ABSTRACT
BACKGROUND: Restoration of hand function after traumatic brachial plexus injury (BPI) remains a formidable challenge. Traditional methods such as nerve or free muscle transfers yield suboptimal results. Advancements in myoelectric prostheses, characterized by novel signal acquisition and improved material technology, show promise in restoring functional grasp. This study evaluated the ability of adults with a BPI injury to control an externally powered prosthetic hand using nonintuitive signals, simulating the restoration of grasp with a myoelectric prosthesis. It also assessed the effectiveness of a comprehensive multidisciplinary evaluation in guiding treatment decisions. METHODS: A multidisciplinary brachial plexus team assessed adults with compromised hand function due to BPI. The feasibility of amputation coupled with fitting of a myoelectric prosthesis for grasp reconstruction was evaluated. Participants' ability to control a virtual or model prosthetic hand using surface electromyography (EMG) as well as with contralateral shoulder motion-activated linear transducer signals was tested. The patient's input and injury type, along with the information from the prosthetic evaluation, were used to determine the reconstructive plan. The study also reviewed the number of participants opting for amputation and a myoelectric prosthetic hand for grasp restoration, and a follow-up survey was conducted to assess the impact of the initial evaluation on decision-making. RESULTS: Of 58 subjects evaluated, 47 (81%) had pan-plexus BPI and 42 (72%) received their initial assessment within 1 year post-injury. Forty-seven patients (81%) could control the virtual or model prosthetic hand using nonintuitive surface EMG signals, and all 58 could control it with contralateral uniscapular motion via a linear transducer and harness. Thirty patients (52%) chose and pursued amputation, and 20 (34%) actively used a myoelectric prosthesis for grasp. The initial evaluation was informative and beneficial for the majority of the patients, especially in demonstrating the functionality of the myoelectric prosthesis. CONCLUSIONS: The study indicates that adults with traumatic BPI can effectively operate a virtual or model myoelectric prosthesis using nonintuitive control signals. The simulation and multidisciplinary evaluation influenced informed treatment choices, with a high percentage of patients continuing to use the myoelectric prostheses post-amputation, highlighting its long-term acceptance and viability. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
ABSTRACT
Background: We noted that patients with thoracic outlet syndrome (TOS) have elevation of the ipsilateral scapula and named this the scapular elevation sign (SES). The aim was to determine the prevalence of SES in a normal cohort, compare SES with other provocative tests and to determine the treatment effect on SES. Methods: First, normal asymptomatic subjects were prospectively assessed to determine the prevalence of SES in a normal cohort. Second, patients with TOS were retrospectively examined for the presence of SES and four provocative tests: supraclavicular pressure, scalene test, elevated arm stress test (EAST) and the military brace manoeuvre. All patients were initially treated non-surgically. Surgery was offered to patients with persistent symptoms at 6 months. Patients were re-examined for the presence of the SES after treatment. Results: The prevalence of SES in our normal cohort was 4% (2/53). Our study cohort included 20 patients with TOS. The SES was positive in 18 patients (90%). Supraclavicular pressure was positive in 11 (55%), scalene test in 13 (65%), EAST in 9 (45%) and military brace manoeuvre in 11 patients (55%). Following non-surgical treatment, six patients had symptom resolution, three had improvement, nine persistent symptoms and two were lost to follow-up. The SES was positive in one out of six patients with symptom resolution, two out of three patients with improvement and in all nine patients with persistent symptoms. Patients with persistent symptoms underwent surgery with symptom resolution in eight and improvement in one patient. The SES remained positive in two patients after surgical treatment. Conclusions: The SES is simple and sensitive, does not rely on variations in performance of the test and suitable for diagnosis and assessment of outcomes of TOS. Level of Evidence: Level III (Diagnostic).
Subject(s)
Scapula , Thoracic Outlet Syndrome , Humans , Thoracic Outlet Syndrome/diagnosis , Thoracic Outlet Syndrome/epidemiology , Thoracic Outlet Syndrome/surgery , Male , Female , Adult , Middle Aged , Retrospective Studies , Young Adult , Prospective Studies , Physical ExaminationABSTRACT
PURPOSE: Pan-brachial plexus injury patients present a reconstructive challenge. The root analysis score, developed from parsimonious multivariable modeling of 311 pan-brachial plexus injury patients, determines the probability of having a viable C5 nerve based on four categories: positive C5 Tinel test, intact C5 nerve on computed tomography myelogram, lack of hemidiaphragmatic elevation, and absence of midcervical paraspinal fibrillations. METHODS: Root analysis scores were calculated for a separate cohort of patients with pan-brachial plexus injuries. Scores were validated by the presence or absence of a graftable C5 root, based on supraclavicular exploration and intraoperative electrophysiologic testing. Receiver operating characteristic curve, accuracy, and concordance statistic of the scores were calculated. Patients were divided into three root analysis score cohorts: less than 50 (low), 50-75 (average), and 75-100 points (high) based on dividing the score into quartiles and combining the lowest two. The probability, sensitivity, and specificity of each cohort having an available C5 nerve were based on the intraoperative assessment. RESULTS: Eighty patients (mean age, 33.1 years; 15 women and 65 men) were included. Thirty-one patients (39%) had a viable C5 nerve. The root analysis calculator had an overall accuracy of 82.5%, a receiver operating characteristic of 0.87, and a concordance statistic of 0.87, demonstrating high overall predictive value; 6.5% of patients with a score of less than 50 (94% sensitivity and 43% specificity), 16.1% of patients with a score of 50-75 (94% sensitivity and 67% specificity), and 77.4% of patients with a score of 75-100 (77% sensitivity and 90% specificity) had a graftable C5 nerve. CONCLUSIONS: The root analysis score demonstrated high accuracy and predictive power for a viable C5 nerve. In patients with a score of less than 50, the necessity of supraclavicular root exploration should balance patient factors, presentation timing, and concomitant injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnosis II.
Subject(s)
Brachial Plexus , Spinal Nerve Roots , Humans , Female , Male , Adult , Brachial Plexus/injuries , Spinal Nerve Roots/diagnostic imaging , Middle Aged , ROC Curve , Brachial Plexus Neuropathies/surgery , Sensitivity and Specificity , Retrospective StudiesABSTRACT
Traumatic adult brachial plexus injuries typically cause immediate loss of upper limb function. Timely multidisciplinary treatment in specialized centres often results in a useful helper arm. Both the patient and the surgical team can benefit from an open discussion to set realistic expectations. Surgical reconstruction is customized for each patient, considering their injury factors and functional objectives. Optimizing pain control, adherence to procedure indications and using meticulous surgical techniques help minimize the risk of failing to meet the patient's goals. The need for potential alternative treatment(s) if the desired result is not achieved should be detailed before the initial reconstruction. This review discusses late treatment options, including tendon transfers, joint fusions, free functioning muscle transfers and prosthetics, for managing the failed primary reconstruction of the traumatic adult brachial plexus.
ABSTRACT
CASE: Augmented scapholunate ligament reconstruction using polyether ether ketone anchors and ultra-high molecular weight polyethylene synthetic tape has the theoretical advantage of improved stability, avoidance of K-wire fixation, and the potential for earlier mobilization. We present 3 cases of scaphoid and lunate osteolysis/fragmentation, operative and histologic findings at reoperation, and the sequelae of this technique. CONCLUSION: If planning to use suture anchors and synthetic tapes in small carpal bones, we recommend advising patients about the risk of osteolysis and monitoring closely patients who complain of pain with motion after surgery.
Subject(s)
Joint Instability , Lunate Bone , Osteolysis , Scaphoid Bone , Humans , Osteolysis/diagnostic imaging , Osteolysis/etiology , Osteolysis/surgery , Joint Instability/surgery , Ligaments, Articular/surgery , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/surgeryABSTRACT
Stem cell therapy is rapidly evolving, with preclinical studies showing various stem cell types successfully promoting peripheral nerve regeneration. Despite the lack of clinical studies demonstrating efficacy and safety, the number of commercial entities marketing and promoting this treatment direct to patients is also increasing. We describe three adult traumatic brachial plexus injury (BPI) patients who had stem cell therapies prior to consultation in a multidisciplinary brachial plexus clinic. No functional improvement was noted at long-term follow-up despite claims reported by the commercial entities. Considerations and implications of stem cell application in BPI patients are reviewed.
Subject(s)
Brachial Plexus Neuropathies , Brachial Plexus , Adult , Humans , Brachial Plexus/surgery , Brachial Plexus/injuries , Stem Cell Transplantation , Nerve RegenerationABSTRACT
This report discusses the considerations behind the special modifications made on the finger prostheses fitted for a patient with crushed index, middle, ring, and little fingers resulting in a double-digit amputation with significant postoperative scarring, discoloration, shortening, and contracture of the salvaged index and middle fingers. The deformity and discoloration of the salvaged fingers were factored into the approach taken in the planning, fabrication, and fitting of prosthesis for the amputated digits. Length reduction with increased flexion planned into the prostheses, in addition to color matching them in two different shades, contributed to good aesthetic and functional outcomes.
Subject(s)
Amputation, Traumatic , Contracture , Finger Injuries , Amputation, Traumatic/complications , Amputation, Traumatic/surgery , Contracture/surgery , Disarticulation , Esthetics , Finger Injuries/surgery , Fingers/surgery , Humans , Prostheses and ImplantsABSTRACT
BACKGROUND: Nerve transfers are planned based on the following parameters: location, number of branches, and axon count matching of the donor and recipient nerves. The authors have previously defined the former two in upper limb muscles. In the literature, axon counts are obtained from various sources, using different methods of histomorphometry. This study describes the axon counts of the same primary motor nerve branches from the authors' previous study using a uniform method of manual histomorphometry and completes the authors' blueprint of upper limb neuromuscular anatomy for reconstructive surgery. METHODS: The distal ends of the primary nerve branches of 23 upper limb muscles were harvested from 10 fresh frozen cadaveric upper limbs. Manual quantitative histomorphometry was performed by two independent investigators, and the average was reported. RESULTS: The primary nerve branches of the arm muscles had higher average axon counts (range, 882 to 1835) compared with those of the forearm muscles (range, 267 to 883). In the forearm, wrist flexor (range, 659 to 746) and extensor (range, 543 to 745) nerve branches had axons counts that were similar to those of potential donors (e.g., supinator, n = 602; pronator teres, n = 625; flexor digitorum superficialis, n = 883; and flexor digitorum profundus, n = 832). CONCLUSIONS: Apart from describing the axon counts of the upper limb, the authors have found that the forearm axon counts are very comparable. This insight, when combined with information on the location and number of primary nerve branches, will empower surgeons to tailor bespoke nerve transfers for every clinical situation.
Subject(s)
Arm/innervation , Forearm/innervation , Motor Neurons/transplantation , Muscle, Skeletal/innervation , Nerve Transfer/methods , Adult , Aged , Axons , Cadaver , Cell Count , Female , Humans , Male , Middle AgedABSTRACT
Hand infection has been associated with increased morbidity in people with diabetes mellitus. PURPOSE: This study was conducted to determine risk factors for hand wound infection in patients with diabetes mellitus. METHODS: A 1:3 matched prospective case-control study was conducted from December 2006 to December 2016. All study patients were consecutively identified through the inpatient records upon admission to the University of the Philippines Manila, Philippine General Hospital (Manila, Philippines), for a hand wound infection necessitating surgical treatment and were followed until hospital discharge, wound healing, or death. Adults (≥18 years old) with diabetes mellitus for at least 6 months and with (study group) or without (control group) a hand wound infection were eligible to participate. Persons with a history of amputation or who were in a chronic debilitated state were excluded. Infection was defined as the presence of inflammation and purulent discharge. Eligible control patients were consecutively recruited from the outpatient clinics and were matched to the study patients by age (± 5 years) and gender. Demographic (eg, age, gender, education, occupation, tobacco use) and clinical data (body mass index [BMI], duration of diabetes, HbA1c levels, wound location and duration, delay in treatment, neuropathy, surgical procedures, length of hospital stay, and presence of arteriovenous [AV] fistula) were collected from patient records and entered into Excel spreadsheets for analysis. Regression analysis was performed and reported as odds ratio (OR) with 95% confidence intervals (CI). Level of significance was set P <.05. RESULTS: Participants included 30 study and 90 control patients. No significant differences between study and control patients were noted in terms of BMI, duration of diabetes, presence of peripheral neuropathy, occupation, or education. Significantly more study patients had elevated HbA1c (86 vs. 30; P = .0001), used tobacco (17 vs. 8; P = .0001), and had an AV fistula (3 vs. 0; P = .015). After multivariate analysis, HbA1c ≥48 mmoL/moL (OR = 18.8; 95% CI: 2.3-153.8; P = .006) and tobacco use (OR = 10.7; 95% CI: 3.5-32.7; P = .0001) were identified as independent risk factors for hand/upper extremity infection. CONCLUSION: Patients with diabetes who smoked or exhibited elevated HbA1c levels were at higher risk of having a hand infection. Further research and efforts to help people with diabetes stop smoking and maintain good glycemic control may help decrease the burden of hand infection.
Subject(s)
Hand Injuries/etiology , Wound Infection/etiology , Adult , Aged , Blood Glucose/analysis , Case-Control Studies , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Female , Glycated Hemoglobin/analysis , Hand Injuries/physiopathology , Humans , Male , Middle Aged , Odds Ratio , Philippines/epidemiology , Prospective Studies , Risk Factors , Wound Infection/epidemiology , Wound Infection/physiopathologyABSTRACT
Nerve compression occurs in fibro-osseous tunnels as the nerves cross joints. The pathology involves traction and adhesion, aside from compression. This can occur at multiple sites along the course of the nerve. Regardless of level, clinical assessment is standard and a systematic approach to uncover all sites of compression is advised. Evolution of management for carpal tunnel and cubital tunnel syndrome is reviewed with an emphasis on natural history and nonsurgical treatment, which are not commonly discussed. Treatment is multimodal and the systemic factors that contribute to nerve dysfunction should also be addressed.
Subject(s)
Nerve Compression Syndromes , Carpal Tunnel Syndrome/therapy , Cubital Tunnel Syndrome/therapy , Humans , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/physiopathology , Nerve Compression Syndromes/therapyABSTRACT
BACKGROUND: The authors previously studied the intramuscular innervation of 150 upper limb muscles and demonstrated that certain patterns of intramuscular innervation allowed muscles to be split into compartments with independent function. This study aims to determine the location, extramuscular course, and number of motor nerve branches of upper limb peripheral nerves. The authors want to combine this information with their previous work to create a blueprint of upper limb neuromuscular anatomy that would be useful in reconstructive surgery. METHODS: Ten fresh frozen cadaveric upper limbs were dissected. The origin of branches from the peripheral nerve trunk, their course, and the number of motor nerves per muscle were determined. The authors reviewed all the images of the Sihler-stained muscles from their earlier study. RESULTS: Motor nerve branches arise at the intersection of nerve trunk and muscle belly and are clustered near the origin of muscle groups. Two patterns of extramuscular innervation were noted, with one group having a single motor nerve and another group with consistently more than one motor nerve. A modified classification of muscles was proposed based on the orientation of muscle fibers to the long axis of the limb, the number of muscle compartments, and the number of heads of origin or the tendons of insertion. CONCLUSIONS: Motor nerve clusters can be located based on fixed anatomical landmarks. Muscles with multiple motor nerves have morphology that allows them to be split into individual compartments. The authors created a muscle and nerve blueprint that helps in planning nerve and split muscle transfers.
Subject(s)
Peripheral Nerves/anatomy & histology , Tendon Transfer/methods , Tendons/anatomy & histology , Upper Extremity/innervation , Cadaver , Humans , Motor Neurons/transplantation , Muscle, Skeletal/innervation , Peripheral Nerves/transplantation , Tendons/innervationABSTRACT
Three full-thickness skin graft sites within the hand where the donor sites are well blended with surrounding skin contour and crease are described. Two of these donor sites are located within the digit and these provide nonglaborous skin for small defects of the hand, whereas the third donor site along the palmar crease provides glaborous skin. These donor sites provide ease of access, minimal morbidity, and well-matched skin for resurfacing of small defects around the hand. The indications, contraindications, and technical points of each donor site are discussed.
Subject(s)
Hand Injuries/surgery , Skin Transplantation/methods , Soft Tissue Injuries/surgery , Transplant Donor Site , Wound Healing/physiology , Esthetics , Female , Finger Injuries/diagnosis , Finger Injuries/surgery , Graft Survival , Hand Injuries/diagnosis , Humans , Injury Severity Score , Male , Soft Tissue Injuries/diagnosis , Tissue and Organ HarvestingABSTRACT
PURPOSE: Squeezing a denervated muscle a few weeks after nerve repair produces a characteristic response in patients. This response is observed before any clinical evidence of motor recovery. We called this response the tender muscle sign (TMS) and wanted to determine whether this sign was related to the recovery of motor power. METHODS: We studied 31 adults with unilateral brachial plexus injuries who underwent 50 procedures for reinnervation of the supraspinatus, deltoid, and biceps. Follow-up was monthly for the first year and at 3-monthly intervals thereafter. Average duration of follow-up was 3.3 years. The TMS was sought at each visit. The presence of the TMS, when it was first observed, and time to Medical Research Council (MRC) grade 1 and 3 recoveries were recorded. The sensitivity, specificity, and predictive values of TMS for motor recovery were calculated. RESULTS: The TMS was always detected earlier than palpable muscle contraction. It was significantly associated with recovery of MRC grade 1 and 3 motor power. The sensitivity of TMS for MRC grade 1 recovery was 96% and specificity was 100%. For MRC grade 3 recovery, it had 97% sensitivity and 27% specificity. The positive predictive value was 100% for MRC grade 1 recovery and 83% for MRC grade 3. The negative predictive value was 50% for MRC grade 1 recovery and 75% for MRC grade 3. CONCLUSIONS: Previous studies have demonstrated the presence of nocioceptive receptors in human skeletal muscle. The reinnervation of these receptors by the regenerating axons results in cramp-like tenderness when the muscle is squeezed. This response is specific to a reinnervated muscle and cannot be elicited in denervated or normally innervated muscle. The TMS is a simple, clear, and early indicator of muscle reinnervation that is useful in monitoring motor recovery after nerve regeneration. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
Subject(s)
Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/surgery , Muscle Contraction/physiology , Nerve Regeneration/physiology , Nerve Transfer/methods , Adult , Brachial Plexus/injuries , Brachial Plexus/surgery , Cohort Studies , Electromyography/methods , Female , Humans , Male , Middle Aged , Physical Stimulation/methods , Postoperative Care/methods , Predictive Value of Tests , Plastic Surgery Procedures/methods , Recovery of Function , Retrospective Studies , Time Factors , Young AdultABSTRACT
Deep sacral pressure ulcers in nonambulatory hospitalized patients often are managed using surgical flaps. Reports about the effects of protein status on postoperative healing are inconsistent but surgery often is delayed until serum albumin levels normalize. Considering these conflicting data and the potential effects of delayed closure, the protocol at a Philippine national university hospital was changed to allow for early surgical reconstruction of sacral ulcers in hypoalbuminemic nonambulatory patients. A retrospective chart review was conducted to evaluate clinical outcomes of 16 nonambulatory patients (10 men, 6 women; average age 54 years, range 18 to 74) with moderate to severe hypoalbuminemia who underwent flap surgery for coverage of their Stage III or Stage IV sacral ulcers within a protocol of interdisciplinary care. Outcomes measured included the number of surgeries needed for coverage and wound complications encountered. Patient average albumin level before flap coverage was 21 g/L (range: 8 to 30 g/L), average sacral ulcer size was 10 cm x 10 cm, patients underwent an average of 2.56 procedures to achieve coverage, and average follow-up period was 11.25 months (range: 3 to 33 months, SD +/- 10.4) after surgical closure. Of the 16 flaps, 15 (93.75%) were healed on final follow-up. Six patients (37.5%) had wound-related complications with more complications observed in the younger (<54 years old) patient group (r = 0.516; P = 0.039). Results suggest that with a system of interdisciplinary care and collaboration, sacral ulcer flap surgery can be performed in patients with moderate to severe hypoalbuminemia.
Subject(s)
Albumins/metabolism , Ulcer/surgery , Humans , Retrospective Studies , SacrumABSTRACT
Haemophilus influenzae is a rare cause of necrotizing fasciitis with only a few previously reported cases. We describe the case of a 44-year-old man who had necrotizing fasciitis of the right lower extremity develop after intramuscular injections of paracetamol on his right buttock. The causative organism isolated was Haemophilus influenzae serotype b. This unusual infection was treated with repeated débridement and culture-guided antibiotics. There was no recurrence of infection at last followup 1 year after the initial surgery. Wound coverage was achieved with the use of a full-thickness skin graft after application of platelet-rich plasma and a dermal regeneration template. This resulted in a cosmetically acceptable appearance of the involved extremity for our patient.
Subject(s)
Fasciitis, Necrotizing/microbiology , Haemophilus Infections/microbiology , Haemophilus influenzae type b/immunology , Adult , Anti-Bacterial Agents/therapeutic use , Debridement/methods , Diagnosis, Differential , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Follow-Up Studies , Haemophilus Infections/diagnosis , Haemophilus Infections/therapy , Humans , Male , Skin Transplantation , Wound HealingABSTRACT
Six cases of culture-proven Mycobacterium chelonae tenosynovitis were identified through retrospective chart review. Fifteen cases were identified using computerised Medline search. Clinical features, treatment and outcome were described. Infection control was achieved in our patients with an average of 3.2 surgeries each and antibiotic treatment for six months to one year. Eleven published cases were managed by combined surgery and systemic antibiotics, with an average of 1.73 surgeries per patient and seven weeks to 24 months of antibiotics. All our patients were disease free on final follow-up. Thirteen cases were resolved. Functional outcomes were reported for eight cases. Comparison of functional outcome was not possible because different parameters were used in different reports. Aggressive debridement, susceptibility-guided antibiotics, and supervised rehabilitation resulted in infection control and acceptable hand function for our patients. Standardised data collection on subsequent cases would facilitate outcome monitoring and formulation of a treatment guideline for this disease.
Subject(s)
Hand/microbiology , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium chelonae , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Debridement , Female , Humans , Male , Middle Aged , Physical Therapy Modalities , Recovery of Function , RecurrenceABSTRACT
Lipoblastoma of the hand is a rare benign tumour of infancy. Although benign, the tumour can present as a large mass. We present a case of a two-year-old female with a large, slowly growing soft tissue mass between the second and third metacarpal of the right hand. After excision of the mass, the deep transverse metacarpal ligament (DTML) was reconstructed using a free tendon graft from the extensor indicis propius (EIP).
Subject(s)
Hand , Ligaments, Articular/surgery , Lipoma , Tendons/surgery , Child, Preschool , Female , Hand/pathology , Hand/surgery , Humans , Ligaments, Articular/abnormalities , Ligaments, Articular/pathology , Lipoma/pathology , Lipoma/surgery , Plastic Surgery Procedures , Tendons/pathologyABSTRACT
BACKGROUND: A cross-sectional study was performed to describe the upper limb deformity and function in cerebral palsy patients and to determine the correlation of deformity, spasticity, motor control, and sensation to hand function in the said population. MATERIALS AND METHODS: Thirty patients satisfying our inclusion criteria underwent physical, sensory, and functional assessment using a standard protocol. Physical assessment included documentation of the degree of spasticity, deformity and muscle control. Sensation was tested using static two-point discrimination test and stereognosis test. Melbourne Assessment of the Unilateral Upper Limb Function Test (MAULF), Functional Hand Grip Test (FHGT), and Functional Independence Measure for children (WeeFIM) were used to evaluate hand function. Deformity, spasticity, motor control, and sensation were analyzed for correlation with hand function using Pearson Correlation analysis. A p-value of less than 0.05 was considered statistically significant. RESULTS: Functional deficits of the hand increased with increasing severity of deformity and spasticity. Tetraplegics were most affected by spasticity, deformity, poor motor control, sensory and functional deficits. Triplegics, followed by diplegics had more functional upper limbs in terms of the MAULF and FHGT scores. Unilaterally affected patients (triplegics and hemiplegics) scored better in performance of activities of daily living. The MAULF and FHGT had a stronger correlation to deformity, spasticity and motor control compared to the WeeFIM. CONCLUSION: The degree of deformity, spasticity, sensory deficit, and motor control affected the hand function of a cerebral palsy patient significantly. The MAULF and FHGT more accurately represents hand function deficit in cerebral palsy patients.
ABSTRACT
Aneurysms of the hand are uncommon lesions. The most common location is the ulnar artery. We present a case of a young female who consulted us for a hand mass with a history of trauma to the hand. Pre-operative arteriogram showed a superficial palmar arch aneurysm. The mass was excised and the arch was reconstructed using a reversed Y-shaped vein graft. Fourteen months after surgery, there was no recurrence of the aneurysm and the patient only reported occasional cold intolerance.