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(1) Background: An elevated wrist circumference may indicate excess weight and cardiometabolic risk. The present study aims to identify wrist circumference cutoff points (WrC) to determine excess weight levels and predict cardiometabolic risk in adults. (2) Methods: A cross-sectional study was conducted with adults aged 20 to 59 years old, attending the outpatient clinic at University Hospital/Federal University of Sergipe HU/UFS-EBSERH. Demographic, anthropometric, biochemical, and blood pressure (BP) data were collected. Cardiometabolic risk was assessed, according to the global risk score (ERG) and Framingham score criteria. The descriptive analysis included calculating medians and frequencies of anthropometric, demographic, biochemical, and blood pressure variables. The gender and age of adult groups were compared using the Mann-Whitney test. Spearman's correlation coefficient and multiple regression analysis were used to assess the association between wrist circumference (WrC) and the variables mentioned above. The predictive validity of WrC in identifying excess weight levels and cardiometabolic risk was analyzed using the ROC curve. The sample consisted of 1487 adults aged 20 to 59 years, 55.7% of whom were female; (3) Results: WrC correlated positively with other adiposity indicators such as waist circumference and Body Mass Index. WrC was the anthropometric indicator most significantly associated with cardiometabolic risk factors. WrC cutoff points identified by the study for determining excess weight were categorized by gender and age group. For males aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 17.1 cm and 17.3 cm, and for obesity, 17.9 cm and 17.5 cm. For females aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 15.6 cm and 15.4 cm, and for obesity, 16.1 cm and 16 cm (4). Conclusions: Wrist circumference showed a significant correlation with other adiposity indicators and can be used to identify adults with excess weight and predict cardiometabolic risk.

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SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

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Wrist shape varies greatly across primates and previous studies indicate that the numerous morphological differences among them are related to a complex mixture of phylogeny and function. However, little is known about whether the variation in these various anatomical differences is linked and to what extent the wrist bones vary independently. Here, we used 3D geometric morphometrics on a sample of extant hominines (Homo sapiens, Pan troglodytes, Gorilla gorilla, and Gorilla beringei), to find the model that best describes the covariation patterns among four of the eight carpals (i.e., capitate, lunate, scaphoid, and trapezium). For this purpose, 15 modular hypotheses were tested using the Covariance Ratio. Results indicate that there is a covariation structure common to all hominines, which corresponds to stronger covariation within each carpal as compared to the covariation between carpals. However, the results also indicate that that there is a degree of codependence in the variation of some carpals, which is unique in humans, chimpanzees, and gorillas, respectively. In humans there is evidence of associated shape changes between the lunate and capitate, and between the scaphoid and trapezium. This covariation between lunate and capitate is also apparent in gorillas, while chimpanzees display the greatest disassociation among carpals, showing low covariation values in all pairwise comparisons. Our analyses indicate that carpals have an important level of variational independence which might suggest a high degree of independent evolvability in the wrists of hominines, and that although weak, the structure of associated changes of these four carpals varies across genera. To our knowledge this is the first report on the patterns of modularity between these four wrist bones in the Homininae and future studies might attempt to investigate whether the anatomical shape associations among carpals are functionally related to locomotion and manipulation.

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Objetivo: Evaluar, en forma retrospectiva, las diferentes variantes de los tubérculos de Lister y el extensor largo del pulgar en imágenes de resonancia magnética de muñecas y, sobre la base de dichos hallazgos, proponer variables a la clasificación. Materiales y métodos: Estudio retrospectivo utilizando imágenes de resonancia magnética entre el 1 de marzo y el 10 de noviembre de 2019. Se incluyeron imágenes de muñeca de pacientes sanos (cortes axiales, sagitales y coronales de 1 mm de espesor), >18 años, sin fractura de muñeca o del carpo, previa o actual, y se excluyó a quienes no cumplían estos criterios. Se analizaron el tubérculo de Lister, la altura de los picos radial y cubital, el ángulo, la longitud del tubérculo, la profundidad de los valles y la altura del tabique. Se evaluó el extensor largo del pulgar analizando la altura, el espesor, la superficie y la presencia o no inflamación asociada. Resultados: Se analizaron 500 imágenes de muñeca, y se obtuvieron 11 subtipos de tubérculo de Lister: 411 tipo 1, 58 tipo 2 y 26 tipo 3. Dentro de estos, el más frecuente fue el tipo 1B. El 26,6% tenía inflamación asintomática en el tercero y cuarto compartimento. Conclusiones: El tubérculo de Lister es importante en muchos procedimientos y sirve como punto de referencia anatómico; por lo tanto, es preciso conocer su patrón más frecuente y sus variantes anatómicas. Proponemos una ampliación de la clasificación, adicionando nuevos tipos de tubérculo por conocer y su relación con el extensor largo del pulgar. Nivel de Evidencia: IV

Objective: To retrospectively evaluate the different variants of Lister's tubercle (LT) and extensor pollicis longus (EPL) using magnetic resonance imaging (MRI) of the wrists, and based on these findings propose variables for classification. Materials and Methods: Retrospective study using images from MRI database files between 03/01/19 to 11/10/19. We included MRI of the wrist of healthy patients (axial, sagittal, and coronal slices of 1 mm thickness) who were older than 18 years, with no history of previous or current wrist or carpal fracture, excluding those who did not meet these criteria. We analyzed LT, height of the radial and ulnar peaks, the angle, tubercle length, depth of the grooves and septum height. We evaluated the EPL, analyzing the height, thickness, surface, and presence of associated inflammation. Results: We evaluated 500 MRI of the wrist, obtaining 11 different subtypes of LT. We found 411 type 1 Lister tubercles, 58 type 2, and 26 type 3. Among these, the most frequent were types 1b. 26.6% presented asymptomatic inflammation in 3rd and 4th compartments. Conclusion: Lister's tubercle is of importance in many procedures and serves as an anatomical landmark, meriting to know its most frequent pattern and its anatomical variants. We propose an extension of the classification, adding new types of tubercles to be known and their relationship with the EPL. Level of Evidence: IV

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The aim of this study is to investigate rs1805086 and rs1805065 polymorphisms of MSTN gene of national and amateur Turkish arm wrestlers and people leading a sedentary lifestyle, and the anthropometric properties such as hand, wrist, and forearm circumferences of national and amateur Turkish arm wrestlers are aimed to be explored. In this study, a total of 79 volunteers who were 24 national (7 females, 17 males) Turkish arm wrestlers, 21 amateur (7 females, 14 males) Turkish arm wrestlers and 34 sedentary people (12 females, 22 males) participated. To analyse the data, Statistical Package for the Social Sciences, SPSS 22 (SPSS Inc., Chicago, IL, USA) was used. As a result of the study, when data on rs1805086 and rs1805065 polymorphisms of MSTN gene were examined respectively, it was found out that MSTN 153KK genotype was 100.0% dominant in both national (n=24) and amateur (n=21) arm wrestlers, and it was 94.12 % dominant in sedentary people. KR genotype was observed in 5.88 % of the sedentary people. The data from the other rs1805065 polymorphism of MSTN gene showed that all participants (n = 45, 100.0 %) were carriers of normal homozygous genotype. Furthermore, for both female group and male group, there found to be statistically significant difference in terms of anthropometric properties. It can be concluded that though there was no significant difference between national and amateur Turkish arm wrestlers in terms of their MSTN gene characteristics; in terms of anthropometric properties, significant differences were discovered. It was found out that on these athletes, not MSTN gene polymorphisms but anthropometric properties were effective.

El objetivo de este estudio fue investigar los polimorfismos rs1805086 y rs1805065 del gen MSTN de luchadores de brazos turcos, nacionales y aficionados, y personas que llevan un estilo de vida sedentario, y las propiedades antropométricas además de las circunferencias de manos, muñecas y antebrazos de los luchadores de brazos turcos nacionales y aficionados. En este estudio, participaron un total de 79 voluntarios: 24 luchadores de brazos turcos nacionales (7 mujeres, 17 hombres), 21 luchadores de brazos turcos aficionados (7 mujeres, 14 hombres) y 34 personas sedentarias (12 mujeres, 22 hombres). Para analizar los datos, se utilizó el Paquete Estadístico para las Ciencias Sociales, SPSS 22 (SPSS Inc., Chicago, IL, EE. UU.). Como resultado del estudio, cuando se examinaron los datos sobre los polimorfismos rs1805086 y rs1805065 del gen MSTN respectivamente, se descubrió que el genotipo MSTN 153KK era 100,0 % dominante en luchadores de brazos nacionales (n = 24) y aficionados (n = 21) , y era 94,12 % dominante en personas sedentarias. El genotipo KR se observó en el 5,88 % de las personas sedentarias. Los datos del otro polimorfismo rs1805065 del gen MSTN mostraron que todos los participantes (n = 45; 100,0 %) eran portadores del genotipo homocigoto normal. Además, tanto para el grupo femenino como para el masculino, se encontró una diferencia estadísticamente significativa en términos de propiedades antropométricas. Se puede concluir que, aunque no hubo una diferencia significativa entre los luchadores de brazos turcos nacionales y aficionados en términos de sus características genéticas MSTN; en términos de propiedades antropométricas, se descubrieron diferencias significativas. Se descubrió que, en estos atletas, no fueron los polimorfismos del gen MSTN sino las propiedades antropométricas las efectivas.

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OBJECTIVE: To determine if ulnar variance can be evaluated by magnetic resonance (MR) imaging and if this measure can be used as a reliable indicator when correlated to the gold standard technique, conventional radiography (CR). MATERIALS AND METHODS: From January to July 2018, the MR images of 64 participants, comprising 66 wrists (mean age 34.9 years; 33 females; 31 males), were obtained. Among those, 29 were referred for evaluation of the wrist for different medical reasons and 35 were asymptomatic volunteers from our radiology group. All subjects had a plain radiography of the wrist in a posteroanterior view with a mean interval between images of 1 day. Local ethics committee approved the study and written informed consent was obtained from all patients. Two musculoskeletal radiologists evaluated the images. Correlation coefficients and a linear regression model were used for statistical analyses. RESULTS: Intra- and inter-observer analyses were performed for both diagnostic methods with results showing concordance (intra-observer: kappa score: MR 0.915/CR 0.931; p < 0.05; inter-observer: kappa score: MR 0.857/CR 0.931; p < 0.05). The intraclass correlations of MR and CR to evaluate agreement between the radiologists was slightly higher for radiologist #1 (0.771) than for radiologist #2 (0.659). A linear regression model showed good model fit indicating that MR does correlate with the ulnar variance as measured by CR (CR = 0.554 + 0.897 × MR, R2 = 0.665). CONCLUSION: Although CR is the gold standard method for the evaluation of ulnar variance, our study demonstrated that MR can be used as a reliable qualitative option.

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The morphology and morphometry of the distal articular surface of the lunate exhibits inter-population variations. They are of clinical importance to hand surgeons due to their influence on the occurrence of proximal pole arthrosis which is a cause of ulnar-side wrist pain. The objective of the study was to determine the morphology and morphometry of the distal articular surface of the lunate bone in an adult Kenyan population. A descriptive cross-sectional study at the Department of Human Anatomy, University of Nairobi. Fifty-six human hands obtained for routine dissection were used. The morphology of the distal articular surface of the lunate was classified as either Type I or Type II depending on the absence or presence of a medial facet for articulation with the hamate respectively. The width of the wrists and of the medial facet in Type II lunates was measured with SOMETTM CN-25 1234 vernier calipers (accurate to 1mm). Photomacrographs of representative lunate were taken. Data were analyzed using SPSS version 17.0. The Pearson correlation test was used to check for any correlations. Type II lunate morphology was more common with a prevalence of 34 (61 %) while 19 (34 %) were Type I. The mean width of wrists with Type I lunate was 41.1±2.8 mm while those with Type II had a mean width of 46.1±4.3 mm. The mean width of the medial facet in lunate type II was 4.4±1.4 mm. Lunotriquetral fusion was demonstrated in 3 (5 %) wrists. Prevalence of Type II lunate was higher than Type I. Wrists with a Type II lunate were wider than those with Type I. There was no correlation between the width of the wrist and the width of the medial facet of the lunate.

La morfología y morfometría de la superficie articular distal del hueso semilunar muestra variaciones entre la población. Es de importancia clínica para los cirujanos de mano debido a su influencia en la incidencia de la artrosis del polo proximal, que causa dolor ulnar en la muñeca. El objetivo fue determinar la morfología y morfometría de la superficie articular del hueso semilunar en una población adulta de Kenia. Estudio descriptivo de corte transversal, realizado en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se utilizaron 56 manos humanas que fueron sometidas a disección de rutina. La morfología de la superficie articular distal del hueso semilunar se clasificó en Tipo I o Tipo II en función de la ausencia o presencia de una faceta medial de la articulación. El ancho de las muñecas y de la faceta medial en el Tipo II se midió con el caliper SOMETTM CN-25 1234 (precisión de 1 mm). Se tomaron macrofotografías representativas del hueso semilunar. Los datos fueron analizados con el programa SPSS versión 17.0. Se utilizó la prueba de correlación de Pearson. La morfología del hueso semilunar Tipo II fue más frecuente con una prevalencia de 34 casos (61 %), mientras que 19 casos (34 %) eran de Tipo I. El ancho promedio de las muñecas del hueso semilunar Tipo I fue de 41,1±2,8 mm, mientras que las de Tipo II fue de 46,1±4,3 mm. El ancho promedio de la cara medial del hueso semilunar Tipo II fue de 4,4±1,4 mm. Se demostró fusión semilunar-piramidal en 3 casos (5 %). La prevalencia del hueso semilunar Tipo II fue mayor que la del hueso semilunar Tipo I. Las muñecas que presentaban hueso semilunar Tipo II fueron más anchas que las de Tipo I. No hubo correlación entre el ancho de la muñeca y el ancho de la faceta medial del hueso semilunar.

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The anatomical snuffbox is a small triangular area situated in the radial part of the wrist, often used to perform clinical and surgical procedures. Despite the frequency with which this area is used, there is scarce information in literature about its details. The objective of this study is detailed knowledge of the anatomical snuffbox's anatomy and its components, the reported alterations at this portion, besides the clinical uses and significance of this area.

La tabaquera anatómica, es una pequeña área triangular ubicada en la parte radial de la muñeca utilizada a menudo para realizar procedimientos clínicos y quirúrgicos. A pesar de la frecuencia con la que se utiliza esta zona, escasea la información acerca de sus detalles en la literatura. El objetivo de este estudio es conocer con detalle la anatomía de la tabaquera anatómica y sus componentes, las alteraciones reportadas a ese nivel, y los usos e importancia clínica de esta región.

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Los extensores radiales del carpo son dos músculos de la parte lateral del compartimento posterior del antebrazo, que se utilizan con frecuencia en cirugías de transferencia de tendón. Las variaciones anatómicas de estos músculos son bastante comunes y su conocimiento es clínicamente significativo, ya que se pueden utilizar para corregir deformidades de la mano. El objetivo de este estudio es conocer la anatomía de los músculos extensores radiales, su embriología, sus variaciones anatómicas y su importancia clínica.

Extensor carpi radialis are two lateral muscles of the posterior compartment of the forearm which are often used in tendon-transfer surgery. The anatomical variations of these muscles are quite common and knowledge about these variations is clinically significant, as it is useful to correct deformities of the hand. The aim of this study is to know the anatomy of the extensor radial muscles, embryology, anatomical variations and their clinical significance.

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Debido a la importancia del diagnóstico precoz de osteoporosis, fue objeto de este estudio realizar la comparación de dos métodos radiológicos convencionales para la evaluación de la densidad ósea en mujeres posmenopáusicas. Fueron seleccionadas imágenes de radiografía panorámica y de radiografía carpal, correspondiente a 68 pacientes de sexo femenino, con edades comprendidas entre los 49 y 80 años de edad, realizadas en la Clínica de Radiología Odontológica, para evaluación previa a la colocación de implantes. Para la interpretación de la densidad ósea en la mandíbula a través de las radiografías panorámicas fue utilizado el método del espesor cortical mandibular (PMI). Para la evaluación de las imágenes radiológicas obtenidas por la radiografía carpal, fue aplicado el método de la radiogrametría. Se concluye que existe correlación entre la presencia de una baja densidad ósea a nivel mandibular observada en la radiografía panorámica en las pacientes de la muestra, con la baja densidad ósea presentada en la radiografía carpal.

Due the importance of diagnosis precocious of osteoporosis, this study carried out the comparison of two conventional radiological methods for the evaluation of bone density in postmenopausal women. X-ray images of panoramic and carpal were selected, corresponding to 68 women between 49 and 80 years old, obtained at the Clinic of Dental Radiology, for holding dental implant. The interpretation of bone density in jaw on panoramic radiography was the method to determine mandibular cortical thickness. The carpal radiography was evaluated for the radiogrammetry method. It was concluded that there was a correlation between low bone density observed in the mandibular panoramic radiography with low bone density on carpal radiography.

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We sought to determine whether childhood wrist circumference predicts insulin resistance in adulthood. Measures were taken in prepubertal children and then approximately 30 years later in the same subjects as adults. Our findings suggest that wrist circumference in childhood is not a predictor of insulin resistance in adulthood.

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The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.

El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro.

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The Abductor Pollicis Longus (APL) is known to have a big variety in its number of insertion tendons.Because of that, studies about variations in its origin are not frequently achieved like studies about its insertionforms. This study describes an anatomic variation of the Abductor Pollicis Longus, with an anomalous venteroriginated of the inferior portion of the lateral border of the radio. Surgical and clinical implications are inrelation principally with the big number of tendons of insertion of the APL, but there are related cases inthe literature in that additional venter of this muscle also can be involved in the physiopathology of clinicalsyndromes, like the tenosynovitis of de Quervain

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We describe the case of an original insertion and course of the abductor digiti minimi muscle on the medial part of the palmaris longus tendon. The anomalous muscle was only present on the left side. Various studies have reported the frequency of anomalous muscles in approximately 22 to 35% of hands and it was in majority an anomalous abductor digiti minimi muscle. The knowledge of this original insertion is important because it can sometimes be correlated with ulnar nerve compression at Guyon's canal. But Guyon's canal syndrome is less common than carpal tunnel syndrome, and the incidence of ulnar nerve compression in relation with anomalous muscle is approximately 2.9% of cases. It is possible to diagnose the anomalous muscle through ultrasound or MRI. This variation should be taken into consideration by surgeons during surgical procedures for ulnar nerve decompression at Guyon's canal and when performing anteromedial approach to the wrist between flexors tendons and ulnar bundle.

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BACKGROUND: Traditional volumetry based on Archimedes' principle is the gold standard for the measurement of limb volume, but the routine use of this technique is discouraged because of several disadvantages. OBJECTIVE: The purpose of this study was to evaluate intraobserver and interobserver reliability of direct measurements of wrist-hand volume using a new communicating vessels volumeter based on Pascal's law. DESIGN: A reliability study was conducted. METHODS: To evaluate the reliability of the communicating vessels volumeter in generating measurements, 30 hands of 15 participants (9 women, 6 men) were measured 3 times each by 3 observers, totaling 270 volumetric results. RESULTS: Measurement time was short (X =3 minutes 42 seconds). The intraclass correlation coefficient (ICC) was .9977 for observer 1 and .9976 for observers 2 and 3. The interobserver ICC was .9998. The standard error of measurement was about 3 mL for all observers; the interobserver result was 1 mL. The interrater coefficient of variance (CV) was 1.15% for the series of 9 measurements collected for each segment; the intrarater CV was 1.20%. Limitations No swollen hands were measured, and measurements were not compared with the gold standard technique. Thus, accuracy of the new volumeter was not determined in this study. CONCLUSION: A new device has been developed for plethysmography of the extremities, and the results of its use to measure the volume of the wrist-hand segment were reliable in both intraobserver and interobserver analyses.

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BACKGROUND: The present study examines the hand movements of children with cerebral palsy during functional tests and compares the childrens' performance with and without the aid of an orthosis that provides wrist extension and thumb abduction. METHODS: The range of motion of the trapeziometacarpal joint was assessed for 32 participants via a reflexive markers image system. Observed motions included flexion-extension and abduction-adduction motions performed in the course of four tests for manual ability; the rest position, lateral and tripod pinches and cylindrical grasp. Muscle strength and manual ability were evaluated using dynamometry and the Jebsen-Taylor test. FINDINGS: The range of motion tests for the rest position, lateral and tripod pinches and cylindrical grasp demonstrated improvements from 17% to 42% (P<0.001) for flexion/extension and from 36% to 54% for abduction/adduction (P<0.001) with the use of the orthosis. Dynamometry measurements showed that the improvement in muscle strength obtained through use of the orthosis was 50% (P<0.001). Improvements in the time required to perform the movements as determined using the Jebsen-Taylor test varied from 13% to 24% (P<0.01) for the four considered tests of manual ability. INTERPRETATION: The orthosis improved the range of motion of the trapeziometacarpal joint, muscle strength and manual ability. The combination of the three techniques may provide the basis for a quantitative assessment of hand dysfunction/improvement in cerebral palsy that will ultimately guide health professionals in their clinical interventions.

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OBJECT: The anatomy of the Guyon canal is crucial for open and endoscopic surgeries for ulnar canal syndrome at the wrist level. It is also of interest for surgical treatment of carpal canal syndromes. Whereas the Guyon canal is largely described in adults, no studies exist in children. In the present study, the authors examined the Guyon canal in children. METHODS: Sectional anatomy was used. Thirty-two formalin-fixed cadavers (64 sides) were examined (age range 2-11 years). The hands were transversely cut into 2-3-mm-thick slices. Slices were placed in embedding medium, and transverse sections (10 µm thick) were stained with histological methods and photographed under a light microscope. RESULTS: The roof of the Guyon canal was attached to the flexor retinaculum laterally to the hamulus of the hamate bone. Thus, the radial boundary of the Guyon canal was lateral to the hamulus, which became part of the floor of the Guyon canal. An ulnar neurovascular bundle was found directly volar to the hamulus in 93.8% of the cases and slightly medial to the hamulus (to the ulnar side) in 6.2% of the cases. Proximally, the ulnar artery and nerve were sustained by the flexor retinaculum in direct apposition to the carpal canal. CONCLUSIONS: In children, the Guyon canal displays an anatomical particularity regarding the topography of the ulnar artery and nerve that may be of relevance for intraoperative orientation and endoscopic navigation to avoid lesions to the ulnar nerve and artery in carpal and Guyon canal syndromes.

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This study describes a rare case of the accessory muscle originated from the flexor carpi ulnaris muscle. Anunusual variation of the flexor muscle was observed during the male cadaver dissection. The presence of ananatomical variation muscle was verified in the forearm on the left side of a 59 year old corpse settled in formol10%. Morphological variability and clinical significance are reviewed.

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La mano y la muñeca tienen anatomía y función muy complejas que la hacen susceptible a diversas lesiones de tejidos blandos y también representan áreas anatómicas que con frecuencia son afectadas por enfermedades de etiología diversa, como artritis inflamatoria, degenerativa y por depósitos de cristales. La ultrasonografía representa una técnica de imagen muy útil para el estudio de la mano y muñeca por su capacidad multiplanar, sin emisión de radiaciones y de bajo costo, características que le dan ventaja sobre otras técnicas.

The hand and wrist are very complex anatomy and function that make it susceptible to various soft tissue injuries and also represent anatomical areas are often affected by diseases of different etiologies as inflammatory arthritis, degenerative and crystal deposits. Ultrasonography is a useful imaging technique for the study of the hand and wrist by its multiplanar capability, without emission of radiation and low-cost features that give an advantage over other techniques.

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RESUMEN

Palmaris longus (PL) muscle, although of little functional use to the human upper limb, assumes great importance when used as a donor tendon for transfer or transplant. The surgeon's awareness of the incidence in a population is therefore desirable. In the present study, 500 Medical students (242 males and 258 females) of ages 16 to 40 years from both College of Medicine of the University of Lagos, Idi-Araba and Lagos State University College of Medicine, Ikeja were examined for the presence or absence of the PL tendon, using the conventional (Schaffer's) test. The prevalence and pattern of PL agenesis was further analyzed statistically for differences in the prevalence or pattern of PL agenesis with regard to body side or sex. The prevalence of PL agenesis was found to be 12.6 percent (8 percent Unilateral and 4.6 percent Bilateral). Out of those with unilateral agenesis, 20 (4 percent) had left-sided agenesis and 20 (4 percent) had right-sided agenesis. Although female subjects had a prevalence of agenesis of PL tendon (Unilateral and Bilateral combined) of 36 out of 258, (13.95 percent) while in male subjects this prevalence was 23 out of 242 (9.5 percent). The prevalence of PL muscle agenesis in this study was found to be much higher than the reported average for blacks (2-3 percent).

El músculo palmar largo (PL), aunque de poco uso funcional en el miembro superior humano, asume gran importancia cuando se utiliza como un tendón donante para la transferencia o trasplante. El cirujano ha tomado conciencia que la incidencia en una población es por tanto deseable. En el presente estudio, 500 estudiantes de medicina (242 hombres y 258 mujeres) de 16 a 40 años, de la Facultad de Medicina de la Universidad de Lagos (Idi-Araba) y la Facultad de Medicina de la Universidad Estatal de Lagos (Ikeja) fueron examinados para evaluar la presencia o ausencia del tendón del PL, utilizando la prueba convencional (Schaffer's). La prevalencia y el patrón de agenesia del PL fueron determinados para analizar diferencias estadísticas en la prevalencia o patrón de agenesia del PL con respecto al lado del cuerpo o sexo. Se encontró una prevalencia de agenesia del PL de 12,6 por ciento (8 por ciento y 4,6 por ciento unilateral y bilateralmente). De los sujetos con agenesia unilateral, 20 (4 por ciento) eran en el lado izquierdo y 20 (4 por ciento) en el lado derecho. Las mujeres tuvieron una prevalencia de agenesia del tendón del PL (unilaterales y bilaterales combinadas) en 36 de 258 (13,95 por ciento), mientras que en los hombres esta prevalencia fue en 23 de 242 (9,5 por ciento). La prevalencia de agenesia del músculo PL en este estudio se encontró mucho más alto que el promedio reportado para los negros (2-3 por ciento).

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