The Journal of hand surgery
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Normal functional variations of the flexor digitorum superficialis were clinically determined by use of the standard and modified superficialis flexion tests in 50 normal subjects. Forty hands of 20 cadavers were dissected to correlate the anatomic variations with the clinical findings. A flexor digitorum superficialis-independent pattern was found 58% of the time. ⋯ The right and left hands were asymmetric 26% of the time. All cadaver hands had a flexor digitorum superficialis tendon present in the palm and finger. The variability in flexor digitorum superficialis function may be explained by interconnections between the flexor digitorum superficialis of the small finger and either the flexor digitorum superficialis of the ring finger or the flexor digitorum profundus of the small finger.
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Case Reports
Interpositional vein grafts to restore the superficial palmar arch in severe devascularizing injuries of the hand.
The use of an interpositional vein graft to restore inflow to the digits by recreating the superficial palmar arch is presented. This technique is best reserved for severe, devascularizing injuries to the hand, significant damage to the palmar vessels, and when they may a paucity of donor vein available.
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Case Reports
Delayed rupture of the extensor pollicis longus tendon after nonunion of a fracture of the dorsal radial tubercle.
Several apparently conflicting mechanisms have been proposed to explain the seemingly spontaneous delayed rupture of the extensor pollicis longus tendon (EPL). The following case, the first of its kind of which we are aware, may help to clarify the relationships between these mechanisms. ⋯ The long period between accident and rupture is evidence that rupture was not caused by crush injury. Because a fracture of Lister's tubercle will not normally be visible on radiographs, after accidents in which this may have occurred or when the EPL ruptures more than 3 months after injury, we recommend that special radiographs of Lister's tubercle be taken to determine if such a fracture exists.
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Seventeen cases of lipofibromatous hamartoma of nerve (14 with histologic confirmation) were treated between 1935 and 1985. One patient had bilateral involvement. Fourteen lesions were located in the upper extremity and four in the lower extremity. ⋯ Three patients were treated with carpal tunnel release alone and 14 with combined procedures to decrease the size of the affected part. Sensibility in the affected part often appeared unrelated to removal or preservation of hamartomatous nerve tissue. Complications related to nerve surgery included recurrence of carpal tunnel syndrome in one patient, recurrent soft tissue mass in one patient, and painful calcification of the involved tissues 20 years postoperatively in one patient.