Blauth II thumb hypoplasia: a management algorithm for the unstable metacarpophalangeal joint

Blauth Type II thumb hypoplasia is defined by first web space narrowing, deficiency of thenar musculature, and instability of the metacarpophalangeal joint (MCPJ). This instability can be uni-axial (type IIA) or multi-axial (type IIB). The aim of this study was to assess the results of treating type II thumb hypoplasia using an algorithm based on the type of instability present. Cases of uni-axial MCPJ laxity (type IIA) underwent stabilization as part of a flexor digitorum superficialis opposition transfer. Type IIB cases with multi-axial instability were treated with an MCPJ chondrodesis and an abductor digit minimi transfer for opposition. First web space release was achieved using a z-plasty approach in all patients. An analysis was carried out of all cases of type II thumb hypoplasia treated by the senior author within the setting of a tertiary referral children’s hospital over a 9 year period. Using our management algorithm, equivalent functional results were seen in each subgroup in terms of first web space release, MCPJ stabilization, and opposition.

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A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211044653 ◽

2021 ◽

pp. 175319342110446

Author(s):

Konrad Mende ◽

José Annelie Suurmeijer ◽

Will T.M. Mason ◽

Belinda J. Smith ◽

Michael A. Tonkin

Keyword(s):

Metacarpophalangeal Joint ◽

Flexor Digitorum Superficialis ◽

Long Term Outcomes ◽

Level Of Evidence ◽

Local Tissue ◽

Thumb Hypoplasia ◽

Abductor Digiti Minimi ◽

Global Strength ◽

Flexor Digitorum

This retrospective study analyses long-term outcomes of reconstruction for congenital thumb hypoplasia Grades 2 and 3 A. In 22 thumbs (mean follow-up 9 years), instability of the metacarpophalangeal joint was found in 20 thumbs regardless of the method of reconstruction, double breasting of local tissue with or without adductor pollicis advancement or use of a slip of flexor digitorum superficialis to supplement local tissue. There was a trend towards a greater global strength, higher Kapandji score and better subjective function score when the abductor digiti minimi was used as an opposition transfer as compared with the flexor digitorum superficialis. Results for motion and subjective parameters were consistent with comparable studies though these comparisons are compromised by different methods of classification and assessment. Consistent application of an expanded Blauth grading system and a formal hypoplastic thumb score will improve the ability to compare pre- and postoperative status, different techniques and results from different centres. Level of evidence: IV

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Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415600663 ◽

2015 ◽

Vol 41 (3) ◽

pp. 258-264 ◽

Cited By ~ 10

Author(s):

M. de Kraker ◽

R. W. Selles ◽

J. M. Zuidam ◽

H. M. Molenaar ◽

H. J. Stam ◽

...

Keyword(s):

Range Of Motion ◽

Tendon Transfer ◽

Ring Finger ◽

Metacarpophalangeal Joint ◽

Pinch Strength ◽

Type Ii ◽

Flexor Digitorum Superficialis ◽

Joint Stability ◽

Type Iiia ◽

Flexor Digitorum

This study reports on outcomes of the flexor digitorum superficialis tendon transfer from the ring finger in Type II and IIIA hypoplastic thumbs. We included 22 patients with 27 involved hands: 16 Type II thumbs and five Type IIIA treated by transfer and six non-operated Type II thumbs. The outcomes were assessed by range of motion, strength, sensibility, joint stability and patient/parent satisfaction. Compared with normative data, the range of motion was diminished in all patient groups. Opposition strength in operated Type II thumbs was significantly better than in non-operated thumbs. Grip strength, pinch strength, tripod strength and key pinch strength were approximately 50% of normal in Type II thumbs and 35% in Type IIIA thumbs. Metacarpophalangeal joint stability was restored in all operated Type II thumbs and in 40% of Type IIIA thumbs. We conclude that the flexor digitorum superficialis tendon transfer of the ring finger is a good functioning opponensplasty in both Type II and IIIA thumbs. The transfer provides excellent stability of the metacarpophalangeal joint in Type II thumbs. Level of Evidence: Level IV

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Variations of the Flexor Digitorum Superficialis Tendon of the Little Finger

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80082-4 ◽

1997 ◽

Vol 22 (2) ◽

pp. 277-280 ◽

Cited By ~ 20

Author(s):

M. H. GONZALEZ ◽

J. WHITTUM ◽

M. KOGAN ◽

N. WEINZWEIG

Keyword(s):

Anatomical Variation ◽

Anatomical Variations ◽

Metacarpophalangeal Joint ◽

Flexor Digitorum Superficialis ◽

Flexor Digitorum ◽

Little Finger

Seventy cadaveric hands were dissected to study variations of the flexor digitorum superficialis tendon (FDS) to the little finger. Anatomical variations were present in 13% of hands and 10% of the hands showed an anatomical variation that would preclude independent FDS function in the little finger. The distance of the decussation from the metacarpophalangeal joint was measured. A ratio of this distance to proximal phalangeal length was calculated. The ratio indicated that decussation position was independent of phalangeal size.

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Flexor Digitorum Superficialis Opposition Transfer for Augmenting Function in Types II and IIIA Thumb Hypoplasia

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2015.11.017 ◽

2016 ◽

Vol 41 (2) ◽

pp. 244-249 ◽

Cited By ~ 9

Author(s):

Carley Vuillermin ◽

Lesley Butler ◽

Amy Lake ◽

Marybeth Ezaki ◽

Scott Oishi

Keyword(s):

Flexor Digitorum Superficialis ◽

Thumb Hypoplasia ◽

Flexor Digitorum

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Treatment of Extensor Lag Using the Flexor Digitorum Superficialis after Crushing-Penetrating Injury to the Metacarpophalangeal Joint

Journal of Hand and Microsurgery ◽

10.1055/s-0039-1683459 ◽

2019 ◽

Vol 11 (03) ◽

pp. 175-177

Author(s):

Yoshitaka Hamada ◽

Emiko Horii ◽

Hiroyasu Toyama ◽

Yoshitaka Minamikawa ◽

Yukiko Kinoshita ◽

...

Keyword(s):

Middle Finger ◽

Metacarpophalangeal Joint ◽

Flexor Digitorum Superficialis ◽

Beneficial Effects ◽

Alternative Donor ◽

Palmaris Longus Tendon ◽

Flexor Digitorum ◽

Donor Muscle ◽

Extensor Carpi Radialis ◽

Extensor Lag

AbstractWe previously reported the beneficial effects of tendon transfer to eliminate extension lag of the interphalangeal joints, using the extensor carpi radialis longus prolonged by palmaris longus tendon grafts after crushing-penetrating injuries around the metacarpophalangeal (MP) joint of the middle finger. We used the flexor digitorum superficialis (FDS) as the alternative donor muscle and treated two cases of severe crushing injuries to MP joint, and then obtained good outcomes.

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A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420981852 ◽

2021 ◽

pp. 175319342098185

Author(s):

Xia Fang ◽

Ping-tak Chan ◽

Shengbo Zhou ◽

Xinyi Dai ◽

Ruiji Guo ◽

...

Keyword(s):

Case Series ◽

Functional Results ◽

Metacarpophalangeal Joint ◽

Contralateral Side ◽

Average Score ◽

Pinch Strength ◽

Level Of Evidence ◽

Volar Approach ◽

Flexion Extension ◽

Aesthetic Results

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

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Recovery and Fatigue Behavior of Forearm Muscles during a Repetitive Power Grip Gesture in Racing Motorcycle Riders

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157926 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7926

Author(s):

Michel Marina ◽

Priscila Torrado ◽

Raul Bescós

Keyword(s):

Duty Cycle ◽

Fatigue Behavior ◽

Median Frequency ◽

Flexor Digitorum Superficialis ◽

Muscle Training ◽

Maximal Voluntary Isometric Contraction ◽

Power Grip ◽

Road Racing ◽

Flexor Digitorum ◽

Forearm Muscle

Despite a reduction in the maximal voluntary isometric contraction (MVCisom) observed systematically in intermittent fatigue protocols (IFP), decrements of the median frequency, assessed by surface electromyography (sEMG), has not been consistently verified. This study aimed to determine whether recovery periods of 60 s were too long to induce a reduction in the normalized median frequency (MFEMG) of the flexor digitorum superficialis and carpi radialis muscles. Twenty-one road racing motorcycle riders performed an IFP that simulated the posture and braking gesture on a motorcycle. The MVCisom was reduced by 53% (p < 0.001). A positive and significant relationship (p < 0.005) was found between MFEMG and duration of the fatiguing task when 5 s contractions at 30% MVCisom were interspersed by 5 s recovery in both muscles. In contrast, no relationship was found (p > 0.133) when 10 s contractions at 50% MVC were interspersed by 1 min recovery. Comparative analysis of variance (ANOVA) confirmed a decrement of MFEMG in the IFP at 30% MVCisom including short recovery periods with a duty cycle of 100% (5 s/5 s = 1), whereas no differences were observed in the IFP at 50% MVCisom and longer recovery periods, with a duty cycle of 16%. These findings show that recovery periods during IFP are more relevant than the intensity of MVCisom. Thus, we recommend the use of short recovery periods between 5 and 10 s after submaximal muscle contractions for specific forearm muscle training and testing purposes in motorcycle riders.

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