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- ItemSomente MetadadadosAbnormal course of the superficial palmar branch of the radial artery(Springer, 1996-04-01) Olave, E.; Prates, J. C.; Gabrielli, C.; DelSol, M.; Mandiola, E.; UNIV LA FRONTERA; UNIV AUSTRAL CHILE; Universidade Federal de São Paulo (UNIFESP)The structures in the carpal tunnel are the flexor muscle tendons and their sheaths and the median n. Due to the inflexibility of its walls, any swelling of its contents that produces decrease of its volume, may compress the median n, There are many possible causes of nerve compression, such as the presence of arteries in this tunnel [3, 13]. the carpal tunnels of 70 hands of 35 adult cadavers of both sexes, whose age ranged from 23 to 77 years, were studied by dissection, An abnormal course of the superficial palmar branch of the radial a. was found in 2 hands (2.85%). This vascular branch passed through the carpal tunnel, This unusual course of the superficial palmar branch of the radial a. is described with details correlating its presence in the carpal tunnel with the median n.
- ItemSomente MetadadadosAnatomical Study of the A1 Pulley: Length and Location by Means of Cutaneous Landmarks on the Palmar Surface(Elsevier B.V., 2011-03-01) Fiorini, Harold J. [UNIFESP]; Santos, Joao B. G. [UNIFESP]; Hirakawa, Celso K. [UNIFESP]; Sato, Edson S. [UNIFESP]; Faloppa, Flavio [UNIFESP]; Albertoni, Walter M. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose the objectives of this study were to evaluate palmar surface parameters to identify the exact location of the proximal edge of the flexor tendon A1 pulley relative to the digital palmar crease of the index, middle, ring, and little fingers and to evaluate the length of this pulley.Methods We studied 280 fingers on 70 hands from 35 fresh human cadavers, initially by measuring the distance between the digital-palmar and proximal interphalangeal creases (measure A), followed by dissection of the fingers and measurement of the distance between the proximal edge of the A1 pulley and the digital-palmar crease (measure B) and the length of the A1 pulley (measure C). We carried out statistical analysis using Hotelling's multi-variate T(2)-test and the paired-samples t-test.Results We found no statistically significant difference between measures A and B in each finger (p > .05). the mean lengths, in tenths of millimeters, were as follows: measure A: index finger 22.0 mm, middle finger 24.4 mm, ring finger 22.0 mm, and little finger 17.9 mm; measure B: index finger 21.9 mm, middle finger 24.2 mm, ring finger 22.3 mm, and little finger 18.1 mm. the average lengths of the A1 pulley were: index finger 9.8 mm, middle finger 10.7 mm, ring finger 9.6 mm, and little finger 8.1 mm.Conclusions the distance between the digital-palmar and proximal interphalangeal creases may be used as a cutaneous landmark on the palmar surface for the exact location of the proximal edge of the A1 pulley in the palm of the hand, thereby ensuring greater safety in surgical procedures such as percutaneous release of trigger finger. (J Hand Surg 2011;36A: 464-468. Copyright (C) 2011 by the American Society for Surgery of the Hand. All rights reserved.)
- ItemAcesso aberto (Open Access)Condução nervosa em nervos da mão e o fator fisiológico idade(Academia Brasileira de Neurologia - ABNEURO, 2004-03-01) Valerio, Berenice Cataldo Oliveira; Nóbrega, João Antonio Maciel [UNIFESP]; Tilbery, Charles Peter; Faculdade da Santa Casa Departamento de Clínica Médica; Universidade Federal de São Paulo (UNIFESP)Many researchers have established the influence of physiological factors as age, for the parameters of the study of the motor and sensitive conduction. The objective of this study was to analyze the influence of the variable age in the study of the motor and sensitive nervous conduction of the median and ulnar nerves. The data were collected from 92 volunteers: 61 women and 31 men. Their age was from 13 to 74 years old, with a mean of 36.3 years. Most of them were employees at Santa Casa de São Paulo. It was observed that a reduction in the velocity of sensitive and motor nervous conduction takes place with the age. This reduction is associated with a reduction in the amplitude of the evoked potential.
- ItemSomente MetadadadosDeep palmer arch patterns in Brazilian individuals(Springer, 1999-08-01) Olave, Enrique [UNIFESP]; Prates, José Carlos [UNIFESP]; Univ La Frontera; Universidade Federal de São Paulo (UNIFESP)The deep palmar arch is very important in the blood supply to the hand. Consequently, the radial artery and the deep palmar arch were studied in 60 hands from 30 cadavers of adult Brazilian individuals, of both sexes. The cadavers belong to the Universidade Federal de Sao Paulo, Brazil. The hand arteries were injected with red stained latex neoprene: the deep palmar arch was observed in 59 preparations (98.3%). The arch conformation was classified in two groups, according to the course of the radial artery through the interosseous spaces from the dorsal to the deep palmar region. In group I the radial artery passed through the first interosseous space, and was observed in 51 preparations (85.0%); in group II, the artery passed through the second interosseous space, and was observed in 8 preparations (13.3%). In each group the arches were subdivided according to the number and origin of the deep palmar branch. In group I the arch was formed by the radial artery anastomosing with one deep palmar branch in 41 cases (68.3%), and with two deep palmar branches in 10 cases (16.7%). These branches originated from the ulnar artery, ulnar proper palmar digital artery of the little finger or the common palmar digital artery of the fourth interosseous space. In group II the deep palmar arch was formed by the radial artery anastomosing with one deep palmar branch in 7 cases (11.7%) and in only one case (1.7%) with two deep palmar branches. Knowledge of the arterial variations is very important for surgical procedures in the palmar region.
- ItemAcesso aberto (Open Access)EFFECTIVENESS of A NIGHT-TIME HAND POSITIONING SPLINT in RHEUMATOID ARTHRITIS: A RANDOMIZED CONTROLLED TRIAL(Taylor & Francis As, 2008-10-01) Silva, Ana Carolina [UNIFESP]; Jones, Anamaria [UNIFESP]; Silva, Paula Gabriel [UNIFESP]; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the effectiveness of a night-time hand positioning splint in patients with rheumatoid arthritis.Design: Randomized controlled trial.Methods: Fifty patients with rheumatoid arthritis were divided randomly into 2 groups. the study group used a night-time splint starting at baseline, while the control group used the splint only, during evaluations. All patients attended evaluations wearing their splints, so that the assessor remained blinded to patient allocation. the splints used in the control group were stored in a cabinet between assessments. Participants were evaluated at baseline, 45 and 90 days, using the visual analogue scale for pain; the Jamar dynamometer for grip strength; a pinch gauge for pinch strength; a Health Assessment Questionnaire for function; the Disability of the Arm, Shoulder and Hand (DASH) questionnaire for upper limb disability and symptoms; and a Likert scale for patient satisfaction with treatment.Results: the groups were homogenous for all parameters at baseline. Pain, Health Assessment Questionnaire score, DASH score, grip strength and pinch strength were significantly different between groups over time and satisfaction with the splint was reported as better and much better by most participants.Conclusion: the use of a night-time hand positioning splint reduces pain, improves grip and pinch strength, upper limb function and functional status in patients with rheumatoid arthritis.
- ItemSomente MetadadadosInterphalangeal Joint Sonography of Symptomatic Hand Osteoarthritis Clinical and Functional Correlation(Amer Inst Ultrasound Medicine, 2017) Spolidoro Paschoal, Natalia de Oliva [UNIFESP]; Natour, Jamil [UNIFESP]; Machado, Flavia S. [UNIFESP]; Veiga de Oliveira, Hilda Alcantara [UNIFESP]; Vilar Furtado, Rita Nely [UNIFESP]Objectives-To assess the correlation between inflammatory sonographic findings (grayscale synovial hypertrophy and power Doppler) and clinical and functional assessments in hand osteoarthritis (symptomatic interphalangeal joints) and to correlate the intraobserver and interobserver reliability of these findings. Methods-A prospective double-blind study of 60 interphalangeal joints was conducted. The joints were assessed 6 times per year by clinician and sonographer observers. Results-A total of 720 measurement recesses were included (360 palmar and 360 dorsal). Small correlations and a few associations were found. Proximal interphalangeal joint quantitative measurements of the dorsal recess showed a statistical correlation with joint swelling (P=.043) and pulp-to-pulp pinch strength (P=.043)
- ItemSomente MetadadadosMedian artery and superficial palmar branch of the radial artery in the carpal tunnel(Scandinavian University Press, 1997-03-01) Olave, Enrique [UNIFESP]; Prates, José Carlos [UNIFESP]; Gabrielli, Carla [UNIFESP]; Pardi, Paulo [UNIFESP]; UNIV LA FRONTERA; Universidade Federal de São Paulo (UNIFESP)In the carpal tunnel there are the flexor muscle tendons, their sheaths, and the median nerve. Because its walls are inflexible, any thickening of its components that reduce its area may compress the median nerve. There are many reasons for nerve compression, including persistence of the median artery into adult life. We dissected the arteries in the carpal tunnel of 102 hands of 51 adult cadavers of both sexes, age range 23-77 years, and injected latex into 42 hands. In the carpal tunnel we sought the median artery and the superficial palmar branch of the radial artery. We found the median artery in 23 of 102 cases (23%), and its calibre ranged from 0.7 to 2.7 mm, mean (SD) 1.6 (0.5) mm. In 16 cases it made up part of the superficial palmar arch. The superficial palmar branch of the radial artery was partly responsible for the distal irrigation of the hand in 48 cases (47%); and in three hands (3%) it passed through the carpal tunnel. The external diameters of these vessels were 1.8, 1.9, and 1.8 mm, respectively. These arteries might cause compression of the median nerve and consequently the carpal tunnel syndrome.
- ItemSomente MetadadadosMycetoma caused by Fusarium solani with osteolytic lesions on the hand: case report(Kluwer Academic Publ, 2002-01-01) Tomimori-Yamashita, J.; Ogawa, M. M.; Hirata, S. H.; Fischman, O.; Michalany, N. S.; Yamashita, H. K.; Alchorne, MMA; Universidade Federal de São Paulo (UNIFESP)Eumycetoma is a mycotic disease caused by saprophytic soil fungi that are usually inoculated through minor injuries. A case of mycetoma in a Brazilian farmer aged 71 years is reported. This patient presented erythema and edema on the dorsal Surface of the left hand with multiple crusted and cicatricial lesions. No macroscopic grains were observed. the histopathological findings showed grains consisted of numerous hyphae which stained well with Gomori-Grocott method. This material obtained by cutaneous biopsy was submitted to culture on Sabouraud's medium and the colonies were identified as Fusarium solani. the radioloyical studies revealed bone osteolytic lesions and the ultrasound showed pseudocysts and fistulae at the site of this infection. the patient was treated with oral ketoconazole with a good clinical response.
- ItemAcesso aberto (Open Access)Orthesis' initial impact in rheumatoid arthritis patients with boutonnières deformity on the thumb(Sociedade Brasileira de Reumatologia, 2004-08-01) Silva, Silmara Nicolau Pedro da [UNIFESP]; Valim, Valeria [UNIFESP]; Lemos, Maria Carolina Davel [UNIFESP]; Araujo, Pola Maria Poli de [UNIFESP]; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the use of a static positioning orthesis for boutonnière deformity on the thumb. METHODS: Twenty women aged between 25 and 74 years old were included in the study. They were distributed at random into a control group and a group using orthesis. Pinch and Jamar's dynamometers, Pain Visual Scale and O'Connor's Functional Evaluation were applied to all patients. Wilcoxon's, Mann Whitney's and Scheffe's tests were used for the statistical analysis. RESULTS: After 30 days in the intra-group analysis, there was functional improvement, evaluated by O'Connor's test in 40% of the controls and 70% of these patients using orthesis. There was no statistically significant difference between the groups in any of the evaluated parameters. CONCLUSIONS: These results suggest that orthesis is beneficial to the functional improvement; the tested model was comfortable and well accepted by patients. Nevertheless, subsequent studies of longer duration and including more subjects are needed.
- ItemSomente MetadadadosPerforating branches: Important contribution to the formation of the dorsal metacarpal arteries(Scandinavian University Press, 1998-06-01) Olave, Enrique [UNIFESP]; Prates, José Carlos [UNIFESP]; Gabrielli, Carla [UNIFESP]; Mandiola, Eduardo; Univ La Frontera; Universidade Federal de São Paulo (UNIFESP); Univ Austral ChileThe perforating branches that originate from the deep palmar arch of the hand have been studied to provide a complete anatomical description of these vessels and assess their importance in the blood collateral pathway of the hand. We injected latex into the arteries of 50 cadaveric hands of 25 adults of both sexes, all of Brazilian origin. These were dissected under a stereoscopic microscope. The perforating branch of the second interosseous space originated from the deep palmar arch in 80% of the cases, and it corresponded to the radial artery passing through the second space in 16%; the one of the third interosseous space originated from the deep palmar arch in 76% of the cases and from the palmar metacarpal artery of the third interosseous space in 16%; the one of the fourth interosseous space originated from the deep palmar arch in half the cases, from the deep palmar branch of the ulnar artery in 14%, and from the palmar metacarpal artery of this space in 18%. The perforating branch of the second space anastomosed with the second dorsal metacarpal artery (DMA) in 60% of the cases and formed it in 10%; the one of the third space anastomosed with the third DMA in 20% and formed it in 64%; the one of the fourth space anastomosed with the fourth DMA in 8% and formed it in 78%. These vessels are an important anastomotic pathway between the dorsal carpal network and the deep arteries of the hand and an important in the supply to the dorsum.