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Kurumadani H, Kurauchi K, Date S, Ishii Y, Sunagawa T. Effect of the position of the interphalangeal joint on movements of the trapeziometacarpal joint during thumb opposition. J Hand Surg Eur Vol 2022; 47:495-500. [PMID: 35001677 DOI: 10.1177/17531934211065879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Kapandji test is a simple method to score thumb opposition; however, the position of the interphalangeal joint of the thumb during this test has not been described. We aimed to quantitatively examine the effect of the thumb interphalangeal joint position on movements of the trapeziometacarpal joint during thumb opposition using the Kapandji test. The Kapandji test was carried out in 20 healthy participants during thumb interphalangeal joint extension and flexion. Movements of the joints and the activity of thenar muscles were recorded using motion capture and electromyography, respectively. We found that interphalangeal joint extension increased the trapeziometacarpal joint movement and thenar muscle activity compared with interphalangeal joint flexion, which contributed to thumb opposition at Kapandji Positions 0-6. These findings suggest the position of the thumb interphalangeal joint affects the trapeziometacarpal joint during thumb opposition, and assessment of thumb opposition using the Kapandji test is best done with the thumb interphalangeal joint in extension.
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Affiliation(s)
- Hiroshi Kurumadani
- Analysis and Control of Upper Extremity Function, Hiroshima University, Hiroshima, Japan
| | - Kazuya Kurauchi
- Analysis and Control of Upper Extremity Function, Hiroshima University, Hiroshima, Japan
| | - Shota Date
- Analysis and Control of Upper Extremity Function, Hiroshima University, Hiroshima, Japan
| | - Yosuke Ishii
- Department of Biomechanics, Hiroshima University, Hiroshima, Japan
| | - Toru Sunagawa
- Analysis and Control of Upper Extremity Function, Hiroshima University, Hiroshima, Japan
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Fontaine C, D'Agostino P, Maes-Clavier C, Boutan M, Sturbois-Nachef N. Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints. HAND SURGERY & REHABILITATION 2021; 40S:S3-S14. [PMID: 34118467 DOI: 10.1016/j.hansur.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 10/21/2022]
Abstract
Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.
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Affiliation(s)
- C Fontaine
- Laboratoire d'Anatomie et Organogenèse, Faculté de Médecine Henri Warembourg, Université de Lille, Rue Michel Polonovski, 59045 Lille cedex, France; Laboratoire d'Automatique, de Mécanique et d'Informatique Industrielle et Humaine LAMIH, Université de Valenciennes et du Hainaut-Cambrésis, Le Mont Houy, 59313 Valenciennes cedex, France; Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France.
| | - P D'Agostino
- Clinique de la Main, Bruxelles et Brabant-Wallon, Avenue Louise 284, 1050 Bruxelles, Belgique
| | - C Maes-Clavier
- Service de Chirurgie Orthopédique et Traumatologique, CHU Amiens-Picardie, Site sud Route départementale 408, 80054 Amiens cedex 1, France
| | - M Boutan
- Résidence Dryades, Bâtiment A1, 1, rue du 11 novembre, 40990 Saint-Paul-les-Dax, France
| | - N Sturbois-Nachef
- Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France
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3
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Loss J, Li ZM. Biometry of thenar muscle origins on the flexor retinaculum. Clin Anat 2020; 33:1176-1180. [PMID: 31894884 DOI: 10.1002/ca.23558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/22/2019] [Accepted: 12/28/2019] [Indexed: 11/09/2022]
Abstract
The transverse carpal ligament (TCL), the main part of the flexor retinaculum, serves as an anchor for the thenar muscles: abductor pollicis brevis (APB), superficial head of the flexor pollicis brevis (sFPB), and opponens pollicis (OPP). Biomechanically, the thenar muscles rely on their TCL anchoring to transmit muscle contractions distally for thumb force and motion production, and reciprocally, muscle contraction interacts with the TCL at the proximal end through the origins. However, scarce knowledge exists regarding the distribution pattern of the thenar muscle origins. The purpose of this study was to understand the anatomical interface between the thenar muscles and TCL by examining the origin distributions of the individual muscles. Ten cadaveric specimens were dissected for digitization of the muscle origins and TCL volar surface. Digitized data were used for mesh reconstruction and calculation of surface areas and centroids. The origin areas for APB, sFPB, and OPP were 105.8 ± 30.3, 64.6 ± 15.2, and 245.9 ± 70.7 mm2 , respectively. The surface area of the TCL was 386.2 ± 86.9 mm2 . The origin areas of APB and OPP on the TCL were comparable, 18.4 ± 4.8% and 17.3 ± 9.6% of the TCL area, respectively. The origin locations for APB, sFPB, and OPP were in proximal-radial quadrant of the TCL, on distal aponeurosis outside the TCL, and around the ridge of trapezium, respectively. The knowledge of the anatomical interface provides a foundation for the understanding of biomechanical interactions between the muscles and ligaments and pathomechanical implications.
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Affiliation(s)
- Jeremy Loss
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio
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Lonne M, Sparks DS, Stephan C, Wagels M, Berger A. Clinical Examination of the Extensor Pollicis Brevis: Anatomical Study and Description of a Novel Clinical Sign. J Hand Surg Asian Pac Vol 2018; 23:330-335. [DOI: 10.1142/s2424835518500315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The Extensor Pollicis Brevis (EPB) is an extrinsic thumb muscle whose main function is extension of the first metacarpophalangeal joint (MCPJ). It is subject to significant anatomical variation and may be absent, vestigial or have an anomalous distal attachment. Clinical examination of EPB is notoriously difficult and no reliable test has yet been described. We propose a novel test for the accurate examination of EPB. We sought to clarify the anatomical variations of EPB and to validate our clinical test using human cadaveric anatomical tests. Methods: A structured literature review of all human cadaveric anatomical studies describing the attachments of EPB was performed using MEDLINE and Embase with the key words “Extensor Pollicis Brevis”. A cadaveric anatomical study was performed using 18 unembalmed upper limbs. Positive and negative tests were simulated by manipulating the tendons of EPB, Extensor Pollicis Longus (EPL) and Flexor Pollicis Longus (FPL). Changes in tendon tension and joint position were measured and recorded. The EPB anatomy was then determined by dissection. Results: Anatomical variations were present in the majority of wrists, with only 35% of EPB tendons having a distal attachment to the proximal phalanx alone. EPB was absent in 5% of specimens. There was a significant difference between the change in MCPJ position between a positive (36 degrees; 95% CI 25 to 47 degrees) and negative (19 degrees; 95% CI 14 to 25 degrees) clinical test (p = 0.002). Conclusions: The functional importance of EPB depends on its congenital architecture in addition to the functional demands of the patient. We report a novel clinical test which is effective in demonstrating the integrity of the EPB. A positive test result is observed when a change in MCPJ position that occurs while the interphalangeal joint is brought into flexion from full thumb extension is 25 degrees or more.
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Affiliation(s)
- Michael Lonne
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - David S. Sparks
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Carl Stephan
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Michael Wagels
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Anthony Berger
- Hand Surgery Unit, St Vincent's Public Hospital, Fitzroy, VIC, Australia
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Hu MT, Hsu AT, Su FC. Kinematic Analyses of the Thumb during Simulated Posteroanterior Glide Mobilization. PLoS One 2016; 11:e0161624. [PMID: 27583407 PMCID: PMC5008622 DOI: 10.1371/journal.pone.0161624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/09/2016] [Indexed: 11/20/2022] Open
Abstract
Objective Thumb problems are common in some health professionals such as physical therapists. The purpose of this case-control study is to investigate the influence of clinical experience and different mobilization techniques on the kinematics of the thumb. Methods Twenty-three participants without exposure to manual techniques (the Novice Group) and fifteen physical therapists with at least 3 years of orthopedic experience (the Experienced Group) participated. The kinematics of the thumb while performing 3 different simulated posteroanterior (PA) glide mobilization techniques on a load cell was monitored. These 3 techniques were: 1) unsupported, 2) with digital support and 3) with thumb interphalangeal joint supported by the index finger. The amount of forces exerted were 25% to 100% of maximum effort at 25% increments. The main effects of experience and technique on thumb kinematics were assessed. Results Both experience and technique had main effects on the flexion/extension angles of the thumb joints. Experienced participants assumed a more flexed position at the carpometacarpal (CMC) joint, and the novice participants performed with angles closer to the neutral position (F = 7.593, p = 0.010). Participants’ metacarpophalangeal (MCP) joints were in a more flexed position while performing PA glide with thumb interphalangeal (IP) joint supported by the index as compared to the other two techniques (p < .001). Conclusions Negative correlations were generally obtained between the sagittal plane angles of adjacent thumb joints during mobilization/manipulation. Therapists are recommended to treat patient with more stable PA glide mobilization techniques, such as PA glide with thumb interphalangeal joint supported by the index finger, to prevent potential mobilization-related thumb disorders.
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Affiliation(s)
- Meng-Tzu Hu
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, Tzu Hui Institute of Technology, Ping Tung, Taiwan
| | - Ar-Tyan Hsu
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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Xiong J, Muraki S. Thumb performance of elderly users on smartphone touchscreen. SPRINGERPLUS 2016; 5:1218. [PMID: 27516956 PMCID: PMC4967054 DOI: 10.1186/s40064-016-2877-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/20/2016] [Indexed: 11/17/2022]
Abstract
This study investigated the relationship between thumb muscle activity and thumb operating tasks on a smartphone touchscreen in elderly users (right hand posture). Three thumb muscles were targeted in the experiment, namely, abductor pollicis brevis, abductor pollicis longus (APL) and first dorsal interosseous (FDI). The results showed that the elderly participants developed fatigue rapidly and tapped more slowly when operating on smaller buttons (diameter 3.0 mm compared with 9.0 mm) and moving in the flexion–extension (compared with adduction–abduction) orientation. Meanwhile, electromyography and perceived exertion evaluation revealed significant increases in FDI in the small button task, and results for APL were significantly greater in the flexion–extension task. This study suggests that the use of small touch-buttons and flexion–extension movement should be minimised in the handheld touchscreen interface design for elderly users.
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Affiliation(s)
- Jinghong Xiong
- Graduate School of Design, Kyushu University, 4-9-1 Shiobaru, Minami-ku, Fukuoka City, 815 8540 Japan
| | - Satoshi Muraki
- Faculty of Design, Kyushu University, 4-9-1 Shiobaru, Minami-ku, Fukuoka City, 815 8540 Japan
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Rappaport PO, Thoreson AR, Yang TH, Reisdorf RL, Rappaport SM, An KN, Amadio PC. Effect of wrist and interphalangeal thumb movement on zone T2 flexor pollicis longus tendon tension in a human cadaver model. J Hand Ther 2016. [PMID: 26209161 DOI: 10.1016/j.jht.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Therapy after flexor pollicis longus (FPL) repair typically mimics finger flexor management, but this ignores anatomic and biomechanical features unique to the FPL. PURPOSE OF THE STUDY We measured FPL tendon tension in zone T2 to identify biomechanically appropriate exercises for mobilizing the FPL. METHODS Eight human cadaver hands were studied to identify motions that generated enough force to achieve FPL movement without exceeding hypothetical suture strength. RESULTS With the carpometacarpal and metacarpophalangeal joints blocked, appropriate forces were produced for both passive interphalangeal (IP) motion with 30° wrist extension and simulated active IP flexion from 0° to 35° with the wrist in the neutral position. DISCUSSION This work provides a biomechanical basis for safely and effectively mobilizing the zone T2 FPL tendon. CONCLUSION Our cadaver study suggests that it is safe and effective to perform early passive and active exercise to an isolated IP joint. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Patricia O Rappaport
- Tendon and Soft Tissue Biology Laboratory and the Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Tendon and Soft Tissue Biology Laboratory and the Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Tai-Hua Yang
- Tendon and Soft Tissue Biology Laboratory and the Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Ramona L Reisdorf
- Tendon and Soft Tissue Biology Laboratory and the Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Rappaport
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Kai-Nan An
- Tendon and Soft Tissue Biology Laboratory and the Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Peter C Amadio
- Tendon and Soft Tissue Biology Laboratory and the Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
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8
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KIM SH, KWON OY, AN MR, KIM YS. Increased range of motion and decreased strength of the thumb in massage practitioners with thumb pain. INDUSTRIAL HEALTH 2014; 52:347-353. [PMID: 24739763 PMCID: PMC4243020 DOI: 10.2486/indhealth.2013-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to compare the range of motion (ROM) and strength of the metacarpophalangeal (MP) and interphalangeal (IP) joints among massage practitioners with and without thumb pain and control subjects. Sixteen massage practitioners with thumb pain, 16 practitioners without thumb pain, and 16 control subjects participated in this study. ROM of flexion, extension, and abduction in the MP joint; ROM of flexion and extension in the IP joint of the thumb; strength of the flexor pollicis brevis (FPB), extensor pollicis brevis (EPB), abductor pollicis brevis, flexor pollicis longus (FPL), and extensor pollicis longus measured in all subjects. ROM of extension and abduction in the MP joint were significantly increased in massage practitioners with and without thumb pain compared with control subjects. ROM of extension in the IP joint was significantly increased in massage practitioners with thumb pain compared with those without thumb pain. The strength of the EPB and FPL muscle was significantly decreased in massage practitioners with thumb pain compared with those without thumb pain and control subjects, respectively. In addition, there was significantly increased EPB/FPB strength in massage practitioners without thumb pain compared to those with thumb pain and control subjects.
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Affiliation(s)
- Si-hyun KIM
- Department of Physical Therapy, Graduate School, Yonsei
University, Republic of Korea
| | - Oh-yun KWON
- Department of Physical Therapy, Kinetic Ergocise Based on
Movement Analysis Laboratory, College of Health Science, Yonsei University, Republic of
Korea
| | - Mi-ryung AN
- Department of Skin & Health Care, Sahm Yook Health
University, Republic of Korea
| | - Yoon-shin KIM
- Department of Occupational & Environmental Medicine,
Hanyang University, Republic of Korea
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9
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Mayer SW, Ruch DS, Leversedge FJ. The influence of thumb metacarpophalangeal joint rotation on the evaluation of ulnar collateral ligament injuries: a biomechanical study in a cadaver model. J Hand Surg Am 2014; 39:474-9. [PMID: 24495627 DOI: 10.1016/j.jhsa.2013.11.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/23/2013] [Accepted: 11/25/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether variation in thumb metacarpophalangeal (MCP) joint pronosupination influences perceived ulnar collateral ligament (UCL) stability during clinical stress testing. METHODS Twelve fresh-frozen specimens underwent sequential evaluation for the following conditions: ligament intact (LI), proper UCL deficient (-pUCL), and proper and accessory UCL deficient (UCL). Valgus stress testing was completed in both 0° and 30° MCP joint flexion for thumb pronation, neutral, and supination. RESULTS Compared with neutral MCP joint rotation, supination decreased and pronation increased stability such that established treatment guidelines could be incorrectly applied. During evaluation in supination and 0° flexion, 9/12 -pUCL had greater than 35° laxity and, similarly, the mean laxity of -pUCL was similar to the UCL group in neutral rotation and 0° flexion, incorrectly suggesting a complete ligament tear. In comparison, mean laxity of the *UCL in pronation and 0° flexion was not different than -pUCL in neutral rotation and 0° flexion, emphasizing the stabilizing effect of pronation. CONCLUSIONS Thumb MCP joint pronosupination significantly influenced the evaluation of joint stability, where pronation improved valgus stability in contrast to supination that tended to increase joint instability, In pronation and 0° flexion, a complete UCL injury could be misdiagnosed as a partial injury. In supination and 30° flexion, an intact UCL could be misdiagnosed as a partial UCL injury. In supination and 0°, a partial UCL injury could be misdiagnosed as a complete UCL injury. CLINICAL RELEVANCE Accurate evaluation of thumb UCL stability is critical for guiding treatment. Variations in thumb MCP joint rotation during stress testing may influence clinical interpretation and, therefore, we recommend standardization of testing with the thumb MCP joint in neutral rotation.
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Affiliation(s)
- Stephanie W Mayer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Fraser J Leversedge
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
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Ferrand M, Piquilloud G, Dumontier C. Loss of thumb metacarpophalangeal joint extension after carpal tunnel release. J Hand Surg Eur Vol 2013; 38:564. [PMID: 23212986 DOI: 10.1177/1753193412469133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M. Ferrand
- Orthopedic and Hand Surgery Department, Hôpital Universitaire Saint Antoine, Hand Institute, Paris, France
| | - G. Piquilloud
- Orthopedic and Hand Surgery Department, Hôpital Universitaire Saint Antoine, Hand Institute, Paris, France
| | - C. Dumontier
- Orthopedic and Hand Surgery Department, Hôpital Universitaire Saint Antoine, Hand Institute, Paris, France
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Influence of index finger proximal interphalangeal joint arthrodesis on precision pinch kinematics. J Hand Surg Am 2011; 36:1944-9. [PMID: 22051227 PMCID: PMC3226898 DOI: 10.1016/j.jhsa.2011.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/03/2011] [Accepted: 09/12/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of proximal interphalangeal (PIP) joint arthrodesis on the kinematics of precision pinch. METHODS Eleven healthy subjects performed index finger-thumb pinch motions under 4 conditions: unrestricted thumb and index finger (CONTROL) and fusion of the PIP joint of the index finger in flexion of 30° (PIP30), 40° (PIP40), and 50° (PIP50). Fusion was simulated with metallic splints. Kinematics of the thumb and index finger were recorded with a motion capture system. RESULTS Proximal interphalangeal joint fusion at 30°, 40°, and 50° restricted maximal pinch span between the thumb tip and index finger tip by 6%, 10%, and 14%, respectively. At the time of pulp contact, PIP fusion led to an increase in index metacarpophalangeal joint flexion angle for the PIP30 condition and an increase in variability of thumb tip location for the PIP50 condition. Furthermore, the dynamic coordination between joint angles throughout the movement was affected by PIP fusion. CONCLUSIONS This study reports impairment in the kinematics of precision pinch associated with index finger PIP joint fusion. A PIP joint fusion at 40° to 50° leads to a more natural precision pinch posture, but it restricts the aperture and reduces pinch precision.
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Domalain MF, Seitz WH, Evans PJ, Li ZM. Biomechanical effect of increasing or decreasing degrees of freedom for surgery of trapeziometacarpal joint arthritis: a simulation study. J Orthop Res 2011; 29:1675-81. [PMID: 21547941 DOI: 10.1002/jor.21453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 04/22/2011] [Indexed: 02/04/2023]
Abstract
Osteoarthritis of the trapeziometacarpal (TMC) joint can be treated by arthrodesis and arthroplasty, which potentially decreases or increases the degrees of freedom (DoF) of the joint, respectively. The aim of our study was to bring novel biomechanical insights into these joint surgery procedures by investigating the influence of DoF at the TMC joint on muscle and joint forces in the thumb. A musculoskeletal model of the thumb was developed to equilibrate a 1 N external force in various directions while the thumb assumed key and pulp pinch postures. Muscle and joint forces were computed with an optimization method. In comparison to that of the 2-DoF (intact joint) condition, muscle forces slightly decreased in the 0-DoF (arthrodesis) condition, but drastically increased in the 3-DoF (arthroplasty) condition. TMC joint forces in the 3-DoF condition were 12 times larger than the 2-DoF joint. This study contributes to a further understanding of the biomechanics of the intact and surgically repaired TMC joint and addresses the biomechanical consequences of changing a joint's DoF by surgery.
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Affiliation(s)
- Mathieu F Domalain
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, Ohio 44195, USA
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13
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Jemec B, Verjee LS, Jain A, Sandford F. Rotation in the interphalangeal thumb joint in vivo. J Hand Surg Am 2010; 35:425-9. [PMID: 20193859 DOI: 10.1016/j.jhsa.2009.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 11/22/2009] [Accepted: 11/24/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate rotation at the thumb interphalangeal (IP) joint in vivo to optimize the position of fusion of this joint. METHODS Standardized photographs were taken of 176 thumbs end-on (88 asymptomatic volunteers) placed on a custom-made splint with the IP joint at 40 degrees . Three blinded investigators measured rotation at the IP joint from these photographs as the angle between a line aligning the eponychial folds and a line aligning the proximal phalanx condyles. Gender, age, hand dominance, and type of occupation of the asymptomatic vounteers were recorded. RESULTS The variable pronation at the IP joint of the thumb (range, 0 degrees to 12 degrees) was significantly greater on the left than right (p=.001), although the actual difference was only 1 degrees . In subjects who performed fine dexterous work, thumb IP joint pronation was significantly less than in subjects who performed administrative or manual work (p=.009), but we found no statistical difference between manual and administrative groups. There was no correlation between thumb IP joint rotation and hand dominance (p=.2), age (p=.4) or gender (p=.5). CONCLUSIONS There is functional pronation at the IP joint of the thumb. We propose that this should be taken into account when performing arthrodesis on the joint or designing a joint replacement. The degree of rotation may be associated with occupation.
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Affiliation(s)
- Barbara Jemec
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK.
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14
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Wu JZ, Li ZM, Cutlip RG, An KN. A simulating analysis of the effects of increased joint stiffness on muscle loading in a thumb. Biomed Eng Online 2009; 8:41. [PMID: 20015378 PMCID: PMC2804669 DOI: 10.1186/1475-925x-8-41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 12/16/2009] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The development of osteoarthritis (OA) in the hand results in increased joint stiffness, which in turn affects the grip strength. The goal of the present study is to theoretically analyze the muscle forces in a thumb in response to the increased joint stiffness. METHODS The thumb was modeled as a linkage system consisting of a trapezium, a metacarpal bone, a proximal and a distal phalanx. Nine muscles were included in the model: flexor pollicis longus (FPL), extensor pollicis longus (EPL), extensor pollicis brevis (EPB), abductor pollicis longus (APL), flexor pollicis brevis (FPB), abductor pollicis brevis (APB), the transverse head of the adductor pollicis (ADPt), the oblique head of the adductor pollicis (ADPo), and opponens pollicis (OPP). Numerical tests were performed using an inverse dynamic approach. The joints were prescribed to an angular motion at one degree-of-freedom (DOF) each time with all other DOFs of the joints being mechanically constrained, while the muscle forces in response to the joint motions were predicted. The normal joint stiffness was assumed to be 0.05, 0.10, and 0.15 N m/rad for interphalangeal (IP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joint, respectively. The joint stiffness was assumed to increase by 50% and 100%, simulating the biomechanical consequences of OA. RESULTS Our simulations indicated that the increase in joint stiffness induced substantial increases in muscle forces, especially in the EPL and FPL muscles in response to IP, MCP, or CMC extension/flexion motions. CONCLUSIONS Because the strength of the muscles in the fingers is limited, the muscles will not be able to overcome joint resistance if joint stiffness is increased to its limit due to OA. This may contribute to the reduced range of motion typically seen in OA.
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Affiliation(s)
- John Z Wu
- Health Effects Laboratory Division, National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA.
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Kuo LC, Cooney WP, An KN, Lai KY, Wang SM, Su FC. Effects of age and gender on the movement workspace of the trapeziometacarpal joint. Proc Inst Mech Eng H 2009; 223:133-42. [PMID: 19278191 DOI: 10.1243/09544119jeim489] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While researchers have suggested that joint mobility would probably be affected by age and gender, research findings often present discrepancies. Little research has been performed on the factors which effect mobility of the trapeziometacarpal (TMC) joint. The purpose of this study was to address the effects of age and gender on the ranges of motion of the normal TMC joint. Eighty normal subjects divided into four age groups participated in this study. The TMC joint motions were recorded using an electromagnetic tracking system. In order to achieve a maximal range of TMC joint motion which was defined as the maximal workspace, each subject was asked to perform actively maximal circumduction, flexion-extension, and abduction-adduction of the TMC joint. Numerical and statistical methods were used to compute the TMC workspace and to detect significant differences. A workspace-to-length ratio was determined as an index to examine the effects of the age and gender on the joint mobility. The results demonstrated that age and gender had significant influences on the TMC workspace among the groups studied. The understanding of TMC joint mobility under different age and gender conditions is achieved through this study. The findings can be used to report clinical measures in the determination of the extent of impairment of osteoarthritis as well as the outcomes between pre- and post-surgical (or non-surgical) interventions.
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Affiliation(s)
- L-C Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan
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