Anterior Interosseous Neuropathy in Instrumental Musicians

2006 ◽  
Vol 21 (3) ◽  
pp. 137-141
Author(s):  
Richard J Lederman
Keyword(s):  
Index Finger ◽  
Age At Onset ◽  
Flexor Digitorum Profundus ◽  
Left Index Finger ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Neuralgic Amyotrophy ◽  
Electrodiagnostic Testing ◽  
The Right ◽  
Flexor Digitorum

The anterior interosseous nerve is a pure motor branch of the median nerve supplying the flexor pollicis longus, flexor digitorum profundus of the index and middle fingers, and pronator quadratus. Anterior interosseous neuropathy is rare and typically causes weakness of flexion of the tips of the thumb and index finger. Four instrumentalists, 3 violinists and 1 pianist (3 males, 1 female), seen from 1986 to 2002 at our clinic, are the subjects of this report. Age at onset ranged from 16 to 76 yrs. A possible precipitating factor was identified in each. One violinist could not hold the bow; two others noted inability to stabilize the distal left first (index) finger. The pianist noted impaired dexterity of the right hand. Examination showed weakness of flexion of the distal phalanx of the index finger and thumb and variable weakness of forearm pronation. Electrodiagnostic testing confirmed the diagnosis in all four patients. All improved over time. One symphony violinist continued to play for over 15 yrs, despite some persisting difficulty with the left index finger. Another violinist recovered function almost completely but suffered a stroke affecting the opposite hand 2.5 years later. The third violinist retired from the symphony on disability because his recovery was delayed for >1 yr. The young pianist is playing 4 to 5 hrs/day. It is likely that at least three of the four had a localized form of neuralgic amyotrophy.

LINBURG-COMSTOCK PHENOMENON FOLLOWING FOREARM LACERATION

Hand Surgery ◽  
2012 ◽  
Vol 17 (02) ◽  
pp. 221-224 ◽  
Author(s):  
B. Lin ◽  
S. Sreedharan ◽  
Andrew Y. H. Chin
Keyword(s):  
Index Finger ◽  
Interphalangeal Joint ◽  
Penetrating Injury ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Distal Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
The Right ◽  
Flexor Digitorum ◽  
Wide Awake

A 20-year-old man presented with an inability to flex the interphalangeal joint of the right thumb without simultaneous flexion of the distal interphalangeal joint of the index finger following a penetrating injury to the right forearm. With a clinical suspicion of intertendinous adhesions between the flexor pollicis longus and the flexor digitorum profundus to the index finger, surgical exploration under wide-awake anesthesia was performed. Intraoperatively, the intertendinous adhesions were identified and divided completely. Postoperatively, the patient achieved good, independent flexion of the interphalangeal joint of the thumb. This case demonstrates a clinical picture similar to that of Linburg-Comstock syndrome, which occurred following a forearm penetrating injury. We call this the Linburg-Comstock (LC) phenomenon.

Anterior interosseous nerve compression after supracondylar fracture of the humerus: a metaanalysis

1999 ◽  
Vol 90 (6) ◽  
pp. 1053-1056 ◽  
Author(s):  
Alexander Joist ◽  
Uwe Joosten ◽  
Dirk Wetterkamp ◽  
Michael Neuber ◽  
Axel Probst ◽  
...  
Keyword(s):  
Index Finger ◽  
Interphalangeal Joint ◽  
Nerve Compression ◽  
Flexor Digitorum Profundus ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Content Type ◽  
Anterior Interosseous Nerve ◽  
Anterior Interosseous Nerve Syndrome ◽  
Fine Print

Object. The authors conducted a metaanalysis of reports of anterior interosseous nerve syndrome, a rare nerve compression neuropathy that affects only the motor branch of the median nerve. This syndrome is characterized by paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index finger, and the pronator quadratus, with weakness on flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger without sensory loss.Methods. The authors reviewed reports of 34 cases of anterior interosseous nerve syndrome combined with supracondylar fractures of the humerus in children. They have added a new case identified in a 7-year-old boy in whom a diagnosis was made from the clinical findings and whose treatment and outcome are analyzed. The ages of patients reported in the literature ranged from 4 to 10 years. Ten patients (29%) were treated with closed reduction and application of a cast, whereas 25 patients (71%) were treated with open reduction and fixation of the fracture.Conclusions. All patients regained full flexion and strength after 4 to 17 weeks. The fractures that were surgically treated showed no entrapment of the anterior interosseous nerve.

scholarly journals A Silent Closed Rupture of the Flexor Digitorum Profundus on the Index Finger: An Unsolved Mystery

2021 ◽  
Vol 17 (2) ◽  
pp. 146-149
Author(s):  
Hyun-Dong Yeo ◽  
Na-Hyun Hwang ◽  
Seung-Ha Park ◽  
Byung-Il Lee ◽  
Eul-Sik Yoon ◽  
...  
Keyword(s):  
Tendon Rupture ◽  
Flexor Tendon ◽  
Index Finger ◽  
Tendon Graft ◽  
Flexor Digitorum Profundus ◽  
Left Index Finger ◽  
Two Stage ◽  
Closed Rupture ◽  
Flexor Tendon Rupture ◽  
Flexor Digitorum

We report the case of a patient who fully recovered from a closed flexor tendon rupture through a two-stage flexor tendon reconstruction using silicone rods, despite a considerable delay in treatment. A 17-year-old male patient visited our clinic with a sudden inability to flex his left index finger, although there were no signs of injury. Magnetic resonance imaging revealed an extensive rupture of the flexor digitorum profundus from the base of the distal phalanx to the proximal phalangeal joint of his left hand. After a two-stage tendon graft operation was performed, the patient regained full flexion of the index finger and was able to hold a fist without any limitations in range of motion. Complete rupture of tendons usually accompanies history of trauma or underlying tendon pathology. In our case, however, the tendon rupture occurred silently with no obvious underlying causes. It is important to recognize the signs to evaluate the underlying structures for appropriate management and treatment. Even with considerable delay, the patient may regain full function of the tendon.

Flexor Digitorum Profundus Common to Thumb and Index Finger, Associated with a Post-Traumatic Distal Adherence of Both Tendons

1988 ◽  
Vol 13 (1) ◽  
pp. 72-74
Author(s):  
A. RICO AGUADO ◽  
V. del PINO PAREDES
Keyword(s):  
Index Finger ◽  
Flexor Digitorum Profundus ◽  
Complete Fusion ◽  
Flexor Pollicis Longus ◽  
Rare Anomaly ◽  
Right Hand ◽  
Bilateral Case ◽  
Post Traumatic ◽  
The Right ◽  
Flexor Digitorum

The existence of connections, in the form of tendon slips, between the tendons of the flexor pollicis longus and the flexor digitorum profundus indicis has been described by different authors as being a relatively frequent anomaly. Complete fusion between the two muscles, however, must be considered a very rare anomaly. A bilateral case is described, in which the right hand also had post-traumatic adhesions between the two tendons.

Patterns of median nerve branching in the cubital fossa: implications for nerve transfers to restore motor function in a paralyzed upper limb

2021 ◽  
pp. 1-10
Author(s):  
Jayme A. Bertelli ◽  
Neehar Patel ◽  
Francisco Soldado ◽  
Elisa Cristiana Winkelmann Duarte
Keyword(s):  
Median Nerve ◽  
Nerve Transfer ◽  
Flexor Digitorum Profundus ◽  
Medial Branch ◽  
Flexor Digitorum Superficialis ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Cubital Fossa ◽  
Flexor Digitorum ◽  
Single Branch

OBJECTIVE The purpose of this study was to describe the anatomy of donor and recipient median nerve motor branches for nerve transfer surgery within the cubital fossa. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS In the cubital fossa, the first branch was always the proximal branch of the pronator teres (PPT), whereas the last one was the anterior interosseous nerve (AIN) and the distal motor branch of the flexor digitorum superficialis (DFDS) on a consistent basis. The PT muscle was also innervated by a distal branch (DPT), which emerged from the anterior side of the median nerve and provided innervation to its deep head. The palmaris longus (PL) motor branch was always the second branch after the PPT, emerging as a single branch together with the flexor carpi radialis (FCR) or the proximal branch of the flexor digitorum superficialis. The FCR motor branch was prone to variations. It originated proximally with the PL branch (35%) or distally with the AIN (35%), and less frequently from the DPT. In 40% of dissections, the FDS was innervated by a single branch (i.e., the DFDS) originating close to the AIN. In 60% of cases, a proximal branch originated together with the PL or FCR. The AIN emerged from the posterior side of the median nerve and had a diameter of 2.3 mm, twice that of other branches. When dissections were performed between the PT and FCR muscles at the FDS arcade, we observed the AIN lying lateral and the DFDS medial to the median nerve. After crossing the FDS arcade, the AIN divided into: 1) a lateral branch to the flexor pollicis longus (FPL), which bifurcated to reach the anterior and posterior surfaces of the FPL; 2) a medial branch, which bifurcated to reach the flexor digitorum profundus (FDP); and 3) a long middle branch to the pronator quadratus. The average numbers of myelinated fibers within each median nerve branch were as follows (values expressed as the mean ± SD): PPT 646 ± 249; DPT 599 ± 150; PL 259 ± 105; FCR 541 ± 199; proximal FDS 435 ± 158; DFDS 376 ± 150; FPL 480 ± 309; first branch to the FDP 397 ± 12; and second branch to the FDP 369 ± 33. CONCLUSIONS The median nerve's branching pattern in the cubital fossa is predictable. The most important variation involves the FCR motor branch. These anatomical findings aid during nerve transfer surgery to restore function when paralysis results from injury to the radial or median nerves, brachial plexus, or spinal cord.

scholarly journals Response preparation involves a release of intracortical inhibition in task-irrelevant muscles

2020 ◽  
Author(s):  
Isaac N. Gomez ◽  
Kara Ormiston ◽  
Ian Greenhouse
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Index Finger ◽  
Intracortical Inhibition ◽  
Left Index Finger ◽  
Task Condition ◽  
Response Preparation ◽  
Action Preparation ◽  
The Right ◽  
Task Irrelevant

AbstractAction preparation involves widespread modulation of motor system excitability, but the precise mechanisms are unknown. In this study, we investigated whether intracortical inhibition changes in task-irrelevant muscle representations during action preparation. We used transcranial magnetic stimulation (TMS) combined with electromyography in healthy human adults to measure motor evoked potentials (MEPs) and cortical silent periods (CSPs) in task-irrelevant muscles during the preparatory period of simple delayed response tasks. In Experiment 1, participants responded with the left-index finger in one task condition and the right-index finger in another task condition, while MEPs and CSPs were measured from the contralateral non-responding and tonically contracted index finger. During Experiment 2, participants responded with the right pinky finger while MEPs and CSPs were measured from the tonically contracted left-index finger. In both experiments, MEPs and CSPs were compared between the task preparatory period and a resting intertrial baseline. The CSP duration during response preparation decreased from baseline in every case. A laterality difference was also observed in Experiment 1, with a greater CSP reduction during the preparation of left finger responses compared to right finger responses. MEP amplitudes showed no modulation during movement preparation in any of the three response conditions. These findings indicate cortical inhibition associated with task-irrelevant muscles is transiently released during action preparation and implicate a novel mechanism for the controlled and coordinated release of motor cortex inhibition.New & NoteworthyIn this study we observed the first evidence of a release of intracortical inhibition in task-irrelevant muscle representations during response preparation. We applied transcranial magnetic stimulation to elicit cortical silent periods in task-irrelevant muscles during response preparation and observed a consistent decrease in the silent period duration relative to a resting baseline. These findings address the question of whether cortical mechanisms underlie widespread modulation in motor excitability during response preparation.

Rupture of Flexor Digitorum Profundus to the Index Finger after a Distal Radial Fracture

1987 ◽  
Vol 12 (1) ◽  
pp. 115-116
Author(s):  
L. A. RYMASZEWSKI ◽  
A. P. WALKER
Keyword(s):  
Index Finger ◽  
Flexor Digitorum Profundus ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Successful Result ◽  
Flexor Tendons ◽  
Bony Fragment ◽  
One Year ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Attrition ruptures of flexor tendons to the fingers following Colles’ fractures are very rare. In the case reported here, a protruding bony fragment caused a delayed rupture of the flexor digitorum profundus tendon to the index finger one year after a fracture of the distal end of the radius. Suture of the distal end of the tendon to the adjacent profundus tendon two years after the fracture produced a successful result.

Assessment of Radiation Protection in Hand-Shielding Products With Mini C-Arm Fluoroscopy

Hand ◽  
2019 ◽  
pp. 155894471986593 ◽  
Author(s):  
Matthew B. Cantlon ◽  
Asif M. Ilyas
Keyword(s):  
Radiation Exposure ◽  
Index Finger ◽  
Proximal Phalanx ◽  
Left Index Finger ◽  
Surgical Glove ◽  
Thermoluminescent Dosimeters ◽  
Intraoperative Fluoroscopy ◽  
The Mean ◽  
The Right ◽  
Free Metal

Background: Previous studies have highlighted the particular risk of radiation exposure to the surgeon’s hands with intraoperative fluoroscopy. Although evidence exists that shielding equipment for the hands reduces exposure, the extent of protection is not well understood. Therefore, we set out to determine the degree to which radiation exposure to the surgeon’s hands is decreased with hand-shielding products. Methods: An anthropomorphic model was positioned to simulate a surgeon sitting at a hand table. Thermoluminescent dosimeters were placed on the proximal phalanx of each index finger. The right index finger dosimeter was covered with a standard polyisoprene surgical glove (control arm), whereas the left index finger dosimeter was covered with commercially available hand-shielding products (study arm): lead-free metal-oxide gloves, leaded gloves, and radiation-attenuating cream. Mini fluoroscope position, configuration, and settings were standardized. The model was scanned for 15 continuous minutes in each test run, and each comparative arm was run 3 times. Results: The mean radiation dose absorbed by the control and variable dosimeters across all tests was 44.8 mrem (range, 30-54) and 18.6 mrem (range, 14-26), respectively. Each hand-shielding product resulted in statistically lower radiation exposure than a single polyisoprene surgical glove. Conclusions: The mean radiation exposure to the hands was significantly decreased when protected by radiation-attenuating options. Each product individually resulted in a statistically significant decrease in hand exposure compared with the control. We recommend that in addition to efforts to decrease radiation exposure, surgeons consider routine use of hand-shielding products when using mini c-arm fluoroscopy.

Music Affects Learning of a Braille-Like Task by Sighted Subjects

1989 ◽  
Vol 69 (3-1) ◽  
pp. 923-929
Author(s):  
Robert F. Kennison ◽  
Richard A. Mcfarland
Keyword(s):  
College Students ◽  
Sensory Input ◽  
Index Finger ◽  
Practical Importance ◽  
Left Index Finger ◽  
Interhemispheric Competition ◽  
Male College ◽  
The Right ◽  
The Brain ◽  
Male College Students

24 consistently right-handed male college students felt sets of four Braille symbols with either the right or the left index finger and identified by touch alone which two of the four symbols in each set were identical. During the task music was played to either the right ear, the left ear, both ears, or neither ear. Significantly fewer errors were made when the music was in the ear contralateral to whichever hand performed the task. The ipsilateral, binaural, and no-music groups did not differ significantly from each other. It is suggested that monaural music to the ear contralateral to the engaged hand led to reduced interhemispheric competition acting on the hemisphere controlling the hand. Such a facilitating effect may be of practical importance in tasks during which one hemisphere receives the bulk of the task-related sensory input and/or processes the final order from the brain to the task-related muscles.

Cortical Representation of Swallowing: A Modified Dual Task Paradigm

2002 ◽  
Vol 94 (3) ◽  
pp. 1029-1040 ◽  
Author(s):  
Stephanie K. Daniels ◽  
David M. Corey ◽  
Cristen L. Barnes ◽  
Nikki M. Faucheaux ◽  
Daniel H. Priestly ◽  
...  
Keyword(s):  
Dual Task ◽  
Right Hemisphere ◽  
Index Finger ◽  
Finger Tapping ◽  
Left Index Finger ◽  
Cortical Representation ◽  
Word Repetition ◽  
Dual Task Paradigm ◽  
Left And Right ◽  
The Right

It is unclear whether the cortical representation of swallowing is lateralized to the left cerebral hemisphere, right hemisphere, or bilaterally represented. As dysphagia is common in acute stroke, it is important to elucidate swallowing lateralization to facilitate earlier detection of stroke patients who may be at greater risk for dysphagia and aspiration. In this study, a modified dual task paradigm was designed to study laterality of swallowing in a group of 14 healthy, young, right-handed, male adults. The subjects were studied at baseline and with interference. Baseline conditions, performed separately, were continuous swallowing, finger tapping using the right and left index fingers, and word repetition. Interference tasks, including tapping with the right index finger, tapping with the left index finger, and word repetition, were completed with and without swallowing. Finger-tapping rate was measured, and x-ray samples of the swallowing task were taped to measure swallowing rate and volume swallowed. At baseline, the rate of tapping the right index finger was significantly faster than that of the left index finger. There was a significant decline in the tapping rates of both left and right index fingers with swallowing interference. The volume per swallow was significantly reduced during the interfering language task of silent repetition. These results offer partial support for a bilateral representation of swallowing as well as suggest an important left hemispheric contribution to swallowing. However, it cannot be concluded that the left hemisphere is more important than the right, as a comparable right hemisphere task was not studied.

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