[Two-Stage Reconstruction in Bony Finger Joint Defects - Long-Term Results]. / Zweizeitige Arthrodese bei knöchernen Fingergelenkdefekten ­ Langfristige Ergebnisse.

BACKGROUND: Bony defects in finger injuries and infections impose high demands on their treatment due to the close anatomic relationships. Ideally, the injuries are entirely treated in emergency care. Due to the mechanism of the accident, contaminated and compromised soft tissues are often present and set limits to single-stage treatment. We present the long-term subjective and functional results after two-stage reconstruction of bony finger joint defect injuries. PATIENTS AND METHODS: Over a period of 15 years, a total of 40 patients with 43 fingers were treated due to a defect injury in the phalanges. Initially, the finger was stabilised with Kirschner wires after debridement. After consolidation of the soft tissue, the bone was reconstructed in a subsequent operation by interposition of an iliac crest graft. Complications occurred in 9 patients. Twenty-five patients with 27 fingers were followed up for 10.3 years. Range of motion, length of the affected finger, and grip force, each in relation to the contralateral extremity, were recorded. In addition to a subjective assessment of the global result, the daily function was determined by means of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Significant differences compared with the contralateral extremity (p<0.05) were found in length (70 mm; 91.0%) and total mobility of the affected finger (95°; 46.0%), hand span when the thumb was involved (202.5 mm; 93.4%), and power grip when one of the fingers was injured (30 kg; 84.1%). The DASH score was 4.2 points (0-55.8). Subjectively, 88% of patients were satisfied with the treatment outcome. CONCLUSION: In case of contaminated and compromised soft tissues, the two-stage treatment of bony defect injuries in finger joints by arthrodesis of the joint is a reliable treatment strategy. In the long run, it results in a very satisfactory function of the hand in everyday life although significant differences have been measured compared with the contralateral extremity.

Anatomical principles of ankle denervation - An update.

BACKGROUND: Denervation is a surgical option in ankle arthrosis when conservative therapy has failed. Sectioning all joint branches is essential for its success. The locations of the articular branches of the saphenous (Sa), tibial (Ti), sural (Su), superficial (Ps) and deep peroneal (Pp) nerves are specified. METHODS: In 16 cryopreserved specimens, the courses of the nerves were prepared. Their articular branches were identified, and their respective locations documented by using a new reference system. RESULTS: The articular branches to the ankle ranged from 5 to 30 cm measured from the foot sole. The Sa should be transected at 22.5 cm, the Su at 20 cm, and the Pp at 15 cm. The Ti should be skeletonized up to 25 cm. Epifascial dissection of the Ps is to be performed below 15 cm. CONCLUSION: The study specifies the joint branches of the ankle in an intraoperatively reproducible reference system and thus minimizes the required skin incisions.

[Long-Term Results of Extensor Indicis Transposition Following Rupture of the Extensor Pollicis Longus Tendon after Paediatric Forearm Fracture]. / Langzeitergebnisse der Extensor-indicis-Transposition bei Ruptur der Extensor pollicis longus Sehne nach kindlicher Unterarmfraktur.

BACKGROUND: A rare but typical perioperative complication in the surgical treatment of pediatric forearm fractures is injury to the extensor pollicis longus (EPL) tendon. This article presents the long-term results after reconstruction of the EPL tendon with transposition of the extensor indicis (EI) tendon in children and adolescents after surgically treated forearm fracture. PATIENTS AND METHODS: Over a period of 15 years, 22 children up to the age of 16 were treated with EI transposition analogous to adult care. In a follow-up examination, the range of motion of the finger and thumb joints, retropulsion of the thumb and index finger, abduction and opposition were examined. In addition, hand span and strength in the gross, key, and point grasp were measured. Subjective complaints were questioned and the DASH score was assessed. RESULTS: Rupture of the EPL tendon is a rare complication, accounting for 1% of all surgically treated paediatric forearm fractures. 15 patients with an average age of 10.9 years could be followed up for an average of 66.5 months after transposition of the EI tendon. Significant differences were found in reduced mobility of the metacarpophalangeal joint of the thumb, isolated extensor strength of the index finger, a reduced span between the thumb and index finger in palmar abduction, and reduced strength in the pointed grip. Subjectively, the differences between the sides were not noticed by the patients and their parents in everyday life. CONCLUSIONS: Transposition of the EI tendon for reconstruction of a ruptured EPL tendon as a rare complication after paediatric forearm fracture does lead to a measurable and significant reduction in index finger mobility on the affected side in the long term, but without subjective limitations of the children.

Der Einfluss der simulierten Endgelenksversteifung auf die Bewegung und Kraftentwicklung des Fingers.

PURPOSE: Distal interphalangeal joint (DIPJ) arthrodesis is a well-proven therapy for osteoarthritis in the DIPJ. Since the upper limb is effectively a linked chain which is moved by interlinked, joint-overlapping muscle-tendon units, impacts on movement and force patterns are expected to occur in response to arthrodesis. In this context, a real-time quantitative analysis has not been performed to date. MATERIAL AND METHODS: Finger motion and force development during grasping were dynamically measured and quantitatively analyzed in 19 healthy volunteers with a simulated DIPJ arthrodesis using a TUB (Technische Universität Berlin) sensor glove during fist closure and evaluating two types of force grips compared with the physiological grip. RESULTS: Typical motion patterns were found. During physiological fist closure, the average flexion angle was 71.5° in the metacarpophalangeal joint (MPJ), 76.8° in the proximal interphalangeal joint (PIPJ) and 37.3° in the distal interphalangeal joint (DIPJ). With DIPJ arthrodesis, the flexion angle decreased to 49.6° in the PIPJ, whereas it increased slightly to 77.3° in the MPJ. During force grip I, the average physiological flexion angles were 18.3° in the MPJ, 39.6° in the PIPJ and 42.6° in the DIPJ. With simulated DIPJ arthrodesis, the flexion angle in the MPJ increased to 28.4°, whereas it decreased to 25.2° in the PIPJ. Force grip II yielded physiological flexion angles of 30.9° in the MPJ, 36.6° in the PIPJ and 29.0° in the DIPJ. In response to simulated DIPJ arthrodesis, the angle in the MPJ increased to 34.4° while it decreased to 23.3° in the PIPJ. The forces measured with force grips were almost equally distributed under physiological conditions. In response to simulated DIPJ arthrodesis, the average decrease in the measured force of a finger was no more than 1.4%. CONCLUSION: This study was the first to introduce a quantitative analysis of grasping with simulated DIPJ arthrodesis. Based on this analysis, the study demonstrates the dynamic interaction of the finger joints as well as force patterns on the individual finger rays of the hand in real-time.

[Ulnar Shortening Osteotomy - Two Weeks of Immobilization Sufficient]. / Ulnaverkürzungsosteotomie ­ Zwei Wochen Ruhigstellung ausreichend.

BACKGROUND: Diaphyseal ulnar shortening osteotomy (USO) as surgical treatment of ulnar impaction syndrome is standardized nowadays with good to very good results. In contrast, a wide spectrum of different postoperative treatment regimens can be found in the current literature. The results after USO with modern, angular stable implants with immobilization for 2 weeks are presented. PATIENTS AND METHODS: A retrospective database analysis identified 49 patients (31 women, 18 men, mean age 37.6 years) with a total of 51 USO over a 13-year period and were followed up for 73.5 (15.9-192.9). All USO were obliquely sawed and stabilized with palmar locking implants. The wrist was immobilized postoperatively in 30° extension in a dorsal forearm splint for 2 weeks. RESULTS: All USO showed load-stable consolidation signs after an average of 7.0 (SD 1.9; 4.9-14.1) weeks. Wrist range of motion was significantly improved in extension/flexion from 107.6° (60-155) preoperatively to 123.7° (80-160) postoperatively and in ulnar/radial deviation from 55.1° (25-90) to 60.8° (30-90) (p<0.05). Pain level was significantly reduced from 3.2 (0-8) to 0.1 (0-2) at rest and from 7.3 (4-10) to 1.2 (0-9) under weight bearing (p<0.01). A total of 5 complications (9.8%) were noted. Nonunion was not found. CONCLUSION: By using angular stable implants to stabilize a USO, the duration of immobilization can be reduced to 2 weeks without compromising bone healing.

[Corrective Osteotomy of malunited Fractures of the Base of the first Metacarpal Bone]. / Die Korrekturosteotomie an der Basis des ersten Mittelhandknochens nach in Fehlstellung konsolidierter Fraktur.

PURPOSE: In this study, the results after corrective osteotomy of the base of the first metacarpal bone are presented. PATIENTS AND METHODS: There were 24 malunion following a fracture of the base of the first metacarpal, these included 19 Bennett's fractures, 3 Rolando fractures, and 2 Winterstein fractures. The time between the corrective osteotomy and the initial trauma averaged 16 (range, 4 to 66) weeks. The Bennett and Rolando fractures had an average step-off of 2.3 (range, 0 to 4) mm, as well as gaps between 0.9 and 5.4 mm in the basal articular surface of the first metacarpal. There was a subluxation in 16 patients. Patients with Rolando or Winterstein fractures showed an axis deviation of the first metacarpal ranging from 31° to 57°. Two of the patients with Rolando fracture showed a step-off of the articular surface of 1 and 3 millimetres, respectively. Screw osteosynthesis was carried out 10 times, K-wire osteosynthesis 13 times, and once, both procedures were combined. One osteotomy was performed with use of a plate osteosynthesis. RESULTS: The corrective osteotomy in patients with Bennett's fracture improved the radial abduction on average from 37° to 49° and the palmar abduction on average from 37° to 47°. Thirteen patients presented a congruent articular surface postoperatively. A step-off in the articular surface between 0.5 and 2.2 millimetres remained in 6 cases. In one patient the subluxation could not be completely corrected. In two cases a trapezectomy was required due to the remaining displacement in the joint and a post-traumatic osteoarthritis. The mobility after Rolando and Winterstein fractures improved on average from 31° to 41° for radial abduction and from 32° to 43° for palmar abduction. Congruent joint surfaces as well as repositioning of the first metacarpal was seen in all patients, only one patient showed a persisting axis deviation of 35° postoperatively. All patients returned to work. CONCLUSION: The study shows that posttraumatic malunion of the base of the first metacarpal can be treated effectively by corrective osteotomy resulting in good outcomes, if degenerative changes have not occurred, while alternative treatment methods remain to be performed.

[Secondary flexor tendon reconstructions - how good are they?] / Sekundäre Beugesehnenplastiken ­ Wie gut sind sie?

BACKGROUND: Secondary reconstructions of flexor tendons are nowadays seldom - due to developments in primary repairs of flexor tendon. They are however indicated in complex cases. The results of a tertiary, supraregionally operating hand centre are presented. The results are compared with recent and historic published results. PATIENTS AND METHODS: During a period of 11 years and with a total of 644 flexor tendon repairs, there have been 52 secondary flexor tendon reconstructions: 7 single staged reconstructions, 16 tendon transpositions and 29 two staged reconstructions. A total of 39 patients have been evaluated retrospectively using the system of Buck-Gramcko. RESULTS: Excellent to good results have been achieved in 60 % of the single staged reconstructions. Functional = excellent to good results are found in 75 % of the transpositions. 50 % of the two staged reconstructions obtained a functional result. In total 58.5 % of the secondary flexor tendon reconstructions achieved a functional result according to the system of Buck-Gramcko. CONCLUSIONS: Secondary flexor tendon reconstructions make up about 7.5 % of all flexor tendon injuries. The functional results have changed little during the last decades and relevant improvement appears to be impossible. In comparison to primary suture of flexor tendons, the results are disappointing. The objective is to further optimize the primary repair of flexor tendons and consequently to reduce the need for secondary reconstructions.

Predictive value of metacarpophalangeal stabilization tests for simulated ulnar nerve lesion measured by a sensor glove.

STUDY DESIGN: A within-subject research design was used in this study. The difference of the range of motion (ROM) with and without ulnar nerve block was analyzed. INTRODUCTION: For the clinical evaluation of the functional effects of ulnar nerve palsy at the hand the relevance of clinical tests is in discussion. PURPOSE OF THE STUDY: The aim of the study was to evaluate the predictive value of 2 clinical tests for a simulated ulnar nerve lesion by motion analysis with a sensor glove. METHODS: In 28 healthy subjects, dynamic measurements of the finger joints were performed by a sensor glove with and without ulnar nerve block at the wrist. In the 0° metacarpophalangeal (MCP) stabilization test, the subjects were asked to stabilize the MCP joints actively in 0° while moving the interphalangeal joints, whereas at the 90° MCP stabilization test, the subjects stabilized the MCP joints actively in the 90° position. RESULTS: In the 0° MCP stabilization test, no remarkable changes of the ROM were found at the MCP joints; at the proximal interphalangeal joints 2-5, the ROM decreased with ulnar nerve block, significantly at the index, middle, and ring fingers (P < .05). In the 90° MCP stabilization test, the average ROM of the MCP joints 2-5 significantly increased with ulnar nerve block (P < .05), whereas at the PIP joints, the average ROM decreased (P < .05). DISCUSSION: The 90° MCP stabilization test had a high predictive value for the discrimination between healthy subjects and subjects with a simulated peripheral ulnar nerve lesion. CONCLUSIONS: The results could be relevant for the determination of the functional effect of ulnar nerve palsy and the quantification of clawing in hand rehabilitation. LEVEL OF EVIDENCE: II.

[Midterm results after sole percutaneous treatment for central impression fractures of the base of the middle phalanx]. / Mittelfristige Ergebnisse nach alleiniger perkutaner Versorgung zentraler Impressionsfrakturen der Mittelphalanxbasis.

PURPOSE: This study investigated the midterm results after sole percutaneous treatment for central depression fractures of the base of the middle phalanx. PATIENTS AND METHODS: 19 men and 2 women with an average age of 31.9 (18 - 57) years with a central depression fracture of the middle phalanx treated solely by intramedullary reposition with a bended K-wire and percutaneous K-wire fixation were followed on average of 13.2 (3 - 40) months. RESULTS: At the time of the last follow-up, all patients were able to pursue their previous occupational activity as well as their usual leisure activities and were painfree (VAS 0). The postoperative active flexion of the affected PIP joint was 86° with an average extension deficit of 1° or 93 % of the range of motion of the uninjured PIPJ of the opposite side. Radiologically there was a nice remodeling of the articular surface with no osteoarthrosis. There were no pin-associated complications or wound healing disorders. CONCLUSION: The sole intramedullary reduction with K-wire osteosynthesis is a suitable and reliable method for the treatment of the central impression fracture. Good functional results can be achieved with low surgical effort.

Quantification of weakness caused by distal median nerve lesion by dynamometry.

INTRODUCTION: In the assessment of hand and upper limb function, grip strength is of major importance. Use of the JAMAR dynamometer has been an accepted test of grip strength and routinely part of the physical examination. PURPOSE OF THE STUDY: The aim of this study was to determine by means of a median nerve block simulating a patient group if the measurement of different types of grip force can improve the quantification of impairment of the hand beyond the sole power grip measurements. METHODS: In 29 healthy volunteers, grip force measurement was done by the JAMAR dynamometer for power grip and by a pinch grip dynamometer for pincer grip, precision grip, pinch grip, and palmar abduction. At the power grip, the force of digit 2-5 was measured separately by a sensor glove. For each measurement, 3 trials were recorded subsequently. STUDY DESIGN: A within-subject research design was used in this prospective study. Each subject served as the control by preinjection measurements of grip and pinch strength. Subsequent measurements after median nerve block were used to examine within-subject change. RESULTS: In power grip, there was no significant reduction of maximum grip force with median nerve block compared with grip force without block. By measuring the finger forces by a sensor glove, a reduction of force at the individual fingers was found compared with the setting with no block, although significant only at the middle finger (P < .017). With median nerve block, average grip force decreased significantly 20% in pincer grip (P < .021), 29.5% in pinch grip (P < .002), 39.5% in precision grip (P < .001), and 70.7% in palmar abduction (P < .013). CONCLUSIONS: These experiments suggest a minor role of the measurement of the power grip force in the diagnostics of distal median nerve block with the dynamometer, which could not be substantially improved by the digit forces and the force distribution of the individual fingers. The assessment of other grip forms, such as pincer grasp, precision grip, pinch grip, and especially palmar abduction, leads to a relevant improvement in the diagnostics of distal median nerve lesion. LEVEL OF EVIDENCE: II.

Quantification of hand function by power grip and pinch strength force measurements in ulnar nerve lesion simulated by ulnar nerve block.

INTRODUCTION: In the assessment of hand and upper limb function, grip strength is of the major importance. The measurement by dynamometers has been established. PURPOSE OF THE STUDY: In this study, the effect of a simulated ulnar nerve lesion on different grip force measurements was evaluated. METHODS: In 25 healthy volunteers, grip force measurement was done by the JAMAR dynamometer (Fabrication Enterprises Inc, Irvington, NY) for power grip and by a pinch strength dynamometer for tip pinch strength, tripod grip, and key pinch strength. STUDY DESIGN: A within-subject research design was used in this prospective study. Each subject served as the control by preinjection measurements of grip and pinch strength. Subsequent measurements after ulnar nerve block were used to examine within-subject change. RESULTS: In power grip, there was a significant reduction of maximum grip force of 26.9% with ulnar nerve block compared with grip force without block (P < .0001). Larger reductions in pinch strength were observed with block: 57.5% in tip pinch strength (P < .0001), 61.0% in tripod grip (P < .0001), and 58.3% in key pinch strength (P < .0001). DISCUSSION: The effect of the distal ulnar nerve block on grip and pinch force could be confirmed. However, the assessment of other dimensions of hand strength as tip pinch, tripod pinch and key pinch had more relevance in demonstrating hand strength changes resulting from an distal ulnar nerve lesion. CONCLUSIONS: The measurement of tip pinch, tripod grip and key pinch can improve the follow-up in hand rehabilitation. LEVEL OF EVIDENCE: II.

[Early functional passive mobilization of flexor tendon injuries of the hand (zone 2) : Exercise with an exoskeleton compared to physical therapy]. / Die frühfunktionelle passive Mobilisation nach Beugesehnenverletzung (Zone 2) an der Hand : Beübung mit einem Exoskelett im Vergleich zur Physiotherapie.

BACKGROUND: These days there are different types of aftercare following flexor tendon injury. Patients in this study received a dynamic Kleinert protocol and additionally two different postoperative treatments. Both treatment groups were compared to each other and results were put into perspective when compared to other treatment options. METHODS: Sixty-two patients presenting with clean lesions of the two flexor tendons in zone 2 received postoperative treatment with a dynamic Kleinert protocol. Patients were randomly divided into either Group I (physical therapy) or Group II (exoskeleton). Range of motion was assessed after 6, 12 and 18 weeks. In addition, we measured the Strickland score and grip strength at the 18-week follow-up. DASH scores were obtained at weeks 12 and 18. RESULTS: Regardless of the received postoperative treatment, range of motion was predominantly limited in the proximal interphalangeal and distal interphalangeal joints after 6 weeks. This deficit decreased with time and almost full range of motion was achieved after 18 weeks. Grip strength measured 75% (Group I) and 78% (Group II) of the healthy hand's level. Good functional outcome was observed in the DASH scores after 12 weeks, which improved further, measuring 7.5 (Group I) and 6.8 (Group II) at the 18-week follow-up. We did not see any clinically relevant differences between the two patient groups. CONCLUSION: Regarding possible reruptures, the Kleinert protocol delivers a safe treatment regime. The possible disadvantage of flexion contractures with the Kleinert protocol was not seen in our measurements. Additional motion exercises using an exoskeleton delivered comparable results to classic physical therapy.

[Dorsal ligamentoplasty for posttraumatic scapholunate dissociation]. / Die dorsale Bandplastik bei posttraumatischer skapholunärer Dissoziation.

Scapholunate dissociation in stages 2 and 3 may lead to posttraumatic damage if left untreated. Different types of treatment have been described, including capsulodesis, tenodesis, and others. The purpose of all procedures is to avoid palmar shift of the distal scaphoid resulting in secondary arthritis (SLAC wrist). This study aimed to evaluate a modified dorsal ligamentoplasty in second- and third-degree scapholunate dissociation in a prospective study design. Furthermore, the study aimed to find out if there is a correlation between radiological and clinical parameters at follow-up and whether or not a SLAC wrist can be avoided. From 2007 to 2011 we performed 29 dorsal ligamentoplasties in our hospital in patients with second- and third-degree scapholunate dissociation. In a prospective study design, 25 patients were followed up after an average period of 18 months. Parameters recorded preoperatively included ROM, the radiological parameters SL diastasis, SL diastasis in power grip and SL angle, the DASH score, and the VAS score. The postoperative evaluation additionally included power grip, the Mayo wrist score, and patients' subjective satisfaction. The average subjective satisfaction after surgery was good. The average postoperative ROM was 83.8 % of the ROM of the healthy wrist and decreased by 11 % compared with the preoperative level. The average postoperative grip strength was 85.7 % of the strength of the healthy hand. The VAS score was 2.7 with a significant reduction from 6.7 preoperatively. The average DASH score decreased significantly from 60 preoperatively to 22.5 postoperatively. The average Mayo wrist score after surgery was 73. All radiological parameters at follow-up were significantly better than preoperatively, although they remained in a pathological range. The Pearson correlation analysis showed no relevant correlation between clinical and radiological scores. Three cases (12 %) required revision surgery. The described modified dorsal ligamentoplasty at the carpus can be recommended in second- and third-degree scapholunate dissociation. Clinical results are comparable to other techniques, but there is only a single approach required and the complication rate is very low. The short average follow-up of 18 months must be viewed critically as the rate of SLAC wrists might be higher during longer follow-up periods.

Image guidance can support scaphoid K-wire insertion: an experimental study and initial clinical experience.

PURPOSE: In the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique. METHODS: For this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system's workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting. RESULTS: In the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users. CONCLUSION: The system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.

The role of periaqueductal gray and cingulate cortex during suppression of pain in complex regional pain syndrome.

OBJECTIVE: Complex regional pain syndrome I (CRPS I) is a frequent and debilitating condition with unclear etiology. Hypothesizing that maladaptive central processes play a crucial role in CRPS, the current study set out to explore cerebral activation during a task to suppress the feeling of pain under constant painful stimulation. METHODS: Ten individuals with CRPS I with symptoms on their left hand were subjected to electrical stimulation of both index fingers subsequently in a functional magnetic resonance imaging experiment. Their data were compared with 15 healthy controls. RESULTS: Concerning psychophysical measures, patients succeeded similarly as healthy controls in suppressing the feeling of pain. However, during constant painful stimulation and with the task to suppress the feeling of pain, there were significant differences in the interaction analyses of the corresponding cortical activation. DISCUSSION: Patients differ from healthy controls by the activation pattern of cerebral areas that belong to the descending opioid pain suppression pathway: PAG and cingulate cortex are activated significantly less during suppression of pain, regardless of whether the symptomatic or asymptomatic hand was stimulated. Thus, there is a generalized functional change in individuals with CRPS I. However, it cannot be deducted whether the abnormality is causative or merely an effect, possibly maladaptive.

Different activation of opercular and posterior cingulate cortex (PCC) in patients with complex regional pain syndrome (CRPS I) compared with healthy controls during perception of electrically induced pain: a functional MRI study.

OBJECTIVES: Although the etiology of complex regional pain syndrome type 1 (CRPS 1) is still debated, many arguments favor central maladaptive changes in pain processing as an important causative factor. METHODS: To look for the suspected alterations, 10 patients with CRPS affecting the left hand were explored with functional magnetic resonance imaging during graded electrical painful stimulation of both hands subsequently and compared with healthy participants. RESULTS: Activation of the anterior insula, posterior cingulate cortex (PCC), and caudate nucleus was seen in patients during painful stimulation. Compared with controls, CRPS patients had stronger activation of the PCC during painful stimulation of the symptomatic hand. The comparison of insular/opercular activation between controls and patients with CRPS I during painful stimulation showed stronger (posterior) opercular activation in controls than in patients. DISCUSSION: Stronger PCC activation during painful stimulation may be interpreted as a correlate of motor inhibition during painful stimuli different from controls. Also, the decreased opercular activation in CRPS patients shows less sensory-discriminative processing of painful stimuli.These results show that changed cerebral pain processing in CRPS patients is less sensory-discriminative but more motor inhibition during painful stimuli. These changes are not limited to the diseased side but show generalized alterations of cerebral pain processing in chronic pain patients.

Motion coordination patterns during cylinder grip analyzed with a sensor glove.

PURPOSE: To determine whether the grip of a healthy subject's hand shows certain universal characteristics. To accomplish this, we examined the complex interactions of the fingers during gripping of different-size cylindrical objects. METHODS: A total of 48 subjects (11 women, 37 men) performed 5 cylinder grips with different object sizes. The 14 joint angular profiles of the 5 digits were measured dynamically with a Technische Universität Berlin sensor glove. RESULTS: Frequently, initial movement was detected before the actual grip. This movement consisted of passive flexion of the fingers the moment the hand rose from the table, followed by active extension of the fingers before gripping the object. Along with the type of joint, the size of the object gripped influenced the frequency of these initial movements (p<.001). During actual grip, the proximal interphalangeal joints' flexion was significantly greater than the flexion of the metacarpophalangeal and distal interphalangeal joints (p<.001). The mean flexion of the proximal interphalangeal joints was 43 degrees , that of the metacarpophalangeal joints was 28 degrees , and that of the distal interphalangeal joints was 26 degrees. Apart from these findings, the larger the flexion angle was, the more time tended to be needed to fulfil the motion. CONCLUSIONS: The results show that there is a universal motion pattern with the cylinder grip in healthy individuals concerning the range of movement of the finger joints. However, to fully understand the cylinder grip in healthy individuals, our next step will be to analyze the dynamics of the cylinder grip as well. For that purpose, we examine the dynamic interactions between the fingers--that is, their chronological sequence during the cylinder grip.