• Archives of Plastic Surgery
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• v.51 no.1
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• pp.118-125
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• 2024

Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation.

• Physical Therapy Korea
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• v.14 no.3
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• pp.9-15
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• 2007

The purpose of this study was to investigate electromyographic activities of the flexor digitorum superficialis (FDS) and the flexor carpi ulnaris (FCU) by the shape of the ultrasound head. Twelve healthy subjects participated and performed ultrasound therapy with a round head and a long handled head during each 5-minute application. Electromyographic activities of the FDS and FCU were recorded by surface electrodes and normalized by maximal voluntary isometric contraction (MVIC) values. There was no difference in the muscular fatigue of FDS and FCU as determined by the shape of the ultrasound head (p>.05). Without the shape of head, the mean power frequency decreased with the time. There also was no difference in %MVIC of the FDS and FCU as determined by the shape of the ultrasound head (p>.05), but the force exerted exceeded 20%MVIC. There was however a significant difference in the amount of cumulative workload of the FDS and FCU as determined by the shape of ultrasound head (p<.05). The workload was however not affected by the shape of the ultrasound head. Constant static grasp of ultrasound transducer head during ultrasound therapy is considered a high risk factor of work-related musculoskeletal disease.

• Korean Journal of Veterinary Research
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• v.16 no.2
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• pp.205-219
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• 1976

한국재래산양(韓國在來山羊) 12마리의 후지근(後肢筋)을 절개하여 관찰하였던 바 다음과 같은 결과를 얻었다. 1. 한국재래산양(韓國在來山羊)의 후지근(後肢筋)에서는 다음과 같은 근(筋)들을 관찰할 수 있었다 : 소요근(小腰筋) M. psoas minor, 대요근(大腰筋) M. psoas major, 장골근(腸骨筋) M. iliacus, 요방형근(腰方形筋) M. quadratus lumborum, 대퇴근막장근(大腿筋膜張筋) M. tensor fasciae lata, 중둔근(中臀筋) M. gluteus medius, 심둔근(深臀筋) M. gluteus profundus, 둔이두근(臀二頭筋) M. gluteobiceps, 반건양근(半腱樣筋) M. semitendinosus, 반막양근(半膜樣筋) M. semimbranosus, 봉공근(縫工筋) M. sartorius, 박근(薄筋) M. gracilis, 치골근(恥骨筋) M. pectineus, 내전근(內轉筋) M. adductor, 대퇴방형근(大腿方形筋) M. quadratus femoris, 외폐쇄근(外閉鎖筋) M. obturatorius externus, 내폐쇄근(內閉鎖筋) M. obturatorius internus, 쌍자근(雙子筋) M. gemelli, 대퇴사두근(大腿四頭筋) M. quadriceps femoris, 제삼비골근 M. fibularis tertius, 내측지신근(內側趾伸筋) M. extensor digitorum medialis, 장지신근(長趾伸筋) M. extensor digitorum longus, 전경골근(前脛骨筋) M. tibialis cranialis, 장비골근 M. fibularis longes, 외측지신근(外側趾伸筋) M. extensor digitorum lateralis, 비복근 M. gastrocnemius, 가제미근(筋) M. soleus, 천지굴근(淺趾屈筋) M. flexor digitorum superficialis, 심지굴근(深趾屈筋) M. flexor digitorum profundus, 슬와근(膝窩筋) M. popliteus, 골간근(骨間筋) M. interosseus medius. 2. 천둔근(淺臀筋)의 전부(前部)는 대퇴근막장근(大腿筋膜張筋)과 융합된 것 같고, 후부(後部)는 대퇴이두근(大腿二頭筋)과 융합된 것 같다. 그러나 천둔근(淺臀筋)의 후부(後部)와 대퇴이두근(大腿二頭筋)이 결합된 것으로 생각되는 부분에는 완전융합이 일어나지 않고 천둔근(淺臀筋)을 구분(區分)할 수 있을 정도로 표면으로 2근(筋)을 분리(分離)할 수 있었다. 3. 외측지신근(外側趾伸筋)과 내측지신근(內側趾伸筋)의 건(腱)은 부전골의 원위(遠位) 1/3부(部)에서 서로 건막성(腱膜性)띠에 의하여 서로 연결 되었는데, 이 건막성(腱膜性) 띠는 건섬유(腱纖維)의 방향(方向)으로 보아 외측지신근(外側趾伸筋)의 건(腱)에서 분리(分離)되어 나온 한 가지 (branch)가 내측지신근(內側趾伸筋)의 건(腱)으로 이행되고 있었다. 4, 양(羊)에서 볼 수 있는 이상근(梨狀筋) M. piriformis과 장모지신근(長母趾伸筋) M. extensor hallucis longus은 나타나지 않았다.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.117-120
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• 2011

Purpose: Carpal tunnel syndrome is the most common peripheral compressive neuropathy. Most cases are idiopathic, but rarely carpal tunnel syndrome can be associated with a ganglionic mass. We report our recently encountered experience of surgical treatment of carpal tunnel syndrome caused by a simple ganglionic mass. Methods: A 53-year-old man presented with chief complaints of numbness and hypoesthesia of his left palm, thumb, index finger, long finger, and ring finger of one and half month duration. Physical examination revealed positive Tinnel's sign without previous trauma, infection or any other events. Electromyography showed entrapment neuropathy of the median nerve. Magnetic resonance imaging (MRI) showed an approximately 2.0 cm-sized mass below the transverse carpal ligament. Upon surgical excision, a $1{\times}1.5cm^2$ mass attached to the perineurium of the median nerve and synovial sheath of the flexor digitorum superficialis and redness and hypertrophy of the median nerve were discovered. With surgical intervention, we completely removed the ganglionic mass and performed surgical release of the transverse carpal ligament. Results: The pathology report confirmed the mass to be a ganglion. The patient exhibited post-operative improvement of his symptoms and did not show any complications. Conclusion: We present a review of our experience with this rare case of carpal tunnel syndrome caused by a ganglionic mass and give a detailed follow-up on the patient treated by surgical exploration with carpal tunnel release.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.90-95
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• 2019

Objective : Anomalous muscles of the wrist are infrequently encountered during carpal tunnel surgery. Anatomic variants of the palmaris longus (PL), flexor digitorum superficialis, lumbricalis and abductor digiti minimi (ADM) have been reported but are usually clinically insignificant. Anomalies of the wrist muscles, encountered during endoscopic carpal tunnel surgery have rarely been described. I conducted this study to evaluate muscular anomalies of the volar aspect of the wrist, encountered during endoscopic carpal tunnel surgery. Methods : I studied a consecutive series of 1235 hands in 809 patients with carpal tunnel syndrome who underwent single-portal endoscopic carpal tunnel release (ECTR) from 2002 to 2014. Nine hundred seventy-three hands in 644 patients who had minimal 6-month postoperative follow-up were included in the study. The postoperative surgical outcome was assessed at least 6 months after surgery. Results : In eight patients, anomalous muscles were found under the antebrachial fascia at the proximal wrist crease and superficial to the ulnar bursa, passing superficial to the transverse carpal ligament. Those anomalous muscles were presumed to be variants of the PL or accessory ADM muscle, necessitating splitting and retraction to enter the carpal tunnel during the ECTR procedure. Other muscle anomalies were not seen within the carpal tunnel on the endoscopic view. The surgical outcome for all eight wrists was successful at the 6-month postoperative follow-up. Conclusion : Carpal tunnel surgeons, especially those using an endoscope should be familiar with unusual findings of anomalous muscles of the wrist because early recognition of those muscles can contribute to avoiding unnecessary surgical exploration and unsuccessful surgical outcomes.

• Physical Therapy Korea
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• v.25 no.3
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• pp.51-59
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• 2018

Background: Despite muscle latency times and patterns were used as broad examination tools to diagnose disease and recovery, previous studies have not compared the dominant arm to the non-dominant arm in muscle latency time and muscle recruitment patterns during reaching and reach-to-grasp movements. Objects: The present study aimed to investigate dominant and non-dominant hand differences in muscle latency time and recruitment pattern during reaching and reach-to-grasp movements. In addition, by manipulating the speed of movement, we examined the effect of movement speed on neuromuscular control of both right and left hands. Methods: A total of 28 right-handed (measured by Edinburgh Handedness Inventory) healthy subjects were recruited. We recorded surface electromyography muscle latency time and muscle recruitment patterns of four upper extremity muscles (i.e., anterior deltoid, triceps brachii, flexor digitorum superficialis, and extensor digitorum) from each left and right arm. Mixed-effect linear regression was used to detect differences between hands, reaching and reach-to-grasp, and the fast and preferred speed conditions. Results: There were no significant differences in muscle latency time between dominant and non-dominant hands or reaching and reach-to-grasp tasks (p>.05). However, there was a significantly longer muscle latency time in the preferred speed condition than the fast speed condition on both reaching and reach-to-grasp tasks (p<.05). Conclusion: These findings showed similar muscle latency time and muscle activation patterns with respect to movement speeds and tasks. Our findings hope to provide normative muscle physiology data for both right and left hands, thus aiding the understanding of the abnormal movements from patients and to develop appropriate rehabilitation strategies specific to dominant and non-dominant hands.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.62-67
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• 2015

Purpose: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. Materials and Methods: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. Results: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. Conclusion: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.205-207
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• 2008

Purpose: Although muscle hernia has been well described in the lower-extremity, muscle hernias in the upper extremity are extremely rare. As with lower extremity muscle hernias, the forearm muscle hernia may result from forced exertion of strenuous activity or following blunt trauma. The objective of this paper is to report an extraordinary case of forearm muscle hernia after radial forearm sensory tendocutaneous free flap with references. Methods: A 58-year-old male patient received wide excision and radical neck dissection and lower lip reconstruction with radial forearm sensory tendocutaneous free flap for squamous cell cancer on the lower lip. 16 weeks after the operation, he complained of protruding mass on the forearm and the size was increasing. In postoperative 18 weeks, MRI showed herniation of flexor digitorum superficialis. For unaesthetic cause and preventing progress, the authors performed direct fascial closure and Mesh graft. Results: In 12 months after the surgery there was no recurrence and the patient remained symptom-free. Conclusion: Pain on extremity exertion and unaesthetic buldge of forearm due to forearm muscle hernia were the primary indications for surgery which consist of direct closure, fasciotomy, fascia lata onlay graft, fascia lata inlay graft, etc. The authors experienced uncommon forearm muscle hernia after radial forearm free flap and satisfying result of treatment.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.79-83
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• 2009

Purpose: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. Methods: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. Results: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. Conclusion: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.

• Journal of the Korean Society of Physical Medicine
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• v.4 no.4
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• pp.275-280
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• 2009

Purpose：We have investigated to analysis biomechanics for pinch strength due to elbow flexion degree. Methods：Pinch strength was measured by Electro Dynamometer(G-100) using four elbow flexion degree ($0^{\circ}$, $45^{\circ}$, $90^{\circ}$, $135^{\circ}$). Results：In experimental results, we found that pinch strengths were 5.4kg($0^{\circ}$), 4.8kg($45^{\circ}$), 5.6kg($90^{\circ}$) and 5.2kg($135^{\circ}$), respectively. The Pinch strengths got maximum at $90^{\circ}$ degree, minimum at $45^{\circ}$ degree. We have calculated F1 values using $\sum$T=0. As a result F1 values were 540N($0^{\circ}$), 480N($45^{\circ}$), 560N($90^{\circ}$) and 520N($135^{\circ}$), respectively. F1 values got maximum at $90^{\circ}$ degree, minimum at $45^{\circ}$ degree. Data curve line of $F_1$ values was increased in 45~90 section and decreased in 0~45, 90~135 sections, respectively. Conclusion：$F_1$ (Flexor digitorum superficialis and profundus) values were 10 times bigger than pinch strengths. Data curve line of $F_1$ values was similar to active length-tension curve in 45~90, 90~135 sections.