothenar eminence. In addition, the patient had numbness over the ulnar border of the hand, little finger, and half of the ring finger, and weakness in the intrinsic muscles of the hand (palmar and dorsal interossei). He …

OBJECTIVE : To investigate the presence of trigger points (TrPs) in feet musculature and topographical pressure sensitivity maps of the feet as well as the relationship between TrPs, pressure pain maps, and clinical variables in women with fibromyalgia (FMS). METHODS : Fifty-one FMS women and 24 comparable healthy women participated. TrPs within the flexor hallucis brevis, adductor hallucis, dorsal interossei, extensor digitorum brevis, and quadratus plantae, as well as external and internal gastrocnemius, were explored. Pressure pain thresholds (PPTs) were assessed in a blind manner over seven locations on each foot. Topographical pressure sensitivity maps of the plantar region were generated using the averaged PPT of each location. RESULTS : The prevalence rate of foot pain was 63% (n = 32). The number of active TrPs for each FMS woman with foot pain was 5 ± 1.5 without any latent TrPs. Women with FMS without foot pain and healthy controls had only latent TrPs (2.2 ± 0.8 and 1.5 ± 1.3, respectively). Active TrPs in the flexor hallucis brevis and adductor hallucis muscles were the most prevalent. Topographical pressure pain sensitivity maps revealed that FMS women with foot pain had lower PPT than FMS women without pain and healthy controls, and higher PPT on the calcaneus bone (P < 0.001). CONCLUSIONS : The presence of foot pain in women with FMS is high. The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in these patients. FMS women suffering foot pain showed higher pressure hypersensitivity in the plantar region than those FMS women without pain.

PURPOSE This study is to determine the diagnostic utility of optimal recording electrode placement for distal latency comparison of median-second lumbrical and ulnar-interossei/third lumbrical (M2L-UI3L) in carpal tunnel syndrome. METHODS Sixty-five hands of control and 75 hands of 62 clinically suspected carpal tunnel syndromes were used for the M2L-UI3L and standard conduction studies. To obtain optimal M2L-UI3L, the recording active electrode (E1) was placed at the midpalm over the third metacarpal bone, whereas the reference electrode (E2) was attached to the palmar digital crease area. Then, median and ulnar nerves were stimulated on the wrist each at 8 cm proximal to E1. M2L-UI3L and standard nerve conduction studies were performed. Sensitivity and specificity of M2L-UI3L were measured in the diagnosis of mild carpal tunnel syndrome. RESULTS For statistical analysis, the receiver operating characteristics and Student t-test were used. The area under the receiver operating characteristic curve of M2L-UI3L was 0.993. Diagnostic cutoff value of M2L-UI3L greater than 0.6 milliseconds yields sensitivity of 93% and specificity of 97%. The distal median motor latency to the second lumbrical alone showed the area under the curve of 0.998, and the diagnostic cutoff value greater than 3.4 milliseconds yields sensitivity of 96% and specificity of 100%. CONCLUSIONS This technique for M2L-UI3L shows high sensitivity and specificity compared with the previous reports on the diagnosis of carpal tunnel syndrome. Furthermore, the values of median-second lumbrical motor latency alone have higher sensitivity and specificity, comparable with the median sensory conduction study across the wrist segment.

Background The aims of this study were to elucidate why the cephalic vein provides a reliable cannulation site from a morphological viewpoint and identify an effective landmark for avoiding injury to the superficial branch of the radial nerve (SBRN), allowing for safe venipuncture of the cephalic vein. Findings We examined 32 forearms and wrists from 18 cadavers. The cephalic vein was a constant structure containing a branch communicating with a collateral vein of the deep palmar arch via the first dorsal interossei muscle. The metacarpal vein from the medial two digits flowed into the cephalic vein. The venous confluence formed 5.8 ± 1.2 cm proximal to the radial styloid process. The SBRN passed 0.4 ± 0.3 cm volar to the venous confluence. The distance between the venous confluence and subcutaneous emergence of the SBRN was 2.6 ± 1.0 cm. Conclusions These observations suggest that the cephalic vein is a constant structure that serves as a drainage vein of the hand and provides a reliable cannulation site in the forearm. The venous confluence may serve as a novel landmark to predict the running course of the SBRN.

Objectives To provide musculoskeletal ultrasound (MSKUS) images of hand anatomy in the position of hemiparetic flexion as a reference for spasticity injections. After a stroke, spasticity can result in anatomic distortion of the hand. Spasticity may require treatment with botulinum toxin or phenol injections. Anatomic distortion may decrease the accuracy of injections. Standard anatomic references are of limited utility because they are not in this spastic hemiparetic position. There presently is no anatomic reference in the literature for these spastic postures. This study is part three of a series examining torsional anatomy of the body. Design Ultrasound (US) images were obtained in a healthy subject. The muscles examined included the lumbricals and the flexor pollicis brevis. A marker dot was placed at each dorsal and palmar anatomic injection site for these muscles. The US probe was placed on these dots to obtain a cross-sectional view. A pair of US images was recorded with and without power Doppler imaging: the first in anatomic neutral and second in hemiparetic spastic positions. In addition, a video recording of the movement of the muscles during this rotation was made at each site. Results On the palmar view, the lumbricals rotated medially. On dorsal view, the lumbricals can be seen deep to the dorsal interossei muscles, with spastic position, and they become difficult to identify. The flexor pollicis brevis (FPB) muscle contracts with torsion, making abductor pollicis brevis (APB) predominately in view. Discussion The anatomic location of the lumbrical muscles makes them difficult to inject even with ultrasound guidance. However, recognizing the nearby digital vasculature allows for improved identification of the musculature for injection purposes. The FPB muscle also can be identified by its adjacent radial artery lateral to the flexor pollicus longus tendon. Conclusion Normal anatomy of hand can become distorted in spastic hemiparesis. Diagnostic ultrasound is able to discern these anatomic locations if the sonographer is competent in recognizing the appearance of normal anatomy and is skilled in resolving the visual changes that occur in spastic hemiparesis. The authors hope this series of images will increase the accuracy, safety, and efficacy of spasticity injections in the hand.

The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits (α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits (α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China (approval No. DF-187) in January 2016.

Background Tenosynovitis (TSV) occurs in individuals at-risk of developing RA and could explain pain and stiffness in the absence of synovitis. TSV of the wrist and finger flexor tendons has been described in at-risk individuals but involvement of other hand tendons has not been well investigated. The hand interossei are crucial to hand function and can become inflamed in RA(. 1 Whether the interosseous tendons (IT) are sites of inflammation in at-risk individuals, and how this relates to joint inflammation and clinical features is unknown. Objectives To describe the anatomy, prevalence, pattern and clinical associations of IT inflammation in anti-CCP positive at-risk individuals. Methods Anti-CCP positive individuals with no synovitis (CCP+), healthy controls (HC), DMARD-naive early RA patients (ERA) and treated ‘late’ RA patients (LRA) were recruited. All subjects underwent clinical and MRI assessment. 1.5T or 3T unilateral hand MRI scans were consensus scored for RAMRIS, TSV and IT inflammation by two radiologists. IT inflammation was defined as enhancing tissue around the tendon evident in two planes. For RAMRIS and tenosynovitis, scores were adjusted for 193 age-matched controls(. 2 To understand the anatomical basis for MRI IT inflammation, a cadaveric study was performed on 20 fresh hand specimens; coloured dyes were injected along the first dorsal IT and into the adjacent second MCP joint and specimens were frozen and sectioned. Results 93 CCP+, 20 HC, 47 ERA and 28 LRA were recruited. Frequency of swollen and tender joints, MRI inflammation (synovitis, BME, erosions, TSV) and CRP level increased along the RA continuum with increasing disease duration. The proportion of patients with IT inflammation increased along the RA continuum. No HC, 18/93 (19%) CCP+, 23/47 (49%) ERA and 16/28 (57%) LRA patients had inflammation of ≥1 IT (p Conclusions IT inflammation represents a peri-tendonitis and is present in anti-CCP +at risk individuals and RA patients where it is associated with MCPJ swelling and tenderness. IT inflammation can occur as the lone MRI abnormality in CCP +at risk individuals suggesting the interossei may be an early extra-capsular target in the development of RA. References [1] Rowbotham, et al. Eur Radiol2015. [2] Mangnus, et al. Arthritis Rheum2016. Acknowledgements D Glinatsi, M Ostergaard, P Bird Disclosure of Interest None declared

Rationale: Cubital tunnel syndrome has been recognized as a common pathology in rheumatoid arthritis (RA) of the elbow. We encountered a patient with RA of the elbow showing attrition rupture of the ulnar nerve. This pathology is extremely rare, and we discussed preventive measures for similar cases in the future based on our case. Patient concerns: A 53-year-old woman, received drug treatment for RA since 30 years earlier, had numbness in the left ulnar nerve territory, dorsal interossei muscle atrophy, and resulting claw hand. Diagnoses: Plain x-ray examination showed bone destruction of the left elbow joint and marked osteophyte formation in the medial joint space. In nerve conduction velocity (NCV) tests, the Motor NCV was immeasurable in the ulnar nerve territory. Based on these findings, a diagnosis of left cubital tunnel syndrome was made, and anterior transposition of the ulnar nerve was planned. Interventions: When the ulnar nerve dissection was advanced, about 80% portion of the ulnar nerve was ruptured. After the ends of the divided nerve were freshened, end-to-end anastomosis was possible by anterior transposition of the ulnar nerve. Outcomes: Two years after the operation, numbness and muscle atrophy also remained. There were no changes in the level of daily activities after the operation. However, motor NCV, showed improvement (22.8 m/s) after the operation. Lessons: In patients with RA showing ulnar neuropathy symptoms, marked osteophyte formation in the medial joint space or valgus deformity may indicate attrition nerve rupture. In the future, when such patients with RA are examined, active nerve exposure and dissection should be considered in terms of ulnar nerve protection.

Skin auto-fluorescence (SAF) has generated broad interest about the prospects for non-invasive advanced glycation end product assessment and its direct interplay with the development of microvascular complications, but clinical application of the existing SAF measuring of non-palmoplantar sites in non-Caucasian subjects with dark skin type is still controversial. Here, we tested the diabetic complication screening performance of a novel SAF measuring system in Asian type 2 diabetes mellitus (T2DM) subjects. A total of 166 Korean patients with T2DM were enrolled in this study and palmoplantar SAF was measured by a newly developed transmission-geometry noninvasive optical system. We found that transmitted SAF values of palmoplantar sites, 1st dorsal interossei muscles of the hand, in a complication group were significantly higher than in a non-complication group while no differences were observed between the two groups in reflected SAF of non-palmoplantar sites. The transmitted SAF values of palmoplantar sites were dramatically increased in subjects with multiple complications and were tightly correlated with the duration of microvascular complications. In conclusion, the SAF measurement in the palmoplantar sites with a non-invasive transmission-geometry optical system provided better microvascular complication screening performance compared to the SAF measurement of non-palmoplantar sites specifically in Asian T2DM subjects.

Objectives The dorsal interossei of the human foot are arranged so that they abduct the digits around the second digit, while those of non-hominoid anthropoid primates are mostly arranged around the third or fourth digit. This is thought to relate to the medial shift in the functional axis, an essential modification in the evolution of the human foot. However, studies of the arrangement of interosseous muscles are relatively limited and there is some debate about their arrangement in great apes. In particular, some researchers claim that the interossei of chimpanzees are arranged around the second digit, whereas others claim that their foot axis lies on the third digit. Materials and methods We examined the arrangement of the foot interosseous muscles in ten chimpanzees, one bonobo, and three gorillas. Results The interossei were arranged around the second digit in two chimpanzees, one bonobo, and one gorilla, whereas the third digit was the axis in the other specimens. Discussions The variation observed suggests that the arrangement of the interosseous muscles of the great apes is in a transitional condition from monkey-type to human-type. Considering that osteological and foot pressure research supports the idea that the foot axis is on the second digit in great apes, modification in the interosseous muscles appears to lag behind modification in the metatarsals and foot motion.

Background Camptodactyly is common, but its treatment remains controversial. Multiple deforming forces have been implicated in its pathogenesis. This study evaluates a logical clinical assessment and corresponding stepwise surgical plan. Methods Eighteen consecutive fingers (12 children) had surgery to treat camptodactyly of the proximal interphalangeal joint at a mean age of 8 years (range, 9 months to 15 years). The little (n = 13), ring (n = 2), and middle fingers (n = 3) were involved. Mean preoperative flexion contracture was 57 degrees (range, 35 to 75 degrees). All digits had moderate to severe contracture with functional impairment and were offered surgery. Preoperative and postoperative active range of motion was recorded. The sequential treatment steps correspond to the clinical examination and potentially involve volar skin release with flap, fascial release, flexor digitorum superficialis tenotomy, sliding volar plate release, extension lag correction, and Fowler extensor tenotomy. Results Mean postoperative flexion contracture resolved to 3 degrees (range, 0 to 25 degrees) at a mean follow-up of 11 months (range, 3 to 32 months). Mean proximal interphalangeal joint flexion was 88 degrees (range, 50 to 100 degrees). Fifteen of 18 fingers achieved full active proximal interphalangeal joint extension. The remaining digits had residual contractures of 5, 20, and 25 degrees. All digits had soft-tissue release with flap and flexor digitorum superficialis tenotomy, 16 had volar plate release, two had intrinsic transfers, and three had Fowler tenotomy release performed. Conclusions This stepwise surgical approach effectively treats severe camptodactyly and appears to confirm the authors' suspected pathogenesis of the disorder. Lumbricals and interossei were not involved. Clinical question/level of evidence Therapeutic, IV.

Dear Sirs, Monomelic amyotrophy refers to conditions characterized by motor defect limited to a small number of myotomes, usually in one upper limb, with weakness and atrophy of distal muscles and clinically distinguished from degenerative motor neuron diseases [1, 2]. Characteristics are onset in the early 20s, male preponderance, insidious weakness of hand and forearm muscles, mainly in C7–T1 distribution, no sensory, sphincteric or cranial involvement [1, 3]. Progression is slow and generally self-limiting. Neuroimaging of the spinal cord can be normal or reveal focal unilateral atrophy and, on occasion, T2-weighted hyperintense lesions. Loss of attachment of the posterior dural sac to the lamina, leading to a dural forward displacement with flexion of the neck, is especially distinctive of Hirayama disease [2]. We present here a 46-year-old man displaying monomelic amyotrophy associated with cervical myelopathy caused by direct compression of anterior horns due to displacement of anterior dural sac induced by neck flexion. A 46-year-old, right-handed, man presented at the age of 45 with atrophy and weakness of right biceps and triceps brachii and pectoral muscles with progression over the months and then substantial stability. Neurological evaluation at 46 years showed moderate inferior trapezius, deltoid, triceps, biceps, pectoral major, rhomboid, infraspinatus and mild dorsal hand interossei muscle weakness. Right winged scapula was present. Remaining examination was normal, in particular no pyramidal or sensory abnormalities were detected. Motor and sensory conduction studies were normal; needle electromyography revealed acute/chronic denervation in C5–C6 innervated muscles and mild chronic denervation in C7 innervated muscles on the right arm. Motor evoked potentials (MEPs) study in the neck-flexed position revealed a slight reduction of amplitude from cortical stimulation, mildly predominant on the right side (Fig. 1). Somatosensory evoked potentials were normal both in basal and sensitized condition. Spine MRI revealed T2-weighted abnormal signal hyperintensity in right anterior horn and atrophy of ipsilateral spinal cord at C3–C5 level. A mild anterior epidural space enlargement was detected between C2–C4 level, more pronounced in neck-flexed position (Fig. 2). Brain and remaining cord MRI was normal. Assessment 16 months later showed a slight improvement of the muscle weakness and no modification of neurophysiological and MRI findings. Hence, the patient refused any surgery. Our case of middle-aged man with right arm amyotrophy shares several characteristics with the Hirayama disease, although with some peculiarities. In agreement with Hirayama disease, the patient presented with slowly progressive weakness and atrophy confined to one upper limb [4]. In contrast to Hirayama disease, age of onset in our patient was later than usual and clinical picture was & Laura Brambilla laura.brambilla@istituto-besta.it

The structure of the limbs of elephants is unusual among mammals. In African elephants (Loxodonta africana, Blumenbach 1797), the front limbs serve to support the greatest part of the body mass of the largest land animal. In this study, we present new and detailed anatomical data regarding muscular and specific fascial structures of the lower front limb which were examined by means of standard anatomical and histological techniques. The muscles and tendons of the forearm (antebrachium) and hand (manus) are tightly surrounded by thick, highly elastic fascial layers which fuse with the lacertus (lac.) fibrosus and the so-called ligamentum (lig.) humeroulnare. A well-developed musculus (m.) brachioradialis occupies the proximolateral aspect of the forearm and its tendon inserts together with the lac. fibrosus on the os carpi intermedium. The lac. fibrosus, the lig. humeroulnare and the m. flexor carpi radialis reveal a large proportion of elastic fibres. These three structures may play an important role in storing strain energy thus promoting energy-saving locomotion. On the palmar aspect of the carpus, metacarpus and digits, short flexor, abductor, adductor, lumbricales and interossei muscles are present, whereas supinator muscles are absent in all specimens. The short muscles of the hand together with specific dorsal tendons enable precise movements of specific toes.

This study was to assess the motor-cortex integrity and reaction time of the upper limb in patients early after stroke after CPPS approach with Theta Burst Stimulation (TBS) an repetitive Trans-cranial Magnetic Stimulation (TMS) paradigm and Neuromuscular Electrical Stimulation (NMES).Ten patients and ten age matched controls underwent three experimental sessions in three consecutive weeks. First-week W1 (TBS) with TBS alone, second-week W2 (NMES) with NMES alone and third-week W3 (TBS + NMES) with both TBS and NMES given sequentially. Cortical excitability was assessed with single pulse TMS stimulator before and immediately after the three interventions for Resting Motor Threshold (RMT) from the ipsilesional and contralesional hemisphere in the corresponding first dorsal interossei muscle of the ipsilateral and contralateral hand. Post intervention functional assessment was done with 9 Hole Peg Test (9PHT) for change in reaction time (RT) for both ipsilataral and contralateral hand.All the three interventions showed significant improvement from the baseline, however W3 (TBS + NMES) showed significantly greater improvement when compared to other interventions in RMT and 9 HPT.CPPS with TBS and NMES showed synergistic effect in both electrophysiological and clinical assessment. A combined approach (CPPS) may be more effective for post-stroke motor rehabilitation.

© The Author(s) 2017. An accurate measurement of intrinsic hand muscle strength (IHMS) is required by clinicians for effective clinical decision-making, diagnosis of certain diseases, and evaluation of the outcome of treatment. In practice, the clinicians use Intrins-o-meter and Rotterdam Intrinsic Hand Myometer for IHMS measurement. These are quite bulky, expensive, and possess poor interobserver reliability (37–52%) and sensitivity. The purpose of this study was to develop an alternative lightweight, accurate, cost-effective force measurement device with a simple electronic circuit and test its suitability for IHMS measurement. The device was constructed with ketjenblack/deproteinized natural rubber sensor, 1-MΩ potential divider, and Arduino Uno through the custom-written software. Then, the device was calibrated and tested for accuracy and repeatability within the force range of finger muscles (100 N). The 95% limit of agreement in accuracy from −1.95 N to 2.06 N for 10 to 100 N applied load and repeatability coefficient of ±1.91 N or 6.2% was achieved. Furthermore, the expenditure for the device construction was around US$ 53. For a practical demonstration, the device was tested among 16 participants for isometric strength measurement of the ulnar abductor and dorsal interossei. The results revealed that the performance of the device was suitable for IHMS measurement.

Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis. Before surgery, it was impossible to detect an independent signal for each interossei; however, after the surgery, signals were reliably detected, which allowed these muscles to serve as myosites for finger flexion using a myoelectric prosthesis and move each digit independently. This concept of salvaging innervated and perfused muscles from an amputated part and transferring them into the more proximal and superficial portion of a salvaged limb has broad applications for improved myoelectric prosthetic control.

Objective To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals. Methods Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of “Group”. Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed. Results There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks. Conclusion A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects.

This work describes a model which is able to simulate the surface electromyography (sEMG) of different muscles. The model assumes that each muscle is controlled by many motor units (MU). Therefore, the motor unit action potential (MUAP) can be mathematically formulated as the spatiotemporal sum of divers potential actions produced by its fiber muscles. We evaluate the sEMG of four different muscles: soleus, tibialis anterior, dorsal interossei and platysma muscles.

In this chapter we describe the upper limb musculature musculature of the bonobos dissected by us and by other previous authors, and compare it with that of common chimpanzees. The three major differences between the two chimpanzee species are: (1) the intermetacarpales and flexores breves profundi muscles in the hand of bonobos usually fuse to form dorsal interossei, a shared feature with modern humans; (2) bonobos usually have a stout tendon of the flexor digitorum profundus attaching to digit 1 (in modern humans the homologous tendon of the flexor pollicis longus to digit 1 is usually also stout; and (3) bonobos usually have an attachment between the pectoralis minor and the coracoid process of the scapula, as modern humans usually do.

Introduction/Background Diabetes mellitus is the most common metabolic disease. The carpal tunnel syndrome (CTS) occurs frequently in this disease. In diabetes mellitus due to effects of generalized neuropathy on peripheral nerves, the diagnosis of CTS with conventional EDX criteria (onset latency of median SNAP or distal latency of median CMAP) is challenged, so another methods such as 2nd lumbrical-interossei test is used. On the other hand Inching method is a technique in which used for diagnosis and determining the site of compression in carpal tunnel. The purpose of the present study is to evaluate diagnostic value of the inching method and 2nd lumbrical-interossei test in patients with diabetic peripheral neuropathy and signs or symptoms of carpal tunnel syndrome. Material and method Thirty hands with history of diabetes mellitus and signs and symptoms of CTS that confirmed diagnosis of peripheral neuropathy with conventional electro-diagnosis were evaluated. Then for diagnosis of CTS, sensory and motor median distal latencies were measured by nerve conduction study. In the next step, inching method and second lumbrical-interossei test was performed for all hands and sensitivity and specificity of two tests was calculated. Results Mean age of participants was 53.87 ± 11.53 years (range 26 to 70 years). Ten participants were female and 6 participants were male. The sensitivity and specificity of inching method in this study were 95.65 and 85.71, respectively and the results for second lumbrica-interossei test 73.91 and 71.42 were calculated. Conclusion In this study, we showed the inching method is more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS in diabetic peripheral neuropathy with sensitivity and specificity 95.65 and 85.71, respectively and also the sensitivity of inching method was greater than specificity.