Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review.

OBJECTIVE: The aim of this study is to systematically review the scientific findings about the efficacy of the measure of the Adductor Pollicis Muscle Thickness for nutritional assessment of individuals in various clinical conditions. METHOD: Systematic review study performed according to the methodology Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: 13 original articles published between 2004 and 2016 were included. The measure was associated/correlated to parameters of nutritional status (such as weight, body mass index and Global Subjective Assessment) and muscle mass markers (such as circumference brachial muscle circumference, brachial muscle area, calf circumference, and muscle mass). All these correlations were weak or moderate. CONCLUSION: The measurement can be used in different populations, being able to estimate nutritional status and muscle mass. However, it is suggested that it be used in a complementary way to the nutritional evaluation, not constituting a single diagnostic/monitoring parameter.

Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review / Espesura del Músculo Aductor del Pulgar para evaluación nutricional: una revisión sistemática / Espessura do Músculo Adutor do Polegar para avaliação nutricional: uma revisão sistemática

ABSTRACT Objective: The aim of this study is to systematically review the scientific findings about the efficacy of the measure of the Adductor Pollicis Muscle Thickness for nutritional assessment of individuals in various clinical conditions. Method: Systematic review study performed according to the methodology Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: 13 original articles published between 2004 and 2016 were included. The measure was associated/correlated to parameters of nutritional status (such as weight, body mass index and Global Subjective Assessment) and muscle mass markers (such as circumference brachial muscle circumference, brachial muscle area, calf circumference, and muscle mass). All these correlations were weak or moderate. Conclusion: The measurement can be used in different populations, being able to estimate nutritional status and muscle mass. However, it is suggested that it be used in a complementary way to the nutritional evaluation, not constituting a single diagnostic/monitoring parameter.

RESUMEN Objetivo: Revisar de forma sistemática las constataciones científicas acerca de la eficacia de la medida de la Espesura del Músculo Aductor del Pulgar para evaluación nutricional de los individuos bajo diversas condiciones clínicas. Método: Estudio de revisión sistemática, realizado conforme la metodología Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Se incluyeron 13 artículos originales publicados entre 2004 y 2016. La medida se presentó asociada/correlacionada a los parámetros de evaluación del estado nutricional (peso, índice de masa corporal y Evaluación Subjetiva Global) y a los marcadores de masa muscular (como circunferencia braquial, circunferencia muscular braquial, área muscular braquial, circunferencia de la pantorrilla y masa muscular). Todas estas correlaciones fueron débiles o moderadas. Conclusión: La medida puede ser utilizada en diferentes poblaciones, siendo capaz de estimar el estado nutricional y la masa muscular. Sin embargo, se sugiere que se emplee de forma complementaria la evaluación nutricional, no constituyendo un parámetro único de diagnóstico/monitoreo.

RESUMO Objetivo: Revisar de forma sistemática as constatações científicas acerca da eficácia da medida da Espessura do Músculo Adutor do Polegar para avaliação nutricional de indivíduos em diversas condições clínicas. Método: Estudo de revisão sistemática, realizado conforme a metodologia PreferredReportingItems for SystematicReviewsand Meta-Analyses (PRISMA). Resultados: Foram incluídos 13 artigos originais publicados entre 2004 e 2016. A medida apresentou-se associada/correlacionada aos parâmetros de avaliação do estado nutricional (como peso, índice de massa corporal e Avaliação Subjetiva Global) e aos marcadores da massa muscular (como circunferência braquial, circunferência muscular braquial, área muscular braquial, circunferência da panturrilha e massa muscular). Todas essas correlações foram fracas ou moderadas. Conclusão: A medida pode ser utilizada em diferentes populações, sendo capaz de estimar o estado nutricional e a massa muscular. No entanto, sugere-se que seja empregada de modo complementar à avaliação nutricional, não constituindo um parâmetro único de diagnóstico/monitoramento.

An overview of robotic/mechanical devices for post-stroke thumb rehabilitation.

PURPOSE: This article aims to clarify the current state-of-the-art of robotic/mechanical devices for post-stroke thumb rehabilitation as well as the anatomical characteristics and motions of the thumb that are crucial for the development of any device that aims to support its motion. METHODS: A systematic literature search was conducted to identify robotic/mechanical devices for post-stroke thumb rehabilitation. Specific electronic databases and well-defined search terms and inclusion/exclusion criteria were used for such purpose. A reasoning model was devised to support the structured abstraction of relevant data from the literature of interest. RESULTS: Following the main search and after removing duplicated and other non-relevant studies, 68 articles (corresponding to 32 devices) were left for further examination. These articles were analyzed to extract data relative to (i) the motions assisted/permitted - either actively or passively - by the device per anatomical joint of the thumb and (ii) mechanical-related aspects (i.e., architecture, connections to thumb, other fingers supported, adjustability to different hand sizes, actuators - type, quantity, location, power transmission and motion trajectory). CONCLUSIONS: Most articles describe preliminary design and testing of prototypes, rather than the thorough evaluation of commercially ready devices. Defining appropriate kinematic models of the thumb upon which to design such devices still remains a challenging and unresolved task. Further research is needed before these devices can actually be implemented in clinical environments to serve their intended purpose of complementing the labour of therapists by facilitating intensive treatment with precise and repeatable exercises. Implications for Rehabilitation Post-stroke functional disability of the hand, and particularly of the thumb, significantly affects the capability to perform activities of daily living, threatening the independence and quality of life of the stroke survivors. The latest studies show that a high-dose intensive therapy (in terms of frequency, duration and intensity/effort) is the key to effectively modify neural organization and recover the motor skills that were lost after a stroke. Conventional therapy based on manual interaction with physical therapists makes the procedure labour intensive and increases the costs. Robotic/mechanical devices hold promise for complementing conventional post-stroke therapy. Specifically, these devices can provide reliable and accurate therapy for long periods of time without the associated fatigue. Also, they can be used as a means to assess patients? performance and progress in an objective and consistent manner. The full potential of robot-assisted therapy is still to be unveiled. Further exploration will surely lead to devices that can be well accepted equally by therapists and patients and that can be useful both in clinical and home-based rehabilitation practice such that motor recovery of the hand becomes a common outcome in stroke survivors. This overview provides the reader, possibly a designer of such a device, with a complete overview of the state-of-the-art of robotic/mechanical devices consisting of or including features for the rehabilitation of the thumb. Also, we clarify the anatomical characteristics and motions of the thumb that are crucial for the development of any device that aims to support its motion. Hopefully, this?combined with the outlined opportunities for further research?leads to the improvement of current devices and the development of new technology and knowledge in the field.

Características histológicas de la piel de la cara volar del pulgar en individuos chilenos con desvanecimiento del dactilograma / Histological characteristics of the skin of the volar side of the thumb in Chilean individuals with vanishing dactylogram

En forma característica, la piel de manos y de pies presenta un diseño morfológico particular denominado dactilograma. Este patrón es característico de la piel gruesa de dígitos, palma de manos y plantas de pies y sus propiedades le permiten cumplir un rol protagónico en la identificación humana. No se han descrito los cambios que ocurren en la cara volar de pulgar debido al proceso de envejecimiento. Es por esta razón que el objetivo del presente trabajo fue evidenciar los cambios en la bioestructura de la piel de la cara volar del primer dígito de la mano derecha en individuos de edad avanzada. Para este estudio se utilizaron muestras de piel de pulgar derecho de individuos chilenos de ambos sexos y de edad avanzada. Estas muestras fueron sometidas a estudio histológico con H-E, Tricromico de Mallory, Rojo Sirio de Junquiera, Reaccion de PAS y tinción de Orceina. Las observaciones y registros se realizaron con Microscopio Zeiss Axiostar Plus, cámara fotográfica Canon modelo PowerShot A 640 y software Image Tool 3.0 UTHSCSA, 2002. Los resultados evidenciaron cambios significativos en el grosor de la epidermis, en la morfología de la membrana basal, en la forma y cantidad de vasos sanguíneos, en la distribución y patrón de ordenamiento de las fibras elásticas y colágenas y en el aumento de corpúsculos táctiles. Estos cambios confirman la existencia de cambios histológicos importantes debido al proceso de envejecimiento, lo que podría ser determinante en el paulatino desvanecimiento de las características morfológicas del dactilograma, dificultando observar, evidenciar y registrar el dactilograma en individuos de edad avanzada, disminuyendo la posibilidad de identificación de estos individuos, acarreando posibles consecuencias médico-legales.

Characteristically the skin of hands and feet shows a particular morphological design called dactylogram. This pattern is typically on the thick skin of the digits, the palm of the hands and the soles of the feet, and its properties have a leading role in human identification. The changes that take place on the volar side of the thumb due to the aging process have not yet been described. It is for this reason that the objective of the present work is to show the variation of the biostructure on the skin of the volar side of the first digit of the right hand in elderly individuals. For this research, skin samples of the right thumb from elderly Chilean subjects of both sexes were used. These samples underwent histological studies with H & E, Mallory´s trichrome, Sirio of Junqueira Red, PAS Reaction and Orcein staining. The observation and records were made with Zeiss Axiostar Plus Microscope, a Canon PowerShot A 640 camera, and Image Tool 3.0 software UTHSCSA, 2002. The results showed significant changes on the epidermis thickness, in the basement membrane morphology, in the shape and quantity of blood vessels, the distribution and arrangement pattern of the collagen and elastic fibers, and in the increase of tactile corpuscles. These changes confirm the existence of significant histological changes due to the aging process, which could be decisive in the gradual fading of the morphological characteristics of the dactylogram, making it difficult to observe, demonstrate and record the dactylogram on individuals of advanced age which reduces the possibility of identification of those individuals, leading to possible medical-legal consequences.

Thickness of the adductor pollicis muscle in nutritional assessment of surgical patients.

OBJECTIVE: To evaluate the correlation between thickness of the muscle adductor pollicis and anthropometric measurements, body mass index and Subjective Global Assessment in the nutritional assessment of surgical patients. METHODS: The study population comprised patients admitted to the general and reconstructive surgery unit of a university hospital in the city of Vitória (ES), Brazil. The inclusion criteria were patients evaluated in the first 48 hours of admission, aged ≥20 years, hemodynamically stable, with no edema or ascites. Data analysis was performed using the software Statistical Package for Social Science 21.0, significance level of 5%. RESULTS: The sample consisted of 150 patients that were candidates to surgery, mean age of 42.7±12.0 years. The most common reasons for hospitalization were surgical procedures, gastrintestinal diseases and neoplasm. Significant association was observed between thickness of adductor pollicis muscle and Subjective Global Assessment (p=0.021) and body mass index (p=0.008) for nutritional risk. Significant correlation was found between thickness of adductor pollicis muscle and arm muscle circumference, corrected arm muscle area, calf circumference and body mass index. There were no significant correlations between thickness of adductor pollicis muscle and triceps skinfold and age. CONCLUSION: The use of thickness of adductor pollicis muscle proved to be an efficient method to detect malnutrition in surgical patients and it should be added to the screening process of hospitalized patients, since it is easy to perform, inexpensive and noninvasive.

Thickness of the adductor pollicis muscle in nutritional assessment of surgical patients / Espessura do músculo adutor do polegar na avaliação nutricional de pacientes cirúrgicos

ABSTRACT Objective To evaluate the correlation between thickness of the muscle adductor pollicis and anthropometric measurements, body mass index and Subjective Global Assessment in the nutritional assessment of surgical patients. Methods The study population comprised patients admitted to the general and reconstructive surgery unit of a university hospital in the city of Vitória (ES), Brazil. The inclusion criteria were patients evaluated in the first 48 hours of admission, aged ≥20 years, hemodynamically stable, with no edema or ascites. Data analysis was performed using the software Statistical Package for Social Science 21.0, significance level of 5%. Results The sample consisted of 150 patients that were candidates to surgery, mean age of 42.7±12.0 years. The most common reasons for hospitalization were surgical procedures, gastrintestinal diseases and neoplasm. Significant association was observed between thickness of adductor pollicis muscle and Subjective Global Assessment (p=0.021) and body mass index (p=0.008) for nutritional risk. Significant correlation was found between thickness of adductor pollicis muscle and arm muscle circumference, corrected arm muscle area, calf circumference and body mass index. There were no significant correlations between thickness of adductor pollicis muscle and triceps skinfold and age. Conclusion The use of thickness of adductor pollicis muscle proved to be an efficient method to detect malnutrition in surgical patients and it should be added to the screening process of hospitalized patients, since it is easy to perform, inexpensive and noninvasive.

RESUMO Objetivo Avaliar a correlação entre a medida da espessura do músculo adutor do polegar com medidas antropométricas, índice de massa corporal e Avaliação Subjetiva Global no diagnóstico nutricional de pacientes cirúrgicos. Métodos Participaram do estudo pacientes internados em uma unidade de cirurgia geral e reparadora de um hospital universitário de Vitória (ES), Brasil. Os critérios de inclusão foram pacientes avaliados nas primeiras 48 horas de internação, idade ≥20 anos hemodinamicamente estáveis, sem edema ou ascite. A análise dos dados foi realizada pelo softwareStatistical Package for Social Science, versão 21.0, com nível de significância de 5%. Resultados Compuseram a amostra 150 pacientes candidatos à cirurgia, com média de idade de 42,7±12,0 anos. Os motivos de internação mais comuns foram procedimentos cirúrgicos, doenças do trato gastrointestinal e neoplasias. Observou-se associação significativa entre a espessura do músculo adutor do polegar com a Avaliação Subjetiva Global (p=0,021) e com o índice de massa corporal para risco nutricional (p=0,008). Foram encontradas correlações significativas entre a espessura do músculo adutor do polegar com circunferência muscular do braço, área muscular do braço corrigida, circunferência da panturrilha e índice de massa corporal. Não foram encontradas correlações significativas entre a espessura do músculo adutor do polegar com prega cutânea triciptal e idade. Conclusão O uso da espessura do músculo adutor do polegar mostrou-se um método eficiente na detecção de desnutrição em pacientes cirúrgicos e deve ser acrescentado ao processo de triagem de pacientes hospitalizados, uma vez que é de fácil execução, baixo custo e não invasivo.

Estudio anatómico del fascículo accesorio del músculo flexor largo del pulgar y su relación con el nervio interóseo anterior en individuos brasileños / Anatomical study of the accessory head of the flexor pollicis longus muscle and its relationship to the anterior interosseous nerve in Brazilian individuals

Entre los síndromes de compresión nerviosa en el antebrazo, debido a la presencia de arcos tendinosos de músculos relacionados al trayecto de los nervios que transcurren entre sus capas musculares, se encuentra el del nervio interóseo anterior (NIA). La presencia de variaciones musculares puede generar arcos que ocasionan compresión nerviosa. El objetivo fue establecer la incidencia y morfología del músculo accesorio del flexor largo del pulgar (AFLP) y la relación de éste con el NIA o sus ramos motores. Se utilizaron 30 antebrazos, de cadáveres formolizados de individuos adultos brasileños. El punto de referencia seleccionado para las mediciones fue el epicóndilo medial del humero (EMH). Se observó que tres miembros superiores presentaron el AFLP (10%), en todos ellos se originó en el EMH para terminar insertándose en el tendón del músculo flexor largo del pulgar (FLP). El vientre muscular presentó aspecto fusiforme, el cual tenía un tendón que formó un arco con el FLP. En uno de los casos, este arco se relacionó con el paso del NIA; en los otros dos, lo hizo con los ramos motores que se originan del NIA. Al diagnosticar los síndromes generados por compresión nerviosa se debe considerar la presencia del AFLP, el cual, potencialmente se puede relacionar con el trayecto del NIA o de sus ramos.

Between the syndromes of nerve compression in the forearm, due to the presence of the tendinous arches related to the nerves that pass between its muscle layers, is the anterior interosseous nerve (AIN). The presence of muscular variations can generate arches that cause nerve compression. The aim of our study was to establish the incidence and morphology of the accessory head of flexor pollicis longus muscle (AFPLm) and its relationship with AIN or its branches. Thirty forearms of formalized corpses of adult Brazilians were used. The selected landmark for measurements was the medial epicondyle of the humerus (MEH). It was noted that three upper limbs presented the AFPLm (10%), originated from the MEH to end inserted into the tendon of the flexor pollicis longus muscle. The AFPLm showed fusiform appearance, which had a tendon that formed an arch with the flexor pollicis longus muscle. In one case, this arch was associated with the passage of AIN. In the other two, this arch was related to motor branches originating from the AIN. The diagnosis of nerve compression syndromes should consider the presence of AFLPm, which potentially can be related to the course of the AIN or its branches.

Anatomical analysis of thumb opponency movement in the capuchin monkey (Sapajus sp).

Capuchin monkeys present a wide variety of manipulatory skills and make routine use of tools both in captivity and in the wild. Efficient handling of objects in this genus has led several investigators to assume near-human thumb movements despite the lack of anatomical studies. Here we perform an anatomical analysis of muscles and bones in the capuchin hand. Trapezo-metacarpal joint surfaces observed in capuchins indicate that medial rotation of metacarpal I is either absent or very limited. Overall, bone structural arrangement and thumb position relative to the other digits and the hand's palm suggest that capuchins are unable to perform any kind of thumb opponency, but rather a 'lateral pinch' movement. Although the capuchin hand apparatus bears other features necessary for complex tool use, the lack thumb opposition movements suggests that a developed cognitive and motor nervous system may be even more important for high manipulatory skills than traditionally held.

Anomalous origin of the Abductor Pollicis Longus (APL): clinical and surgical applications

The Abductor Pollicis Longus (APL) is known to have a big variety in its number of insertion tendons.Because of that, studies about variations in its origin are not frequently achieved like studies about its insertionforms. This study describes an anatomic variation of the Abductor Pollicis Longus, with an anomalous venteroriginated of the inferior portion of the lateral border of the radio. Surgical and clinical implications are inrelation principally with the big number of tendons of insertion of the APL, but there are related cases inthe literature in that additional venter of this muscle also can be involved in the physiopathology of clinicalsyndromes, like the tenosynovitis of de Quervain

Unusual topography of posterior antebrachial musculature in the first osseofibrous compartment of wrist: clinicomorphological appraisal / Topografía inusual de la musculatura antebraquial posterior en el primer compartimento osteofibroso de la muñeca: valoración clínico-morfológica

Anatomical variations of abductor pollicis longus and extensor pollicis brevis are important in clinical assessment of diseased and traumatized hand. The present case reports an unusual fusion of muscle bellies of abductor pollicis longus and extensor pollicis brevis with two separate tendons of insertion, the medial tendon inserted into the base of first metacarpal and the lateral tendon into the abductor pollicis brevis muscle. Knowledge of such anatomical variations is of utmost importance in the management of De Quervain's disease and reconstructive surgeries of hand.

Las variaciones anatómicas de los músculos abductor largo del pulgar y extensor corto del pulgar son importantes en la evaluación clínica de la mano enferma y traumatizada. El presente caso informa una inusual fusión de los vientres musculares de los Mm. abductor largo del pulgar y extensor corto del pulgar con dos tendones de inserción separados, el tendón medial se insertó en la base del primer metacarpiano y el tendón lateral en el músculo abductor corto del pulgar. El conocimiento de estas variaciones anatómicas es de importancia en el manejo de la enfermedad de De Quervain y cirugía reconstructiva de la mano.

Improvement of hand function in children with cerebral palsy via an orthosis that provides wrist extension and thumb abduction.

BACKGROUND: The present study examines the hand movements of children with cerebral palsy during functional tests and compares the childrens' performance with and without the aid of an orthosis that provides wrist extension and thumb abduction. METHODS: The range of motion of the trapeziometacarpal joint was assessed for 32 participants via a reflexive markers image system. Observed motions included flexion-extension and abduction-adduction motions performed in the course of four tests for manual ability; the rest position, lateral and tripod pinches and cylindrical grasp. Muscle strength and manual ability were evaluated using dynamometry and the Jebsen-Taylor test. FINDINGS: The range of motion tests for the rest position, lateral and tripod pinches and cylindrical grasp demonstrated improvements from 17% to 42% (P<0.001) for flexion/extension and from 36% to 54% for abduction/adduction (P<0.001) with the use of the orthosis. Dynamometry measurements showed that the improvement in muscle strength obtained through use of the orthosis was 50% (P<0.001). Improvements in the time required to perform the movements as determined using the Jebsen-Taylor test varied from 13% to 24% (P<0.01) for the four considered tests of manual ability. INTERPRETATION: The orthosis improved the range of motion of the trapeziometacarpal joint, muscle strength and manual ability. The combination of the three techniques may provide the basis for a quantitative assessment of hand dysfunction/improvement in cerebral palsy that will ultimately guide health professionals in their clinical interventions.

Superficial portion of abductor pollicis brevis muscle, morphological study and literature review: case report / Fascículo superficial del músculo abductor corto del pulgar, estudio morfológico y revisión de la literatura. reporte de caso

Abductor pollicis brevis muscle (APB) belongs to the foreground of the subfascial muscle thenar region, which is of great importance in the movement of the thumb on its two-joint arrangement. In this article, we report the presence of a superficial portion of the APB muscle and its relationship and discuss the available literature and the clinical implications of the presence of this variation.

El músculo abductor corto del pulgar (ACP) pertenece al primer plano muscular subfascial de la región tenar de gran importancia en los movimientos del pulgar por su disposición biarticular. En el presente artículo reportamos la presencia de un fascículo superficial del músculo ACP y sus relaciones, se analiza la literatura disponible y se discuten las implicancias clínicas de la presencia de esta variación.

Musculatura adutora do polegar: um novo índice prognóstico em cirurgia cardíaca valvar / Adductor pollicis muscle: a new prognostic index in cardiac valve surgery

A desnutrição é um achado comum nos pacientes com cardiopatia, especilamente naqueles com valulopatia mitral, que parecem estar mais gravemente consumidos.O estado nutricional pode ser agravado pelo trauma cirúrgico, comprometendo a evolução pós-operatória.Até o momento, nenhum parâmetro isolado da avaliação nutricional tradicional tem se mostrado eficiente em apontar, no pré-operatório, a prevalência de complicações sépticas, não-sépticas, mortalidade e tempo de internação hospitalar no pós-operatório.Nenhum estudo, até o presente momento, utilizou a medida da espessura do músculo adutor do polegar no período de pré-operatório, de modo comparativo com os parâmetros clássicos da avaliação nutricional, como indicador prognóstico para complicações cirúrgicas pós-operatória

Adductor pollicis muscle: a new anthropometric parameter.

PURPOSE: To measure the thickness of adductor pollicis muscle in healthy adults. This measurement will be used as a nutritional anthropometric parameter in further studies. SUBJECTS AND METHOD: Four hundred and twenty-one healthy adults were studied, 209 men and 212 women, with ages ranging from 18 to 87 years, living in Rio de Janeiro. The adductor pollicis muscle was also studied in the human anatomy lab as well as in normal healthy volunteers using CAT scans and nuclear magnetic resonance imaging to ensure that only the adductor pollicis was included in measurement of muscle thickness with a Lange caliper. To standardize the measurement, the methodology was detailed, with subjects sitting with the dominant hand dangling over the homolateral thigh and the elbow bent at approximately a 90 degrees angle. The Lange caliper was applied at a pressure of 10 g/mm2, pinching the adductor pollicis muscle at the vertex of an imaginary angle between the thumb and the index finger. The average of 3 consecutive measurements was considered to be the muscle thickness. RESULTS: This study provides the first estimates of adductor pollicis thickness in normal healthy subjects as an anthropometric parameter. The normal values in the dominant hand for men were 12.5 +/- 2.8 mm (mean +/- SD), median 12 mm, and for women were 10.5 +/- 2.3 mm, median 10 mm.

Adductor policis muscle: a new anthropometric parameter

OBJETIVO: Padronizar a medida da espessura do músculo adutor do polegar em adultos saudáveis, para futuras avaliações como parâmetro antropométrico. INDIVÍDUOS E MÉTODOS: Foram estudados 421 adultos saudáveis, oriundos de vários municípios do Rio de Janeiro, de ambos os sexos e nas faixas etárias compreendidas entre 18 a 25 anos, 26 a 45 anos, 46 a 65 anos e mais de 65 anos. Após a confirmação pelos estudos radiológicos e anatômicos, concluindo que com a técnica empregada, nenhum outro músculo além do adutor do polegar foi incluído na medição, foi elaborado o seguinte método: Com o indivíduo sentado, mão dominante repousando sobre o joelho homolateral, cotovelo em ângulo de aproximadamente noventa graus sobre o membro inferior, foi utilizado o paquímetro de Lange exercendo uma pressão contínua de 10g/mm2 para pinçar o músculo adutor no vértice de um ângulo imaginário formado pela extensão do polegar e o dedo indicador. A média de três aferições foi considerada como a medida da espessura do músculo adutor. RESULTADOS: A média obtida para a espessura do músculo adutor do polegar, na mão dominante, no sexo masculino foi de 12,5 ± 2,8 mm, com uma mediana de 12 mm e no sexo feminino foi de 10,5 ± 2,3 mm, com uma mediana de 10 mm.

Músculo adutor do polegar: um novo parâmetro antropométrico

O autor estudou 421 adultos saudáveis, de ambos os sexos, oriundos de vários municípios do Rio de Janeiro, com idade variando de 18 a 87 anos. A avaliação nutricional foi realizada com os parâmetros antropométricos clássicos, Avaliação Global Subjetiva e avaliação subjetiva do estado trófico da musculatura temporal superficial, interóssea das mãos, adutora do polegar e panturrilhas. Nenhum indivíduo apresentou desnutrição quando considerado no mínimo dois parâmetros nutricionais antropométricos, nem quando avaliados pela Avaliação Global Subjetiva. Alguns resultados da antropometria clássica contrastam com os descritos em tabelas americanas, principalmente quanto a reserva gordurosa e muscular, em ambos os sexos. Esse achado enfatiza a necessidade de se obter os resultados antropométricos para nossa população saudável. A medida da espessura do músculo adutor do polegar na mão dominante foi padronizada, com relato detalhado da metodologia utilizada. A média para o sexo mesculino foi de 12,5 mm e a do sexo feminino foi de 10,5 mm. Em indivíduos saudáveis, a prevalência de atrofia da musculatura temporal superficial, adutora do polegar, interóssea e da panturrilha é extremamente rara.

The author studied four hundred and twenty one healthy adults (209 men and 212 women) with age ranging from 18 to 87 years old, living in Rio de Janeiro. Nutritional assessment was determined with classical anthropometrics parameters, Subjective Global Assessment and subjective appraisal of muscle trophic state from superficial temporal muscle, interosseus, adductor pollicis e calves. Considering at least two nutritional anthropometries parameters, malnutrition were not detected in any of adult and SGA were normal in all subjects. However, some results obtained from classical anthropometries measures were not comparable with populational american tables. The amount of fat and protein reserves were quite different both in men and women. These data emphasize that normal anthropometries values are needed to healthy brazilian population. The prevalence of subjective atrophy of superficial temporal, interosseus, calves and adductor pollicis muscle were extremely rare. This study provides the first estimates of adductor pollicis thickness as a new anthropometric parameter. The methodology is detailed and the normal values in nondominant hand were considered 12,5 mm in men and 10,5 mm in women.

Cirugía del pulgar: nueva técnica de reconstrucción / Thumb reconstruction

A manera de presentación previa, se expone un nuevo método reconstructivo, original del autor, destinado a reconstruir un pulgar ausente, que preserve la articulación trapecio-metacarpiana funcionante, constituyendo una nueva e interesante alternativa. Una mínima pérdida (tercera falange del dedo medio, total o parcial de la misma mano o de la mano opuesta), permite la reconstrucción de un pulgar sensible y de excelente aspecto cosmético. Un rápido análisis sobre la experiencia personal del autor con todos los métodos existentes hasta el presente en dicha rea permite dar una ubicación más precisa dentro del contexto reconstructivo del pulgar a esta nueva técnica. Procedimientos macroquirúrgico o microquirúrgico y/o combinados pueden ser empleados según el caso clínico determinante. Se encuentra contraindicado este procedimiento en niños en proceso de crecimiento, debido a la utilización de injerto óseo de la cresta ilíaca

Pinça polegar-indicador: análise eletromiográfica de sua musculatura intrínseca e extrínseca / Thumb-index finger grip: electromyographic study of their intrinsic and extrinsic muscular groups

Em 10 indivíduos adultos, os músculos adutor do polegar, o primeiro interósseo dorsal e o flexor curto do polegar (grupo intrínseco) e mais os músculos flexores longos do indicador e do polegar foram analisados com eletrodos de agulha co-axiais simples, ligados a um aparelho TECA TE 2-7. Verificou-se predominância absoluta da musculatura extrínseca nos movimentos de preensäo leve com a ponta dos dedos; nos movimentos delicados de pinça, mas com os dedos indicador e polegar estendidos, predominou a musculatura intrínseca; e nos movimentos de preensäo forte, registrou-se atividade eletromiográfica acentuada de ambos os grupos musculares

Manejo quirurgico del pulgar en la palma / Surgical management of the thumb in the palm

Analiza los resultados de una tecnica quirurgica (tenodesis-transferencia del APL al ECRB o ECRL) desarrollada en el Instituto F.D. Roosvelt de Bogota, como parte del tratamiento del pulgar cortical o "pulgar en la palma" producida por la espasticidad resultante de paralisis cerebral. La operacion descrita permite corregir la deformidad y estabilizar la articulacion metacarpofalangica subluxada. Tiene especial relevancia en la rehabilitacion funcional de la mano de estos pacientes (mantenimiento de la movilidad, agarre-liberacion-pinza y velocidad satisfactorios y mejoria de la apariencia y la postura). Presenta 26 pacientes tratados entre 1969 y 1985, 7 de los cuales necesitaron mas de una operacion (1969-1982); 6 a quienes se les hizo tenodesis APL-BR (1983-84) y 13 manejados con la nueva operacion (desde 1984). 10 tenian entre 4 y 8 anos y 3 eran mayores y no se encontro relacion entre la edad del paciente y los resultados del tratamiento. La proporcion hombre mujer fue de 3:1. En la valoracion preoperatoria la PC se clasifico por la escala de Little, se encontraron paresias principalmente derechas con predominio del grupo II (Golden-Zancolli) la lesion de la mano fue unilateral en todos los casos y derecha en el 53 por ciento . Todos los ninos tenian extension voluntaria del puno y en mayores de 4 anos se evaluo la sensibilidad. Asociadas a la deformidad se encontraron alteraciones en la posicion de los dedos, el hombro, el codo y el antebrazo y alteraciones musculares minimas con diferentes grados de espasticidad. La operacion se complemento con terapia fisica. Los resultados fueron buenos en 10 casos y regulares en 3 (Goldner)