The Journal of hand surgery
-
Interfascicular neurolysis was performed in nine patients with spontaneous anterior interosseous nerve palsy. In eight of these patients, an hourglass-like constriction in the fascicles forming the anterior interosseous nerve was found within the main trunk of the median nerve at 2-7.5 cm above the medial epicondyle. The clinical signs and symptoms of these eight patients were similar to those that have been described to isolated neuritis. While the etiology remains unknown, when spontaneous anterior interosseous nerve palsy is suspected to be caused by isolated neuritis, interfascicular neurolysis should be performed to confirm the lesion and to discover whether fascicular constriction is present.
-
The anatomy of the palmar aponeurosis pulley has been well described, but its biomechanical function is not as well characterized. This study describes the functional importance of the palmar aponeurosis pulley by using efficiency parameters. We obtained data by generating load, excursion, and work efficiencies in the intact pulley system and compared these to the efficiencies obtained after sectioning the palmar aponeurosis pulley alone and in combination with the proximal annular pulleys. ⋯ Change in work is due not only to an increase in excursion, but also to the increased resistance that results from the acute angulation that the tendon must endure as it follows behind the remaining pulleys during flexion. Intergroup comparisons show a significant contribution by the palmar aponeurosis pulley. This study demonstrates a significant biomechanical role for the palmar aponeurosis pulleys and suggests that it be considered similar to the annular and cruciate flexor tendon pulleys in importance.
-
To investigate the relationship between hand dominance and the risk of major hand injury, the case records of 125 patients who had been treated for digital amputation were retrospectively reviewed. A second group of 116 patients treated for minor hand trauma was similarly evaluated. The incidence of left-hand dominance among the digital amputation group was 35%, and among the minor trauma group the incidence was 11%. ⋯ The most common mechanism of amputating injury was by power saw. The present data suggest that left-handed individuals have a relative risk of sustaining an amputating injury that is 4.9 times greater than the right-handed individuals, while minor hand trauma occurs at rates proportional to the distribution of left handedness within the population. Additional safety measures and the redesigning of tools, assembly lines, and workstations are recommended to help decrease the incidence of serious hand injury among left-handed individuals.