The outcome of treatment of trigger thumb in children.
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Our aim was to determine the outcome of the treatment of trigger thumb in children. There was a rate of spontaneous recovery of 49% in those children whose thumbs were observed before a final decision to operate was made. Spontaneous recovery occurred more commonly in children over 12 months old. All patients treated by operation had a satisfactory outcome with few complications. The overall rate of recurrence was 4.0% and it was more common in younger children. Our results suggest that a conservative approach to surgery for this condition could be adopted. (+info)
Primary thumb sensory cortex located at the lateral shoulder of the inverted omega-shape on the axial images of the central sulcus.
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Useful landmarks on magnetic resonance (MR) images were identified for preoperative prediction of the relationship of a tumor to the primary sensory cortex of the thumb. Functional MR (fMR) imaging and magnetoencephalography were used to retrospectively localize the hand-digit sensorimotor area in four patients who underwent tumor resection around the central sulcus with intraoperative neurophysiological mapping. fMR imaging revealed the hand-digit motor cortex in the so-called "precentral knob" inside the characteristic inverted-omega on axial MR images. Equivalent current dipoles of the N20 m response in somatosensory evoked fields (SEFs) of the thumb, median nerve, and ulnar nerve stimuli were localized at the lateral portion of the inverted omega-shape from the lateral to medial directions. The SEF-based thumb sensory cortex was verified by intraoperative functional mapping with a neuronavigation system. The hand-digit somatosensory cortices were localized at the lateral shoulder of the inverted-omega, in the lateral anterior inferior position to the hand-digit motor cortices in the precentral knob. Axial MR imaging can provide useful preoperative planning information for the surgical treatment of tumors within or adjacent to the motor-somatosensory cortex. (+info)
The neurovascular island flap for defective sensibility of the thumb.
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In six patients with defective sensibility of the thumb the transfer of a neurovascular island flap was performed according to Littler's technique. This review one to eleven years later was mainly to determine if reorientation of the cortical representation of stimuli had developed and if tactile gnosis had persisted. The pick-up test was carried through by the three patients with a lesion of the dominant hand. All six patients referred pin-prick in the flap to the donor finger; all had absent two-point discrimination corresponding to the flap, although it had been present within normal limits a few months after operation; and all had better touch, pain and temperature sensibility in the flap than in the surrounding recipient area. All six reported functional improvement. For the best results an intelligent patient is required who has a lesion of the dominant hand and is prepared to use or exercise it regularly. (+info)
Sonographic evaluation of the thenar compartment musculature.
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The thenar region was studied with ultrasonography in 10 healthy volunteers. All thenar muscles could be identified and their course followed entirely. In addition, their function could be assessed by scanning during unresisted or resisted active movements. Standard approach, normal appearance, and dynamic tests for each muscle are described. (+info)
Brain metastasis of epithelioid sarcoma--case report.
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A 20-year-old-female first presented with an epithelioid sarcoma of the right thumb, and the right thumb was amputated. Five years later, a metastasis was found in the right lower lung and a partial lobectomy was performed. Three years later, computed tomography showed a metastatic brain tumor in the left frontal lobe, which was removed surgically. Adjuvant radiotherapy and chemotherapy were given after all operations. Histological examination showed all resected tumors were epithelioid sarcoma. She has maintained a good activity of daily living level as an outpatient for 2 years, although subcutaneous metastases and bronchial lymph node metastases have been observed. Such intensive treatment of slowly growing tumors often prolongs survival time, even in patients with multiple metastases. (+info)
Experimental and clinical application of microvascular surgery.
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The object of these studies was the development of a technique whereby a vessel of 1 mm or smaller could be easily anastomosed. In total replantation of rabbit ears, only 3 ears survived replantation in 80 attempts in the first series. In the second series of 80, 35 ears survived completely, 3 ears partially survived and 8 additional ears survived the postoperative period, but the rabbits died within 2 weeks due to diarrhea. Thirty-five ears failed and venous obstruction was the primary cause. Free transplantation of a great toe and a second toe to recreate a thumb is also described. The operative procedure of the great toe to thumb transplantation does not appear to be difficult. Six months after operation, the function of the newly created thumb was good. The second toe to thumb transfer was more difficult technically compared to the great toe to thumb transfer due to the much smaller size of the digital vessels of the second toe. However, removal of the second toe causes less disadvantage than the removal of the great toe. Nine months postoperatively, the function of the newly created thumb was satisfactory. Digital replantation is described with 36 cases with 65 complete finger amputations. Thirty-two with 45 fingers survived the reattachment. Repair of one artery per digit is sufficient, although two probably are better. A minimum of 2 veins per digit must be repaired. Prompt re-exploration is imperative if postoperative circulatory impairment occurs. In this group, arterial obstruction was more frequent than venous obstruction as the cause of replantation failure. The function of the replanted fingers is satisfactory in the majority of the cases. (+info)
Neuroplastic changes related to pain occur at multiple levels of the human somatosensory system: A somatosensory-evoked potentials study in patients with cervical radicular pain.
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Studies suggest that pain may play a major role in determining cortical rearrangements in the adult human somatosensory system. Most studies, however, have been performed under conditions whereby pain coexists with massive deafferentation (e.g., amputations). Moreover, no information is available on whether spinal and brainstem changes contribute to pain-related reorganizational processes in humans. Here we assess the relationships between pain and plasticity by recording somatosensory-evoked potentials (SEPs) in patients who complained of pain to the right thumb after a right cervical monoradiculopathy caused by compression of the sixth cervical root, but did not present with clinical or neurophysiological signs of deafferentation. Subcortical and cortical potentials evoked by stimulation of digital nerves of the right thumb and middle finger were compared with those obtained after stimulation of the left thumb and middle finger and with those obtained in a control group tested in comparable conditions. Amplitudes of spinal N13, brainstem P14, parietal N20 and P27, and frontal N30 potentials after stimulation of the painful right thumb were greater than those of the nonpainful left thumb and showed a positive correlation with magnitude of pain. This right-left asymmetry was absent after stimulation of the patients' middle fingers and in control subjects. Results suggest that chronic cervical radicular pain is associated with changes in neural activity at multiple levels of the somatosensory system. The absence of correlation between the amplitude of spinal, brainstem, and cortical components of SEPs suggests that enhancement of cortical activity is not a simple amplification of subcortical enhancement. (+info)
Simultaneous Bennett's fracture and metacarpophalangeal dislocation of the same thumb in a soccer player.
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Double dislocations of finger joints are rare. An unusual case of a simultaneous Bennett's fracture/dislocation ofthe carpometacarpal joint and a dorsal dislocation of the metacarpophalangeal joint of the same thumb, and the management of this injury are reported. The patient had an excellent functional result. (+info)