Introduction The superficial palmar arch is the main contributor to the vascular supply of the hand. Numerous anatomical variants have been described and there are multiple classifications of the superficial palmar arch available. The Kaplan cardinal line is used occasionally as a reference to identify the deep structures of the hand. However, there are also multiple variants of the line and multiple reports regarding the structures that can be identified with it.
Material and Methods Ten anatomical dissections of hands were performed in seven cadaveric specimens. The anatomical variants of the superficial palmar arch were recorded, as well as their relationship with the Kaplan cardinal line. A review of the available literature was made.
Results According to the classification by Coleman et al, the most common type was the complete superficial palmar arch, present in seven hands, while the incomplete superficial palmar arch was found in three hands. The most frequent complete palmar arch was type IB, followed by type IIB, and finally type IA and type IIA. The most common relation was with the Kaplan cardinal line type A to the apex of the arch and with type B to the curvature of the ulnar artery.
Conclusions There is a great anatomical variability in the superficial palmar arch. There was a greater frequency of the complete superficial palmar arch, with the ulnar artery being the dominant vascular supply. The Kaplan cardinal line can be used as a safety limit to avoid the superficial palmar arch if it is drawn to intersect the pisiform bone.
Clinical Relevance It is important to be aware of the anatomical variants of the superficial palmar arch, as well as of its relationship with the superficial structures of the hand to be able to perform invasive or reconstructive procedures and to preserve the vascularity of the hand.
Background:
Stroke is the third cause of disability and the first cause of motor impairment of the upper limb, which significantly reduces independence in activities of daily living. Therefore, the development and use of new therapeutic approaches is needed. Brain-computer interfaces (BCI) based on movement intention (MI) have the potential to improve hand function and brain plasticity after stroke.
Purpose:
Improve hand function after stroke with BCI with MI.
Methods:
8 patients with subacute stroke, left or right hemiparesis was divided in two groups. The first received conventional therapy followed by BCI-MI therapy and the second was given BCI-MI therapy and then conventional therapy. The outcome variables were sensory-motor recovery, hand function, spasticity, level of disability, grip strength, change in motor threshold and amplitude of motor evoked potentials (MEP) and changes in desynchronization/synchronization event-related (EDR/EDS).
Results:
4 patients were female, the average age 56 ± 12.7 years, and 87% were ischemic stroke. No differences were found between post-conventional therapy and postBCI-MI in the sensorimotor recovery, the spasticity, and the degree of deficiency in the strength. Only in hand function measured with the Action Research Arm Test (ARAT), a statistically significant difference was found in the BCI-MI therapy group (p= 0.0247). Dynamometry grip strength had a tendency to increase the Post-BCI group. A MEP was obtained in the ipsilesional primary motor cortex of 3 patients. A higher EDR was found in the injured hemisphere in favor of the post-BCI group (p= 0.0165).
Conclusions:
This study shows that BCI-MI rehabilitation, which combines MI with a robotic hand orthosis as feedback, has a significant improvement in hand function and a greater ERD in the ipsilesional primary motor cortex. It is necessary to carry out controlled clinical trials with a larger sample and with a greater frequency and duration of intervention to measure hand motor and functional improvement of patients after stroke.
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