Ulnar Intrinsic Anatomy and Dysfunction

Dell, Paul C.; Sforzo, Christopher R

doi:10.1197/j.jht.2005.02.008

Cited by 25 publications

(14 citation statements)

References 9 publications

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“…The insertions of the interossei and lumbrical muscles are complex, involving insertions onto bone, the extensor apparatus, the palmar plate and the lateral band (Eladoumikdachi et al, 2002a, b;Dell, 2005). Numerous insertion sites have been described: (1) the flexor sheath/pulleys -either A1 or A2 (Brooks and Jones, 1975;Duerksen and Schwarz, 2004;Omer, 1999;Zancolli, 1979), (2) the interossei tendons (Palande, 1983), (3) the lateral bands (Brand, 1961;Bunnell, 1942) and (4) the proximal phalanges (Burkhalter, 1973).…”

Section: Insertionmentioning

confidence: 99%

A Review of the Biomechanics of Intrinsic Replacement in Ulnar Palsy

Schwarz

Brandsma

Giurintano

2009

J Hand Surg Eur Vol

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The actions of the interossei and lumbricals are many and their loss causes significant impairment of hand function. Many procedures have been described to restore intrinsic function following ulnar nerve palsy. There are many biomechanical issues involved in tendon transfers, including choice of muscle-tendon unit, route, insertion site, tension and drag. The surgeon, therefore, should have a good understanding of biomechanical principles to ensure optimal results. In this article the principles of biomechanics are reviewed with specific reference to tendon transfers for intrinsic reconstruction in ulnar palsy, along with their practical implications.

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Section: Insertionmentioning

confidence: 99%

A Review of the Biomechanics of Intrinsic Replacement in Ulnar Palsy

Schwarz

Brandsma

Giurintano

2009

J Hand Surg Eur Vol

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“…While the extrinsic flexors provide concurrent flexion of MCPand IP joints, the intrinsic muscles couple MCP joint flexion with IP joint extension. 6,7 This coupling delays IP flexion relative to MCP joint flexion, allowing the hand to wrap around larger objects. Thus, this sweeping “intrinsic-activated” grasp is considered much more functional.…”

Section: Introductionmentioning

confidence: 99%

Intrinsic Hand Muscle Function, Part 2: Kinematic Comparison of 2 Reconstructive Procedures

Muzykewicz¹,

Arnet²,

Lieber³

et al. 2013

The Journal of Hand Surgery

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Purpose Reconstruction of grasp is a high priority for tetraplegic patients. Restoration of finger flexion by surgical activation of flexor digitorum profundus can result in roll-up finger flexion, interphalangeal (IP) joint before metacarpophalangeal (MCP) joint flexion, which can be improved by restoring intrinsic function. This study compares grasp kinematics between 2 intrinsic balancing procedures—Zancolli-llasso and House. Methods The intrinsic muscles of 12 cadaver hands were reconstructed by either the Zancolli-lasso or the House procedure (n=6 each) and tested by deforming FDP with a motor to simulate hand closure. Results were compared to 5 control hands. All 17 hands were studied by video analysis. Kinematics were characterized by the order of MCP joint and IP joint flexion. Optimal grasp was defined as the maximal fingertip-to-palm distance during the arc of finger closure. Results Kinematics differed between the 2 procedures. The Zancolli-lasso reconstructed hands flexed first in the IP joints, and then in MCP joints, resembling an unreconstructed intrinsic-minus hand while the House reconstructed hands flexed first in MCP joints and then in the IP jointss, resembling an intrinsic-activated hand. Maximal fingertip-to-palm distance did not differ significantly between the 2 procedures, and both showed improvement over unreconstructed controls. Discussion Both intrinsic balancing techniques improved grasp. Only the House procedure restored hand kinematics approximating those of an intrinsic-activated hand. Improvement in fingertip-to-palm distance in Zancolli-lasso hands resulted primarily from the initial resting MCP joint flexion of 40°. We therefore advocate the more physiologic House procedure for restoration of intrinsic function in tetraplegic patients. Clinical Relevance This study provides a rationale for advocacy of 1 reconstructive procedure over another.

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“…Indeed, abnormal function in either (or both) of the systems, but especially the intrinsic muscles, is now thought to be a major contributor to the development of deformities such as ulnar drift. 4 For most clinicians, ulnar drift is pathognomonic of RA. Ulnar drift describes the results of 2 combined abnormalities of the metacarpophalangeal (MCP) joint-namely, ulnar deviation and ulnar shift-resulting in a typical RA hand deformity (Fig.…”

mentioning

confidence: 99%