A Cadaveric Study on the Anomalous Extensors of the Hand

Background: The hands play a pivotal role in skilled movements. Anomalous muscles of the extensors of the hand are seen usually in anatomical dissections and during surgeries. Variations of the muscles in the dorsum of hand may be asymptomatic or may cause dorsal wrist pain, particularly if a muscle belly encroaches on and obstruct the wrist’s small extensor compartments deep to extensor retinaculum. Methods: A total of 54 upper limb specimens were used for the current study from the Anatomy Department of an undergraduate & postgraduate teaching Medical College in India. Incidence of additional muscle belly and its tendon in the posterior compartment of the forearm and dorsum of the hand were noted and photographed. Results: The anomalous muscle bellies and tendons in extensor compartment of forearm and dorsum of hand were observed in 10 limbs (18.5%) of 54 limbs. Of which, the extensor medii proprius (EMP) was 9.3%, extensor digitorum brevis manus (EDBM) was 3.7%. The numbers of the tendon of the extensor digitorum (ED) were varied in 3 limbs (5.6%). Conclusion: Knowledge of anatomical data of such variant muscles and additional belly or tendon in the extensor compartment of forearm and dorsum of hand is essential for surgeons to modify treatment plan, so as to avoid reporting error and of surgical procedures while operating on hand.

Comparison of the electromyographic activity of different zones of the abductor digiti minimi manus muscle in search of a functional compartmentalisation / Comparación de la actividad electromiográfica de diferentes zonas del músculo abductor digiti minimi manus en busca de una compartimentación funcional

SUMMARY: There is evidence demonstrating the presence of functional compartmentalisation (FC) in some skeletal muscles. This means that the motor units (MU), grouped in certain areas of the muscle, show different levels of activation in comparison to those located in other zones. This has only been described in large muscles whose morphology proves the existence of a FC. However, there is no background information about small muscles, such as the Abductor digiti minimi manus (ADM). The objective of this study was to compare the activation of the MU in different zones of the ADM to support the hypothesis of the existence of a FC in the ADM. By using a cross- sectional, analytical, observational study, the activity of the MUs in the ADM was assessed in 12 volunteers (age 21 ± 1.6 years old; weight 75.3 ± 8 kg; height 176.2 ± 7.3 cm; average ± standard deviation). The activity of MUs was evaluated using high-density surface electromyography (HD-sEMG) with an array of 64 electrodes arranged two-dimensionally. This allowed us to record the activity of the MUs in three zones of the ADM (Z1: dorsal zone; Z2: dorsal-palmar zone and Z3: palmar zone). Electromyographic recordings were obtained during voluntary isometric contractions of the ADM at 20, 40, 60 and 80 % of the maximum voluntary contraction (MVC). The comparison of the activation levels of MUs between the three zones was carried out using a mixed model analysis of covariance. The results showed a significant difference between the dorsal and palmar zones at 40 % of the MVC (p= 0.03), and between the dorsal and dorsal- palmar zone at 80 % of the MVC (p= 0.03). The results obtained in the evaluated sample support the hypothesis of the existence of FC in the ADM. However, further research is needed to determine with greater certainty the presence of this compartmentalisation in the ADM.

RESUMEN: Existe evidencia que demuestra la presencia de una compartimentalización funcional (CF) en algunos músculos esqueléticos. Aquello se traduce en que las unidades motoras (UM) agrupadas en ciertas zonas del músculo, presentan diferentes niveles de activación a las ubicadas en otras regiones. Esto solo ha sido descrito en músculos grandes, cuya morfología justifica la existencia de una CF. Sin embargo, no existen antecedentes de aquello en músculos pequeños, tales como el abductor digiti minimi manus (ADM). El objetivo de este estudio fue comparar la activación de las UM en distintas zonas del ADM, con la finalidad sostener la hipótesis de la existencia de una CF en el ADM. Mediante un estudio observacional analítico transversal se evaluó la actividad de las UM del ADM en 12 voluntarios (edad 21±1,6 años; peso 75,3±8 kg; altura 176,2 ± 7,3 cm; promedio ± desviación estándar). La actividad de las UM, se evaluó mediante electromiografía de superficie alta densidad usando una matriz de 64 electrodos dispuestos bidimensionalmente. Esta permitió registrar la actividad de las UM en tres zonas del ADM (Z1: zona dorsal; Z2: zona dorso-palmar y Z3: zona palmar). Los registros electromiográficos fueron obtenidos durante contracciones isométricas voluntarias del ADM al 20, 40, 60 y 80 % de la contracción voluntaria máxima (CVM). La comparación de los niveles de activación de las UM entre las tres zonas fue realizada mediante un análisis de modelos mixtos de covarianza. Los resultados indicaron que existió diferencia significativa entre la zona dorsal y palmar al 40 % de la CVM (p=0,03), y entre la zona dorsal y dorso-palmar al 80 % de la CVM (p=0,03). Los resultados obtenidos en la muestra evaluada sostienen la hipótesis de la existencia de una CF en el ADM. Sin embargo, son necesarias más investigaciones para establecer con mayor certeza la presencia de esta compartimentalización en el ADM.

A rare bilateral variation on the dorsum of the hand: extensor digitorum brevis manus and extensor medii proprius / 대한해부학회지

A 78-year-old male cadaver showed bilateral anomalous muscles on the dorsum of the hand. An extensor digitorum brevis manus was noted on the dorsum of the right hand. It originated from the distal end of the radius and the radiocarpal joint ligaments and inserted into the metacarpophalangeal joint of the third digit. On the dorsum of the left hand, an extensor digiti medii proprius was identified. It originated from the distal third of the ulna near the extensor indicis proprius and the interosseous membrane and inserted into the metacarpophalangeal joint of the third digit. Awareness of these combined muscular variation would be helpful in understanding the identification of digital extensors and in requiring careful consideration for the reconstruction surgery of the hand.

Extensor Digitorum Brevis Manus / 대한정형외과학회잡지

Extensor digitorum brevis manus (EDBM) is a rare variation of the extensor muscle of the dorsum of the hand, which is found incidentally during surgery or magnetic resonance imaging (MRI). EDBM arises from the wrist capsule inferior to the extensor retinaculum, which frequently goes into the ulna side of the basis of the proximal phalanx between the 2nd and 3rd fingers. The aim of this report is evaluate to investigate the symptomatic mass on the dorsum of the hand and wrist using an image study (MRI or ultrasonography) to confirm whether it is a tumor or EDBM. Surgical excision was chosen as a treatment.

A Case of Bilateral Tinea Manus and the Frequency of the Superficial Fungal Hand Infection (1997-2016) / 대한의진균학회지

Dermatophytosis of the palm of the hands (tinea manus) tends to involve one hand. We encountered a case of bilateral tinea manus in a patient with type 1 diabetes mellitus and bilateral tinea pedis. A 57-year-old man presented for evaluation of hyperkeratotic lesions on both his palms and soles. Skin examination revealed hyperkeratotic scaly lesions on the palmar surfaces of his hands and plantar surfaces of his feet. Yellow discoloration and thickening were observed on both his nails. Fasting venous plasma glucose concentration and hemoglobin A1c levels were 332 mg/dL and 7.5%, respectively. Fungus cultures revealed white colonies with brown color on the reverse side in a 14-day incubation period. Trichophyton rubrum infection was identified using polymerase chain reaction with amplified internal transcribed spacer regions. He was treated with oral fluconazole (150 mg/week) and topical flutrimazole spray. In addition, we examined the frequency of 77 superficial fungal hand infections (age, sex, seasonal distributions and coexisting fungal infections) among patients who visited the dermatologic clinic of Chonbuk University Hospital between January 1997 and December 2016.

Macroanatomy of the ones of thoracic limb of an Asian elephant (Elephas maximus) / Macroanatomía de los huesos del miembro torácico de un elefante asiático (Elephas maximus)

Bones of forelimb were studied from a prepared skeleton of an adult female Asian elephant (Elephas maximus) in Anatomy Museum of Chittagong Veterinary and Animal Sciences University to understand the morphological form and structure of Asian elephant forelimb. The angle was approximately 123 between caudal border of scapula and caudal border of humerus. The scapula, humerus and bones of the antebrachium (particularly the ulna) were massive bones. The bones of manus were the short and relatively small. The dorsal border of scapula extended from the level of proximal extremity of first rib to the middle of the 6th rib. Ventral angle of scapula articulated with humerus by elongated shaped glenoid cavity (cavitas glenoidalis) of scapula and head of humerus (caput humeri). The major tubercle (tuberculum majus) of humerus was situated laterally to the head, which had smaller cranial part with large caudal part and extended cranially to the head. The crest of minor tubercle (tuberculum minus) was present as the rough line on the mediocaudal surface of humerus that ends in a slight depressed or elevated area, known as teres major tuberosity (tuberositas teres major). The lateral supracondyler crest (crista supra condylaris lateralis) at the caudal surface of the shaft limit the musculo-spiral groove in body of humerus. The radius and ulna are twin bones of forearm and the attachment between ulna and radius occurs in such a way, the radius articulates craniomedially with the ulna in the proximal part. But the shaft spirals laterally over the cranial surface of the ulna to articulate distally with the medial aspect of the ulna. There were 8 carpal bones, 5 metacarpal bones and 5 digits. The comparative size of the proximal and distal raw of carpal bones were ulnar carpal > radial > intermediate > accessory carpal and IV > III > II > I respectively. The gradual lengths of the metacarpal bones were III > IV > II > V > I. Digits I and V were vertical and digit II, III and IV were horizontal.

En el Museo de Anatomía de la Universidad de Veterinaria y Ciencias de Animales de Chittagong fueron estudiados los huesos del miembro torácico de un esqueleto preparado de un elefante asiático (Elephas maximus), hembra adulta, para analizar su morfología y estructura. El ángulo entre el margen caudal de la escápula y el margen caudal del húmero era de aproximadamente 123°. La escápula, húmero y los huesos del antebrazo (en particular la ulna) eran huesos macizos. Los huesos de las manos eran cortos y relativamente pequeños. El margen dorsal de la escápula se extendía desde el nivel de la porción proximal de la primera costilla para la parte media de la sexta costilla. El ángulo ventral de la escápula está articulado con el húmero por la cavidad glenoidea (cavitas glenoidalis), de forma alargada, de la escápula y la cabeza del húmero (caput humeri). El principal tubérculo (tuberculum majus) del húmero estaba situado lateralmente a la cabeza, que tenía una parte craneal pequeña y una mayor parte caudal, extendiéndose cranealmente en la cabeza. La cresta del tubérculo menor (tuberculum minus) estaba presente como la línea áspera sobre la superficie mediocaudal del húmero que termina en una pequeña zona deprimida o elevada, conocida como tuberosidad redonda mayor (tuberositas teres major). La cresta supracondilar lateral (crista supra condylaris lateralis) en la superficie caudal del eje limita la ranura músculo-espiral en el húmero. El radio y la ulna son huesos gemelos del antebrazo y la unión entre la ulna y el radio se produce de tal manera, que el radio articula, craneal y medialmente, con la ulna en la porción proximal. Pero el eje en espiral está ubicado lateralmente sobre la superficie craneal de la ulna para articular distalmente con la cara medial de la ulna. Se identificaron 8 huesos del carpo, 5 metacarpianos y 5 dígitos. El tamaño comparativo de las porciones proximal y distal de los huesos del carpo fue ulna > radial > Intermedio> carpiano accesorio y IV > III > II > I, respectivamente. Las longitudes graduales de los huesos metacarpianos eran III > IV > II > V > I. Dígitos I y V eran verticales y dígitos II, III y IV fueron horizontales.

Músculo extensor anómalo de la mano: "extensor digitorum brevis manus" / Anomalous extensor hand muscle: extensor digitorum brevis manus

En la región dorsal de la muñeca y la mano, se describen varios músculos accesorios o supernumerarios, que pueden actuar como simuladores de entidades patológicas y producir síntomas clínicos (gangliones, quistes sinoviales, etc.). El diagnóstico clínico es cada vez más accesible; la ecografía y la resonancia magnética han permitido conocer su naturaleza y extensión. La presencia de este músculo, por lo general, pasa desapercibida y no causa síntomas, aunque puede producir clínica de tumefacción y dolor en el carpo; se acentúa con la actividad, sobre todo, aquellas que requieran la extensión forzada de la muñeca y los dedos. Puede manifestarse bilateralmente en un tercio de los pacientes y la incidencia no difiere entre los sexos. Cuando los síntomas son graves, hay que recurrir al tratamiento quirúrgico que consiste en la resección completa del músculo o en la división del retináculo extensor; con ambas técnicas se obtienen buenos resultados; en algunos casos, se lo ha usado como colgajo para reconstruir lesiones tendinosas en otros niveles. Este músculo es muy poco frecuente; la revisión bibliográfica de este trabajo ayudaría a considerar esta patología a la hora de realizar diferentes diagnósticos diferenciales en la región de la muñeca y la mano.

In the dorsal region of the wrist and hand, various accessory and supernumerary muscles are described; they can act as simulators and produce clinical entities (ganglion, synovial cysts, etc.). The clinical diagnosis is increasingly accessible; ultrasound and magnetic resonance have allowed to evaluate their nature and extent. The presence of this muscle usually goes unnoticed without symptoms, but it can cause swelling and pain in the carp; it is accentuated with activities, especially those requiring the forced extension of the wrist and fingers. It can manifest bilaterally in one third of patients and the incidence did not differ between males and females. When symptoms are severe, surgical treatment is indicated with the complete resection of the muscle or the division of the extensor retinaculum; both techniques achieve good results; in some cases, it has been used as a flap to reconstruct tendon injuries at other levels. The frequency of this muscle is very low; our literature review will help to consider this condition among the various differential diagnoses in the region of the wrist and hand.

A Cadaveric Study of Incidence, Morphology, Phylogeny and Classification of Extensor Digitorum Brevis Manus.

Introduction: A rare type of variation of extensor muscles on the dorsum of hand is extensor digitorum brevis manus (EDBM).It is a small muscle rarely present on the dorsum of the hand which can be misinterpreted a pathological mass on the dorsum of the hand. Aim: Aim of the present cadaveric study is to observe the incidence, anatomical morphology of EDBM and to study its phylogenetic significance. Material and Methods: Present study was conducted on 32 adult human cadaveric hands of which 24 were of male and 8 were of female cadavers. Results: The EDBM was observed in one incidence (3.1%) of the specimens. EDBM was found to be between the tendons of extensor digitorum for index and middle fingers. It was of Anatomical variant type I. Conclusion: The knowledge of incidence and morphology of EDBM is of greater relevance in clinical practice to rule out any pathological mass on the dorsum of the hand.

Double-Bellied Extensor Digitorum Brevis Manus: A Case Report.

Most of the anatomical variations are noted during the cadaveric dissections. A rare variation of the Extensor digitorum brevis manus was observed on the dorsal aspect of the right hand of a 69-year-old male cadaver. This atavistic muscle had two bellies which originated from the dorsal aspect of the lower end of radius and the capsule of the wrist joint respectively. The two bellies fused to form a single tendon which inserted into the ulnar side of the dorsal digital expansion of the middle finger. Posterior interosseous nerve innervated the two bellies. This muscle may be involved in the wrist pain or may be misinterpreted as a ganglion or a nodule upon radiological examination. This muscle may be used for reconstructive purposes.

The Clinical and Mycological Study of Tinea Manus and Concomitant Dermatophytosis / 대한의진균학회지

BACKGROUND: Tinea manus is a common superficial dermatophyte infection that is usually coexistent with tinea pedis. Trichophytom rubrum is the most commonly isolated agent in tinea manus. Despite this condition, there have been only a few reports on the clinical and mycological features of tinea manus. OBJECTIVE: This study aims to evaluate the variables related with tinea manus and to determine the correlation with other superficial dermatophyte infection. METHODS: Clinical and mycological features of 54 cases with tinea manus from the department of dermatology in Daegu Catholic University Hospital and the Catholic Skin Clinic from January 2011 to December 2012 were evaluated retrospectively. RESULTS: The male to female ratio was 2:1. The age distribution ranged from 14 to 81 years old. The affected site was the palm in 31 cases (57.4%), the dorsum in 13 cases (24.1%), and both palm and sole in 10 cases (18.5%). Tinea manus was accompanied with other superficial dermatophyte infections, such as tinea pedis, tinea unguium, and tinea corporis in 42 cases (77.8%) and not in 12 cases (22.2%). Fungal culture result was positive in 8 cases of tinea manus only group and in 26 cases of tinea manus with other dermatophyte infection group. The most commonly isolated agent was Trichophyton rubrum in both groups. CONCLUSION: The patients with only tinea manus tend to predilect the dorsum of hand and were relatively more caused by other fungus than Trichophyton ruburum when compared with the patients with other dermatophytosis.

Tinea Manus Caused by Trichophyton mentagrophytes var. erinacei Transferred from a Hedgehog / 대한피부과학회지

The hedgehog has recently become a fashionable pet in South Korea, especially among the younger persons. However, hedgehogs have been rarely reported to carry fungus that can cause human dermatomycosis. We report such a case. A 12-year-old boy was bitten by his hedgehog one week prior to presentation; he developed two clearly defined erythematous plaques with some pustules on the fingers. Periodic acid-Schiff stain of the biopsy specimen showed long, septated fungal hyphae in the keratin layer. KOH examination and fungus culture showed Trichophyton(T.) mentagrophytes. The subtype was identified as T. mentagrophytes var. erinacei by sequence analysis of the internal transcribed spacer regions of theribosomal DNA. The patient was treated with oral itraconazole (3.3 mg/kg, twice a day for 4 weeks) and topical ketoconazole cream with potassium permanganate wet dressings twice a day, resulting in complete resolution of the skin lesions.

Extensor digitorum brevis manus: a raremuscle on the dorsum of the hand

The extensor digitorum brevis manus is one of the rare anatomic variations which occur on the dorsum of the hand. Only some 295 articles were found worldwide in an extensive bibliographic review carried out in 2003. This muscle was dissected bilaterally on a male corpse at the Human Anatomy Laboratory of the Morphophysiological Department of the “Faculty of Medical Sciences of Minas Gerais”. It is an elongated, small muscle, originating at the carpal bones and at the extensor retinaculum and inserting into one of the tendons of the finger’s extensor muscle. Even though it does not present an essential function in the movement of the fingers nor the hand, it can lead to pain when hypertrophied, creating the need for clinical or even surgical treatment.

The Efficacy and Safety of Short-term Therapy with Itraconazole Melt-Extrusion Tablet in The Hyperkeratotic Type of Tinea Pedis and/or Tinea Manus / 대한의진균학회지

BACKGROUND: The many antifungal agents have been used in fungal infections. In usual trial agents, itraconazole still remains difficult to absorption in gastrointestinal tract. OBJECTIVE: The purpose of this study is to evaluate the clinical efficacy and adverse reactions of short-term itraconazole melt-extrusion tablet increased in hyperkeratotic type of tinea pedis and/or tinea mauns. METHODS: From November 1998 to February 1999, a total of 60 patients with palmoplantar type of tinea pedis and/or tinea manus at Department of Dermatology of 5 general hospital, were enrolled in a subject group for the study. Itraconazole melt-extrusion tablet was administered, 200mg twice daily, in one week. Clinical symptoms and signs with mycological findings were assessed. RESULTS: Fifty-six patients (male 33, female 23; mean age 36.1+/-10.7; mean duration 6.5+/-4.8) completed the follow-ups. Direct KOH smear examination was positive in all them. Decrease in initial percentages of patients showing symptoms at the last follow-up 2 months after starting therapy: for scale, from 100% to 85.4%; for ertyema, from 91.1% to 10.7%; for hyperkeratosis from 100% to 32.3%; for pruritus, from 82.1% to 10.7%. Mycologic cure rate was 92.9% at the last follow-up. Overall clinical responses evaluated at the last follow-up were 'cured' in 6 pathients(10.7%), 'markedly improved' in 38 patiendts(67.9%), making a clinical response rate of 78.6%. During therapy, transient epigastria pain and indigeastion developed in 5 patients(8.9%). CONCLUSION: With these results, itraconazole melt-extrusion table is considered an effective and safe treatment modality for hyperkeratotic type of tinea pedis and/or tinea manus.

Efficacy of Itraconazole Melt-Extrusion Tablet One-week Therapy in Treatment of Hyperkeratotic Type of Tinea Pedis and/or Tinea Manus / 대한피부과학회지

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.

Tinea pedis and tinea manus in children / 대한피부과학회지

BACKGROUND: Because of concern about the infrequent occurre icc of tinea pedis tinea manus, we studied the incidence of them. OBJECTIVE: The purpose of the study was to investigate clinical and mycological features of tinea pedis tinea manus. MEHTODS: We reviewed outpatients with tinea pedis tinea minus at the Catholic Skin Disease Clinic from 1976 to 1991. RESULTS: The incidence was 0.08% out of 1,106,246 outpatients in tinea pedis, 0.02% in tinea manus. Interdigital lesions were the most common in tinea pedis. The ratio of male to female patients was 1.46: 1 in tinea pedis, 1.34:1 in tinea manus. The seasonaI pevalance was highest in summer. The species isolated were, in order of decreasing frequency, Trihohyton(T.) rubrum(89.9%), T. mentagrophytes(8.5%), Microgorum(M.) canis (1.6%) in tinea pedis, T. rubrum(77.8%), T. mentagrophytes(18.2%), M. Canis(2.0%), Epidermophyton(E.) floccosam(2.0% in tinea manus. CONCLUSION: We find that, the incidence of tinea pedis has been inc easing in recent years.