Thumb hypoplasia occurs in various forms and degrees. This article describes the cause, types, and specific treatment options for different levels of presentation. A review of results for treatment is presented.
Thumb hypoplasia occurs in various forms and degrees. This article describes the cause, types, and specific treatment options for different levels of presentation. A review of results for treatment is presented.
This brief article describes the technique of hand intrinsic muscle reanimation using the anterior interosseous nerve for both specific median- and ulnar nerve-based deficits.
Despite advances in many other fields in hand surgery, nerve repair has not improved substantially from the techniques for nerve repair established by Sir Sidney Sunderland during World War II. The key obstacles to repair include the accuracy of regeneration; the time required; and the lack of adequate donor nerve graft tissue for bridging a gap in a nerve, with the proper cytokines and substrate to promote regeneration without causing a defect in another site. Less than 50% of regenerating sensory or motor axons reach the correct end organ. Regeneration of motor axons is limited to approximately 12 months, after which time absorption of motor end plates occurs.Autogenous nerve grafts are in extremely limited supply, with sural nerve grafts being the primary source. Synthetic nerve grafts currently are unable to support nerve regeneration across long defects, but hold great promise. Bioengineering strategies for such grafts seek to enhance nerve regeneration by using neurotrophic factors to increase the speed of regeneration, making structural changes to improve the accuracy of repair, and incorporating cytokines, which might inhibit the re-absorption of motor end plates.
Hand surgeons often are called on to interpret the electrodiagnostic report, which includes both nerve conduction studies and electromyography (EMG). The EMG examination can provide useful information as to the normal and abnormal electrophysiology of muscle and its nerve. The various potentials described, however, do not point to a specific diagnosis. Through an understanding of the methodology and principles of testing the clinician will be better suited to recognizing when the report conclusions do not match the electromyographic data, or when to request further testing in cases in which insufficient data compromises one’s ability to draw definitive conclusions. The indication for surgery still hinges on reproducible physical findings combined with the appropriate clinical symptoms rather than on a test abnormality.
The basic steps and principles of tendon transfers in the treatment of patients with nerve injuries or palsies is presented. Technical tips on tendon selection, tensioning, and placement are provided. Specific transfers for different types of nerve palsies are indicated, along with their functional outcomes.
Specific compression syndromes of the median nerve are known in the proximal forearm and at the wrist. Carpal tunnel syndrome is the best known and most common, but pronator teres syndrome and anterior interosseous nerve syndrome also are clinically significant. In this discussion, we review the history, relevant anatomy, diagnosis, and treatment modalities for these compression syndromes.
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