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Contribution of intrinsic muscles to functional grasp

Contribution of intrinsic muscles to functional grasp. Ursina Arnet Swiss Paraplegic Research, Nottwil, Switzerland, University of California, San Diego, USA David Muzykewicz University of California, San Diego, USA

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Contribution of intrinsic muscles to functional grasp

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  1. Contribution of intrinsic muscles to functional grasp Ursina ArnetSwiss Paraplegic Research, Nottwil, Switzerland, University of California, San Diego, USA David MuzykewiczUniversity of California, San Diego, USA Jan FridénSahlgrenska University Hospital, Gothenburg, Sweden, Swiss Paraplegic Centre, Nottwil, Switzerland Richard LieberUniversity of California, San Diego, USA

  2. IntroductionReconstruction of finger flexion reconstructed FDP only Restoration of grasp by surgical transfer: Extensor carpi radialis longus (ECRL)-to-flexor digitorum profundus (FDP) Problem: normal finger movement → intrinsic hand muscles → roll-up finger movement inability to grasp large objects

  3. Introduction Aim of the study Aim: To quantify the role of intrinsic muscle force in creating a functional grasp. Functional grasp = large fingertip-to-palm distance palm

  4. Methods Sample preparation and testing: 5 cadaveric hands (fresh frozen), amputated at radiocarpaljoint Skin excised FDP tendons: attached to motor INT: 2-0 silk at tendinousinsertion into lateral band, attached to weights via pulley Extensor digitorum communis (EDC) tendons: attached to weight via pulley 50mm 0g, 250g, 500g, 750g Motor 50g

  5. Methods Kinematic analysis x PIP x x DIP x x x x x x x x x Kirschner wires into metacarpals and phalanx bones (all fingers) Video capture from radial side (2D) Digitization of wire position (Matlab): wires vectors bone vectors joint angles joint and fingertip positions MCP x x x x

  6. Methods Data analysis Analyzed data: joint angles during movement (MCP, PIP, DIP) excursion of maximal angular change order of joint movement fingertip position fingertip-palm distance Repeated measures ANOVA palm

  7. Results Movement 0g 500g With vs. without intrinsics

  8. Results Fingertip Trajectory of fingertip (mean all fingers) 0g 250g 500g 750g Maximal distance fingertip to palm* (middle finger) 0g 250g 500g 750g 67±9mm 79±7mm 87±6mm 89±mm *significant difference between INT load (p < 0.001)

  9. Results Joint angles MCP PIP DIP 750g 0g 250g 500g ◊ = Excursion of maximal angular change* *significant difference between INT load (p < 0.001)

  10. Discussion Role of intrinsics Simultaneous activation of FDP and INT = more functional hand closing Functional hand closing: - larger fingertip-palm distance - finger flexion initiated at MCP and followed by PIP and DIP These results illustrate the importance of INT balancing during reconstruction of grasp in tetraplegic patients. With INT balancing, patients will be able to grasp larger objects, increasing their independence.

  11. Thank you for the attention Questions? Comments?

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