• Physical Therapy Korea
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• v.12 no.4
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• pp.33-40
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• 2005

The purpose of this study was to define more precisely the anatomy of the thumb flexor pulley system and to determine the relative contribution of each of the pulleys to the biomechanics of thumb motion at the metacarpophalangeal (MP) and interphalangeal (IP) joints. For this, 22 hands from 11 cadavers were used and randomly assigned to two groups. In the first group, the first annular (A1) pulley was cut first followed by the variable annular (Av) pulley and then the oblique pulley. In the second group, the oblique pulley was cut first followed by the, pulley and then the Av pulley. In 7 of 22 hands, it was a transverse structure parallel to the, pulley with a gap between the A1 and Av pulleys, referred to here as type I. In 9 hands, the A1 and Av pulleys were connected without any gap (type II). In 6 hands, the space between the A1 and Av pulleys were triangular in shape with fibers of the Av pulley converging toward the radial side (type III). In biomechanical study of both first and second experiments, there was no significant difference in MCP joint flexion between the all intact, A1 section, A1/Av section, A2 intact (A1/Av/oblique section), and no pulley configuration (p>.05). In occurring displacements less than 10 mm, there was no significant difference in IP joint flexion (p>.05). However, there was a significant decrease in IP joint flexion occurred in both 15 mm and 20 mm excursion (p<.05), when the oblique pulley was resected additionally after cutting the A1 and Av pulleys in first experiment, and when the A1 pulley was resected additionally after cutting the oblique pulley. According to the results, the injury of only the oblique pulley does not decrease thumb motion significantly. The oblique pulley injury with both the A1 and Av pulleys laceration decreased thumb motion significantly. The additional laceration of the A2 pulley does not decrease thumb motion.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.56-61
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• 2000

Recommendable reconstructive surgery in the patient with thumb amputation through base of the first metacarpal bone is pollicization. Some patients who do not agree with harvest sound finger as a new thumb, we can consider other options as toe transplantation or osteoplastic thumb reconstruction for creating thumb. Toe transplantation to the thumb is effective procedure in the amputation of distal to metacarpal shaft, it is rarely indicated in the cases of proximal to base of the first metacarpal bone. We performed three cases of modified osteoplastic thumb reconstruction with free vascularized rib that combined with scapular free flap or radial forearm flap. The length of transplanted rib ranged from 7~11cm, the donor vessels are posterior intercostal artery and vein which anastomosed to radial artery. The grafted rib wrapped with additional free flap for creating new thumb. Result of that procedure was not much encouraging, aesthetic appearance and mobility of thumb were not so satisfactory but reconstructed thumb gave improvement of the hand function without sacrificing toe or other digit. That gave reasonable stability for powerful side pinch and three pod pinch and opposable thumb with normal carpo-metacarpal joint motion that can give much function to the thumb absent hand. In spite of those disadvantages, thumb reconstruction with rib transfer can be useful for patients who do not want to lose another part of the body for creating thumb in basal amputation of the thumb metacarpal.

• Archives of Reconstructive Microsurgery
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• v.20 no.2
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• pp.126-131
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• 2011

Purpose: The subcutaneous pocket graft of the thumb tip amputation across or proximal to the lunula is chosen in case of impossible microvascular anastomosis and in patient who strongly desired to preserve the thumb tip after failed replantation. Materials and Methods: Two patients who underwent a subcutaneous pocket graft for a thumb tip reconstruction between August 2008 and November 2009 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 48 years and had sustained complete thumb tip amputations across or proximal to the lunula. In one case, the microsurgical replantation was not feasible and the other one revealed arterial insufficiency at the 7th day after microsurgical replantation. Results: Authors had experienced 2 cases of flaps which survived completely. The results of sensibility was good, the range of motion at interphalangeal joint and tip to tip pinch was acceptable and color mismatch and loss of thumb finger nail was unacceptable after more than 1 year follow up with conventional successful thumb tip replantation. Conclusion: The subcutaneous pocket graft could be chosen in thumb tip amputation in case of impossible microvascular anastomosis as well as who strongly desires to preserve thumb tip after failed replantation.

• Journal of the Korean Society for Precision Engineering
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• v.31 no.7
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• pp.643-649
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• 2014

In order to demonstrate the possibility of applying an ionic polymer metal composite (IPMC) to a finger exoskeleton, pinching motion analysis was performed for a thumb-index finger dummy actuated by IPMC actuators. The IPMC actuators of 5mm in width and 40mm in length with 2.4mm thickness generated 1.52N of blocking force for the applying voltage of 4.0V. Three actuators were installed on the three rotary joint of an index finger, and one actuator was installed on one proximal joint. Positions of each joint and finger tip were recorded on the video camera, and motion was analyzed. Power supply to the index finger actuators preceded power supply to the thumb actuator, and key pinching motion was accomplished in 180s. Tip pinching was accomplished in 135s as power supply to the thumb preceded power supply to the index finger.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.821-828
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• 2011

Purpose: The authors applied Bilhaut-Cloquet procedure to Wassel type III and IV duplicated thumb, which was limited to patients with Wassel type I, II. This procedure was applied in order to improve the growth potential, range of joint motion, joint stability and cosmetic outcome. Methods: Sixteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from May, 2005 to December, 2010. Seven patients were Wassel type III, nine patients were type IV. This procedure was applied not only to balanced type, but also unbalanced type or convergent type. Five patients were balanced type and eleven patients were unbalanced type. Convergent type of Wassel type IV was three. Sex ratio was the same, mean age at the operation was 20.1 months old (8~52 months old). Angular deformity, joint stability and range of joint motion and cosmetic outcome were considered together and estimated in Tada score. Also, postoperative subjective satisfaction score of the parents was evaluated by a 100-points scale. Results: Mean subjective satisfaction scored 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Range of motion was mean 20 degrees in interphalangeal joint and mean 73 degrees in metacarpophalangeal joint. Tada score showed 'good' in eleven patients (68.8%), 'fair' in three patients (18.7%) and 'poor' in two patients (12.5%). In seven patients those who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb. Conclusion: Bilhaut-Cloquet procedure can be applied not only to balanced type of Wassel type III, IV duplicated thumb, but also to unbalanced type or convergent type that focused on functional reconstruction and cosmetic improvement.

• Journal of Institute of Control, Robotics and Systems
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• v.16 no.9
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• pp.833-839
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• 2010

In this paper, a novel 1 DOF hand rehabilitation robot is proposed in consideration of ADL training for stroke patients. To perform several ADL trainings, the proposed robot can move the thumb part and the part of 4 fingers simultaneously and realize the full ROM (Range of Motion) in grasp. Based on these characteristics, the proposed robot realizes several types of grasp such as cylindrical grasp, lateral grasp, and pinch grasp by using a passive revolute joint that can change the thumb movement direction. The movement of the thumb is driven by a cable mechanism and the part of 4 fingers is moved by a four-bar linkage mechanism.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.527-532
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• 2008

Purpose: Transverse type or volar oblique type of defect of thumb tip can be covered by Moberg flap or second toe pulp free flap. We compared these two methods in functional result, patients' satisfaction, and sensation, etc. to find a better way to cover the defect of the thumb tip. Methods: From 2003 to 2006, we chose the patients randomly with preoperative pictures. The patients had the defect of the thumb tip which is either transverse or volar oblique type. The 6 patients were treated with Moberg flap and other 6 patients were treated with second toe pulp free flap. We have analyzed the results by 2 point discrimination, side pinching power test, pulp to pulp pinching power test, pain scales (visual analogue scale), satisfaction scales of the patients (functional and aesthetic), the degree of the range of motion, etc. Results: All flaps survived without any complications. In the cases of Moberg flaps, the value of static 2 point discrimination test was 5.6 mm, and the value of moving 2 point discrimination test was 4.8 mm. In the cases of second toe pulp free flaps, the values were 9.6 mm and 9.3 mm. In the cases of Moberg flaps, the value of the Side pinch power test was 6.6 kg, 4.4 kg. In the case of second toe pulp free flaps, the values were 4.8 kg and 2.5 kg. The value of aesthetic satisfaction scale of the patients in Moberg flaps was 5.6, the value of functional satisfaction scale of the patients was 3.6. In cases of second toe pulp free flaps, the values were 5.6 and 3.6. The active range of motion of Interphalangeal joint in the cases of Moberg flaps was 46.6 degree, and the active range of motion of metacarpophalangeal joint was 55 degree, in the cases of second toe pulp free flaps, the values were 36.6 degree and 59 degree. Conclusion: As a result, when the defect of the thumb tip is transverse or volar oblique type, we suggest that the operators choose Moberg flap to cover the defect of the thumb tip.

• Journal of Biomedical Engineering Research
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• v.32 no.4
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• pp.312-318
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• 2011

The purpose of study was to evaluate effects for repetitive use of thumb according to two different input types (button and touch) of mobile phones. A total of eight young and healthy subjects (6 males and 2 females: $24.63{\pm}8.04$ years) volunteered, and force measurement on thumb using film type pressure sensor was carried out for an hour. Before the experiment De Quervain's syndrome test were performed to check the left and right muscles related with thumb motion and after measuring the pressing force fatigue feeling survey achieved. For a statistical analysis, 1-to-5 ranking scale was used to score the fatigue feeling. From the result of pressure measurement, forces acting on thumb in button type were 3.36 times (the right thumb) and 3.16 times (the left thumb) for the touch type. And the result of survey, fatigue by using the button type of mobile phone was largely triggered than by using touch type. The abductor pollicis brevis and the flexor pollicis brevis were found as common part of fatigue for repetitively using thumb during texting messages. In the further study, some quantitative fatigue comparisons for various input motions are required to analyze repetitive strain injury syndrome.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.101-107
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• 2008

Purpose: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. Materials and Methods: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. Results: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. Conclusion: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.

• The Journal of Korean Physical Therapy
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• v.22 no.1
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• pp.33-38
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• 2010

Purpose: This study investigated the effect of taping therapy on metacarpophalangeal (MCP) disorders of the thumb. Methods: Twenty eight patients were enrolled in this study. They were randomly assigned to experimental (n=16) or a control group (n=12). The experimental and control groups received Ultrasound (Gymna Pulson 200) operating at a frequency of 3MHz and an intensity of $1.0W/cm^2$ with a 100% duty cycle for 10 minutes. The experimental group received, additionally, taping using Kinesiotape on the injured thumb. The following parameters were measured:pain during rest and flexion of the thumb, tenderness, range of motion (ROM), pinch and spherical grip power pre- and post-treatment. This study was carried out 3 days per week throughout the 2-week treatment. Results: There were significant improvements in pain during rest and flexion of the thumb, tenderness, ROM, pinch and spherical grip power between pre- and post-treatment times in both groups (p<0.05). However, there was a significant difference in all parameters between the experimental and control groups (p<0.05). Finally, the satisfaction level after intervention was significantly higher in the experimental group than in the control group (p<0.05). Conclusion: Taping is effective for treating pain and dysfunction in patients with thumb disorders.