The Hand Hug: A Novel Test for Linburg–Comstock Syndrome and Wide-awake Correction of the Anomaly
Notice bibliographique
Résumé
In 1979, Linburg and Comstock1 described an inability to flex the interphalangeal joint of the thumb without simultaneously flexing the distal interphalangeal joint of the index finger, caused by a congenital anomalous connection between the flexor pollicis longus tendon and the flexor digitorum profundus tendon to the index finger. The “hand hug test” is a novel clinical test for this condition. The palm of the affected hand of the patient is placed on the ipsilateral palm of the examiner’s hand with all the digits lined up in extension. The thumbs are abducted. The patient is asked to bend the thumb around the examiner’s hand while the examiner does the same action—as if the hands are “hugging.” Because the index finger of the patient and the small finger of the examiner are aligned and blocking each other in extension, the thumb of the patient with the Linburg-Comstock anomaly is not able to make a “hand hug.” We report the case of a 20-year-old, right-hand dominant carpentry student who had a complete inability to move his right thumb and right index finger independently. The patient did have the anomaly on the contralateral side, but it was far less pronounced. Specific activities affected by the anomaly were piano, typing, and rock climbing. The phenomenon had always been present but was progressively becoming more pronounced, with no clear history of an inciting traumatic event. We performed a point-of-care ultrasound examination and observed a pathologic band in both the coronal and sagittal view, which was 4 cm in length. We agree that magnetic resonance imaging or computed tomography scan can be helpful to characterize the anatomy, but high-frequency ultrasonography is sufficient to localize the congenital band.2 We performed wide-awake surgery with subcutaneous local anesthesia infiltration of 10 mL lidocaine 1% with 10 mg/mL of epinephrine with 20 mL saline buffered with 2 mL 8.3% bicarbonate [wide awake local anesthesia no tourniquet (WALANT) technique].3 The local anesthesia was allowed at least 45 minutes to take effect before the procedure. The patient was positioned supine with the affected limb on an arm board without a tourniquet. The surgical field was prepared and draped using field sterility. A linear incision was made along the radial aspect of the distal forearm over the flexor carpi radialis tendon, just proximal to the volar wrist crease. The anomalous connection was confirmed by the synkinesis of the tendons on both active and passive intraoperative testing. We observed the fibrous type anomalous connection, which is the most common type among the classification of Yurasakpong et al.4 We sharply divided the connection, which immediately corrected the anomaly. The thumb and index finger could now move independently, and the patient was able to make the “hand hug” with the surgeon [See Video (online), which displays the preoperative clinical and ultrasound examination, surgical procedure, and final result with the “hand hug test” for each step]. The patient was mobilized immediately, using principles of hand elevation, early cessation of postoperative analgesics, and “pain-guided healing.” Hand therapy was used to encourage independent tendon gliding. He made a complete recovery and was able to return to normal activities without restrictions. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"This video displays the preoperative clinical and ultrasound examination, surgical procedure and final result with the « hand hug test” for each step.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_pcsm1wze"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} PATIENT CONSENT The patient provided written consent for the use of his image.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».