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3.
Saudi Med J ; 45(9): 919-928, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39218469

RESUMO

OBJECTIVES: To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. METHODS: This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. RESULTS: For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. CONCLUSION: Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.


Assuntos
Artrite Reumatoide , Articulações Carpometacarpais , Padrões de Prática Médica , Encaminhamento e Consulta , Polegar , Humanos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Transversais , Articulações Carpometacarpais/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Polegar/cirurgia , Arábia Saudita , Artrite Reumatoide/cirurgia , Cirurgiões Ortopédicos/estatística & dados numéricos , Inquéritos e Questionários , Masculino , Feminino , Cirurgiões/estatística & dados numéricos
4.
Int J Mol Sci ; 25(17)2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39273297

RESUMO

Genetic variants in the zone of polarizing activity regulatory sequence (ZRS) that induce ectopic expression of the SHH gene have been associated with different ZRS-related phenotypes. We report the first patient with a de novo variant, c.423+4916 T>C, in ZRS (previously classified as a variant of uncertain significance) that causes tibial hemimelia-polysyndactyly-triphalangeal thumb syndrome (THPTTS). A two-month-old male patient presented with bilateral preaxial polydactyly, triphalangeal thumb, and tibial agenesis and was heterozygous for the variant c.423+4916T>C (neither of his parents was a carrier). The findings obtained from the family study were sufficient to reclassify the variant from "uncertain significance" to "likely pathogenic" according to three criteria from the American College of Medical Genetics and Genomics guidelines, as follows: (1) absence of gnomAD, (2) confirmation of paternity and maternity, and (3) strong phenotype-genotype association. In ZRS-associated syndromes, a wide clinical spectrum has been observed, ranging from polydactyly to THPTTS; our patient has the most severe and rare phenotype. We did not perform functional assays. However, the c.423+4916T>C variant is flanked by three variants, which have been proven not only to cause the phenotype but also to increase the expression of SHH. Through all this data gathering, we consider the c.423+4916T>C variant to be causative of THPTTS.


Assuntos
Polegar , Humanos , Masculino , Polegar/anormalidades , Lactente , Tíbia/anormalidades , Polidactilia/genética , Fenótipo , Ectromelia/genética , Proteínas Hedgehog/genética , Dedos/anormalidades , Anormalidades Múltiplas/genética , Deformidades Congênitas da Mão/genética , Dedos do Pé/anormalidades , Mutação , Estudos de Associação Genética , Anormalidades Congênitas , Disostose Mandibulofacial
5.
Sci Rep ; 14(1): 21558, 2024 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-39285215

RESUMO

Human movement augmentation is a rising field of research. A promising control strategy for augmented effectors involves utilizing electroencephalography through motor imagery (MI) functions. However, performing MI of a supernumerary effector is challenging, to which MI training is one potential solution. In this study, we investigate the validity of a virtual reality (VR) environment as a medium for eliciting MI neural activations for a supernumerary thumb. Specifically, we assess whether it is possible to induce a distinct neural signature for MI of a supernumerary thumb in VR. Twenty participants underwent a two-fold experiment in which they observed movements of natural and supernumerary thumbs, then engaged in MI of the observed movements. Spectral power and event related desynchronization (ERD) analyses at the group level showed that the MI signature associated with the supernumerary thumb was indeed distinct, significantly different from both the baseline and the MI signature associated with the natural thumb, while single-trial classification showed that it is distinguishable with a 78% and 69% classification accuracy, respectively. Furthermore, spectral power and ERD analyses at the group level showed that the MI signatures associated with directional movement of the supernumerary thumb, flexion and extension, were also significantly different, and single-trial classification demonstrated that these movements could be distinguished with 60% accuracy. Fine-tuning the models further increased the respective classification accuracies, indicating the potential presence of personalized features across subjects.


Assuntos
Eletroencefalografia , Movimento , Polegar , Realidade Virtual , Humanos , Polegar/fisiologia , Eletroencefalografia/métodos , Masculino , Feminino , Adulto , Adulto Jovem , Movimento/fisiologia , Imaginação/fisiologia
7.
BMC Med Genomics ; 17(1): 222, 2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39210340

RESUMO

BACKGROUND: Kagami-Ogata syndrome (KOS) and Temple syndrome (TS) are two imprinting disorders characterized by the absence or reduced expression of maternal or paternal genes in the chromosome 14q32 region, respectively. We present a rare prenatally diagnosed case of recurrent KOS inherited from a mother affected by TS. CASE PRESENTATION: The woman's two affected pregnancies exhibited recurrent manifestations of prenatal overgrowth, polyhydramnios, and omphalocele, as well as a small bell-shaped thorax with coat-hanger ribs postnatally. Prenatal genetic testing using a single-nucleotide polymorphism array detected a 268.2-kb deletion in the chromosome 14q32 imprinted region inherited from the mother, leading to the diagnosis of KOS. Additionally, the woman carried a de novo deletion in the paternal chromosome 14q32 imprinted region and presented with short stature and small hands and feet, indicating a diagnosis of TS. CONCLUSIONS: Given the rarity of KOS as an imprinting disorder, accurate prenatal diagnosis of this rare imprinting disorder depends on two factors: (1) increasing clinician recognition of the clinical phenotype and related genetic mechanism, and (2) emphasizing the importance of imprinted regions in the CMA workflow for laboratory analysis.


Assuntos
Diagnóstico Pré-Natal , Humanos , Feminino , Gravidez , Adulto , Impressão Genômica , Cromossomos Humanos Par 14/genética , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/diagnóstico , Polimorfismo de Nucleotídeo Único , Transtornos da Impressão Genômica , Polegar/anormalidades , Hipotonia Muscular , Deficiência Intelectual , Fácies , Unhas Malformadas , Hallux/anormalidades
8.
Jt Dis Relat Surg ; 35(3): 706-710, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-39189582

RESUMO

The primary goal is to preserve thumb integrity and functionality to the greatest extent possible, even in cases involving very small amputated parts. In this article, we present a case in whom the seemingly non-replantable dorsal skin-nail composite tissue of the thumb could be successfully replanted with a single artery anastomosis. No additional procedures were required, and complete recovery was achieved. In conclusion, given the unique vascular structure of the thumb, all amputated parts should be carefully evaluated for replantation. Replanting a partially amputated finger yields superior functional and cosmetic outcomes compared to any reconstructive method.


Assuntos
Amputação Traumática , Reimplante , Polegar , Humanos , Reimplante/métodos , Polegar/cirurgia , Polegar/lesões , Amputação Traumática/cirurgia , Masculino , Transplante de Pele/métodos , Adulto , Resultado do Tratamento , Recuperação de Função Fisiológica
10.
BMJ Case Rep ; 17(8)2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39214582

RESUMO

A woman in her 40s presented with pain and tenderness over the volar aspect of distal phalanx of her thumb without any swelling or discolouration. MRI indicated a possible glomus tumour. The treatment involved complete excision, and histopathological examination of the excised tissue confirmed the diagnosis of a glomus tumour. Most reported cases of glomus tumours are usually located in either the subungual region or the tip of the finger. This case represents a rare presentation in an unusual location-the volar aspect of the distal phalanx of the thumb.


Assuntos
Tumor Glômico , Imageamento por Ressonância Magnética , Polegar , Humanos , Tumor Glômico/cirurgia , Tumor Glômico/patologia , Tumor Glômico/diagnóstico , Tumor Glômico/diagnóstico por imagem , Feminino , Polegar/cirurgia , Adulto , Falanges dos Dedos da Mão/patologia , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia
11.
Clin Plast Surg ; 51(4): 559-573, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39216942

RESUMO

Traumatic thumb injuries significantly affect overall hand function and may result in considerable disability. Reconstructing the traumatized thumb requires a detailed preoperative assessment of the defect and evaluation of the patient's social history and medical comorbidities. Reconstructive techniques can be stratified by the level of thumb injury. The goals of thumb reconstruction are to restore length, stability, mobility, and sensibility. This article reviews reconstructive principles and operative techniques for reconstructing the traumatized thumb.


Assuntos
Procedimentos de Cirurgia Plástica , Polegar , Humanos , Polegar/lesões , Polegar/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Amputação Traumática/cirurgia , Retalhos Cirúrgicos
12.
Clin Plast Surg ; 51(4): 575-582, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39216943

RESUMO

Functional impairment, absence, or traumatic loss of the thumb is associated with considerable morbidity. A fully functioning thumb is estimated to account for 40% of hand function. An array of options exists for thumb reconstruction, and the intervention selected must be tailored to each individual patient. Pollicization is a powerful and elegant operation that can dramatically improve function for many patients. However, the surgeon and patient must be keenly aware that pollicization does not construct a "normal" thumb. Herein, we present a stepwise approach to treatment, including surgical nuances, alternatives to pollicization, complications, and outcomes.


Assuntos
Procedimentos de Cirurgia Plástica , Polegar , Humanos , Polegar/cirurgia , Polegar/anormalidades , Polegar/lesões , Procedimentos de Cirurgia Plástica/métodos , Criança , Amputação Traumática/cirurgia , Retalhos Cirúrgicos
13.
Fa Yi Xue Za Zhi ; 40(3): 237-244, 2024 Jun 25.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-39166304

RESUMO

OBJECTIVES: To explore the effects of different test positions on quantitative muscle strength of wrist and finger flexor muscle groups and to establish a standardized muscle strength test protocol for each muscle group. METHODS: Forty healthy subjects (12 males and 28 females) were recruited. A portable digital quantitative muscle strength tester, Micro FET2TM, was used to measure the flexor muscle strength of each finger and the wrist joint at the 30° extension, 0° neutral, and 30° flexion, respectively. Palmar abduction strength of the thumb was measured at 30° and 60°, respectively. Ten subjects were randomly selected from the 40 subjects, and the quantitative muscle strength of each muscle group was tested again by the same operator after an interval of 10 to 15 days. RESULTS: Except for the fact that in males, there was no significant difference in flexor muscle strength of thumb and wrist joint between 30° of wrist extension and neutral 0° position, the muscle strength of the other fingers flexion and wrist palmar flexor showed the following characteristics:30° of wrist extension > neutral 0° position > 30° of flexion, and the PAST was 30°>60°; The flexor muscle strength of all the subjects was thumb > index finger > middle finger > ring finger > little finger; All muscle strength values of male were greater than those of female, and the difference was statistically significant (P<0.05); There was no significant difference between the left and right side muscle strength values of all subjects (P>0.05). The reliability of muscle strength values measured at different times in 10 subjects was good. CONCLUSIONS: The quantitative muscle strength of each muscle group of the hand and wrist is affected by the test position, and a standardized and uniformed test position should be adopted in the actual identification. Micro FET2TM has good reliability for hand and wrist quantitative muscle strength testing. The 30° extension of the wrist can be used as the best standardized test position for the flexion muscle strength of each finger and wrist joint. The 30° position can be used as the best standardized test position for PAST.


Assuntos
Dedos , Força Muscular , Músculo Esquelético , Articulação do Punho , Humanos , Masculino , Feminino , Dedos/fisiologia , Músculo Esquelético/fisiologia , Adulto , Força Muscular/fisiologia , Adulto Jovem , Articulação do Punho/fisiologia , Punho/fisiologia , Força da Mão/fisiologia , Amplitude de Movimento Articular/fisiologia , Postura/fisiologia , Dinamômetro de Força Muscular , Polegar/fisiologia , Articulações dos Dedos/fisiologia , Reprodutibilidade dos Testes
14.
J Plast Reconstr Aesthet Surg ; 96: 123-128, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39084025

RESUMO

PURPOSE: To describe and evaluate the anatomical skin shape of the first web space in cadavers and to guide flap design for this area. METHODS: Twelve cadavers (24 hands on both sides) were selected. Marker points were chosen based on the characteristics of the first web for morphological measurement and observation. The morphological characteristics of the first web under the radial or palmar abduction position of the thumb were measured and compared. The best morphologic features and parameters of the first web repairing flap were obtained. RESULTS: When the thumb was in the palmar abduction position, the maximum distance a(p) was 6.78 ± 0.72 cm and the skin area s(p) was 20.09 ± 2.63 cm2, both of which were significantly greater than the distance a(r) of 5.86 ± 0.74 cm and the skin area s(r) of 17.39 ± 2.15 cm2 when the thumb was in the radial abduction position (P < 0.05). There was no significant difference in the length b(r) and b(p) of the long axis of the flap between two different abduction positions (P > 0.05). It is found that the shape of the first web area was not a symmetrical spindle but an irregular quadrilateral inclined to the index finger side. CONCLUSION: The flap design and measurement for the first web space covering should take the maximum palmar abduction position of the thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and morphological characteristics of the region.


Assuntos
Cadáver , Retalhos Cirúrgicos , Polegar , Humanos , Masculino , Polegar/anatomia & histologia , Polegar/cirurgia , Feminino , Pele/anatomia & histologia , Idoso , Pessoa de Meia-Idade , Dedos/anatomia & histologia , Dedos/cirurgia
15.
J Hand Surg Asian Pac Vol ; 29(4): 365-369, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39005185

RESUMO

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic).


Assuntos
Transferência de Nervo , Quadriplegia , Transferência Tendinosa , Polegar , Humanos , Transferência Tendinosa/métodos , Quadriplegia/cirurgia , Quadriplegia/fisiopatologia , Polegar/inervação , Polegar/cirurgia , Masculino , Transferência de Nervo/métodos , Amplitude de Movimento Articular , Força da Mão/fisiologia , Dedos/cirurgia , Dedos/inervação
16.
Acta Chir Orthop Traumatol Cech ; 91(3): 175-181, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38963897

RESUMO

PURPOSE OF THE STUDY: The purpose of this study was to assess the patient experience of trapeziectomy under WALANT for trapeziometacarpal joint (TMJ) osteoarthritis (OA) in a prospective study with 2-year follow-up. MATERIAL AND METHODS: The study included 23 patients with TMJ OA undergoing trapeziectomy with WALANT. All patients were seen by a hand therapist preoperatively and at 3, 12, and 24 months postoperatively. At each visit, VAS pain scores, thumb range of motion, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. The Picker Patient Experience (PPE-15) questionnaire was administered within 2 weeks of surgery. RESULTS: All 23 patients completed the PPE-15 questionnaire. Their mean age was 64 years. The 21 patients who remained at the 24-month follow-up all said they would choose the same anaesthesia method again. At this follow-up, VAS pain scores, thumb range of motion, key pinch grip and DASH scores had improved significantly, while thumb opposition and hand grip strength remained largely unchanged. The majority of patients felt well informed before and during the procedure, and all patients rated pain relief as good or satisfactory. Nearly 40% of patients reported receiving inadequate information about the postoperative medications. DISCUSSION: Patients have a positive attitude to trapeziectomy with WALANT, and seem to prefer WALANT over other methods of anaesthesia. Trapeziectomy with WALANT for TMJ OA is a safe procedure and appears to give a functional outcome similar to trapeziectomy under general anaesthesia. CONCLUSIONS: Trapeziectomy with WALANT for TMJ OA is safe, preferred by patients and has similar clinical outcome as trapeziectomy in general anesthesia. KEY WORDS: trapeziectomy, osteoarthritis, WALANT.


Assuntos
Anestesia Local , Osteoartrite , Amplitude de Movimento Articular , Trapézio , Humanos , Osteoartrite/cirurgia , Osteoartrite/fisiopatologia , Pessoa de Meia-Idade , Trapézio/cirurgia , Feminino , Masculino , Anestesia Local/métodos , Estudos Prospectivos , Seguimentos , Articulações Carpometacarpais/cirurgia , Articulações Carpometacarpais/fisiopatologia , Força da Mão , Idoso , Medição da Dor , Satisfação do Paciente , Resultado do Tratamento , Inquéritos e Questionários , Polegar/cirurgia , Polegar/fisiopatologia , Ossos Metacarpais/cirurgia
18.
BMJ Case Rep ; 17(7)2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38991569

RESUMO

Linburg-Comstock syndrome is an acquired symptomatic restrictive thumb index finger flexor tenosynovitis involving a hypertrophic tenosynovium between flexor pollicis longus and flexor digitorum profundus. Patients may report synkinetic movement of the thumb and index finger, pain and swelling. We present the case of a woman in her 80s who presented with painless Linburg-Comstock syndrome after a trapeziectomy 4 months earlier for trapeziometacarpal arthritis. A literature review of PubMed-indexed case reports found that Linburg-Comstock syndrome has never been described in a post-trapeziectomy patient. This unusual presentation that arose as a side effect of hand surgery remains unreported in the literature. We present this unique complication as the first such case in the world. This case report is a valuable addition to the existing knowledge on the complications of trapeziectomy surgery.


Assuntos
Complicações Pós-Operatórias , Trapézio , Humanos , Feminino , Trapézio/cirurgia , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Síndrome , Tenossinovite/cirurgia , Tenossinovite/etiologia , Polegar/anormalidades , Polegar/cirurgia
19.
BMC Musculoskelet Disord ; 25(1): 607, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39085859

RESUMO

PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.


Assuntos
Articulações Carpometacarpais , Prótese Articular , Desenho de Prótese , Amplitude de Movimento Articular , Polegar , Humanos , Masculino , Polegar/cirurgia , Polegar/fisiologia , Polegar/diagnóstico por imagem , Articulações Carpometacarpais/cirurgia , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/fisiopatologia , Adulto , Adulto Jovem , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Osteoartrite/cirurgia , Osteoartrite/fisiopatologia , Osteoartrite/diagnóstico por imagem , Artroplastia de Substituição/instrumentação , Artroplastia de Substituição/métodos
20.
Med Sci Monit ; 30: e943686, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38944680

RESUMO

BACKGROUND Congenital hypoplasia of the thumb type IV, also known as floating thumb, is a condition in which 2 small phalanges are attached to the hand with a thin skin bridge. Surgical management options for this condition vary from amputation to flap reconstruction. MATERIAL AND METHODS This retrospective study analyzed 11 infants with congenital hypoplasia of the thumb type IV who underwent surgical reconstruction using a modified vascularized polydactylous hallux flap. The study included 6 male and 5 female infants, aged 6 to 24 months. Functional evaluations and radiographic studies were conducted postoperatively. RESULTS All 11 patients underwent the complete surgical protocol. Successful vascular and nerve anastomoses were performed during the initial procedure, ensuring sufficient blood supply and neural connectivity to the transferred toes. The second operation showed promising outcomes, including improvements in thumb opposition, grasp strength, and overall function. Postoperative assessments demonstrated satisfactory radiographic alignment and no major complications during the follow-up period. CONCLUSIONS The modified vascularized polydactylous hallux flap reconstruction is a viable surgical option for managing congenital hypoplasia of the thumb type IV in infants. This technique effectively restores thumb opposition, grasp strength, and overall hand function, with satisfactory radiographic alignment and minimal complications. The study findings support the efficacy and safety of this surgical approach in addressing this rare congenital anomaly.


Assuntos
Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Polegar , Humanos , Polegar/anormalidades , Polegar/cirurgia , Polegar/diagnóstico por imagem , Masculino , Feminino , Estudos Retrospectivos , Lactente , Procedimentos de Cirurgia Plástica/métodos , Resultado do Tratamento , Pré-Escolar , Radiografia/métodos , Força da Mão/fisiologia , Deformidades da Mão/cirurgia , Deformidades Congênitas da Mão/cirurgia , Deformidades Congênitas da Mão/diagnóstico por imagem
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