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Case: We report a case in the United States of a 12-year-old girl with multidrug-resistant tuberculous (MDR-TB) osteomyelitis of the hand managed with surgical debridement and second-line anti-TB therapy. The disease course was complicated by dissemination and multifocal progression. Conclusion: Despite early intervention, multidrug resistance makes TB treatment challenging and facilitated progression to disseminated disease in this case. We review the difficulties in diagnosis and treatment of pediatric MDR-TB. [ABSTRACT FROM AUTHOR]

Hair-thread tourniquet syndrome (HTTS) is an emergency phenomenon in which hair or thread tightly wraps around a protruding appendage of the body, resulting in pain, swelling, and rarely ischemia and amputation. While the toes, fingers, and external genitalia are the most affected areas, it can also impact other protruding parts of the body. Nevertheless, except for a few cases of skin tags and hemangioma, HTTS associated with a protruding skin mass is extremely rare in the literature. In this study, we present the management of two cases: One involving a pediatric patient with HTTS affecting the right fourth toe and the other involving a protruding pyogenic granuloma on the back of an adult patient. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) diagnosis of underlying finger pathology can be intimidating due to the presence of unique anatomy. The small size of the fingers and the unique orientation of the thumb compared to the fingers also introduce unique demands on the MRI system and the technologists performing the study. This article will review the anatomy pertinent to injuries at the fingers, provide protocol guidance, and discuss pathology encountered at the fingers. Although much of the encountered pathology in the fingers overlaps with adults, unique pathology to children will be highlighted when applicable. [ABSTRACT FROM AUTHOR]

Background: The human hand is a specialised organ for fine motion and sensation and has a relatively large representation in the homunculus. The pathway of sensation starts from information sent by mechanoreceptors in the hand. This study reports the topography of the Pacinian corpuscle in the fingertips of a human cadaver. Methods: All 10 digits from both hands of a fresh-frozen cadaver were examined. Glabrous skin distal to the distal interphalangeal joint was harvested superficial to the periosteum including fat and subcutaneous tissue. The glabrous skin were divided into 10 sections that included five distal and five proximal sections. Modified gold chloride staining was performed. Sectioned specimens were observed under a light microscope and the density of Pacinian corpuscles was determined in each segment. The density of the corpuscles was compared between the radial/ulnar and proximal/distal segments and also between digits from the right hand versus those from the left hand. Results: Pacinian corpuscles were observed only in the subcutaneous tissue. There was no significant difference in density of the corpuscles between the distal and proximal segments or between the right and left hands. There was a statistically significant greater density of Pacinian corpuscles on the radial segments of all digits except the thumb. Conclusions: There is a greater density of Pacinian corpuscles on the radial side of the human fingertip in all digits except the thumb. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to report the outcomes of flexor tendon repair in zone II and compare two analytic tests – the original and adjusted Strickland scores – and a global hand function test, the 400-points test. Methods: We included 31 consecutive patients (35 fingers) with a mean age of 36 years (range 19–82 years) who underwent surgery for a flexor tendon repair in zone II. All patients were treated in the same healthcare facility by the same surgical team. All the patients were followed and evaluated by the same team of hand therapists. Results: At 3 months after the surgery, we found a good outcome in 26% of patients with the original Strickland score, 66% with the adjusted one and 62% with the 400-points test. Among the 35 fingers, 13 of them were evaluated at 6 months after the surgery. All the scores had improved with 31% good outcomes in the original Strickland score, 77% in the adjusted Strickland score and 87% in the 400-points test. The results were significantly different between the original and adjusted Strickland scores. Good agreement was found between the adjusted Strickland score and the 400-points test. Conclusions: Our results suggest that flexor tendon repair in zone II remains difficult to assess based solely on an analytic test. It should be combined with an objective global hand function test, such as the 400-points test, which appears to correlate with the adjusted Strickland score. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Maintaining brain health and promoting healthy lifestyle strategies to manage modifiable risk factors is vital to ensuring well-being for all – not only for the individuals with memory challenges but also their family caregivers and professional providers. In this brief review paper, we highlight modifiable risk and protective factors and opportunities for dementia risk reduction (e.g., limited alcohol use and reduced exposure to air pollution, secondhand smoke, and excessive noise); provide an overview of the World-Wide FINGERS Network and its goal to adapt the original Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multidomain lifestyle approach in various settings to determine whether the protocol is effective across different populations in varied geographic, cultural, and economic settings and to optimize the model across a continuum of cognitive decline; and, comment on challenges and opportunities for researchers and clinicians including opportunities for risk reduction and intervention in primary care settings and the need to establish linkages across multiple levels of intervention to sustain behavior change in prevention, treatment, and care. [ABSTRACT FROM AUTHOR]

Background: Finger injuries caused by green onion cutting machines in Korean kitchens have unique characteristics of an incomplete amputation in which multiple parallel soft tissues and blood vessels are injured in the same form. In this study, we aimed to describe unique finger injuries and to report the treatment outcomes and experiences of performing possible soft tissue reconstructions. Methods: This case series study included 65 patients (82 fingers) from December 2011 to December 2015. The mean age was 50.5 years. We retrospectively classified the presence of fractures and the degree of damage in patients. The injured area involvement level was categorised as distal, middle or proximal. The direction was categorised as sagittal, coronal, oblique or transverse. The treatment results were compared according to the amputation direction and injury area. Results: Of the 65 patients, 35 had a partial finger necrosis and needed additional surgeries. Finger reconstructions were performed through stump revision or local or free flap use. The survival rate was significantly lower in patients with fractures. As for the injury area, distal involvement led to 17 out of 57 patients displaying necrosis and all 5 patients showing the same in proximal involvement. Conclusions: Unique finger injuries caused by green onion cutting machines can easily be treated with simple sutures. Then prognosis is affected by the extent of injury and the presence of fractures. Reconstruction is necessary for finger necrosis owing to extensive blood vessel damage and limitations when making this selection. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

• Reflex-mediated finger force changes are stabilized by intra-muscle synergies. • No synergies in the space of individual finger force stabilized the force changes. • Effects of dominance are seen in inter-finger but not intra-muscle synergies. • Effects of motor equivalence are seen during reflex-induced force changes. We used the framework of the uncontrolled manifold hypothesis to explore force-stabilizing synergies and motor equivalence in the spaces of individual motor unit (MU) firing frequencies. Healthy subjects performed steady force production tasks by pressing with one finger or three fingers of a hand. Surface EMG was used to identify individual MU action potentials. MUs formed stable groups (MU-modes) with parallel scaling of the firing frequency in both flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC) that allowed identifying them with the reciprocal and coactivation commands. Smooth lifting of the fingers by an "inverse piano" device led to an unintentional, reflex-based force increase. There was significantly larger motion in the space of MU-modes that kept the force unchanged (motor equivalent) compared to motion that changed force (non-motor equivalent). The force change was stabilized by co-varying contributions of the MU-modes defined separately for FDS and EDC. In contrast, analysis of the three-finger task in the space of individual finger forces showed no synergies stabilizing total force change. Effects of hand dominance were seen on multi-finger synergies but not intra-muscle synergies. We conclude that spinal mechanisms, such as recurrent inhibition and reflex loops from proprioceptors, contribute significantly to intra-muscle synergies, while multi-finger synergies reflect supra-spinal processes. These results provide methods to explore the contributions of spinal vs supraspinal circuitry to changed motor synergies in populations with a variety of neurological disorders. [ABSTRACT FROM AUTHOR]

The wrap-around flap (WAF) has become a popular approach to thumb reconstruction because the results are functionally and cosmetically excellent. By modifying to a partial toenail transfer, the WAF can also be used for finger reconstruction. However, performing cosmetically superior finger reconstruction is a significant challenge because it is difficult to reconstruct the natural nailfold by partial nail transplantation, although partial nail transplantation is required to reconstruct a narrow fingernail. One side of the reconstructed lateral nailfold tends to be a missing nail margin, and one side of the proximal nailfold angle tends to be retracted. Based on the rationale that loss of the lateral nailfold volume due to the postoperative tension of the volar flap would result in a missing nail margin, the volume of the lateral nailfold was maintained with a single thread that was passed from the nail to the volar flap. Additionally, half of the proximal nailfold from the nail plate was elevated to advance it forward. The results indicated that a cosmetically natural nailfold was achieved with the WAF approach to finger reconstruction. These easy and simple techniques enable reconstruction of a cosmetically natural nailfold using WAF for finger reconstruction. [ABSTRACT FROM AUTHOR]

Background: Lipomas are the most frequent benign soft tissue tumor that are rarely found in the hand and are exceptionally rare on the fingers. The aim of this study was to investigate lipomas of atypical locations, so that they can be taken into account when making a differential diagnosis of a tumor of the hand or fingers. Methods: We studied a group of 27 patients diagnosed with lipoma of the wrist, palm, and fingers. The diagnosis was made by clinical and imaging examinations. Surgical treatment was established based on symptoms of pain, paresthesias, functional impairment, or aesthetic concerns. Treatment outcomes were assessed clinically at 1.5 years post-intervention. Results: Sizes over 5 cm were recorded in five cases, with the largest lipoma being 8 by 5 by 3.5 cm in size and weighing 125 g, located in the palm. There was one case of spontaneous tendon rupture and one case of carpal tunnel syndrome. There was no recurrence recorded at 1.5-year follow-up. Conclusions: Lipomas in the palm and fingers are rare entities (with more men affected), and surgical treatment consists of complete removal of the tumor and providing definitive healing. Despite their rarity, clinicians should consider lipomas when making differential diagnoses of soft tissue tumors of the hand. [ABSTRACT FROM AUTHOR]

Assessment and therapy for individuals who have hand paresis requires force sensing approaches that can measure a wide range of finger forces in multiple dimensions. Here we present a novel strain-gauge force sensor with 3 degrees of freedom (DOF) designed for use in a hand assessment and rehabilitation device. The sensor features a fiberglass printed circuit board substrate to which eight strain gauges are bonded. All circuity for the sensor is routed directly through the board, which is secured to a larger rehabilitative device via an aluminum frame. After design, the sensing package was characterized for weight, capacity, and resolution requirements. Furthermore, a test sensor was calibrated in a three-axis configuration and validated in the larger spherical workspace to understand how accurate and precise the sensor is, while the sensor has slight shortcomings with validation error, it does satisfy the precision, calibration accuracy, and fine sensing requirements in orthogonal loading, and all structural specifications are met. The sensor is therefore a great candidate for sensing technology in rehabilitation devices that assess dexterity in patients with impaired hand function. [ABSTRACT FROM AUTHOR]

Objective To explore the methods and clinical efficacy of great toe fibular flap in the repair of finger pulp wounds. Methods From December 2015 to March 2020, 9 patients with finger pulp defects due to trauma or scar resection were collected. The great toe fibular flap was used to repair. The size of flap was from 2.0 cm×1.5 cm to 4.0 cm×2.5 cm. All patients were followed up for 3 to 48 months. The appearance, color, sensation of flap and the finger joint movement were observed. Results All flaps survived completely after operation. The appearance was satisfactory. No flap edema was found. The flaps were wearable, the sensation recovered well and the joint movement was normal. The donor site was normal. Conclusion The great toe fibular flap was the first choice in the repair of finger pulp defects. This method showed satisfactory appearance and good functions. The anatomic cutting under microscope can ensure the safety of operation. Therefore, this method can be easily carried out in the primary hospital. [ABSTRACT FROM AUTHOR]

Traumatic finger digit amputation may affect patient's psychology also along with a serious injury to the affected hand. Recently, advanced micro-surgical re-implantation can help save a damaged human finger that is badly injured and/or amputated. Considering its associated financial burden, a vast majority of such patients cannot afford it. For such patients, a hand/finger prosthesis may act as a blessing, boosting social performance. In the present case report, an innovative type of prosthesis finger replacement method is discussed. [ABSTRACT FROM AUTHOR]

An entrapped finger is a relatively uncommon domestic injury. When the finger gets stuck proximal to the proximal interphalangeal joint, the resultant distal edema and inappropriate attempts at retrieval can result in circumferential degloving of the skin and injury to the neurovascular structures. We report a technique that can be used in such circumstances. Strategically placed skin sutures are used to get the skin through the constricting ring, and retrieval is aided by a cut finger glove that wraps the finger and can be lubricated. This non-cutting technique is named as the parachute technique since the withdrawn skin sutures look like the strings of the parachute. This technique is valuable when the finger gets stuck in an idli plate, a common South Indian kitchen utensil, where there is difficulty of access to cutting equipment and where inappropriate attempts at retrieval can result in skin injury making further attempts more difficult. [ABSTRACT FROM AUTHOR]

Background: Hand and finger lacerations presenting to U.S. emergency departments (EDs) are common, although the burden of these injuries is not well understood.Objective: Our aim is to describe the epidemiology and causes of hand and finger lacerations in U.S. EDs.Methods: This National Electronic Injury Surveillance System database review investigates hand and finger lacerations presenting to EDs in the United States from 2015 to 2019.Results: Annually, hand and finger lacerations account for 243,844 and 587,451 ED visits, respectively. Affected patients are frequently White (70.5%), male (63.4%), and aged 18 through 44 years (46.3%). The top three products linked to hand and finger lacerations are knives (30.5%), metal containers (4.2%), and drinkware (3.8%), and men are less likely to have injuries from these products than women, especially knives (odds ratio 0.76; 95% confidence interval 0.60-0.96; p < 0.02). Although a minority of hand and finger lacerations involve alcohol (1.2%), men have greater rates of alcohol involvement than women (χ21 = 11.7; p < 0.001). Lacerations frequently occur in the home (61.3%). Many patients (44.2%) present to very large hospitals, and nearly one-half of patients younger than 5 years and one-third of patients aged 5 through 17 years present to pediatric hospitals. Most patients (97.4%) are treated and released without admission and 0.2% are transferred to another hospital. Patients with alcohol, drug, or medication involvement are more likely to leave against medical advice, be admitted, or held for observation (p < 0.001).Conclusions: Hand and finger lacerations result in a significant number of ED visits. A better understanding of injury trends and presentations can guide injury prevention in manufacturing, education, and public health. [ABSTRACT FROM AUTHOR]

We explored the unintentional force drift across the four fingers of the dominant hand during accurate force production in isometric conditions caused by turning the visual feedback on force off. Our hypotheses were that the Index finger would show smallest drifts and best ability to eliminate the drifts with knowledge of performance in previous trials. Young healthy subjects produced force at 20% of the maximal force level by one finger at a time. There was no significant difference among the fingers in the root mean square error of force during performance with visual feedback. Turning visual feedback off caused force drift to lower magnitudes. The magnitude of force drift was the largest during tasks performed by the Index finger. After each block of twelve trials, the subjects were given feedback on the drift magnitude in that block and used it to correct performance in future trials. There was a total of six blocks. The magnitude of drift correction between consecutive blocks correlated with the magnitude of drift in the earlier block only after the second and fourth blocks. The Index finger failed to improve its performance more than other fingers and demonstrated significant residual drifts to lower force magnitudes in the sixth block of trials. These findings falsified both our hypotheses. Taken together with earlier studies showing advantage of the Index finger across a variety of tasks that require quick and accurate changes in performance, our results suggest that effector specialization along the stability-agility continuum is not limited to the phenomenon of cortical arm/hand dominance but can also be seen across fingers of a hand controlled by the same hemisphere, possibly reflecting the differences in the finger role in prehensile tasks. [ABSTRACT FROM AUTHOR]

Dislocation of a finger is a pathology often encountered in emergency centers. The following case example provides a reminder of its management and the situations in which the patient should be referred to the specialist. [ABSTRACT FROM AUTHOR]

• Unintentional force drifts are smaller when a person produces force against a spring. • The drift magnitude is smaller when acting against more compliant springs. • Subjects are unaware of the force drift and ignore it when asked to match force. • The results strongly suggest drifts in referent coordinates as causes of force drifts. We explored the phenomenon of unintentional force drifts in the absence of visual feedback. Based on the idea of direct force control with internal models and on the idea of indirect force control with referent coordinates to the involved muscle groups, contrasting predictions were drawn for changes in the drift magnitude when acting against external spring loads. Fifteen young subjects performed typical accurate force production tasks by pressing with the Index finger at 20% of maximal voluntary contraction (MVC) in isometric conditions and while acting against one of the three external springs with different stiffness. The visual feedback on the force was turned off after 5 s. At the end of each 20-s trial, the subjects relaxed and then tried to reproduce the final force level. The force drifts were significantly smaller in the spring conditions, particularly when acting against more compliant springs. The subjects were unaware of the force drifts and, during force matching, produced forces close to the initial force magnitude, which were not different across the conditions. There was a trend toward larger drifts during performance by the dominant hand. We view these observations as strong arguments in favor of the theory of control with spatial referent coordinates. In particular, force drifts were likely consequences of drifts of referent coordinates to both agonist and antagonist muscles. The lack of drift effects on both perception-to-report and perception-to-act fit the scheme of kinesthetic perception based on the interaction of efferent (referent coordinate) and afferent processes. [ABSTRACT FROM AUTHOR]

We explored the synergic organization of motor units in extrinsic finger muscles, flexor digitorum superficialis (FDS), and extensor digitorum communis (EDC). Healthy subjects produced accurate cyclical force by pressing with the middle phalanges of one of the three fingers (Index, Middle, and Ring) and all three together. Two wireless sensor arrays were used to record and identify motor unit action potentials in FDS and EDC. Stable motor unit groups were identified within each muscle and across both muscles. Analysis of motor units combined over the two muscles showed one of the first two motor unit groups with consistently opposite signs of the loading factors for the FDS and EDC motor units, and the other group with consistently same signs of the loading factors for the two muscles. We interpret the two motor unit groups as reflections of the reciprocal and co-activation commands within the theory of control with spatial referent coordinates. Force changes within the cycle were primarily associated with the modulation of the co-activation motor unit group. Analysis of inter-cycle variance within the spaces of motor unit groups defined for FDS and EDC separately showed force-stabilizing synergies across both single-finger and three-finger tasks. In contrast, analysis within the motor unit groups defined across both muscles failed to show force-stabilizing synergies. We interpret these results as a reflection of the trade-off across levels within a hierarchical control system. [ABSTRACT FROM AUTHOR]

Background: Finger epiphyseal growth plate stress injuries are the most frequent sport-specific injuries in adolescent climbers. Definitive diagnostic and therapeutic guidelines are pending. Purpose: To evaluate a diagnostic-therapeutic algorithm for finger epiphyseal growth plate stress injuries in adolescent climbers. Study Design: Case series; Level of evidence, 4. Methods: On the basis of previous work on diagnostics and treatment of finger epiphyseal growth plate stress injuries (EGPIs) in adolescent climbers, we developed a new algorithm for management of these injuries, which was implemented into our clinical work. During a 4-year period, we performed a prospective multicentered analysis of our patients treated according to the algorithm. Climbing-specific background was evaluated (training years, climbing level, training methods, etc); injuries were analyzed (Salter-Harris classification and UIAA MedCom score [Union Internationale des Associations d'Alpinisme]); and treatments and outcomes were recorded: union, time to return to climbing, VAS (visual analog scale), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder, and Hand), and a climbing-specific outcome score. Results: Within the observation period, 27 patients with 37 independent EGPIs of the fingers were recorded (mean ± SD age, 14.7 ± 1.5 years; 19 male, 8 female; 66.7% competitive athletes). Regarding maturity at time of injury, the mean age at injury did not differ by sex. Average UIAA climbing level was 9.5 ± 0.8, with 6 ± 4.6 years of climbing or bouldering and 14 ± 9.1 hours of weekly climbing-specific training volume. Among the 37 injuries there were 7 epiphyseal strains, 2 Salter-Harris I fractures, and 28 Salter-Harris III fractures (UIAA 1, n = 7; UIAA 2, n = 30). Thirty-six injuries developed through repetitive stress, while 1 had an acute onset. Twenty-eight injuries were treated nonoperatively and 9 surgically. Osseous union was achieved in all cases, and there were no recurrences. The time between the start of treatment and the return to sport was 40.1 ± 65.2 days. The climbing-specific outcome score was excellent in 34 patients and good in 3. VAS decreased from 2.3 ± 0.6 to 0.1 ± 0.4 after treatment and QuickDASH from 48.1 ± 7.9 to 28.5 ± 3.3. Conclusion: The proposed management algorithm led to osseous union in all cases. Effective treatment of EGPIs of the fingers may include nonsurgical or surgical intervention, depending on the time course and severity of the injury. Further awareness of EGPI is important to help prevent these injuries in the future. [ABSTRACT FROM AUTHOR]

Background: MR imaging is a powerful method for characterization of swellings arising from the tendon sheath especially giant cell tumors and ganglion cyst of the tendon sheath. A trigger finger is a common condition and is either blockage or triggering of the finger from flexion to extension. Objective: To evaluate the diagnostic performance of MRI in non-traumatic finger tendon and ligament-related lesions to allow a more focused assessment of the soft tissue structures of this region. Patients and methods: This study was performed in Radiology Department, Menoufia University Hospitals, during the period from August 2018 to April 2020. This study included 44 patients; 25 males, 19 females with an age range from 13 years to 58 years (mean age 35 years). In terms of clinical presentation, 73% of cases presented by swelling and cases presented by pain were 27%. Results: Primary diagnosis by MRI revealed 50% of cases were giant cell tumors, 25% were ganglion cysts and the remainder were hemangiomas, MRI detection of characterization represented by 100%, the results then compared with pathology and laboratory results with accuracy of MRI in the detection of tissue characterization is 93.3%, MRI evidence of non-traumatic tenosynovitis constituted about 75% of all cases of tenosynovitis. On the other hand, only 25% of cases had a radiological diagnosis of trigger finger. Conclusions: MRI is a great assessment of the tendon and ligaments tear whether partial or complete, any associated marrow edema or bony fragment avulsion, and the extent of retraction in cases of a complete tear. [ABSTRACT FROM AUTHOR]

We investigated the role of task constraints on interpersonal interactions. Twenty-one pairs of coworkers performed a finger force production task on force sensors placed at two ends of a seesaw-like apparatus and matched a combined target force of 20 N for 23 s over 10 trials. There were two experimental conditions: 1) FIXED: the seesaw apparatus was mechanically held in place so that the only task constraint was to match the 20 N resultant force, and 2) MOVING: the lever in the apparatus was allowed to rotate freely around its fulcrum, acting like a seesaw, so an additional task constraint to (implicitly) balance the resultant moment was added. We hypothesized that the additional task constraint of moment stabilization imposed on the MOVING condition would deteriorate task performance compared with the FIXED condition; however, this was rejected, as the performance of the force matching task was similar between two conditions. We also hypothesized that the central nervous systems (CNSs) would employ distinct coworking strategies or interpersonal motor synergy (IPMS) between conditions to satisfy different task constraints, which was supported by our results. Negative covariance between coworker’s forces in the FIXED condition suggested a force stabilization strategy, whereas positive covariance in the MOVING condition suggested a moment stabilization strategy, implying that independent CNSs adopt distinct IPMSs depending on task constraints. We speculate that in the absence of a central neural controller, shared visual and mechanical connections between coworkers may suffice to trigger modulations in the cerebellum of each CNS to satisfy competing task constraints. [ABSTRACT FROM AUTHOR]

We described the case of a 42-year-old man who presented with left index finger mass persisting for 6 months. The mass was small and, painless and had gradually increased in size with limited finger flexion. Physical examination showed a firm mass over the volar surface of the left index finger. There was no tenderness, redness, warmth or punctum. The overlying skin was normal, and the mass did not transilluminate. Further examination of the head and neck, chest, upper limbs and neurovascular system revealed normal findings. No similar masses were found elsewhere in the body. Bedside ultrasound with further investigation and management confirmed the suspected diagnosis. [ABSTRACT FROM AUTHOR]

Post-burn contractures are a common problem and functionally limiting for upper limbs. Many different techniques have been described in the literature for their treatment. Z-plasty and release with SSG cover are the commonest procedures done for post-burn contractures. In this study we assess the use of the square flap technique in post-burn contractures of upper limb. Eleven patients with a total number of twelve upper limb contractures (mild to moderate) involving axilla, elbow and finger underwent release by standard square flap technique. All cases were followed up for at least 6 months and analyzed for range of motion and aesthetic outcome. Patient and surgeon satisfaction was recorded. All operated cases achieved a satisfactory range of movement post-operatively without any recurrence. The number of patients who were satisfied with the surgery were 7 out of 11, and 4 patients were somewhat satisfied with the results obtained. In contrast, the surgeons were satisfied in all cases. Square flap is shown to be an easy and reliable flap for mild to moderate contractures of the anterior or posterior axillary folds, elbow contractures and finger contractures with low recurrence rate. [ABSTRACT FROM AUTHOR]

The fingers are highly vascular sites which bleeds profusely during procedure. Penrose drain and gasket are not readily available in the clinic. For this problem, we advocated the use of hand gloves and cotton gauze to achieve haemostasis at the site of finger. [ABSTRACT FROM AUTHOR]

Posttraumatic malunion of the phalanx with rotational deformity may cause crossing of the finger and impair hand function. Cosmetic disfigurement and severe dysfunction of the fingers require surgical correction, most often via open corrective osteotomies and rigid fixation with plates. However, such an approach requires a longer incision, inevitably results in a scar, and has a higher potential for extensor tendon adhesions, which result in extension lags. In addition, abruption of the periosteum and plating of the phalanges require longer bone healing. This report describes the straightforward, minimally invasive correction of phalangeal malunions with a mini-external fixator. In this procedure, a digital block of the affected finger can be performed. The fully flexed position of all fingers provides accurate correction of phalangeal malunions. Although treatment of phalangeal malunions remains challenging, the present procedure is an alternative solution for phalangeal malunions. [ABSTRACT FROM AUTHOR]

Purpose: Cold-induced vasodilation (CIVD) is a paradoxical rise in blood flow to the digits that occur during prolonged cold exposure. CIVD is thought to occur through active vasodilation and/or sympathetic withdrawal, where nitric oxide (NO) may play a key role in mediating these mechanisms. Beetroot juice (BRJ) is high in dietary nitrate (NO3-) which undergoes sequential reduction to nitrite (NO2-) and subsequently NO. Using a double-blind, randomized, crossover design, we examined the effect of acute BRJ supplementation on the CIVD response in 10 healthy males.Methods: Participants had a resting blood pressure measurement taken prior to ingesting 140 mL of nitrate-rich BRJ (13 mmol NO3-) or a NO3--free placebo (PLA). After 2 h, participants immersed their hand in neutral water (~ 35 °C) for 10 min of baseline before cold water immersion (~ 8 °C) for 30 min. Laser-Doppler fluxmetry and skin temperature were measured continuously on the digits.Results: Compared to PLA (100 ± 3 mmHg), acute BRJ supplementation significantly reduced mean arterial pressure at -30 min (96 ± 2 mmHg; p = 0.007) and 0 min (94 ± 2 mmHg; p = 0.008). Acute BRJ supplementation had no effect on Laser-Doppler fluxmetry during CIVD (expressed as cutaneous vascular conductance) measured as area under the curve (BRJ: 843 ± 148 PU mmHg-1 s; PLA: 1086 ± 333 PU mmHg-1 s), amplitude (BRJ: 0.60 ± 0.12 PU mmHg-1; PLA: 0.69 ± 0.14 PU mmHg-1), and duration (BRJ: 895 ± 60 s; PLA: 894 ± 46 s).Conclusion: Acute BRJ supplementation does not augment the CIVD response in healthy males. [ABSTRACT FROM AUTHOR]

Introduction: Falling studies, i.e. assessing what happens when an individual falls, have been conducted in controlled environments but not in field studies for ethical reasons; this potentially limits the validity and applicability of previous studies. We performed field studies on existing YouTube © videos of skateboarders falling. The aims of these studies were to measure the wrist angle at impact on videos of real unprotected falls and to study the dynamics of the upper limbs when falling.Methods: Youtube © videos of skateboarders falling were studied assessing the direction of the fall, the positions of both upper limbs and especially the wrists on impact quantitatively and qualitatively. This study would not be ethical by other means.Results: In study one (the more quantitative study) there were 48 men and 50 falls. The mean elbow flexion was 300 (range 00 to 800) and the mean maximal wrist extension was 800 (range 500 to 1100). The second wrist extended less or the same in > 90%. The second wrist only once (of 31) extended > 900 which should minimise the risk of toppling. Falls onto only one wrist gave significantly greater maximal wrist extension. In the second more qualitative study we observed the "upper limb falling reflex" where the response to falling is for the upper limb(s) to align the upper limb with the direction of falling of the body with the elbow mostly but not fully extended. Initially the wrists extend c. 400-500 with the fingers held mildly flexed. Immediately before impact the fingers hyper-extend with some compensatory wrist flexion to c. 300 of extension. The fingertips impact the ground first followed by the hand.Conclusion: These studies confirm wrist extension at impact around 800 but the wrist(s) may hyper-extend risking toppling. Falls on both wrists minimise the risk of toppling. The "upper limb falling reflex" is defined; it is a rapid dynamic response leading to the fingers impacting the ground first on falling. Abnormalities with the upper limb falling reflex may indicate problems with development in young children and may increase the risk of injury in older people. [ABSTRACT FROM AUTHOR]

Case: A 22-year-old roofer presented to the emergency department with partial amputation of the leftmiddle finger. He was treated with revision amputation using a glove tourniquet. He followed up 14 days later demonstrating a retained tourniquet with severe ischemic changes. The patient was managed conservatively with aspirin, smoking cessation, and observation. Conclusion: At 2-year follow-up, he had normal sensation and function and returned to work. A finger with severe, but incomplete arterial occlusion and profound venous congestion can be salvaged with conservative management of observation and anticoagulation with aspirin therapy after prolonged ischemia of 14 days. [ABSTRACT FROM AUTHOR]

Introduction: Management of unstable fractures of the proximal phalanx is a challenge.Objective: The purpose of this study is to introduce to the literature the use of "bi-cortical" periarticular K-wire fixation for displaced unstable transverse extra-articular fractures of the base of the proximal phalanx of the fingers.Patients and Methods: This is a retrospective study of 30 patients with such fractures treated by the author over the last 10 years. Demographic data were collected and surgical complications were documented. The outcome was considered excellent, good, fair and poor if the total active motion of the finger was >260o, 250o-259o, 210o - 249o, and <210o; respectively.Results: The worst outcome was seen in an elderly patient who sustained multiple fractures and concurrent flexor tendon injury. The remaining 29 patients were relatively young (mean age of 29 years, range = 19 - 42 years) and sustained an isolated single fracture from a fall or a fight. Out of these 29 patients, the outcome was excellent in 27 patients and good in the remaining 2 patients.Conclusions: The "bi-cortical" periarticular k-wire fixation is best suited for transverse extra-articular fractures of the base of the proximal phalanx. The wire avoids all joints and hence, early post-operative mobilization is feasible. The technique is simple and obtains a favorable outcome in most patients.Type Of Study/level Of Evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Background: To introduce and evaluate an updated surgical technique for the treatment of tendinous mallet finger deformity. Methods: From April 2017 to September 2018, 13 cases of tendinous mallet finger deformity were treated. All patients had zone I extensor tendon rupture, with no residual tendon at the insertion for suture, and no avulsion fracture in the distal phalanx. Extensor tendon insertion reconstruction was realized by suturing the transferred portion of the flexor digitorum profundus tendon with the proximal end of the extensor tendon via a constructed bone tunnel. The treatment efficacy of the enrolled patients was evaluated by using Dargan evaluation criteria post‐operatively. Results: All patients were followed up with an average duration of 10.6 months. At the last follow‐up, 12 patients showed excellent function recovery and one case had unsatisfactory outcome according to the Dargan evaluation criteria. Conclusion: Satisfactory therapeutic outcome for the treatment of tendinous mallet finger deformity can be achieved by reconstructing extensor tendon insertion using a part of the flexor digitorum profundus tendon, implying that the proposed treatment method is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Cellular digital fibroma is a benign fibrous lesion that typically occurred on either a finger or a toe. Cellular digital fibroma was introduced as a distinctive cluster of differentiation 34 (CD34)-positive lesion in July 2005. Cellular digital fibroma has been described in 20 patients: 12 men and 8 women. The patients ranged in age from 27 to 83 years old (median, 52 years old) at diagnosis. The tumor had been present from 2 months to 2 years (median, 11 months) prior to seeking medical attention. The cellular digital fibroma was usually slowly growing and asymptomatic; there has been no prior history of trauma at the tumor site. The lesion typically presented as either an erythematous or a flesh-colored, solitary papule of 5 mm or smaller. It frequently occurred on either the dorsal, lateral or ventral side of a digit. Yet, some of the lesions were located on the nail fold of the digit. Cellular digital fibroma shows a prominent cellular proliferation of spindle-shaped fibroblasts, without any atypia or mitoses, that extends from the papillary into the upper reticular dermis; diffuse and strongly positive CD34 staining is present throughout the entire tumor. There is no erosion by the tumor of the bony phalanx. Other acral tumors, such as superficial acral fibromyxoma (which also has diffuse strongly positive CD34 staining) and acquired digital fibrokeratoma (which is either CD34-negative or only focal CD34 positive), are in the clinical and pathologic differential diagnosis of cellular digital fibroma. Conservative complete excision is the treatment of cellular digital fibroma; however, even for tumors that have only been partially removed during biopsy, recurrence has not been observed. In conclusion, cellular digital fibroma is a unique CD34-positive acral lesion of the distal fingers and toes whose diagnosis requires correlation of the clinical morphology and the pathologic features of the tumor. [ABSTRACT FROM AUTHOR]

Background: Cutaneous fibrous histiocytoma (CFH) is a common, benign skin tumor predominantly occurring on the extremities or trunk. However, CFH on the finger is rare. Objective: This study was undertaken to examine the clinicohistopathological features of CFH of the finger. Materials and Methods: This is a retrospective study of 12 CFHs located on fingers in a tertiary hospital in Korea. All case slides were retrieved from saved files. Results: Ages of the CHF of the finger affected individuals ranged from 9 to 48 years with a male-to-female ratio of 1.4:1. Picker's nodule or wart was the most common clinical diagnosis. In only 2 out of the 12 cases was the pre-biopsy diagnosis of CFH ventured. Fibrocollagenous type was the most common histological type. Majority of the cases were mitotically inactive, exhibiting only 0–1 mitoses per high-power field and there was no recurrence. Tumor cells were uniformly CD34 negative. Conclusion: Because CFH can resemble malignancies including dermatofibrosarcoma protuberans, a lack of familiarity with the occurrence of CFH of the finger may lead to more aggressive treatment. Dermatologists should include CFH in their differential diagnosis of circumscribed nodules on the fingers to ensure proper management. [ABSTRACT FROM AUTHOR]

The protractor-based goniometer is the standard instrument used to measure finger range of motion (ROM). However, the method is often complicated to apply and places a burden on the investigator. Here, we developed a new method for finger ROM measurement using a smartphone. This study was performed to determine the reliability and convenience of this new method. The ROM in 1007 finger joints was measured by both the standard and new method and the data were analyzed using the intraclass correlation coefficient (ICC). The smartphone ICC score was high (0.927), and the average measurement time per joint was 49% lower with the smartphone compared to the goniometer. The results indicated that the smartphone-based measurement method had the same reliability as the conventional goniometer, in addition to an excellent measurement time. [ABSTRACT FROM AUTHOR]

Aim: Although the development of microsurgical techniques and instruments since the first finger replantation, satisfactory results have not been achieved. Every study will bring us closer to the ideal result. In line with this goal, we aimed to present our experience. Patients and Methods: Replantations of 277 fingers of 244 cases were enrolled in this single center study between 2010-2019. Demographic information, surgical and clinical data were collected from patient files, operation notes, photograps and follow-up forms. Results: Mean age was 28.4 years. Total succes rate was found as 64.9%. Most frequent etiology of amputation was avultion and the least one was guillotine amputation. The most successive results rate was found as 88.7% in guillotine amputations. Mean hospital stay was 11.8 days (1-77days). Conclusion: New studies on replantation will increase the success and functional recovery in the future. Most importantly, prevention of the factors that cause finger amputation and smoking will be. [ABSTRACT FROM AUTHOR]

• An efficient hybrid computational model to analyze frictional impact responses during tapping of soft finger is developed. • A lumped-parameter model taking the tangential compliance into account is presented to calculate contact forces. • Event driven scheme and computational strategy are given to solve non-smooth differential equation. • Numerical results are compared with three-dimensional LS-DYNA solutions. • A 'reserve slip' phenomenon caused by large tangential contact compliance is captured. The aim of this paper is to develop an efficient hybrid computational model to analyze the frictional impact dynamic responses of soft finger during the tapping event. The large deformation field and inertial field of soft structure are discretized by absolute nodal coordinate formulation. Lagrange multiplier method is adopted to account for the constraints between neighbor phalanges. Considering tangential contact compliance, a lumped-parameter model at the local contact zone is presented to calculate contact forces. The governing equations of soft finger tapping system expressed by generalized coordinates are derived. An event driven scheme is given to analyze and evaluate the stick–slip transitions. The governing equation is integrated by generalized- α method. The applications of the hybrid computational model are demonstrated using various soft finger tapping systems acted by different driven moments. The feasibility of the proposed model is validated by comparing with the LS-DYNA solution. The error of the solution calculated by the proposed model for the peak value of contact force is less than 8%. Furthermore, numerical results show that the large structural compliance and driven moments have significant effect on the frictional impact responses. The normal relative motion between the fingertip and the rough target surface will experience 1∼4 compression-restitution transitions when Young's Modulus is from 0.01 GPa to 1 GPa or the slenderness ratio of phalanx is from 10.7 to 32. When the posture of soft finger is convex at impact instance, the tangential relative motion will experience 3 slip–stick transitions during the contact process. In addition, it also can be found that the tangential contact compliance can reverse the direction of slip (i.e. 'reverse slip' phenomenon). [ABSTRACT FROM AUTHOR]

Background: Glomus tumors present as painful lesions, most commonly in the fingertips. These can present to outpatient clinics of multiple specialties. Materials and Methods: Retrospective review was performed of 37 patients diagnosed as having glomus tumor in the thumb or fingertips over a 10-year period. The data collected included demographics, presenting symptoms, duration, previous treatment history, physical examination, treatment, and recurrence. The data were presented by means of descriptive statistics. Results: The mean duration of symptoms before presentation was 3.8 years (range 2 to 12 years). The mean age at presentation was 38 years (range 16 to 62 years), and female to male ratio was 21:16. Twenty-two patients had left-hand involvement; thumb 8, index finger 5, middle finger 5, ring finger 14, and little finger 5. Clinical and radiological assessments were made preoperatively. At presentation, 18 cases had nail changes, whereas 19 had no obvious nail changes – out of these, 4 had pulp involvement. The lesion involved the subungual region in 33 cases. The mean size of the lesion was 3.8 mm (range 2 to 10 mm). Thirty-six patients were found to have histopathologically proven glomus tumors, whereas in one no specific lesion was found on histopathological examination; this patient returned with recurrence of symptoms at 2-month follow-up. There was no other patient experienced recurrence of symptoms. Conclusion: Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses. [ABSTRACT FROM AUTHOR]

Introduction: Macrodystrophia lipomatosa is a rare benign condition characterized by a progressive persistent proliferation of the mesenchymal components and elements, with a disproportionate increase in fibro-adipose tissue. It causes a debilitating functional and psychological effect on the patient and his family. Case presentation: A 25-years-old male patient presented complaining of left middle finger swelling which was painless and progressive in size with no restriction of range of motion. Plain X-ray films of the left hand showed a heterogeneous lobulated soft tissue mass on the volar aspect of the middle finger which was confirmed by MRI scan. Surgery was performed by doing a left middle finger soft tissue excision and diagnosis of Macrodystrophia lipomatosa was confirmed by the histopathology report. Patient was on regular follow up in the clinic with no tumour recurrence and an excellent cosmetic as well as functional result with full finger joints range of motion. Conclusion: Macrodystrophia lipomatosa should be suspected with this kind of presentations. Combination of the clinical history and examination with the aid of radiological assays aided in the diagnosis of this extremely rare case and led to the appropriate management by excising this mass and restoring the normal function of the patient's hand. [ABSTRACT FROM AUTHOR]

Background: Arthroscopy is a widely used minimally invasive technique. Nevertheless, no report describes the arthroscopic anatomy of the proximal interphalangeal (PIP) joint for portal creation. To facilitate arthroscopy, this study elucidated the anatomy of the lateral bands of the extensor mechanism and collateral ligaments of PIP joints. Methods: A total of 39 fingers from the right hands of 10 cadavers (4 males, 6 females) were evaluated in this study. We defined the extension line from the proximal interphalangeal volar crease as the C-line. We also defined an imaginary line along the distal edge of the proximal phalanx, which is parallel to the C-line, as the J-line. The distance between J-line and C-line was measured. On the C-line and J-line, we measured the following: from the dorsal skin to the lateral edge of the lateral band (LB), the dorsal edge of the collateral ligament (CL) and from the lateral band and the collateral ligament (D), the width of the finger (W). The finger half-width (M) was measured on the J-line. Comparison between the digits and comparison between radial and ulnar distance were measured and statistical analysis was performed. Results: All PIP joint spaces were distal from the C-line, except for one ring finger. The average distances between the J-line and C-line were 1.8–3.2 mm. On the C-line, only 11 cases (14.1%) showed an interval between the lateral bands and the collateral ligaments, but, on the J-line 72, cases (92.3%) had such an interval. The interval was located 1.6–2.9 mm in a dorsal direction from the midlateral on the J-line. Conclusions: Portal creation at the J-line is safer than at the C-line. This study revealed that safe portals for arthroscopy of the PIP joint are 2 mm dorsal to the midlateral line of the finger on the J-line. [ABSTRACT FROM AUTHOR]

Real macrodactylia is a rare congenital abnormality of unknown etiology, characterized by excessive growth of the anatomical structures of one or several rays of the hand. It is usually isolated and causes a fibrofatty infiltration mainly involving the palm. It can be caused by embryonic or neurogenic abnormalities with or without nerve involvement according to whether macrodactylia has led to an increase in the volume of a major nerve, more often the median. From an evolutionary point of view, it is necessary to distinguish between static macrodactylia (present at birth and remaining stable during growth) and progressive macrodactylia (with a disproportionate growths). Some other syndromes, tumors or abnormalities can cause an increase in finger volume. This abnormality results in functional disability but also in disfigurement. Treatment is based on surgery and rehabilitation. [ABSTRACT FROM AUTHOR]

Hair-thread tourniquet syndrome is wrapping of hair or similar material that straps around and strangulates the limbs such as fingers or toes. This syndrome is a pediatric emergency and is a serious condition that can cause limb necrosis. In this report, we aimed to present two cases of hair-thread tourniquet syndrome. Case 1 was an 8-week-old female infant who had edema and ecchymosis on the third finger. Edema and ecchymosis regressed after the removal of hair. Case 2 was a 2-week-old baby boy who had developed a strangulation in the deep plan of the second and third fingers. After 2 days of hair removal, edema and ecchymosis regressed. Hair-thread tourniquet syndrome is a pediatric emergency and may cause finger or toe necrosis. Its treatment is simple and it is a differential diagnosis that should be kept in mind in strangulated organs. [ABSTRACT FROM AUTHOR]

The long-standing pain in fingers is not only agonising and disabling to the patient but also affects the quality of life. Pointed fingertip pain is also inappropriately managed for years leading to further morbidity. Pinpoint tenderness, paroxysmal pain, and cold hypersensitivity at finger pulp space may be features of glomus tumor. Judicious use of investigations and surgical excision ensure an optimal outcome. We report a case of glomus tumor at an unusual location at the pulp space of distal phalanx of the little finger that was managed by en bloc removal and confirmed on biopsy. History of 6 years of clinical symptoms and multiple treatments underlines the importance of the knowledge of this lesion for early diagnosis. [ABSTRACT FROM AUTHOR]

We explored whether the synergic control of the hand during multi-finger force production tasks depends on the hand muscles involved. Healthy subjects performed accurate force production tasks and targeted force pulses while pressing against loops positioned at the level of fingertips, middle phalanges, and proximal phalanges. This varied the involvement of the extrinsic and intrinsic finger flexors. The framework of the uncontrolled manifold (UCM) hypothesis was used to analyze the structure of inter-trial variance, motor equivalence, and anticipatory synergy adjustments prior to the force pulse in the spaces of finger forces and finger modes (hypothetical finger-specific control signals). Subjects showed larger maximal force magnitudes at the proximal site of force production. There were synergies stabilizing total force during steady-state phases across all three sites of force production; no differences were seen across the sites in indices of structure of variance, motor equivalence, or anticipatory synergy adjustments. Indices of variance, which did not affect the task (within the UCM), correlated with motor equivalent motion between the steady states prior to and after the force pulse; in contrast, variance affecting task performance did not correlate with non-motor equivalent motion. The observations are discussed within the framework of hierarchical control with referent coordinates for salient effectors at each level. The findings suggest that multi-finger synergies are defined at the level of abundant transformation between the low-dimensional hand level and higher dimensional finger level while being relatively immune to transformations between the finger level and muscle level. The results also support the scheme of control with two classes of neural variables that define referent coordinates and gains in back-coupling loops between hierarchical control levels. [ABSTRACT FROM AUTHOR]

Humans exhibit a remarkable ability to discriminate variations in object volume based on natural haptic perception. The discrimination thresholds for the haptic volume perception of the whole hand are well known, but the discrimination thresholds for haptic volume perception of fingers and phalanges are still unknown. In the present study, two psychophysical experiments were performed to investigate haptic volume perception in various fingers and phalanges. The configurations of both experiments were completely dependent on haptic volume perception from the fingers and phalanges. The participants were asked to blindly discriminate the volume variation of regular solid objects in a random order by using the distal phalanx, medial phalanx, and proximal phalanx of their index finger, middle finger, ring finger, and little finger. The discrimination threshold of haptic volume perception gradually decreases from the little finger to the index finger as well as from the proximal phalanx to the distal phalanx. Overall, both the shape of the target and the part of the finger in contact with the target significantly influence the precision of haptic perception of volume. This substantial data set provides detailed and compelling perspectives on the haptic system, including for discrimination of the spatial size of objects and for performing more general perceptual processes. [ABSTRACT FROM AUTHOR]

In the absence of visual feedback, the perceived orientation of the fingers is systematically biased. In right-handers these biases are asymmetrical between the left and right hands in the horizontal plane and may reflect common functional postures for the two hands. Here we compared finger orientation perception in right- and left-handed participants for both hands, across various hand positions in the horizontal plane. Participants rotated a white line on a screen optically superimposed over their hand to indicate the perceived position of the finger that was rotated to one of seven orientations with the hand either aligned with the body midline, aligned with the shoulder, or displaced by twice the shoulder-to-midline distance from the midline. We replicated the asymmetric pattern of biases previously reported in right-handed participants (left hand biased towards an orientation ~30° inward, right hand ~10° inward). However, no such asymmetry was found for left-handers, suggesting left-handers may use different strategies when mapping proprioception to body or space coordinates and/or have less specialization of function between the hands. Both groups' responses rotated further outward as distance of the hand from the body midline increased, consistent with other research showing spatial orientation estimates diverge outward in the periphery. Finally, for right-handers, precision of responses was best when the hand was aligned with the shoulder compared to the other two conditions. These results highlight the unique role of hand dominance and hand position in perception of finger orientation, and provide insight into the proprioceptive position sense of the upper limbs. [ABSTRACT FROM AUTHOR]

Objective: To study the feasibility of magnetic resonance cinematography of the fingers (MRCF) with comparison of image quality of different protocols for depicting the finger anatomy during motion.Materials and Methods: MRCF was performed during a full flexion and extension movement in 14 healthy volunteers using a finger-gating device. Three real-time sequences (frame rates 17-59 images/min) and one proton density (PD) sequence (3 images/min) were acquired during incremental and continuous motion. Analyses were performed independently by three readers. Qualitative image analysis included Likert-scale grading from 0 (useless) to 5 (excellent) and specific visual analog scale (VAS) grading from 0 (insufficient) to 100 (excellent). Signal-to-noise calculation was performed. Overall percentage agreement and mean absolute disagreement were calculated.Results: Within the real-time sequences a high frame-rate true fast imaging with steady-state free precession (TRUFI) yielded the best image quality with Likert and overall VAS scores of 3.0 ± 0.2 and 60.4 ± 25.3, respectively. The best sequence regarding image quality was an incremental PD with mean values of 4.8 ± 0.2 and 91.2 ± 9.4, respectively. Overall percentage agreement and mean absolute disagreement were 47.9 and 0.7, respectively. No statistically significant SNR differences were found between continuous and incremental motion for the real-time protocols.Conclusion: MRCF is feasible with appropriate image quality during continuous motion using a finger-gating device. Almost perfect image quality is achievable with incremental PD imaging, which represents a compromise for MRCF with the drawback of prolonged scanning time. [ABSTRACT FROM AUTHOR]

Frostbite is considered the severest form of cold injury and can lead to necrosis and loss of peripheral appendages. Therefore, prediction of endurance time of limb's tissue in cold condition is not only necessary but also crucial to estimate cold injury intensity and to choose appropriate clothing. According to the previous work which applied a 3-D thermal model for human finger to analyze cold stress, in this study, an expression is presented for endurance time in cold conditions to prevent cold injury. A formula is also recommended to select a proper glove with specific thermal resistance based on the ambient situation and cold exposure time. By employing linear extrapolation and real physical conditions, the proposed formulas were drawn out from numerical simulation. Analytical results show good agreement with numerical data. The used numerical data had been also validated with experimental data existed in the literature. Furthermore, the effect of different parameters such as glove thermal resistance and ambient temperature is investigated analytically. [ABSTRACT FROM AUTHOR]

A novel open-source biomechanical model of the index finger with an electromyography (EMG)-constrained static optimization solution method are developed with the goal of improving co-contraction estimates and providing means to assess tendon tension distribution through the finger. The Intrinsic model has four degrees of freedom and seven muscles (with a 14 component extensor mechanism). A novel plugin developed for the OpenSim modelling software applied the EMG-constrained static optimization solution method. Ten participants performed static pressing in three finger postures and five dynamic free motion tasks. Index finger 3D kinematics, force (5, 15, 30 N), and EMG (4 extrinsic muscles and first dorsal interosseous) were used in the analysis. The Intrinsic model predicted co-contraction increased by 29% during static pressing over the existing model. Further, tendon tension distribution patterns and forces, known to be essential to produce finger action, were determined by the model across all postures. The Intrinsic model and custom solution method improved co-contraction estimates to facilitate force propagation through the finger. These tools improve our interpretation of loads in the finger to develop better rehabilitation and workplace injury risk reduction strategies. [ABSTRACT FROM PUBLISHER]

Background: Impairment of hand and finger function after stroke is common and affects the ability to perform activities of daily living. Even though many of these coordination deficits such as finger individuation have been well characterized, it is critical to understand how stroke survivors learn to explore and reorganize their finger coordination patterns for optimizing rehabilitation. In this study, I examine the use of a body-machine interface to assess how participants explore their movement repertoire, and how this changes with continued practice.Methods: Ten participants with chronic stroke wore a data glove and the finger joint angles were mapped on to the position of a cursor on a screen. The task of the participants was to move the cursor back and forth between two specified targets on a screen. Critically, the map between the finger movements and cursor motion was altered so that participants sometimes had to generate coordination patterns that required finger individuation. There were two phases to the experiment - an initial assessment phase on day 1, followed by a learning phase (days 2-5) where participants trained to reorganize their coordination patterns.Results: Participants showed difficulty in performing tasks which had maps that required finger individuation, and the degree to which they explored their movement repertoire was directly related to clinical tests of hand function. However, over four sessions of practice, participants were able to learn to reorganize their finger movement coordination pattern and improve their performance. Moreover, training also resulted in improvements in movement repertoire outside of the context of the specific task during free exploration.Conclusions: Stroke survivors show deficits in movement repertoire in their paretic hand, but facilitating movement exploration during training can increase the movement repertoire. This suggests that exploration may be an important element of rehabilitation to regain optimal function. [ABSTRACT FROM AUTHOR]