scholarly journals Comparative Study of the Use of Different Sizes of an Ergonomic Instrument Handle for Laparoscopic Surgery

2020 ◽  
Vol 10 (4) ◽  
pp. 1526 ◽  
Author(s):  
Juan A. Sánchez-Margallo ◽  
Alfonso González González ◽  
Lorenzo García Moruno ◽  
J. Carlos Gómez-Blanco ◽  
J. Blas Pagador ◽  
...  
Keyword(s):  
Transfer Task ◽  
Middle Finger ◽  
Wrist Flexion ◽  
Surgical Performance ◽  
Ulnar Deviation ◽  
Hand Eye Coordination ◽  
General Surgeons ◽  
Time Required ◽  
The Right ◽  
Finger Pressure

Previous studies have shown that the handle design of laparoscopic instruments is crucial to surgical performance and surgeon’s ergonomics. In this study, four different sizes of an ergonomic laparoscopic handle design were tested in a blind and randomized fashion with twelve surgeons. They performed three laparoscopic tasks in order to analyze the influence of handle size. Execution time, wrist posture, and finger and palm pressure were evaluated during the performance of each task. The results show a significant reduction in the time required to complete the eye-manual coordination task using the appropriate handle. The incorrectly sized handle resulted in a rise in palm pressure and a reduction in the force exerted by the thumb during the transfer task. In the hand-eye coordination task, the use of the right handle size led to an increase in middle finger pressure. In general, surgeons had an ergonomically adequate wrist flexion in all tasks and an acceptable radio-ulnar deviation during the transfer task using the ergonomic instrument handle. Surgeons found it comfortable the use of the ergonomic handle. Therefore, the use of an appropriately sized instrument handle allows surgeons to improve ergonomics and surgical performance during the laparoscopic practice.

Wrist Posture during Computer Mouse Usage

1995 ◽  
Vol 39 (10) ◽  
pp. 625-629 ◽  
Author(s):  
Elizabeth A. Damann ◽  
Karl H.E. Kroemer
Keyword(s):  
Task Condition ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Ulnar Deviation ◽  
Radial Deviation ◽  
Right Hand ◽  
Computer Mouse ◽  
Pointing Task ◽  
The Right

In this experiment, we investigated the effects that mouse pad surface height and wrist support had on wrist posture. In a pointing task, 16 subjects moved a mouse-controlled cursor clockwise or counterclockwise around three fixed targets, which varied by size and distance depending on task condition. Wrist extension, flexion, radial deviation, and ulnar deviation data were collected via a wrist monitor attached to the right hand and forearm. The presence of a wrist support decreased wrist extension and radial deviation, and increased wrist flexion. Higher pad surface height resulted in increased flexion and ulnar deviation, and decreased extension and radial deviation. A comparison of the conditions which were at the same pad height, but differed due to the presence or absence of wrist support, revealed that wrist extension was reduced by the presence of a wrist support at all but the highest height.

scholarly journals P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Natalia Cernovschi - Feasey ◽  
Julekha Wajed
Keyword(s):  
Pleural Effusion ◽  
Soft Tissue ◽  
Middle Finger ◽  
Joint Involvement ◽  
Long Bones ◽  
History Of ◽  
Systemic Symptoms ◽  
The Right ◽  
Hands And Feet ◽  
Radiographic Changes

Abstract Background/Aims  Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods  A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results  Blood tests showed elevated c-reactive protein 55 (normal <4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion  Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure  N. Cernovschi - Feasey: None. J. Wajed: None.

scholarly journals Normalization in human somatosensory cortex

2015 ◽  
Vol 114 (5) ◽  
pp. 2588-2599 ◽  
Author(s):  
Gijs Joost Brouwer ◽  
Vanessa Arnedo ◽  
Shani Offen ◽  
David J. Heeger ◽  
Arthur C. Grant
Keyword(s):  
Somatosensory Cortex ◽  
Middle Finger ◽  
Functional Magnetic Resonance ◽  
Stimulus Amplitude ◽  
Target Digit ◽  
Divisive Normalization ◽  
Postcentral Gyrus ◽  
Baseline Response ◽  
The Right ◽  
Stimulation Of

Functional magnetic resonance imaging (fMRI) was used to measure activity in human somatosensory cortex and to test for cross-digit suppression. Subjects received stimulation (vibration of varying amplitudes) to the right thumb (target) with or without concurrent stimulation of the right middle finger (mask). Subjects were less sensitive to target stimulation (psychophysical detection thresholds were higher) when target and mask digits were stimulated concurrently compared with when the target was stimulated in isolation. fMRI voxels in a region of the left postcentral gyrus each responded when either digit was stimulated. A regression model (called a forward model) was used to separate the fMRI measurements from these voxels into two hypothetical channels, each of which responded selectively to only one of the two digits. For the channel tuned to the target digit, responses in the left postcentral gyrus increased with target stimulus amplitude but were suppressed by concurrent stimulation to the mask digit, evident as a shift in the gain of the response functions. For the channel tuned to the mask digit, a constant baseline response was evoked for all target amplitudes when the mask was absent and responses decreased with increasing target amplitude when the mask was concurrently presented. A computational model based on divisive normalization provided a good fit to the measurements for both mask-absent and target + mask stimulation. We conclude that the normalization model can explain cross-digit suppression in human somatosensory cortex, supporting the hypothesis that normalization is a canonical neural computation.

The Artisential® Articulated Laparoscopic Forceps: A Dry Lab Study to Examine Dexterity and Learning Effects in Operators with Different Levels of Laparoscopic Experience

2021 ◽  
Author(s):  
Ibrahim Darwich ◽  
Mohammad Abuassi ◽  
Christel Weiss ◽  
Dietmar Stephan ◽  
Frank Willeke
Keyword(s):  
Learning Effect ◽  
Training Session ◽  
Transfer Task ◽  
Learning Effects ◽  
Laparoscopic Instrument ◽  
Significant Difference ◽  
The Times ◽  
Time Required ◽  
Laparoscopic Experience ◽  
Different Levels

Purpose: The advent of robotic surgery has highlighted the advantages of articulation. This dry-lab study examined the dexterity and learning effect of a new articulated laparoscopic instrument: the ArtiSential® forceps (LIVSMED, Seongnam, Republic of Korea). Methods: A peg board task was designed. Three groups of volunteers with varying levels of laparoscopic expertise were organized to perform the task: expert, intermediate and novice. The participants performed the task using articulated and straight instruments, once before a 30-min training session and once afterwards. The times required to perform the task were recorded. The performances were analyzed and compared between the groups as well as between the straight and articulated instruments. Results: The experts were significantly faster than the novices with both instruments before the 30-min training session (p = 0.0317 for each instrument). No significant time difference was found among the three groups after the 30-min training session. The decrease in the time required to perform the peg-transfer task with the articulated instrument was significantly greater in the novice and intermediate groups (p = 0.0159 for each group). No significant difference in time reduction was observed between the groups with the straight instrument. Regardless of the user, the articulated device was associated with faster task performance than the straight device after 8 hours of training (p = 0.0039). Conclusion: The ArtiSential® articulated device can improve dexterity. A significantly greater learning effect was observed in the novice and intermediate groups in comparison with experts. A plateau in the learning curve was observed after a few hours of training.

THE METHOD FOR EVALUATING ADAPTIVE CHANGES IN HUMAN MICROCIRCULATORY-TISSUE SYSTEMS

2020 ◽  
Vol 4 (1) ◽  
pp. 88-99
Author(s):  
A.V. DUNAEV
Keyword(s):  
Middle Finger ◽  
Analysis Data ◽  
The Body ◽  
Tissue Oxygen Saturation ◽  
Doppler Flowmetry ◽  
New Approach ◽  
Adaptive Changes ◽  
Palmar Surface ◽  
Tissue Systems ◽  
The Right

The work is aimed at developing a new approach to assessing adaptive changes in microcirculatory tissue systems when various loads are exerted on the body (sports or physiological stresses), based on the analysis of oscillations in microcirculatory blood flow and tissue oxygen saturation, measured by laser Doppler flowmetry (LDF) and tissue reflectance oximetry (TRO). The study involved eight healthy volunteers aged 21–49 years. Measurements were taken on the palmar surface of the middle finger of the right hand and the medial surface of the lower part of the forearm. The rhythmic oscillations of LDF and TRO were studied using wavelet analysis. Data analysis revealed resonant and synchronized oscillations in the LDF and TRO signals in the myogenic range as an adaptive change as a result of a reaction to physical activity and psychoemotional stress.

Assessment of Muscle Activity and Joint Angles in Small-Handed Pianists: A Pilot Study on the 7/8-Sized Keyboard versus the Full-Sized Keyboard

2006 ◽  
Vol 21 (1) ◽  
pp. 3-9
Author(s):  
B G Wristen ◽  
M C Jung ◽  
A K G Wismer ◽  
M S Hallbeck
Keyword(s):  
Pilot Study ◽  
Research Question ◽  
Wrist Flexion ◽  
Joint Angles ◽  
Ulnar Deviation ◽  
Surface Electrodes ◽  
Musical Excerpt ◽  
Muscle Loading ◽  
Maximal Angle ◽  
Flexion And Extension

This pilot study examined whether the use of a 7/8 keyboard contributed to the physical ease of small-handed pianists as compared with the conventional piano keyboard. A secondary research question focused on the progression of physical ease in pianists making the transition from one keyboard to the other. For the purposes of this study, a hand span of 8 inches or less was used to define a “small-handed” pianist. The goal was to measure muscle loading and hand span during performance of a specified musical excerpt. For data collection, each of the two participants was connected to an 8-channel electromyography system via surface electrodes, which were attached to the upper back/shoulder, parts of the hand and arm, and masseter muscle of the jaw. Subjects also were fitted with electrogoniometers to capture how the span from the first metacarpophalangeal (MCP) joint to the fifth MCP joint moves according to performance demands, as well as wrist flexion and extension and radial and ulnar deviation. We found that small-handed pianists preferred the smaller keyboard and were able to transition between it and the conventional keyboard. The maximal angle of hand span while playing a difficult piece was about 5º smaller radially and 10º smaller ulnarly for the 7/8 keyboard, leading to perceived ease and better performance as rated by the pianists.

scholarly journals Dynamic CT Scan of the Normal Scapholunate Joint in a Clenched Fist and Radial and Ulnar Deviation

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 666-670 ◽  
Author(s):  
Paul M. Kelly ◽  
John G. Hopkins ◽  
Andrew J. Furey ◽  
Daniel S. Squire
Keyword(s):  
Ct Scan ◽  
Range Of Motion ◽  
Ct Imaging ◽  
Dynamic Ct ◽  
Long Term Effects ◽  
Ulnar Deviation ◽  
Left Wrist ◽  
The Right ◽  
User Friendly

Background: Injuries to the scapholunate can have severe long-term effects on the wrist. Early detection of these injuries can help identify pathology. The purpose of this study was to evaluate the motions of the scapholunate joint in normal wrists in a clenched fist and through radial and ulnar deviation using novel dynamic computed tomography (CT) imaging. Methods: Fifteen participants below 40 years of age consented to have their wrist scanned. Eight participants were randomized to have the right wrist scanned and 7 the left wrist. Volunteers were positioned at the back of the gantry with the wrist placed on the table, palmar side down. Participants began with the hand in a relaxed fist position and then proceeded through an established range of motion protocol. Dynamic CT imaging was captured throughout the range of motion. Results: The movement in the healthy scapholunate joint through a clenched fist and radial and ulnar deviation is minimal. The averages were 1.19, 1.01, and 0.95 mm, representing the middle, dorsal, and volar measurements, respectively. Conclusions: This novel dynamic CT scan of the wrist is a user-friendly way of measuring of the scapholunate distance, which is minimal in the normal wrist below 40 years of age.

Quantification of Hand Grip Force under Dynamic Conditions

1993 ◽  
Vol 37 (10) ◽  
pp. 715-719 ◽  
Author(s):  
Katherine R. Lehman ◽  
W. Gary Allread ◽  
P. Lawrence Wright ◽  
William S. Marras
Keyword(s):  
Grip Force ◽  
Wrist Flexion ◽  
Range Of Movement ◽  
Ulnar Deviation ◽  
Dynamic Conditions ◽  
Radial Deviation ◽  
Hand Grip ◽  
Flexion Extension ◽  
Maximum Grip ◽  
Lower Grip

A laboratory experiment was conducted to determine whether grip force capabilities are lower when the wrist is moved than in a static position. The purpose was to determine the wrist velocity levels and wrist postures that had the most significant effect on grip force. Maximum grip forces of five male and five female subjects were determined under both static and dynamic conditions. The dominant wrist of each subject was secured to a CYBEX II dynamometer and grip force was collected during isokinetic wrist deviations for four directions of motion (flexion to extension, extension to flexion, radial to ulnar, and ulnar to radial). Six different velocity levels were analyzed and grip forces were recorded at specific wrist positions throughout each range of movement. For flexion-extension motions, wrist positions from 45 degrees flexion to 45 degrees extension were analyzed whereas positions from 20 degrees radial deviation to 20 degrees ulnar deviation were studied for radial-ulnar activity. Isometric exertions were also performed at each desired wrist position. Results showed that, for all directions of motion, grip forces for all isokinetic conditions were significantly lower than for the isometric exertions. Lower grip forces were exhibited at extreme wrist flexion and extreme radial and ulnar positions for both static and dynamic conditions. The direction of motion was also found to affect grip strength; extension to flexion exertions produced larger grip forces than flexion to extension exertions and radial to ulnar motion showed larger grip forces than ulnar to radial deviation. Although, males produced larger grip forces than females in all exertions, significant interactions between gender and velocity were noted.

Analysis of High-Density Surface EMG and Finger Pressure in the Left Forearm of Violin Players: A Feasibility Study

2017 ◽  
Vol 32 (3) ◽  
pp. 139-151 ◽  
Author(s):  
Paolo Cattarello ◽  
Roberto Merletti ◽  
Francesco Petracca
Keyword(s):  
Pressure Sensors ◽  
Surface Emg ◽  
High Density ◽  
String Instruments ◽  
Activation Patterns ◽  
Study Objective ◽  
Left Hand ◽  
Density Surface ◽  
The Right ◽  
Finger Pressure

Wrist and finger flexor muscles of the left hand were evaluated using high-density surface EMG (HDsEMG) in 17 violin players. Pressure sensors also were mounted below the second string of the violin to evaluate, simultaneously, finger pressure. Electrode grid size was 110x70 mm (12x8 electrodes with interelectrode distance=10 mm and Ø=3 mm). The study objective was to observe the activation patterns of these muscles while the violinists sequentially played four notes—-SI (B), DO# (C#), RE (D), MI (E)—-at 2 bows/s (one bow up in 0.5 s and one down in 0.5 s) and 4 bows/s on the second string, while producing a constant (CONST) or ramp (RAMP) sound volume. HDsEMG images obtained while playing the notes were compared with those obtained during isometric radial or ulnar flexion of the wrist or fingers. Two image descriptors provided information on image differences. Results showed that the technique was reliable and provided reliable signals, and that recognizably different sEMG images could be associated with the four notes tested, despite the variability within and between subjects playing the same note. sEMG activity of the left hand muscles and pressure on the string in the RAMP task were strongly affected in some individuals by the sound volume (controlled by the right hand) and much less in other individuals. These findings question whether there is an individual or generally optimal way of pressing violin strings with the left hand. The answer to this question might substantially modify the teaching of string instruments.

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