Hand and wrist configurations in patients with Carpal Tunnel Syndrome

The association between hand and wrist configurations was investigated in this study. The hand and wrist dimensions of sixty patients with carpal tunnel syndrome and sixty healthy control subjects were measured using specific anatomical landmarks. The palm width was significantly greater in the patient group. There was no significant difference in the hand length between the two groups. Both the wrist width and wrist depth were significantly greater in the patient group. The hand ratio and the wrist ratio were significantly smaller in the patient group indicating that the latter had squarer hands and wrists than the control group respectively. This suggests that the anatomy of the hand and wrist may predispose to carpal tunnel syndrome.peer-reviewe

The Pedagogical Legacy of Vicente Scaramuzza: The Relationship Between Anatomy of the Hand, Tone Production, and Musical Goals

The Italian pianist and pedagogue Vicente Scaramuzza has become one of the most prominent musical figures in Argentina. His students achieved international recognition and his school of piano playing is still being passed on by his former students. My piano teacher in Buenos Aires, Nilda Somma, studied for fourteen years under his supervision, and shared with me his annotations, fingerings, and re-distributions (it is important to point out that decades ago, redistributing notes between both hands in certain passages was not a controversial practice). Among Vicente Scaramuzza’s most renowned students are Martha Argerich, Bruno Gelber, Enrique Barenboim (who later taught his son Daniel), Nilda Somma, Antonio de Raco, Sylvia Kersenbaum, Daniel Rivera, Daniel Levy, and Cristina Viñas. Only one book has been published about Vicente Scaramuzza’s approach to piano technique and tone production. Enseñanzas de un gran Maestro, written by his former student Maria Rosa Oubiña de Castro, provides detailed explanations and illustrations of his unique approach. During lessons, Vicente Scaramuzza would circle a problematic passage and then, in a separate notebook write a full explanation of the necessary steps to solve the issue. My former piano teacher, Nilda Somma, kept her notebooks with Scaramuzza’s annotations, in addition to scores with fingerings and re-distributions. A closer examination of these invaluable materials will help shed light on the musical intelligence and technical mastery of Scaramuzza. The most distinctive characteristic of his school of piano playing is the strong connection between awareness of the anatomy of the hand, re-distributions, tone production, and musical goals. Advisor: Paul Barne

Collar-button abscess as a complication of infected hematoma in the setting of uncontrolled type 2 diabetes

Introduction: Collar-button abscesses are deep space infections of the hand. Case presentation: We present a case of a 66-year-old man who developed an acute collar-button abscess of the hand after a concrete bench fell onto the dorsal aspect of his hand. The hand abscess was managed successfully with intravenous antibiotics and operative intervention. Discussion: While such infections comprise a small percentage of hand infections, insufficient or delayed treatment results in permanent hand disfiguration and dysfunction. This case highlights an uncommon dorsal-to-volar pattern of hand abscess extension. Conclusion: Knowledge of the anatomy of the hand is essential to diagnosis and appropriate surgical management

Strength and reaction time capabilities of New Zealand polo players and their association with polo playing handicap

Polo is an equestrian team sport consisting of four players per team, with level of play determined by cumulative player handicap (-2 to + 10 goals), with a higher handicap denoting a better player. There is minimal literature investigating Polo players’ physical attributes, hence the understanding of the physical characteristics that may contribute to an improved handicap are unknown. This study sought to identify the relationship between pertinent strength measures (left and right hand grip strength; absolute and relative isometric mid-thigh pull) and reaction time in Polo handicap in 19 New Zealand Polo players, and ascertain whether handicap could be predicted by these measures. Correlation coefficients were expressed using R values, accompanying descriptors and 90% confidence intervals (C.I.). Variance explained was expressed via the R2 statistic, and statistical significance set at p < 0.05. Right hand grip strength, isometric mid-thigh pull values were found to significantly correlate to and explain variance within Polo player handicap (all moderate to large correlations; p< 0.05). Whereas left hand grip strength (R: 0.380; 90% C.I. -0.011 to 0.670) and reaction time (0.020; -0.372 to 0.406) were non-significant, moderate and trivial correlates and predictors of handicap respectively. Practically, these findings highlight the differing roles between rein and mallet hands of Polo players and emphasise the importance of a strong and stable platform when riding and striking the ball. Lack of association with reaction time may be explained in part by higher handicapped Polo players employing a more proactive approach to the game

The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access): A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization

BACKGROUND: The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown.METHODS AND RESULTS: The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77).CONCLUSIONS: Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization

Hand and foot pressures in the aye-aye (Daubentonia madagascariensis) reveal novel biomechanical trade-offs required for walking on gracile digits

Arboreal animals with prehensile hands must balance the complex demands of bone strength, grasping and manipulation. An informative example of this problem is that of the aye-aye (Daubentonia madagascariensis), a rare lemuriform primate that is unusual in having exceptionally long, gracile fingers specialized for foraging. In addition, they are among the largest primates to engage in head-first descent on arboreal supports, a posture that should increase loads on their gracile digits. We test the hypothesis that aye-ayes will reduce pressure on their digits during locomotion by curling their fingers off the substrate. This hypothesis was tested using simultaneous videographic and pressure analysis of the hand, foot and digits for five adult aye-ayes during horizontal locomotion and during ascent and descent on a 30 degrees instrumented runway. Aye-ayes consistently curled their fingers during locomotion on all slopes. When the digits were in contact with the substrate, pressures were negligible and significantly less than those experienced by the palm or pedal digits. In addition, aye-ayes lifted their hands vertically off the substrate instead of 'toeing-off' and descended head-first at significantly slower speeds than on other slopes. Pressure on the hand increased during head-first descent relative to horizontal locomotion but not as much as the pressure increased on the foot during ascent. This distribution of pressure suggests that aye-ayes shift their weight posteriorly during head-first descent to reduce loads on their gracile fingers. This research demonstrates several novel biomechanical trade-offs to deal with complex functional demands on the mammalian skeleton

Perception, Causally Efficacious Particulars, and the Range of Phenomenal Consciousness: Reply to Commentaries

This paper responds to critical commentaries on my book, Perceiving Reality (OUP, 2012), by Laura Guerrero, Matthew MacKenzie, and Anand Vaidya. Guerrero focuses on the metaphysics of causation, and its role in the broader question of whether the ‘two truths’ framework of Buddhist philosophy can be reconciled with the claim that science provides the best account of our experienced world. MacKenzie pursues two related questions: (i) Is reflexive awareness (svasaṃvedana) identical with the subjective pole of a dual-aspect cognition or are there alternative, perhaps better, ways of understanding this self-intimating character of mental states? (ii) Is perception constitutively intentional or is it representational? Vaidya argues that, in so far as Husserlian phenomenology and Buddhism differ in terms of their fundamental ontological commit- ments, they must be incompatible, thus rendering any cross-cultural philosophical project that seeks their rapprochement tenuous. One of my aims in Perceiving Reality is to show how accounts of perception informed by metaphysical realism can be problematic on both metaphysical and epistemological grounds, especially when relying on conceptions of consciousness that ignore its properly phenomenological features

Changes In angulation and phalangeal length of fingers and thumbs following surgical treatment for congenital clinodactyly

INTRODUCTION: Congenital clinodactyly is a condition characterized by the deviation of a digit or digits in the coronal plane. Angulation is often due to the presence of a delta phalanx. There is a scarcity of long-term data regarding the results of surgical treatment for clinodactyly, particularly with respect to postoperative phalangeal growth and risk factors for recurrent deformity. METHODS: Our retrospective study involved the analysis of data from medical records of patients who had corrective surgery for congenital clinodactyly. We also measured radiographs to quantify the angle of deviation and the longitudinal lengths of the surgically corrected phalanx and corresponding metacarpal. Clinodactyly was defined as radiographic angulation of 10° or greater in the coronal plane. Recurrence was defined as a final angulation of 10° or greater as well as an increase of at least 10° compared with the immediate postoperative measurement. The primary ratio was defined as the ratio of the length of the primary ossification center of the surgically corrected phalanx to the length of the primary ossification center of the corresponding metacarpal. The secondary ratio was the ratio of the length of the primary and secondary ossification centers together of the corrected phalanx to those of the metacarpal. Comparisons were made between preoperative, postoperative, and most-recent follow-up values. Postoperative data was restricted to radiographs taken within three months after surgery. Final follow-up data was initially permitted if radiographs were taken at least one year after surgery. Additional analysis was performed of patients with a minimum of two years clinical and radiographic follow-up. RESULTS: There was a significant decrease in angulation with surgery and a significant increase in angulation postoperatively (p<0.001; p<0.01). Overall, the mean preoperative and final digital angulation was 40.4° and 17.4°, respectively, when a two-year minimum between the time of surgery and final follow-up measurements was implemented. This resulted in a significant average correction of 23.3° (p<0.001). The postoperative change in angulation was found to be significantly different depending on the surgical technique used. Digits corrected with reverse wedge osteotomies showed little to no change in angulation during the postoperative period. However, digits corrected with closing wedge osteotomies showed a significant increase in angulation between the immediate postoperative and final follow-up measurements (p=0.007). The rate of recurrence was 43.2% (95% CI: 28.7-58.9% with a one year minimum for follow-up; 95% CI: 27.5-60.4% with a two year minimum for follow-up). Postoperative changes in angulation or recurrence were not significantly associated with gender, patient age at the time of surgery, the type of digit corrected, coexisting congenital syndromes, or the presence of additional hand abnormalities. The primary ratio decreased significantly with surgery, from 0.35 preoperatively to 0.27 postoperatively (p=0.03). The primary ratio then increased significantly over time to 0.40 when there was a two-year minimum between the time of surgery and final follow-up. There was an insignificant change in primary ratio from immediately after surgery to final follow-up when data as early as one year postoperatively was included. The secondary ratio did not change significantly with surgery or during the postoperative period regardless of whether one or two-year time restrictions were in place. The mean secondary ratio was 0.29 before surgery, 0.25 immediately after surgery, and 0.33 at the time of final follow-up at least two years after surgery. CONCLUSIONS: Surgery to correct clinodactyly effectively decreases angulation of the digit, despite the risk of recurrent deformity over time. Our study did not identify any factors associated with recurrence. However, there was a significant difference in the change in angulation between the immediate postoperative and final follow-up measurements depending on the surgical technique used. Surgery to correct clinodactyly does not hinder postoperative growth of the corrected phalanx

The anatomy and function of Cleland's ligaments

The cutaneous ligaments of the digits have been recognized by anatomists for several centuries, but the best known description is that of John Cleland. Subsequent varying descriptions of their morphology have resulted in the surgical community having an imprecise view of their structure and dynamic function. We micro-dissected 24 fresh frozen fingers to analyze the individual components of Cleland's ligamentous system. Arising from the proximal interphalangeal (PIP) joint, proximal, and sometimes middle phalanx, we found strong ligaments that ran proximally (PIP-P) and distally (PIP-D). On each side of each finger there was a PIP-P ligament present, which passed obliquely from the lateral side of the proximal and sometimes middle phalanx towards its insertion into the skin at the level of the proximal phalanx. The distal (PIP-D) ligaments were found to pass obliquely distally on the radial and ulnar aspects of the digit towards cutaneous insertions around the middle phalanx. A similar arrangement exists more distally with fibres originating from the DIP joint and middle phalanx (the DIP-P pass obliquely proximally, and the DIP-D, distally). Each individual PIP ligament consisted of three different layers originating from fibres overlying the flexor tendon sheath, periosteum or joint capsule, and extensor expansion. Ligaments arising at the DIP joint had two layers equivalent to the anterior two layers of the proximal ligaments. Cleland's ligaments act as skin anchors maintaining the skin in a fixed relationship to the underlying skeleton during motion and functional tasks. They also prevent the skin from 'bagging', protect the neurovascular bundle, and create a gliding path for the lateral slips of the extensor tendon