Whole Body Little Finger 2005 Dvdrip
Jemima Torguson
The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Whether the upper or lower extremities, the back or abdominal wall, the eyes or ears, or the cardiovascular, digestive, or other system, or psyche are affected, evaluations are based upon lack of usefulness, of these parts or systems, especially in self-support. This imposes upon the medical examiner the responsibility of furnishing, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of disability upon the person's ordinary activity. In this connection, it will be remembered that a person may be too disabled to engage in employment although he or she is up and about and fairly comfortable at home or upon limited activity.
Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.
Ulnar neuropathy occurs when there is damage to the ulnar nerve. This nerve travels down the arm to the wrist, hand, and ring and little fingers. It passes just under the surface of the skin near the elbow. So, bumping the nerve there causes the pain and tingling of "hitting the funny bone."
The joints in our hands are made up of cartilage surfaces that cap the bones. Cartilage is a smooth surface that allows for gliding. When cartilage is healthy, there is a cushioning effect of the cartilage that absorbs and evens out the forces across the joint. Our joints typically have a capsule of tough, but flexible, fibrous tissue that helps hold the joints together and an inner lining of synovium. The synovium has multiple functions including to help provide fluid for lubrication of the joint. The tough fibrous tissue is often what is injured when you have a sprain of a joint.
When discussing hand joints, we refer to the palmar or volar surface (the palm side), the dorsal surface (the back of the hand), the radial side (toward the thumb), and the ulnar side (toward the little finger).
Common problems at the MCP joint include arthritis and collateral ligament injuries. The middle finger MCP joint is the most common finger (it can happen to any finger) to have a radial sagittal band injury. This results in the extensor tendon snapping to the pinky side of the hand.
Carpometacarpal Joint (CMC Joint)
The middle finger CMC joint has little motion. Injuries and problems with this joint are uncommon. Occasionally, joint pain can be caused by a CMC boss.
BDA2 is characterized by hypoplasia/aplasia of the 2nd middle phalanx of the index finger and sometimes little finger. It was first described by Mohr and Wriedt [15]. Characteristically, affected individuals have a triangular-shaped middle phalanx in the index fingers and second toes. In severely affected cases, the index finger is curved radially. Deformity of the 2nd toe is a more consistent finding than deformity of the index finger.
BDA3 is characterized by shortening of the middle phalanx of the little finger. Slanting of the distal articular surface of the middle phalanx leads to radial deflection of the distal phalanx. It is not always associated with clinodactyly. A single flexion crease of the little finger indicates a short or absent middle phalanx. This type should be differentiated from other types of crooked little fingers, namely Kirner deformity and camptodactyly, in the former there is radial bowing of the terminal phalanx due to curving of its shaft. Camptodactyly is a flexure contracture deformity of the interphalangeal joints.
Hertzog [21] defined it as middle phalanx V less than half the length of middle phalanx IV. Garn et al. [22] provided percentiles for the length of the phalanges and metacarpals for various age groups making the diagnosis of brachydactyly possible in doubtful cases. Clinodactyly is not always associated with a short middle phalanx and vice-versa. A single flexion crease of the little finger indicates a short or absent middle phalanx. Other associated anomalies should be sought to diagnose syndromic associations [1].
There is absence or hypoplasia of the terminal parts of the index to little fingers with complete absence of fingernails. The thumbs are always intact but frequently show flattening, splitting or duplication of the distal phalanges. Digits are less severely affected on the radial side of the hand compared to those on the ulnar side. The feet are similarly but less severely affected. The deformity is symmetric. There is soft tissue syndactyly, symphalangism, carpal and/or tarsal fusions and shortening of metacarpals and/or metatarsals.
The hand deformity is characterized by brachymesophalangy of the index, middle and little fingers with hyperphalangy of the index and middle finger and shortening of the 1st metacarpal. The ring finger is usually the longest digit. The proximal phalanx of the index finger has an anomalous configuration resulting in its ulnar deflection. Short metacarpals and symphalangism are occasionally present. The feet are either normal or show ordinary brachydactyly. Temtamy and McKusick [1] reported one family with 10 affected members from 3 generations representing autosomal dominant inheritance and variable expressivity. The proband and her identical twin were similarly affected, with mild variability. Considerable intra- and interfamilial variation has been observed in type C brachydactyly [32].
This malformation of the little finger was first described by Kirner in 1972 [54]. It consists of radial bowing of the terminal phalanx. The tip of the little finger points towards the thenar eminence. This malformation is usually bilateral.
It is of utmost importance in cases of brachydactyly to proceed with clinical evaluation of both hands and feet including radiological evaluation, clinical evaluation of the whole body of the patient, family history (taking non-penetrance into account), and, if possible, clinical evaluation of at least first degrees relatives. If symptoms in other parts of the body are present, specific studies may be needed depending on the accompanying symptoms. Molecular analysis in isolated forms or syndromic cases of brachydactyly should be carried out if results could have consequences for patient care and/or for genetic counseling, or if indicated on research grounds.
The robotic sixth finger setup and experiment. (A) The 3D-printed robotic sixth finger actuated by a servo motor in the chassis. The entire arrangement is designed to be strapped onto the hand of participants, near their left little finger. The right photo is a six-fingered glove worn by a participant with the robotic finger attached. (B) Schematic of the habituation task. In task 1, participants wore a glove with LEDs fixed on the tip of the glove fingers. They bent the finger corresponding to the LED that lit up. In task 2, a tablet PC on the desk displayed a piano-like key under each of the five fingers (including the robotic finger, and except the thumb). The participants pressed the key that lit up. Both tasks were aligned with the beats of popular music that were played in the headphones of the participants. (C) The experiment paradigm. The participants worked in two conditions: controllable and random. In each condition, they started with two pre-tests to measure specific body representations (explained later in the text), followed by the habituation, then two post-tests, and finally ending with a questionnaire (see Fig. 2) to assess their cognitive percept. The photos in (A,B) were taken by Yui Takahara.
Our developed robotic sixth finger system consists of a three-phalanged, one degree of freedom, plastic finger (6 cm in length) and a tactile stimulator in the form of a sliding plastic pin. The finger was actuated by a servo motor (ASV-15-MG, Asakusa Gear Co., Ltd.) (Fig. 1A) that enabled the robotic finger to flex like a real human finger. The robotic finger was connected to the stimulator by a crank-pin link such that the flexing of the robotic finger made the pin slide. The entire arrangement was designed to be strapped onto the hand of participants, near their left little finger, such that the tactile stimulator stimulated the side of their palm, below the little finger when the robotic finger flexed (see Fig. 1A). The robotic finger was operated using electromyography (EMG) recorded from four wrist/finger muscles (flexor carpi radialis muscle, flexor carpi ulnaris muscle, extensors carpi radialis muscle, and extensor digitorum muscle) in their left forearm. We used the Delsys Trigno Wireless EMG System (sampling rate, 2000 Hz) for the EMG recording. The recorded EMG signals were read into the Arduino Mega 2560, utilizing the Simulink Support Package for Arduino Hardware.
Independent haptic sensory feedback: The sliding pin stimulator incorporated with the finger provides haptic feedback of the movement of the robotic finger on the side of the palm, ensuring sensory independence to any other limb of the body.
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