Schwannoma in the Thenar Eminence: a Case Report.

This report describes a rare presentation of schwannoma in the thenar aspect of a surgeon and reviews the literature. A 35-year-old surgeon had a slow-growing swelling in his left thenar eminence. Clinical and radiological findings suggested it was a well-encapsulated mass within the abductor pollicis brevis muscle. A complete surgical excision was done, and the histopathological findings confirmed schwannoma, a benign peripheral nerve tumor. The surgeon remained symptom-free and had no recurrence at 1 year of follow-up. Though a benign peripheral nerve tumor is rare in the hand, it remains one of the differential diagnoses for a thenar eminence swelling. Surgical enucleation preserving the nerve fascicles achieves an excellent functional outcome.

Evaluation the quality of bag-mask ventilation by E/C, T/E and hook technique (a new proposed technique).

BACKGROUND: Bag-Mask Ventilation (BMV) is a crucial skill in managing emergency airway situations and induction of general anesthesia. Ensuring proficient BMV execution is imperative for healthcare providers. Various techniques exist for performing BMV. This study aims to compare the quality of ventilation achieved using the E/C technique, Thenar Eminence (T/E) technique and a novel approach referred to as the hook technique. The goal is to identify the most effective single-person BMV method. METHOD: We conduct a pilot study on manikins involving 63 medical staff members who used the hook technique for ventilation. Subsequently, we obtained ethical approval and patient guardian consent to perform the study on 492 emergency department (ED) patients. These patients were randomly divided into three groups, with each group subjected to one three ventilation techniques. The study focused on patients requiring reliable airway management for rapid sequence intubation (RSI). Ventilation was administrated using bag-mask device connected to the capnograph. End-tidal CO2 (ETCO2) levels were recorded. Demographic data were collected and analyzed by SPSS software version 22. Success rates were reported as frequency (percentage) as well as mean ± standard deviation. RESULT: Comparing partial pressure of CO2 (PCO2) results obtained via capnography between T/E, E/C and hook techniques, we found that the successful ventilation rate was 87.2% for T/E, 89.6% for E/C, and 93.3% for the hook methods. The hook method demonstrated significantly higher success rate compared to the other two techniques (P-value = 0.038). Furthermore, we observed statistically significant trends in PCO2 changes between measurements both within and between groups (P-value < 0/001). CONCLUSION: Our study indicates that the hook method achieved notably higher success rate in ventilation compared to the T/E and E/C methods. This suggests that the hook method, which involves a chin lift maneuver while securely fitting the mask, could serve as a novel BMV technique, particularly for resuscitation with small hands for a prolonged use without fatigue and finger discomfort. Our finding contributes to the development of a new BMV method referred to as the hook technique. TRIAL REGISTRATION: IRCT registration number: IRCT20121010011067N5. URL of trial registry record: https://www.irct.ir/trial/57420 .

Transepidermal water loss and stratum corneum hydration in forearm versus hand palm.

BACKGROUND: Skin measurements of transepidermal water loss (TEWL) and stratum corneum hydration (SCH) reflect different aspects of skin physiology. Since epidermal water loss depends on epidermal-to-air water vapor gradients, a possible quantitative relationship between TEWL and SCH may exist. This investigation's purpose was to test the possible TEWL-SCH relationship. MATERIALS AND METHODS: SCH and TEWL were measured noninvasively on forearm and palmer thenar eminence (hand) in 40 young adults (20 males) along with total body fat percentage (FAT) via bioimpedance. RESULTS: A significant positive nonlinear correlation (p < 0.001) was detected between SCH and TEWL in hands of the male cohort that occurred when SCH exceeded a threshold level. This threshold level was not exceeded in male or female forearms and forearms did not display a SCH-TEWL correlation. There was a weak inverse dependence of TEWL on FAT on both forearm and hand (p < 0.05), but no SCH-FAT relationship was observed. TEWL values on the forearm and hand were moderately correlated with each other (p = 0.002) but SCH values were not. CONCLUSION: The findings clarify the relationship between forearm and palmer hydration and TEWL values, and their relationship to total body fat percentages in young healthy adults. The significant correlation between palmer stratum corneum hydration and palmer TEWL that was discovered in the male but not the female cohort suggests a threshold hydration level for which TEWL depends both on skin barrier function and stratum corneum hydration. This implies that conditions with increased SCH may in part account for elevated TEWL values.

Giant fibrolipoma of the median nerve in the thenar eminence: Case report and literature review.

Nerve fibrolipoma is a very rare benign tumor, corresponding to fibrofatty proliferation of the epineurium and perineurium, where most frequently, the median nerve is touched. We report the case of a 52-year-old patient who has a giant fibrolipoma of the thenar branch of the median nerve evolving at the level of the thenar eminence, an exceptional size and location for this disorder. Our case presents fibrolipoma of the median nerve in thenar eminence, a size and localization that has not been reported in the literature to our knowledge A good dissection makes it possible to obtain total resection without neurological after-effects.

Comparing the efficacy of modified thenar eminence technique with conventional thenar eminence technique of mask ventilation during induction of general anaesthesia - A randomised crossover study.

Background and Aims: Mask ventilation is one of the important skills required for successful airway management. Following the induction of general anaesthesia, there could be airway obstruction due to fall back of the tongue or soft palate. This obstruction could be overcome by manoeuvring the mandible or inserting airways. The primary objective of the study was to compare the efficacy of modified thenar eminence technique of mask ventilation in improving expired tidal volume (VTE) over conventional thenar eminence technique and the secondary objective was to compare peak airway pressure (PMAX) and ease of mask ventilation between the two techniques. Methods: Seventy-six patients were randomised into group M and group C. In group M, the modified thenar eminence technique was performed for five consecutive breaths followed by conventional technique, and vice versa was followed in group C. In each breath, VTE, PMAX and end-tidal carbon dioxide were noted. Participants reported the ease of ventilation score using the Likert scale for each technique. Results: VTE was significantly more in modified thenar eminence technique than conventional technique [mean ± standard deviation, 370 ± 55 ml versus 313 ± 50 ml, P = 0.01]. Ease of ventilation score [median 1.70 (interquartile range (1-2)) versus 2.3 (2-3), P = 0.01] showed that modified technique was easier compared to conventional technique. Conclusion: Modified thenar eminence technique of mask ventilation is superior to the conventional technique in terms of VTE and ease of ventilation in the unanticipated difficult airway.

Giant Schwannoma on Thenar Aspect of the Hand: A Rare Case Report.

Schwannomas are the most common benign tumors of peripheral nerves but are rare in adults. They have an extremely slow rate of growth before the onset of symptoms such as pain, paresthesia, and tingling. Giant schwannomas of the extremities can significantly affect the quality of life. With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a very low risk of recurrence. A case of a symptomatic giant schwannoma on thenar eminence of the right hand in an adult male is discussed in this report.

Comparison of Three Techniques on Facility of Bag-Mask Ventilation: Thenar Eminence, E-O and E-C.

BACKGROUND: Rapid and secure management of airway is an important lifesaving intervention in critically ill patients at emergency wards. Training undergraduate students about airway management must be regarded as a priority in their education period. The aim of the present study was to compare the quality of three ventilation techniques with a bag and mask among two groups of undergraduate students (Novices) and senior group (Experienced) in Tabriz University of Medical Sciences. METHODS: This study was a mannequin type research that was carried out in the faculty of medicine, Tabriz University of Medical Sciences. The study population consisted of two elementary groups (Novices) and senior group (Experienced). The number of participants included 100 individuals. Ventilation quality by bag and mask in two groups was recorded based on the rise of lungs and two reviewers' opinions who gave a score from 1 as weak to 4 as excellent using three techniques of E-C, E-O, and Thenar Eminence. In the E-C technique, index fingers and thumbs form two "C"s facing each other while the remaining fingers lift the mandible and form two "E"s. In E-O techniques, the web between thumb and index finger is used to form a circle around the neck of the mask while other fingers perform a chin lift. In thenar eminence techniques, the thenar eminence and thumb are placed on the top of the mask while other fingers perform jaw thrust. RESULTS: In our study, 27% of undergraduate participants and 59% of seniors were male and the others were female. The mean of age of elementary and seniors were 24 and 33.5, respectively (P < 0.05). E-O technique was well done by the novices group. CONCLUSIONS: Based on our results, it was concluded that the elementary group performed E-O bag and mask ventilation technique appropriately. Therefore, it can be suggested that training of this technique will be placed in educational curriculum of undergraduate students.

Vascular anatomy of the thenar eminence: its relevance to a pedicled or free thenar flap.

BACKGROUND: The aim of this study was to clarify the arterial supply of the skin covering the prominent part of the thenar eminence in order to describe the possibility and potential for harvesting a pedicled or a free flap from the thenar eminence. MATERIALS AND METHODS: The arteries were studied in 30 post-mortem specimens of human hands; 3 previously perfused with 4% formaldehyde solution, and injected with black India ink, and 27 injected with methyl-methacrylate and afterwards corroded in 40% potassium hydroxide solution. RESULTS: In all hands we found two little palmar arteries coming from the anatomical snuff-box portion of the radial artery. We labelled the first (proximal) branch as the middle thenar artery, because it supplies the middle third of the thenar eminence skin. Its diameter varied from 0.25 to 0.55 mm (mean 0.4 mm). The distal, more prominent branch of the radial artery, vascularised the lateral third of the thenar eminence skin, and was named the lateral thenar artery; its diameter ranged from 0.40 to 0.90 mm (mean 0.67 mm). The superficial palmar branch of the radial artery, always present, was classified as: hypoplastic, average or prominent, with a diameter ranging from 0.8 to 2.7 mm (mean 1.47 mm). CONCLUSIONS: Three individually developed branches of the radial artery supplied the skin of the thenar eminence. Cutaneous branches of these three arteries were interconnected via anastomotic vessels.

Repairing the defected volar finger with the free micro-flap based on the superficial palmar branch of radial artery / 中华显微外科杂志

Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger.Methods From October,2012 to September,2015,this flap was used in 25 patients to repair the palmar soft tissue defect of the finger.The artery,the vein and the never in the flaps was anastomosed respectively with that in the recipient site.The donor area was sutured directly.Results All patients were followed-up for a mean of 11 months (range,6-20 months).All 25 flaps survived.The character of flap was good,the appearance and sensitive function obtained satisfactory resume.At the last follow-up,the two-point discrimination was 5-10mm on the affected side.According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association,there were excellent in 17 cases,and good in 8 cases.The wounds of donor site healed by 1st intention with no visible scars.The function of thumb was not damaged.Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site,the inconspicuous scar,and the good appearance and sensitive function of repaired fingers.

Tratamiento quirúrgico del síndrome de túnel del carpo en adultos mayores / Surgical Treatment of Carpal Tunnel Syndrome in Older Adults

Introducción: el síndrome del túnel del carpo constituye el diagnóstico más común para cirujanos de mano. Se han descrito diversos métodos quirúrgicos para su tratamiento, con reportes de buenos resultados. Objetivo: mostrar los resultados del tratamiento quirúrgico del síndrome del túnel del carpo, con empleo de anestesia local, incisión razonable y movilidad precoz en pacientes mayores de 65 años de edad. Método: estudio de intervención longitudinal prospectivo con pacientes mayores de 65 años de edad diagnosticados e intervenidos por síndrome del túnel del carpo entre el 1ro. de enero 2010 y el 1ro. de julio del 2014, y evaluados 1 año después de dicho tratamiento en el CITED. Resultados: serie constituida por 194 pacientes, predominó el sexo femenino (81,44 por ciento), se encontró asociación de síndrome del túnel del carpo con: realización de actividades manuales previas, posibilidad de afectación bilateral, antecedente de fractura de radio distal ipsilateral, comorbilidad con otras enfermedades como diabetes, artritis reumatoide y afecciones de tendones y sus vainas. La mejoría en síntomas, dolor y función al año fue superior al 98 por ciento.Conclusiones: el tratamiento quirúrgico del síndrome del túnel del carpo, con empleo de anestesia local, incisión de piel razonable y movilidad precoz, ocasiona significativa mejoría de los síntomas, del dolor y la función en adultos mayores de 65 años de edad(AU)

Introduction: Carpal tunnel syndrome is the most common diagnosis for hand surgeons. They described various surgical methods for treatment, with reports of good results. Objective: Show the results of surgical treatment of carpal tunnel syndrome using local anesthesia, reasonable incision and early mobility in patients older than 65 years old. Method: Prospective longitudinal intervention study with patients older than 65 years of age diagnosed and surgically treated for carpal tunnel syndrome from January 2010 to July 2014 and they were evaluated one year after treatment at CITED. Results: In the series consisting of 194 patients, women predominated (81.44 percent). Association of carpal tunnel syndrome was found with holding prior manual activities, the possibility of bilateral involvement, history of fracture of ipsilateral distal radius, comorbidity with other diseases such as diabetes, rheumatoid arthritis and diseases of tendons. The improvement of symptoms, pain and function after a year was higher than 98 percent. Conclusions: Surgical treatment of carpal tunnel syndrome using local anesthesia, reasonable skin incision and early mobility causes significant improvement in symptoms, pain and function in adults older than 65 years old(AU)

Tratamiento quirúrgico del síndrome de túnel del carpo en adultos mayores / Surgical treatment of carpal tunnel syndrome in older adults / Traitement chirurgical du syndrome du canal carpien chez les personnes âgées

INTRODUCCIÓN: el síndrome del túnel del carpo constituye el diagnóstico más común para cirujanos de mano. Se han descrito diversos métodos quirúrgicos para su tratamiento, con reportes de buenos resultados. OBJETIVO: mostrar los resultados del tratamiento quirúrgico del síndrome del túnel del carpo, con empleo de anestesia local, incisión razonable y movilidad precoz en pacientes mayores de 65 años de edad. MÉTODO: estudio de intervención longitudinal prospectivo con pacientes mayores de 65 años de edad diagnosticados e intervenidos por síndrome del túnel del carpo entre el 1ro. de enero 2010 y el 1ro. de julio del 2014, y evaluados 1 año después de dicho tratamiento en el CITED. RESULTADOS: serie constituida por 194 pacientes, predominó el sexo femenino (81,44 %), se encontró asociación de síndrome del túnel del carpo con: realización de actividades manuales previas, posibilidad de afectación bilateral, antecedente de fractura de radio distal ipsilateral, comorbilidad con otras enfermedades como diabetes, artritis reumatoide y afecciones de tendones y sus vainas. La mejoría en síntomas, dolor y función al año fue superior al 98 %. CONCLUSIONES: el tratamiento quirúrgico del síndrome del túnel del carpo, con empleo de anestesia local, incisión de piel razonable y movilidad precoz, ocasiona significativa mejoría de los síntomas, del dolor y la función en adultos mayores de 65 años de edad.

INTRODUCTION: Carpal tunnel syndrome is the most common diagnosis for hand surgeons. They described various surgical methods for treatment, with reports of good results. OBJECTIVE: Show the results of surgical treatment of carpal tunnel syndrome using local anesthesia, reasonable incision and early mobility in patients older than 65 years old. METHOD: Prospective longitudinal intervention study with patients older than 65 years of age diagnosed and surgically treated for carpal tunnel syndrome from January 2010 to July 2014 and they were evaluated one year after treatment at CITED. RESULTS: In the series consisting of 194 patients, women predominated (81.44%). Association of carpal tunnel syndrome was found with holding prior manual activities, the possibility of bilateral involvement, history of fracture of ipsilateral distal radius, comorbidity with other diseases such as diabetes, rheumatoid arthritis and diseases of tendons. The improvement of symptoms, pain and function after a year was higher than 98%. CONCLUSIONS: Surgical treatment of carpal tunnel syndrome using local anesthesia, reasonable skin incision and early mobility causes significant improvement in symptoms, pain and function in adults older than 65 years old.

INTRODUCTION: Le syndrome du canal carpien est le diagnostic le plus souvent trouvé par les chirurgiens spécialisés en main. Plusieurs techniques chirurgicales ont été décrites pour son traitement, avec de très bons résultats. OBJECTIFS: Ce travail a le but de montrer les résultats du traitement chirurgical du syndrome du canal carpien à l'aide de l'anesthésie locale, d'une incision raisonnable et d'une mobilité précoce chez les patients âgés de plus de 65 ans. MÉTHODE: Une étude interventionnelle, longitudinale et prospective de patients âgés de plus de 65 ans, diagnostiqués et traités pour syndrome de canal carpien entre le 1er janvier 2010 et le 1er juillet 2014, et évalués un an après, a été effectuée au CITED. RÉSULTATS: Dans une série de 194 patients, où le sexe féminin était en majorité (81,44 %), on a trouvé que le syndrome du canal carpien était associé aux activités manuelles, à un possible trouble bilatéral, à une histoire de fractures du radius distal ipsilatéral, et à une comorbidité avec d'autres maladies telles que le diabète, l'arthrite rhumatoïde et les atteintes des tendons et leurs gaines. Les symptômes, la douleur et la fonction ont amélioré un an après l'opération dans 98 % de cas. CONCLUSIONS: En utilisant de l'anesthésie locale, une incision raisonnable et une mobilité précoce, le traitement chirurgical du syndrome du canal carpien entraîne une significative amélioration des symptômes, de la douleur et de la fonction chez les personnes âgées de plus de 65 ans.

The association between thenar eminence and I-gel(tm) dimensions in paediatric patients / Associação entre as dimensões da eminência tênar e I-gel(tm) em pacientes pediátricos

ABSTRACT OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98 cm (0.53) and 4.54 cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99 cm (0.60) and 3.88 cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r = 0.794,p < 0.001), and between Th-l and Ig-l (r = 0.820, p < 0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

RESUMO OBJETIVOS: Uma referência anatômica prática pode ser útil para determinar o tamanho adequado dos dispositivos para vias aéreas em pacientes pediátricos. O objetivo deste estudo foi investigar a associação entre as dimensões da eminência tênar e do dispositivo I-gel em crianças. MÉTODOS: Após aprovação do Comitê de Ética Institucional, 270 pacientes com estado físico ASA I-II, entre 0-12 anos, programados para cirurgias eletivas sob anestesia geral, sem necessidade de intubação traqueal, foram recrutados para o estudo. A escolha do tamanho do I-gel foi baseada no peso corporal do paciente, de acordo com a recomendação do fabricante. Após a inserção bem-sucedida do I-gel, a dimensão da eminência tênar era determinada. O eixo longo (Th-l) foi medido do ponto de junção do polegar ao vinco do pulso e o eixo curto (Th-w) constitui a maior parte da eminência tênar da extremidade lateral do polegar à primeira linha da mão. As dimensões de fábrica do I-gel inserido no paciente foram comparadas com as dimensões obtidas a partir da eminência tênar. RESULTADOS: As médias (DP) dos valores para (Ig-w) e (Ig-l) foram 2,98 cm (0,53) e 4,54 cm (0,82) e as médias (DP) dos valores para (Th-w) e (TH l) foram 2,99 cm (0,60) e 3,88 cm (0,93), respectivamente. Houve uma correlação estatisticamente significativa entre Th-w e Ig-w (r = 0,794, p < 0,001) e entre Th-l e Ig-l (r = 0,820, p < 0,001). CONCLUSÃO: As dimensões da eminência tênar foram ajustadas àquelas do tamanho do I-gel baseado no peso e essa referência anatômica pode ser uma ferramenta prática para avaliar o tamanho apropriado em pacientes pediátricos.

The association between thenar eminence and I-gel™ dimensions in paediatric patients.

OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98cm (0.53) and 4.54cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99cm (0.60) and 3.88cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r=0.794, p<0.001), and between Th-l and Ig-l (r=0.820, p<0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

[The association between thenar eminence and I-gel™ dimensions in paediatric patients]. / Associação entre as dimensões da eminência tênar e I-gel™ em pacientes pediátricos.

OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98cm (0.53) and 4.54cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99cm (0.60) and 3.88cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r=0.794, p<0.001), and between Th-l and Ig-l (r=0.820, p<0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

A rare case of Glomus Tumor of the Thenar Eminence of the Hand Misdiagnosed as Carpal Tunnel Syndrome.

INTRODUCTION: Glomus body is an apparatus present in the skin at the arterio-venous junction whose main function is to control the body temperature. Hyperplasia of the glomus body results in an entity called glomus tumor. Masson described this entity first in 1924, as a tumor of the neuromyoarterial body. Due to its symptoms, it is of ten misdiagnosed and wrongly treated which adds burden to the patient. CASE REPORT: We report a rare case of glomus tumor presenting at an unusal site that is the thenar eminence of the palm. He had been misdiagnosed and wrongly treated for carpal tunnel syndrome. The tumor was surgically excised and diagnosis was confirmed by histopathological studies. We present this case for its rarity, unusual presentation and it being a cause for misdiagnosis. CONCLUSION: The common sites of glomus tumors are the finger tips or under the nail. Many such cases have been reported in the literature. We present this case because of its unusual site of presentation and a cause of misdiagnosis. The authors feel that this report could offer a learning experience to orthopaedic surgeons when similar patients present to them to avoid adding burden to the already anxious patient.

A novel mutation (g.106737G>T) in zone of polarizing activity regulatory sequence (ZRS) causes variable limb phenotypes in Werner mesomelia.

Werner mesomelia is characterized by a sequence variation in the specific region (position 404) of the enhancer ZRS of SHH. The phenotype comprises variable mesomelia, abnormalities of the thumb and great toe and supernumerary digits. We describe extensive variation in limb phenotype in a large family and report on a novel sequence variation NG_009240.1: g.106737G>T (traditional nomenclature: ZRS404G>T) in the ZRS within the LMBR1 gene. The newly recognized clinical features in this family include small thenar eminence, sandal gap, broad first metatarsals, mesoaxial polydactyly, and postaxial polydactyly. We provide information on 12 affected family members. We review the literature on how a sequence variation in ZRS may cause such diverse phenotypes.

Superficial portion of abductor pollicis brevis muscle, morphological study and literature review: case report / Fascículo superficial del músculo abductor corto del pulgar, estudio morfológico y revisión de la literatura. reporte de caso

Abductor pollicis brevis muscle (APB) belongs to the foreground of the subfascial muscle thenar region, which is of great importance in the movement of the thumb on its two-joint arrangement. In this article, we report the presence of a superficial portion of the APB muscle and its relationship and discuss the available literature and the clinical implications of the presence of this variation.

El músculo abductor corto del pulgar (ACP) pertenece al primer plano muscular subfascial de la región tenar de gran importancia en los movimientos del pulgar por su disposición biarticular. En el presente artículo reportamos la presencia de un fascículo superficial del músculo ACP y sus relaciones, se analiza la literatura disponible y se discuten las implicancias clínicas de la presencia de esta variación.