• Physical Therapy Korea
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• v.18 no.4
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• pp.34-42
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• 2011

The lumbrical muscles contribute to the intrinsic plus position, that is simultaneous metacarpophalangeal (MCP) flexion and interphalangeal (IP) extension. The strength of the lumbrical muscles is necessary for normal hand function. However, there is no objective and efficient method of strength measurement for the lumbrical muscles. In addition, previous studies have not investigated the measurement of the cross-sectional area (CSA) of the lumbrical muscles using ultrasonography (US) and the relationship between lumbrical muscle strength in the intrinsic plus position and the CSA. Therefore, the purpose of this study was to identify the measurement method of the CSA of the lumbrical muscles using US and to examine the relationship between maximal isometric strength and the CSA of lumbrical muscles. Nine healthy males participated in this study. Maximal isometric strength of the second, third, and fourth lumbrical muscles was assessed using a tensiometer in the intrinsic plus position which isolated MCP flexion and IP extension. The CSA of the lumbrical muscles was measured with an US. The US probe was applied on the palmar aspect of the metacarpal head with a transverse view of the hand in resting position. There was no significant difference between maximal isometric strength of the lumbrical muscles, but the fourth lumbrical muscle was stronger than the others. The CSA of the lumbrical muscles was significantly different and the fourth lumbrical muscle was significantly larger than the second lumbrical muscle. There was moderate to good correlation between maximal isometric strength and the CSA of the lumbrical muscles. Therefore, we conclude that maximal isometric strength of the lumbrical muscles was positively correlated to the CSA of the lumbrical muscle in each finger, while the measurement of the CSA of the lumbrical muscles, using US protocol in this study, was useful for measuring the CSA of the lumbrical muscles.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.15 no.1
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• pp.58-63
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• 2009

Purpose: The purpose of this study is to figure out that the scapular stability exercise on unstable position can effect on the pain relief of the patient with lateral epicondylitis. Methods: The subject was 35 year old male, diagnosed as lateral epicondylitis. This patient was controled to do scapular stability exercise with crawling position on unstable surface, changing elbow movement from flexion to extension for 4 weeks, 5 times a week, 20 times in total. We used VAS to find the degree of pain and Cozen's test, Mill's test and Resisted middle finger test were determined for the measurement of epicondylitis changed. Results: The following is the result of this study. 1. Pain on lateral epicondylitis was relived from VAS 7 to VAS 0. 2. There were improvements that the results of tests for epicondylitis, Cozen's test, Mill's test and Resisted middle finger test, changed positive into negative signs. Conclusion: The result of this study indicates that the application scapular stability exercise on the unstable surface to the patient with lateral epicondylitis can relief the pain degree on the lateral epicondylitis and be used as one of lateral epicondylitis treatments.

• Journal of Electrical Engineering and Technology
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• v.9 no.5
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• pp.1774-1779
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• 2014

It is known that muscle strength of human body can alter or deteriorate as aging. In this study, we present an inverse dynamics simulation to investigate the effect of muscle strength on performing the daily activities. A 3D musculoskeletal model developed in this study includes several segments of whole body, long and short muscles, ligaments and disc stiffness. Five daily activities such as standing, flexion, finger tip to floor, standing lift close and lifting flexed were simulated with varying the maximum muscle force capacities (MFC) of each muscle fascicles from 30 to $90N/cm^2$ with an increment of $30N/cm^2$. In the result, no solution can be obtained for finger tip to floor and lifting flexed with $30N/cm^2$. Even though the solution was available for standing lift close activity in case of $30N/cm^2$ capacity, many of muscle fascicles hit the upper bound of muscle strength which means that it is not physiologically possible to perform the acvities in reality. For lifing flexed, even the case of $60N/cm^2$ capaciy, represents the moderate healthy people, was not able to find the solutions, showing that 18 muscles among 258 muscle fascicles reached 100% of muscle capacity. The estimated results imply that people who have low muscle strength such as elders or rehabilitation patients were required higher muscle work to perform and maintain the same daily activities than healthy one.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.135-145
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• 1998

In 1980 Morrison and O'Brien reported their experiences about the reconstruction of amputated thumb using wrap-around neurovascular free flap from the great toe with a nonvascularized iliac bone graft. From then it has been considered to be a good reconstructive procedure for the amputated thumb, but it's indication has been limited distal to the metacarpophalangeal(MP) joint. We have performed 37 cases of wrap-around free flap from the great toe for the reconstruction of thumb amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. Level of amputation was distal to the MP joint in 25 cases and proximal to it in 12 cases. Pinching and grasping power, two point discrimination and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the amount of two point discrimination was significantly high in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of $30^{\circ}$ flexion and $45^{\circ}$ internal rotation but in 6 cases in the fixation of $30^{\circ}$ flexion and $30^{\circ}$ internal rotation, the opposition of reconstructed thumb to the ring and little fingers were impossible in 5 cases and only to the little finger in 1 case. In this study, we concluded that even if amputation proximal to the MP joint, it is no more contraindication of the wrap-around free flap procedure for thumb reconstruction, however in these cases we recommend iliac bone block fixation in the position of $30^{\circ}$ flexion and $45^{\circ}$ infernal rotation for the better functional outcome.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.239-247
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• 2018

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford's criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a significant relationship between gap or step-off and extension lag. Using Crawford's evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

• Physical Therapy Korea
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• v.7 no.2
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• pp.66-75
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• 2000

A single subject experimental design (alternating treatment design) was used to compare the effects of Mulligan method and electrotherapy on the pain and limitation of range of motion in patients with frozen shoulder. In the Mulligan method sessions, the physiotherapist performed a posterior and caudal glide on the patient while the patient was performing shoulder flexion and abduction. In the electrotherapy sessions, the patient received ultrasound and interference current treatments. Mulligan method and electrotherapy were alternately performed on each patient. Pain was measured by visual analogue scale (VAS) and range of motion (ROM) was measured by modified finger ladder. The results showed that both Mulligan method and electrotherapy were effective in pain reduce and ROM increase, but Mulligan method was superior to electrotherapy in ROM increase while electrotherapy was superior to Mulligan method in pain reduce.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.7-11
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• 2001

Purpose : To evaluate the neurologic abnormalities in the donor limb after contralateral C7 transfer in brachial plexus injury. Materials and Methods : From August 1996 to December 1999, five patients with brachial plexus injury were treated with contralateral C7 nerve root transfer. The average follow up was 16 months(range, 5 to 36 months). The clinical findings were assessed using the British Medical Research Council Grading System, and also measured grip power, pinch power of hand and two point discrimination of the fingers. Results : We had no difference in shoulder abduction and elbow flexion after contralateral C7 transfer. The grip and pinch strength were recovered within 4weeks. Sensory loss occurred in all patients and was noted to be more severe on index and middle finger. Four patients recovered within 2 weeks, one continued till one year. Subjective numbness and pain on percussion minimally persisted until last follow-up. Conclusion : The division of the C7 nerve root resulted in minimal and temporary functional deficit in the donor upper limb.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.5 no.1
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• pp.79-85
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• 2011

In this paper, we proposed a design of upper-limb rehabilitation device with power-assist function for stroke survivals. The designed upper-limb rehabilitation device has three degrees of freedom； it is possible to perform flexion and extension motions of wrist, index finger and the other fingers except the thumb independently. The power-assist for wrist motion is performed by a pneumatic double-acting cylinder, but the fingers are actuated by electrical linear actuators to assist motions. A prototype upper-limb rehabilitation device and its controller were implemented. The position controller showed 0.8 mm errors in the steady-state. Experimental results showed that the proposed upper-limb rehabilitation device with power-assist function is feasible.

• Korean Journal of Adult Nursing
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• v.20 no.1
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• pp.55-64
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• 2008

Purpose: The purpose of this study was to identify the effect of Meridian pressure on the functions of upper extremities and discomfort of ADLs of hemiplegic patients. Methods: The research design was a nonequivalent control group, non-synchronized design. Subjects were 35 hemiplegic patients who were hospitalized at L Oriental Medical Hospital; 18 for the experimental group and 17 for the control group. The experimental group was given meridian pressure for 10 minutes daily for 2 weeks. The data were analyzed by SPSS 12.0 program. The ${\chi}^2$-test and t-test were used for the two groups' homogeneity, and t-test was used for the hypothesis test. Results: Manual muscle test, ROMs of wrist extension, elbow flexion, and shoulder extension of the experimental group increased compared to the control group. Shoulder pain and index finger circumference of the experimental group decreased compared to the control group. The experimental group showed to have less discomfort of ADLs than the control group. Conclusion: The study results verified that meridian pressure is effective for improving the functions of hemiplegic patients' upper extremities as well as reducing discomfort of ADLs.