With the increase of hand pathologies in the last decade, the need to better understand the anatomy of the hand is becoming more vital. The cutaneous innervation of the hand is classically described to be supplied by palmar cutaneous branch of the median nerve (PCBMN), common digital nerves (CDNs), ulnar nerve (UN), palmar cutaneous branch of the ulnar nerve, dorsal branch of the ulnar nerve (DBUN), superficial branch of the radial nerve (SBRN) and occasionally the lateral antebrachial cutaneous nerve (LABCN). Although the sensory distribution of the hand has been described in the literature, reports have often shown contradicting views and occasionally different or incomplete descriptions. Furthermore, clinical procedures in the hand and wrist can result in painful and/or disabling postoperative complications. This thesis outlines, categorizes and describes the distribution and branching patterns of cutaneous branches supplying the palmar and dorsal surface of the hand and their relationship to the distal area of the forearm and wrist. It also investigates the palmar and dorsal communicating branches, their patterns and common locations. Moreover, the project discusses the impact of the distribution and branching patterns of the cutaneous nerves on surgical and diagnostic procedures performed in the hand, wrist and distal forearm. 160 cadaveric hands were dissected in the Centre for Anatomy and Human Identification (CAHID), University of Dundee. All cadavers were musculoskeletally mature adults with mean age of 82.5±9.4 (range: 53-101) years. Skin was removed from the distal half of the forearm to the metacarpophalangeal joints. Nerves under investigation were identified, dissected, and traced. Sketches, photographs, and measurements to predefined landmarks including the wrist crease (WC), bistyloid line (BSL) and the third metacarpophalangeal (MCP) joint were taken and results expressed as means, standard deviations and ranges. Patterns are classified and expressed with frequencies. The PCBMN was found to originate from the main trunk of the median nerve (MN) 54.1±15.7 mm proximal to the WC and course distally between flexor carpi radialis and palmaris longus (if present) to innervate the proximal palmar surface of the hand by branching into one of three types identified. Furthermore, two PCBMN were found in 8.9% of cases. The second, third, fourth CDNs were found to divide into proper digital nerves at a point located distal to the 70% of the distance between the third MCP joint and the BSL in 88% of cases. The cutaneous innervation of the palm was found to be relatively constant with the lateral 3½ digits being supplied by the MN and the medial 1½ being supplied by the UN. A palmar CB was found between the third CDN-MN and fourth CDN-UN in 86.9% of the cases coursing in different patterns and changing the palmar sensory innervation of that previously described. The sensory innervation of the dorsum of the hand was variable. The most common pattern was being supplied by the SBRN innervating the lateral dorsal skin and the skin covering the lateral 2½ digits and the DBUN innervating the medial dorsal skin and the skin covering the medial 1½ digits found in 37.3%. All radial supply to the dorsum of the hand with the absence of the DBUN was found in 6.7%. The SBRN connected with the LABCN in 30.7% and with the DBUN in 26.4% complicating the sensory innervation in the dorsum of the hand. Understanding the cutaneous innervation of the hand, appreciation of the possible variations and presence of communicating branches will result in a better evaluation of signs and symptoms, establishing a proper therapeutic plan, avoiding iatrogenic injuries during surgical interventions, and properly diagnose postoperative complications leading to an increased quality of medical service and patient satisfaction.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The hand is one of the most complex of all of the anatomical structures in the human body. It has been found that hand injuries are among the most frequent injuries that occur to the body, predominantly during industrial activities. It has therefore been concluded that more research is needed into protective factors, such as glove use. The design features of a glove emphasise either protection or performance. There is often a trade-off between increased safety and performance capability when donning gloves. It has been determined that gloves which are fitted and comfortable for the worker may provide the best compromise between protective functions and decreased performance. This investigation aimed to assess the influence of glove fit on the performance attributes of industrial tasks, as well as on the responses of the human operator. Glove fit was analysed as 35 male participants donned three different glove sizes during each test, including a best-fitting glove, a glove one size smaller than best-fitting, and a glove one size larger than best-fitting. For each glove size, gloves of two differing materials were tested, namely nitrile and neoprene. A barehanded condition was also tested, totalling seven gloved/barehanded conditions for each test. The seven conditions were assessed in a laboratory setting in a battery of tests. This consisted of components of task performance, including maximum pulling and pushing force, maximum torque, precision of force, tactility, speed and accuracy and dexterity. The performance responses were recorded, as well as participants’ perceptual responses using the Rating of Perceived Exertion scale, and muscle activity. Six muscles were selected: Flexor Digitorum Superficialis, Flexor Pollicus Longus, Extensor Carpi Ulnaris, Extensor Carpi Radialis, Flexor Carpi Ulnaris and Flexor Carpi Radialis. The results revealed that glove fit does affect certain spects of performance, and influences human operator responses for selected task components. Furthermore, discrepancies were distinguished between orking barehanded and working with an optimally fitted glove. There was also a glove material effect established. Overall, it was found that muscle activity when exerting maximum force in a pushing and pulling direction was optimal with the nitrile glove material. Maximum torque performance was enhanced with the use of a best-fitting glove, as compared with an ill-fitting glove or barehanded work. Force precision was preferable when barehanded, as opposed to the tactility task which rendered optimal results with a best-fitting glove. The same was found for speed and accuracy results, as glove fit appeared to have no effect on performance, but performance was improved when participants were barehanded. Dexterity performance was the most conclusively influenced by the conditions, resulting in barehanded performance being optimal. However, should a glove be necessary for a given task, an optimally-fitted glove which is of a thinner material would be recommended. It is necessary to distinguish the performance components of a task within industry and select the most appropriate glove for optimal performance and the least risk of overexertion.

A artrite reumatóide (AR) é uma patologia crônica e sistêmica de etiologia desconhecida provavelmente multifatorial na qual há um predomínio de acometimento da sinóvia. Afeta de 0,5 a 1 % da população com predomínio nas mulheres. O diagnóstico precoce e o inicio da terapêutica adequada são fundamentais e podem modificar a evolução da doença reduzindo as graves seqüelas. O custo do exame de ressonância magnética (RM) é a maior limitação neste método de diagnóstico. O objetivo deste estudo foi avaliar a especificidade e a sensibilidade da ressonância magnética (RM) da mão e do punho de pacientes com AR precoce de acordo com os parâmetros do OMERACT (comitê internacional para avaliação de medidas em reumatologia para análise da ressonância magnética) correlacionando com a radiologia convencional. Foram avaliados 19 pacientes com AR (idade: 22-64 anos) e um grupo controle composto por 10 indivíduos sem história de patologias prévias com idade de 26-46 anos. Foram realizados exames de radiografia (RX) e RM da mão e do punho dominante. Treze articulações foram avaliadas pelo RX convencional (radio-ulnar distal, radiocarpal, intercarpal e metacarpofalângicas do primeiro ao quinto dedo e articulação interfalângicas proximais do primeiro ao quinto dedo). As lesões ósseas no RX foram classificadas de acordo com o método de Van Der Heiidje com graduações de 0 a 4 para redução do espaço articular e de 0 a 5 para erosão óssea. Foram realizados exames de RM num equipamento marca GE 1,5 T Signa Horizon LX (General Eletric medical systems) utilizando T1, T2 eco de spin e T1 eco de Spin com saturação de gordura após a infusão do contraste paramagnético gadopentato dimegumina. O protocolo foi realizado de acordo com as padronizações do OMERACT. Como resultados obtivemos que a RM foi mais sensível na pesquisa de erosão óssea (94,7%) que o RX (78,9%). Somente as articulações intercarpais e metacarpo-falângicas do segundo dedo demonstraram correlação estatística entre os 2 métodos (r=0,47 p=0,04 e r=0,63 p=0,004). Para erosão óssea os compartimentos radiocarpal (73,7%) e intercarpal (84,2%) foram os mais sensíveis e com maior acurácia. Além disso, a RM foi muito sensível no estudo da sinovite presente em 100% dos pacientes com AR comparados com 20% do grupo controle. Quando estudados nos sítios anatômicos o carpo foi o local mais sensível para a sinovite (100%). O edema intra-ósseo foi mais detectado no punho com uma alta especificidade (90%), porém com baixa acurácia (50%) um achado importante é que a analise simultânea do punho e da mão não aumentou a detecção de um maior número de pacientes com AR. Concluindo, a RM foi mais sensível que o RX no estudo da AR precoce. Este trabalho demonstrou que o estudo do punho apresentou uma ótima sensibilidade e especificidade no diagnóstico precoce da AR e somente o estudo deste compartimento parece ser adequado com redução do custo do exame para os pacientes, portanto na análise do AR precoce o punho parece apresentar melhor desempenho. / Rheumatoid arthritis (RA) is a chronic and systemic disease of unknown etiology probably multifactorial with a predominant involvement of synovial tissue. The disease prevalence is 0.5-1% and affects more often women. Early diagnosis and therapy are essential to modify the course of the disease and reduce the degree of severe late sequelae. The cost of MRI of this region is a major limitation for the use of this sensitive exam. We therefore decided to evaluate if the wrist magnetic resonance with a simultaneous reading of wrist and hand compartments according to the OMERACT parameters would be sensitive and accurate to diagnose early RA. We have evaluated 19 patients with RA (ages: 22-64 years) and 10 age-matched controls. X-ray and MRI evaluated the dominant wrist all subjects. Thirteen joints were evaluated by conventional radiography: radio-ulnar distal (DRU), radiocarpal joint (RC), intercarpal (IC), metacarpo-phalageal (first to fifth finger) and phalangophalangeal (first to fifth finger). The bone lesion in the radiograph was scored by the method of Van Der Heidje for joint damage and for joint narrowing space. Wrist MRI imaging was performed with 1,5 T GE Signa Horizon LX 8,2 (General Eletric medical systems) with multiplanar T1, T2 (spin echo and fast spin echo) and T1 fat sat after intravenous injection of gadopentetate dimeglumine, according to the definitions of OMERACT. The MRI was more sensitive to detect erosion (94.7%) than the conventional X-ray (78.9%), and only intercarpal and metacarpofalangic joints of the second finger showed statistic correlation in the two methods (r=0.47 p=0.04 e r= 0.63 p=0.004). Of interest, among the anatomic compartments evaluated the radiocarpal (73.7%) and intercarpal joints (84.2%) were the most sensitive and accurate to detect erosion. Moreover, the MRI was also very sensitive to detect synovitis, present in 100% of the AR compared 20% in the control group, p<0,001. With regards to the anatomic site, synovitis was uniformly observed in all carpal joints (100%). Edema was also more frequently detected in the wrist joints with a high specificity (90%) but low accuracy (50%). Importantly, the simultaneous reading of wrist and hands did not identify additional cases. MRI imaging was more sensitive than conventional radiography in detecting early lesion in RA Our data support the notion that wrist MRI has an excellent sensitivity and specificity to diagnose early RA, and therefore only this assessment seems to be adequate, with a reduced cost for the patients. Additionally, we have demonstrated that the reading may be restrict to the wrist compartment, overcoming the technical limitations of the hand anatomical site.

A artrite reumatóide (AR) é uma patologia crônica e sistêmica de etiologia desconhecida provavelmente multifatorial na qual há um predomínio de acometimento da sinóvia. Afeta de 0,5 a 1 % da população com predomínio nas mulheres. O diagnóstico precoce e o inicio da terapêutica adequada são fundamentais e podem modificar a evolução da doença reduzindo as graves seqüelas. O custo do exame de ressonância magnética (RM) é a maior limitação neste método de diagnóstico. O objetivo deste estudo foi avaliar a especificidade e a sensibilidade da ressonância magnética (RM) da mão e do punho de pacientes com AR precoce de acordo com os parâmetros do OMERACT (comitê internacional para avaliação de medidas em reumatologia para análise da ressonância magnética) correlacionando com a radiologia convencional. Foram avaliados 19 pacientes com AR (idade: 22-64 anos) e um grupo controle composto por 10 indivíduos sem história de patologias prévias com idade de 26-46 anos. Foram realizados exames de radiografia (RX) e RM da mão e do punho dominante. Treze articulações foram avaliadas pelo RX convencional (radio-ulnar distal, radiocarpal, intercarpal e metacarpofalângicas do primeiro ao quinto dedo e articulação interfalângicas proximais do primeiro ao quinto dedo). As lesões ósseas no RX foram classificadas de acordo com o método de Van Der Heiidje com graduações de 0 a 4 para redução do espaço articular e de 0 a 5 para erosão óssea. Foram realizados exames de RM num equipamento marca GE 1,5 T Signa Horizon LX (General Eletric medical systems) utilizando T1, T2 eco de spin e T1 eco de Spin com saturação de gordura após a infusão do contraste paramagnético gadopentato dimegumina. O protocolo foi realizado de acordo com as padronizações do OMERACT. Como resultados obtivemos que a RM foi mais sensível na pesquisa de erosão óssea (94,7%) que o RX (78,9%). Somente as articulações intercarpais e metacarpo-falângicas do segundo dedo demonstraram correlação estatística entre os 2 métodos (r=0,47 p=0,04 e r=0,63 p=0,004). Para erosão óssea os compartimentos radiocarpal (73,7%) e intercarpal (84,2%) foram os mais sensíveis e com maior acurácia. Além disso, a RM foi muito sensível no estudo da sinovite presente em 100% dos pacientes com AR comparados com 20% do grupo controle. Quando estudados nos sítios anatômicos o carpo foi o local mais sensível para a sinovite (100%). O edema intra-ósseo foi mais detectado no punho com uma alta especificidade (90%), porém com baixa acurácia (50%) um achado importante é que a analise simultânea do punho e da mão não aumentou a detecção de um maior número de pacientes com AR. Concluindo, a RM foi mais sensível que o RX no estudo da AR precoce. Este trabalho demonstrou que o estudo do punho apresentou uma ótima sensibilidade e especificidade no diagnóstico precoce da AR e somente o estudo deste compartimento parece ser adequado com redução do custo do exame para os pacientes, portanto na análise do AR precoce o punho parece apresentar melhor desempenho. / Rheumatoid arthritis (RA) is a chronic and systemic disease of unknown etiology probably multifactorial with a predominant involvement of synovial tissue. The disease prevalence is 0.5-1% and affects more often women. Early diagnosis and therapy are essential to modify the course of the disease and reduce the degree of severe late sequelae. The cost of MRI of this region is a major limitation for the use of this sensitive exam. We therefore decided to evaluate if the wrist magnetic resonance with a simultaneous reading of wrist and hand compartments according to the OMERACT parameters would be sensitive and accurate to diagnose early RA. We have evaluated 19 patients with RA (ages: 22-64 years) and 10 age-matched controls. X-ray and MRI evaluated the dominant wrist all subjects. Thirteen joints were evaluated by conventional radiography: radio-ulnar distal (DRU), radiocarpal joint (RC), intercarpal (IC), metacarpo-phalageal (first to fifth finger) and phalangophalangeal (first to fifth finger). The bone lesion in the radiograph was scored by the method of Van Der Heidje for joint damage and for joint narrowing space. Wrist MRI imaging was performed with 1,5 T GE Signa Horizon LX 8,2 (General Eletric medical systems) with multiplanar T1, T2 (spin echo and fast spin echo) and T1 fat sat after intravenous injection of gadopentetate dimeglumine, according to the definitions of OMERACT. The MRI was more sensitive to detect erosion (94.7%) than the conventional X-ray (78.9%), and only intercarpal and metacarpofalangic joints of the second finger showed statistic correlation in the two methods (r=0.47 p=0.04 e r= 0.63 p=0.004). Of interest, among the anatomic compartments evaluated the radiocarpal (73.7%) and intercarpal joints (84.2%) were the most sensitive and accurate to detect erosion. Moreover, the MRI was also very sensitive to detect synovitis, present in 100% of the AR compared 20% in the control group, p<0,001. With regards to the anatomic site, synovitis was uniformly observed in all carpal joints (100%). Edema was also more frequently detected in the wrist joints with a high specificity (90%) but low accuracy (50%). Importantly, the simultaneous reading of wrist and hands did not identify additional cases. MRI imaging was more sensitive than conventional radiography in detecting early lesion in RA Our data support the notion that wrist MRI has an excellent sensitivity and specificity to diagnose early RA, and therefore only this assessment seems to be adequate, with a reduced cost for the patients. Additionally, we have demonstrated that the reading may be restrict to the wrist compartment, overcoming the technical limitations of the hand anatomical site.

The hands and feet account for half of the complexity of the musculoskeletal system, while the skin of the hand is specialised with many important structures. Much of the subtlety of the mechanism of the hand lies in the soft tissues, and the tactile and proprioceptive sensitivity depends on the large number of mechanoreceptors embedded in specific structures of the soft tissues. This thesis investigates synthetic materials and manufacturing techniques to enable building robots that reproduce the biomechanics and tactile sensitivity of vertebrates – histomimetic robotics. The material and mechanical anatomy of the hand is reviewed, highlighting difficulty of numerical measurement in soft-tissue anatomy, and the predictive nature of descriptive anatomical knowledge. The biomechanical mechanisms of the hand and their support of sensorimotor control are presented. A palate of materials and layup techniques are identified for emulating ligaments, joint surfaces, tendon networks, sheaths, soft matrices, and dermal structures. A method for thermoplastically drawing fine elastic fibres, with liquid metal amalgam cores, for connecting embedded sensors is demonstrated. The performance requirements of skeletal muscles are identified. Two classes of muscle-like bulk MEMS electrostatic actuators are shown theoretically to be capable of meeting these requirements. Means to manufacture them, and their additional application as mechanoreceptors are described. A novel machine perception algorithm is outlined as a solution to the problem of measuring soft tissue anatomy, CAD/CAE/CNC for layup of histomimetic robots, and sensory perception by such robots. The results of the work support the view that histomimetic robotics is a viable approach, and identify a number of areas for further investigation including: polymer modification by graft-polymerisation, automated layup tools, and machine perception.

Dans nos sociétés culturelles, trois régions anatomiques sont habituellement apparentes et visibles donc identifiables :ce sont le visage et les mains. La main est donc un élément d’identification spécifique à chaque individu et reconnaissable. En mesurant le volume de la main démembrée d’une personne, peut-on déterminer la typologie de cette personne associant, entre autres mesures de la main, le volume au poids? <p>La mesure du volume de moulage des mains de 109 adultes (dont 14 gauchers) est réalisée à l’aide d’un volumètre à aiguille et plusieurs équations de régression mettent en évidence les relations entre des composantes anthropométriques du corps et de ses segments avec le volume des mains. Ensuite, le volume et des variables spécifiques des mains d’un nouvel échantillon de 88 sujets vivants sont mesurés et leur typologie est également déterminée. Les équations de régression caractérisant les relations entre les variables des mains et la typologie estiment la stature par les longueur et largeur des mains (Main Droite :r² = .66 ;SEE = 4 cm ;Main Gauche :r² = .62 ;SEE = 4,2cm) et le poids par le volume et le périmètre de PII du 5ème doigt (MD :r² = .69 ;SEE = 6.64kg ;MG :r² = .64 ;SEE = 7,13kg). La validation de la méthode est réalisée sur un échantillon analogue mais indépendant de 21 sujets adultes. Le poids de 90.5 % des sujets est estimé avec un écart maximum de 5.98kg et la stature de 76% de l’échantillon avec un écart maximum de 3cm. <p>De nombreuses techniques ont été élaborées afin de reconstruire le visage à partir du crâne d’une personne disparue ;dans le même ordre d’idée peut-on reconstruire l’aspect virtuel de la peau d’une main en disposant de son squelette ?Des modèles informatisés, par CT Scan, des os et de la peau sont obtenus des mains d’un cadavre et d’un volontaire. Le logiciel Lhp Builder permet la localisation des coordonnées spatiales de points de repères anatomiques osseux des modèles. A partir de 3 repères, les relations spatiales entre les modèles sont établies et employées afin d’interpoler la peau manquante de la main. Le volume de la « peau interpolée » et le volume de la « peau réelle » obtenus par imagerie médicale sont comparés afin de valider la méthode. Une différence de volume de 3.5 % entre les volumes respectifs de la main du cadavre et de la main reconstruite situe le niveau de précision de la méthode. <p>D’autres manipulations de reconstruction sont exécutées dans des situations analogues au cadre médico-légal (enfouissement en terre de pièces animales, mise en digestion dans des produits caustiques). <p>Cette première approche méthodologique de reconstruction de la main semble prometteuse et la main reconstruite deviendrait un élément important pour l’identification de personnes disparues./ <p><br><p><p>In our cultural society, three anatomical body parts are usually apparent so visible and thus identifiable: the face and the hands. The hand may be an element of identification specific to each individual and recognizable. By measuring the dismembered hand volume of a person, the typology of this person associating, inter alia measurements of the hand, volume with weight could be determined ?<p>The volume measurement of casts hands of 109 adults (of which 14 left-handed persons) is realized using a needle volumeter and several regression equations highlight the relations between anthropometrical components of the body and its segments with the hands volume. Then, the hands volume and specific hands variables of a new sample of 88 living subjects are measured and their typology is also determined. The regression equations characterizing the relations between the hands variables and typology estimate the stature by hands length and width (Right hand: r² = 66; SEE = 4 cm; Left hand: r² = 62; SEE = 4,2cm) and the weight by volume and perimeter of PII of the 5 th finger (Right hand: r² = 69; SEE = 6.64kg; Left hand: r² = 64; SEE = 7,13kg). The validation of the method is carried out on a sample similar but independent of 21 adult subjects. The weight of 90.5 % of the subjects is estimated with a maximum difference of 5.98kg and the stature of 76% of the sample with 3cm maximum. <p>Many techniques were elaborated in order to rebuild the face starting from cranium of a missing person; in the same order can one rebuild the virtual aspect of the hand skin while having its skeleton? From computerized models, by CT Scan, bones and skin are obtained of hands of a corpse and a living volunteer. The software Lhp Builder allows the localization of the 3D co-ordinates of anatomical bones landmarks of the models. From 3 landmarks, the 3D relations between the models are established and used in order to interpolate the missing skin of the hand. The volume of the " interpolated skin " and the volume of the " real skin " obtained by medical imaging are compared in order to validate the method. A volume difference of 3.5 % between respective volumes of the hand corpse and the rebuilt hand estimates the level of precision of the method. <p>Other experiments of rebuilding are carried out in situations similar to the medico-legal framework (ground hiding of animal parts, digestion in caustic products). <p>This first methodological approach of hand rebuilding seems promising and the rebuilt hand would become a significant element for the identification of missing people. <p><p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished