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Intrinsic hand muscle function, part 1: creating a functional grasp.

Ursina Arnet1, David A Muzykewicz, Jan Fridén

  • 1Swiss Paraplegic Centre, Nottwil, Switzerland; Department of Orthopadeics, University of California, San Diego, California; Sahlgrenska University Hospital, Gothenburg, Sweden.

The Journal of Hand Surgery
|November 12, 2013
PubMed
Summary
This summary is machine-generated.

Restoring hand function in tetraplegia is crucial. Activating intrinsic muscles alongside the flexor digitorum profundus (FDP) improves grasp by altering finger flexion and increasing fingertip-to-palm distance.

Keywords:
Grasphandintrinsic musclestendon transfertetraplegia

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Area of Science:

  • Orthopedics
  • Rehabilitation Medicine
  • Biomechanics

Background:

  • Restoring hand function is a high priority for individuals with tetraplegia.
  • Tendon transfers, such as extensor carpi radialis longus to flexor digitorum profundus (FDP), can restore finger flexion.
  • However, the absence of intrinsic muscle function leads to a 'roll-up' grasp, limiting object manipulation.

Purpose of the Study:

  • To quantify the role of intrinsic muscle force in achieving a functional grasp.
  • To determine if intrinsic muscle activation enhances fingertip-to-palm excursion during grasp.

Main Methods:

  • Cadaveric hand specimens (n=5) were used to measure finger kinematics during grasp.
  • Flexor digitorum profundus (FDP) was activated via a motor.
  • Intrinsic muscles were subjected to varying loads (0-500 g) to simulate activation levels.

Main Results:

  • Without intrinsic muscle contribution, FDP activation caused a sequential joint flexion starting from proximal interphalangeal (PIP) to distal interphalangeal (DIP) and metacarpophalangeal (MCP) joints.
  • Increasing intrinsic muscle load shifted the flexion initiation to the MCP joint, followed by PIP and DIP joints.
  • This altered kinematics resulted in a 19 mm increase in maximal fingertip-to-palm distance at 500 g intrinsic load compared to 0 g.

Conclusions:

  • Simultaneous activation of FDP and intrinsic muscles creates a more functional hand closing compared to FDP alone.
  • The improved grasp is attributed to altered joint kinematics and increased fingertip-to-palm distances.
  • Intrinsic muscle balancing during grasp reconstruction in tetraplegia may significantly enhance hand function.