Extrinsic flexor muscles generate concurrent flexion of all three finger joints

The role of the forearm (extrinsic) finger flexor muscles in initiating rotation of the metacarpophalangeal (MCP) joint and in coordinating flexion at the MCP, the proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints remains a matter of some debate. To address the biomechanical feasibility of the extrinsic flexors performing these actions, a computer simulation of the index finger was created. The model consisted of a planar open-link chain comprised of three revolute joints and four links, driven by the change in length of the flexor muscles. Passive joint characteristics, included in the model, were obtained from system identification experiments involving the application of angular perturbations to the joint of interest. Simulation results reveal that in the absence of passive joint torque, shortening of the extrinsic flexors results in PIP flexion (80°), but DIP (8°) and MCP (7°) joint extension. The inclusion of normal physiological levels of passive joint torque, however, results in simultaneous flexion of all three joints (63° for DIP, 75° for PIP, and 43° for MCP). Applicability of the simulation results was confirmed by recording finger motion produced by electrical stimulation of the extrinsic flexor muscles for the index finger. These findings support the view that the extrinsic flexor muscles can initiate MCP flexion, and produce simultaneous motion at the MCP, PIP, and DIP joints.     

The effect of finger extensor mechanism on the flexor force during isometric tasks.

The role of the intrinsic finger flexor muscles was investigated during finger flexion tasks. A suspension system was used to measure isometric finger forces when the point of force application varied along fingers in a distal-proximal direction. Two biomechanical models, with consideration of extensor mechanism Extensor Mechanism Model (EMM) and without consideration of extensor mechanism Flexor Model (FM), were used to calculate forces of extrinsic and intrinsic finger flexors. When the point of force application was at the distal phalanx, the extrinsic flexor muscles flexor digitorum profundus, FDP, and flexor digitorum superficialis, FDS, accounted for over 80% of the summed force of all flexors, and therefore were the major contributors to the joint flexion at the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints. When the point of force application was at the DIP joint, the FDS accounted for more than 70% of the total force of all flexors, and was the major contributor to the PIP and MCP joint flexion. When the force of application was at the PIP joint, the intrinsic muscle group was the major contributor for MCP flexion, accounting for more than 70% of the combined force of all flexors. The results suggest that the effects of the extensor mechanism on the flexors are relatively small when the location of force application is distal to the PIP joint. When the external force is applied proximally to the PIP joint, the extensor mechanism has large influence on force production of all flexors. The current study provides an experimental protocol and biomechanical models that allow estimation of the effects of extensor mechanism on both the extrinsic and intrinsic flexors in various loading conditions, as well as differentiating the contribution of the intrinsic and extrinsic finger flexors during isometric flexion.     

Ultrasonography,magnetic resonance imaging,radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd–5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP] joints, and distal interphalangeal [DIP] joints) and 1st–5th metatarsophalangeal joints of both hands and feet were assessed with US for the presence of synovitis, bone erosions, bone proliferations, and capsular/extracapsular power Doppler signal (only in the PIP joints). The 2nd–5th flexor and extensor tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer. US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high absolute agreement (85% to 100%) for all destructive changes and a more moderate absolute agreement (73% to 100%) for the inflammatory pathologies were found between US and MRI. US detected a higher frequency of DIP joint changes in the PsA patients compared with RA patients. In particular, bone changes were found exclusively in PsA DIP joints. Furthermore, bone proliferations were more common and tenosynovitis was less frequent in PsA than RA. For other pathologies, no disease-specific pattern was observed. US and MRI have major potential for improved examination of joints, tendons, and entheses in fingers and toes of patients with PsA.     

Biomechanical Analysis of the Human Finger Extensor Mechanism during Isometric Pressing

This study investigated the effects of the finger extensor mechanism on the bone-to-bone contact forces at the interphalangeal and metacarpal joints and also on the forces in the intrinsic and extrinsic muscles during finger pressing. This was done with finger postures ranging from very flexed to fully extended. The role of the finger extensor mechanism was investigated by using two alternative finger models, one which omitted the extensor mechanism and another which included it. A six-camera three-dimensional motion analysis system was used to capture the finger posture during maximum voluntary isometric pressing. The fingertip loads were recorded simultaneously using a force plate system. Two three-dimensional biomechanical finger models, a minimal model without extensor mechanism and a full model with extensor mechanism (tendon network), were used to calculate the joint bone-to-bone contact forces and the extrinsic and intrinsic muscle forces. If the full model is assumed to be realistic, then the results suggest some useful biomechanical advantages provided by the tendon network of the extensor mechanism. It was found that the forces in the intrinsic muscles (interosseus group and lumbrical) are significantly reduced by 22% to 61% due to the action of the extensor mechanism, with the greatest reductions in more flexed postures. The bone-to-bone contact force at the MCP joint is reduced by 10% to 41%. This suggests that the extensor mechanism may help to reduce the risk of injury at the finger joints and also to moderate the forces in intrinsic muscles. These apparent biomechanical advantages may be a result of the extensor mechanism''s distinctive interconnected fibrous structure, through which the contraction of the intrinsic muscles as flexors of the MCP joint can generate extensions at the DIP and PIP joints.     

Normal force distribution and posture of a hand pressing on a flat surface

Hand strength data are needed to understand and predict hand postures and finger loads while placing the hand on an object or surface. This study aims to analyze the effect of hand posture and surface orientation on hand force while pressing a flat surface. Twelve participants, 6 females and 6 males ages 19–25, performed three exertions (100%, 30% and 10% MVC- Maximum Voluntary Contraction) perpendicular to a plate in 4 angles (−45°, 0°, 45° and 90° with respect to the horizontal plane) at elbow height. Exertions involved pushing in two postures: (1) whole hand and (2) constrained to only using the fingertips. Inter-digit joint angles were recorded to map hand and finger motions and estimate joint moments for each condition. Participants exerted twice the force when pushing with whole hand vs. fingertips. 72–75% of the total force was exerted over the base of the palm, while only 11–13% with the thumb for exertions at 90°, 45° or 0° plate angles. Males maximum force for pushing at 0°, 45° and 90° plates averaged 49% higher than females for the whole hand and 62% for the fingertips (p < 0.01). There was no significant sex difference (p > 0.05) for the −45° plate. Thumb joint loads were generally higher than the other individual fingers (p < 0.05) in all % MVC and accounted for 12% of total force during whole hand exertions. On average, joint moments were 30% higher during fingertip conditions vs. whole hand. Thumb and finger joint moment magnitudes when pushing the plate at 100% MVC indicated that Metacarpophalangeal (MCP) joint moments were higher (p < 0.05) than Distal Interphalangeal joints (DIP) and Proximal Interphalangeal joints (PIP) under whole hand and fingertips conditions.     

Biomechanical properties of the crimp grip position in rock climbers

Rock climbers are often using the unique crimp grip position to hold small ledges. Thereby the proximal interphalangeal (PIP) joints are flexed about 90 degrees and the distal interphalangeal joints are hyperextended maximally. During this position of the finger joints bowstringing of the flexor tendon is applying very high load to the flexor tendon pulleys and can cause injuries and overuse syndromes. The objective of this study was to investigate bowstringing and forces during crimp grip position. Two devices were built to measure the force and the distance of bowstringing and one device to measure forces at the fingertip. All measurements of 16 fingers of four subjects were made in vivo. The largest amount of bowstringing was caused by the flexor digitorum profundus tendon in the crimp grip position being less using slope grip position (PIP joint extended). During a warm-up, the distance of bowstringing over the distal edge of the A2 pulley increased by 0.6mm (30%) and was loaded about 3 times the force applied at the fingertip during crimp grip position. Load up to 116N was measured over the A2 pulley. Increase of force in one finger holds by the quadriga effect was shown using crimp and slope grip position.     

Characteristics of human fingertips in the shearing direction

The shearing strain of the human fingertip plays an important role in the determination of the optimal grasping force and in the perception of texture. Most research concerned with the mechanical impedance of the human fingertips has treated the orthogonal direction to the tip surface, and little attention has been paid to the tangential direction. This paper describes impedance characteristics of the human fingertips in the tangential directions to the tip surface. In the experiment, step and ramp shearing forces were individually applied to the tips of the thumb, middle finger, and little finger. Dynamics of the fingertips were represented by the Kelvin model. Experimental results show that each fingertip had different properties with respect to the shearing strain versus the applied force, and that the thumb had the strongest shearing stiffness among these three digits. Moreover, the shearing stiffness depended on the direction of the applied force, and the stiffness in the pointing direction was stronger than that in the perpendicular direction. As the contact force in the orthogonal direction to the fingertip surface was increased, the shearing stiffness and viscosity increased without regard to the load speed of the shearing force. Furthermore, it is shown that the average strain rate of the fingertip in the tangential direction to the fingertip surface became slower and converged to a constant value with higher contact forces.     

Friction between human finger flexor tendons and pulleys at high loads

A method was developed to indirectly measure friction between the flexor tendons and pulleys of the middle and ring finger in vivo. An isokinetic movement device to determine maximum force of wrist flexion, interphalangeal joint flexion (rolling in and out) and isolated proximal interphalangeal (PIP) joint flexion was built. Eccentric and concentric maximum force of these three different movements where gliding of the flexor tendon sheath was involved differently (least in wrist flexion) was measured and compared. Fifty-one hands in 26 male subjects were evaluated. The greatest difference between eccentric and concentric maximum force (29.9%) was found in flexion of the PIP joint. Differences in the rolling in and out movement (26.8%) and in wrist flexion (14.5%) were significantly smaller. The force of friction between flexor tendons and pulleys can be determined by the greater difference between eccentric and concentric maximum force provided by the same muscles in overcoming an external force during flexion of the interphalangeal joints and suggests the presence of a non-muscular force, such as friction. It constitutes of 9% of the eccentric flexion force in the PIP joint and therefore questions the low friction hypothesis at high loads.     

A demonstration of validity of 3-D video motion analysis method for measuring finger flexion and extension

This study demonstrates the validity of using 3-D video motion analysis to measure hand motion. Several researchers have devised ingenious methods to study normal and abnormal hand movements. Although very helpful, these earlier studies are static representations of a dynamic phenomenon. Despite the many studies of hand motion using scientifically impeccable techniques, little is known about digital motion, and there are still few researchers investigating dynamic three-dimensional motion of the hand. Results from a three-camera video motion analysis system were compared to those from the "gold standard", 2-D lateral view fluoroscopy. We used these two methods to record hand motion simultaneously during unrestricted flexion and extension of the index finger of the dominant hand in 6 neurologically normal, healthy volunteers. After collection and post-processing, the waveforms of the PIP, DIP and MCP joint angles were compared using the adjusted coefficient of multiple determination (R2(a), or CMD). The mean CMD values for the MCP, PIP and DIP joint angle waveforms were 0.96, 0.98 and 0.94, respectively, suggesting a close similarity between motion of comparable joints analyzed by the 2-D and 3-D methods. This shows that the method of 3-D motion analysis is capable of accurately quantifying digital joint motion. It is anticipated that 3-D motion analysis, in addition to being used as a research tool, will also have clinical applications such as surgical planning in neuromuscular disorders and the documentation of abnormal motion in many other pathological hand conditions.     

Estimation of finger muscle tendon tensions and pulley forces during specific sport-climbing grip techniques

The present work displayed the first quantitative data of forces acting on tendons and pulleys during specific sport-climbing grip techniques. A three-dimensional static biomechanical model was used to estimate finger muscle tendon and pulley forces during the "slope" and the "crimp" grip. In the slope grip the finger joints are flexed, and in the crimp grip the distal interphalangeal (DIP) joint is hyperextended while the other joints are flexed. The tendons of the flexor digitorum profundus and superficialis (FDP and FDS), the extensor digitorum communis (EDC), the ulnar and radial interosseus (UI and RI), the lumbrical muscle (LU) and two annular pulleys (A2 and A4) were considered in the model. For the crimp grip in equilibrium conditions, a passive moment for the DIP joint was taken into account in the biomechanical model. This moment was quantified by relating the FDP intramuscular electromyogram (EMG) to the DIP joint external moment. Its intensity was estimated at a quarter of the external moment. The involvement of this parameter in the moment equilibrium equation for the DIP joint is thus essential. The FDP-to-FDS tendon-force ratio was 1.75:1 in the crimp grip and 0.88:1 in the slope grip. This result showed that the FDP was the prime finger flexor in the crimp grip, whereas the tendon tensions were equally distributed between the FDP and FDS tendons in the slope grip. The forces acting on the pulleys were 36 times lower for A2 in the slope grip than in the crimp grip, while the forces acting on A4 were 4 times lower. This current work provides both an experimental procedure and a biomechanical model that allows estimation of tendon tensions and pulley forces crucial for the knowledge about finger injuries in sport climbing.     

A demonstration of the validity of a 3-D video motion analysis method for measuring finger flexion and extension

This study demonstrates the validity of using 3-D video motion analysis to measure hand motion. Several researchers have devised ingenious methods to study normal and abnormal hand movements. Although very helpful, these earlier studies are static representations of a dynamic phenomenon. Despite the many studies of hand motion using scientifically impeccable techniques, little is known about digital motion, and there are still few researchers investigating dynamic three-dimensional motion of the hand. Results from a three-camera video motion analysis system were compared to those from the “gold standard”, 2-D lateral view fluoroscopy. We used these two methods to record hand motion simultaneously during unrestricted flexion and extension of the index finger of the dominant hand in 6 neurologically normal, healthy volunteers. After collection and post-processing, the waveforms of the PIP, DIP and MCP joint angles were compared using the adjusted coefficient of multiple determination (R²_a, or CMD). The mean CMD values for the MCP, PIP and DIP joint angle waveforms were 0.96, 0.98 and 0.94, respectively, suggesting a close similarity between motion of comparable joints analyzed by the 2-D and 3-D methods. This shows that the method of 3-D motion analysis is capable of accurately quantifying digital joint motion.

It is anticipated that 3-D motion analysis, in addition to being used as a research tool, will also have clinical applications such as surgical planning in neuromuscular disorders and the documentation of abnormal motion in many other pathological hand conditions.     

Acute effects of direct inhibitory pressure over the biceps brachii myotendinous junction on skeletal muscle activation and force output

Force (F) reduction is reported with myotendinous junction (MTJ) manipulation. Autogenic inhibition reflex (AIR) activation is supposed to be the main mechanism. Still, its role remains unclear. The study aimed at assessing the effects of MTJ direct inhibitory pressure (DIP) on neuromuscular activation and F in the elbow flexor (agonist) and extensor (antagonist) muscles. After maximum voluntary contraction (MVC) assessment, thirty-five participants randomly performed submaximal contractions at 20, 40, 60, and 80% MVC. Electromyographic (EMG), mechanomyographic (MMG), and F signals were recorded. Protocol was repeated under (i) DIP (10-s pressure on the biceps brachii MTJ) with the elbow at 120° (DIP₁₂₀), (ii) DIP with the elbow at 180° (DIP₁₈₀), and (iii) without DIP (Ctrl). Electromechanical delay (EMD) components, EMG and MMG root mean square (RMS), and rate of force development (RFD) were calculated. Independently from the angle, DIP induced decrements in MVC, RFD, and RMS of EMG and MMG signals and lengthened the EMD components in agonist muscles (P < 0.05). The DIP-induced decrease in F output of the agonist muscles seems to be possibly due to a concomitant impairment of the neuromuscular activation and a transient decrease in stiffness. After DIP, the antagonist muscle displayed no changes; therefore, the intervention of AIR remains questionable.     

Coordination of contact forces during multifinger static prehension

This study investigated the effects of modifying contact finger forces in one direction-normal or tangential-on the entire set of the contact forces, while statically holding an object. Subjects grasped a handle instrumented with finger force-moment sensors, maintained it at rest in the air, and then slowly: (1) increased the grasping force, (2) tried to spread fingers apart, and (3) tried to squeeze fingers together. Analysis was mostly performed at the virtual finger (VF) level (the VF is an imaginable finger that generates the same force and moment as the four fingers combined). For all three tasks there were statistically significant changes in the VF normal and tangential forces. For finger spreading/squeezing the tangential force neutral point was located between the index and middle fingers. We conclude that the internal forces are regulated as a whole, including adjustments in both normal and tangential force, instead of only a subset of forces (normal or tangential). The effects of such factors as EFFORT and TORQUE were additive; their interaction was not statistically significant, thus supporting the principle of superposition in human prehension.     

Results of the Matev operation for correction of Boutonnière deformity.

Between December 1971 and December 1977, 41 patients with long-standing boutonnière deformities were treated by Matev's operation. The average follow-up time was 13 months (range 8 to 18 months). The duration of their lesions varied from 32 to 176 days. The digits most affected were the long finger (14) and the ring finger (11). Postoperatively, all patients showed excellent flexion of the fingers with only a very slight deficit in extension of the PIP joint. Eight of them also had some deficit in extension of the DIP joint, with flexion there of 10 degrees to 15 degrees, but little real disability. The results indicate that when the Matev operation is clearly indicated and properly performed, it is an excellent one for the treatment of this condition.     

Tangential finger forces use mechanical advantage during static grasping

When grasping and manipulating objects, the central controller utilizes the mechanical advantage of the normal forces of the fingers for torque production. Whether the same is valid for tangential forces is unknown. The main purpose of this study was to determine the patterns of finger tangential forces and the use of mechanical advantage as a control mechanism when dealing with objects of nonuniform finger positioning. A complementary goal was to explore the interaction of mechanical advantage (moment arm) and the role a finger has as a torque agonist/antagonist with respect to external torques (±0.4 N m). Five 6-df force/torque transducers measured finger forces while subjects held a prism handle (6 cm width × 9 cm height) with and without a single finger displaced 2 cm (handle width). The effect of increasing the tangential moment arm was significant (p < .01) for increasing tangential forces (in >70% of trials) and hence creating greater moments. Thus, the data provides evidence that the grasping system as a rule utilizes mechanical advantage for generating tangential forces. The increase in tangential force was independent of whether the finger was acting as a torque agonist or antagonist, revealing their effects to be additive.     

Nonlinear stiffness--force relationships in whole mammalian skeletal muscles

Small, sinusoidal length changes were superimposed on isometric contractions of fast- and slow-twitch mouse muscles, which were stimulated maximally via their nerves. Stiffness increased with increasing frequency of sinusoidal stimulation, but the relative time course of force and stiffness changes during twitch, tetanic, or partially fused contractions was quite invariant over a range of frequencies in both muscles. Typically, stiffness increases more rapidly than force during contraction and decreases less rapidly during relaxation. This pattern was observed at various temperatures and with various numbers of stimuli. It can be described by a nonlinear relation between stiffness and force with some hysteresis. The presence in the muscle of parallel and series elastic elements, whose stiffness varies with force, may account for the nonlinear relation. This nonlinearity can be used to relate the patterns for summation of force and stiffness observed with brief trains of stimuli under a variety of conditions.     

Measurements of wrist and finger postures: a comparison of goniometric and motion capture techniques

A marker-based kinematic hand model to quantify finger postures was developed and compared to manual goniometric measurements. The model was implemented with data collected from static postures of five subjects. The metacarpal phalangeal (MCP) and proximal interphalangeal (PIP) joints were positioned in flexion of approximately 30, 60, and 90 degrees for 5 subjects. Wrist flexion/extension and ulnar/radial deviations were also examined. The model-based angles for the MCP and PIP joints were not statistically equivalent to the goniometric measurements, with differences of -1.8 degrees and +3.5 degrees, respectively. Differences between the two measurement methods for the MCP and PIP were found to be a function of the posture (i.e., 150, 120, or 90 degree blocks) used. Wrist measurements differed by -4.0 degrees for ulnar/radial deviation and +5.2 degrees for flexion/extension. Much of the difference between the model and goniometric measurements is believed due to inaccuracies in the goniometric measurements. The proposed model is useful for future investigations of finger-intensive activities by supplying accurate and unbiased measures of joint angles.     

Adaptive velocity-based six degree of freedom load control for real-time unconstrained biomechanical testing

Robotic biomechanics is a powerful tool for further developing our understanding of biological joints, tissues and their repair. Both velocity-based and hybrid force control methods have been applied to biomechanics but the complex and non-linear properties of joints have limited these to slow or stepwise loading, which may not capture the real-time behaviour of joints. This paper presents a novel force control scheme combining stiffness and velocity based methods aimed at achieving six degree of freedom unconstrained force control at physiological loading rates.     

Response of a human head/neck/upper-torso replica to dynamic loading--II. Analytical/numerical model

A three-dimensional lumped-parameter model of the human head/neck/upper-torso was developed to predict its motion for any specified initial conditions and that could also be used to compare with the results of other investigators. This model consists of ten rigid bodies representing the head, cervical vertebrae C1-C7, T1 and T2 combined with the rest of the torso. These rigid bodies were connected by intervertebral joints described by a stiffness matrix relating the force (moment) and translation (rotation). Fifteen pairs of muscles were incorporated in the model, represented by three-point linear elements with nonlinear constitutive relationships obtained from cadaver test results. The calculated response compared favorably with human volunteer data for both flexion and lateral whiplash. However, tests on an inanimate replica of a human indicated greater flexibility than predicted by the corresponding numerical model. The difference is believed to be due to insufficient mass of the muscles incorporated in the structure.     

Measurement of finger joint angles and maximum finger forces during cylinder grip activity

Finger joint angles and finger forces during maximal cylindrical grasping were measured using multi-camera photogrammetry and pressure-sensitive sheets, respectively. The experimental data were collected from four healthy subjects gripping cylinders of five different sizes. For joint angles, an image analysis system was used to digitize slides showing markers. During the calibration of the camera system, both the nonlinear least square and the direct linear transform methods were applied and compared, the former providing the fewer errors; it was used to determine joint angles. Data were collected from the pressure-sensitive grip films by using the same image analysis system as used in the collection of the joint angle data. The method of using pressure-sensitive sheets provided an estimation of the weighted centre of the phalangeal forces. Results indicate that finger flexion angles at the metacarpophalangeal and proximal interphalangeal joints gradually increase as cylinder diameter decreases, but that at the distal interphalangeal joint the angle remains constant throughout all cylinder sizes. It was also found that most of the radio-ulnar deviation and the axial rotation angles at the finger joints deviate from zero, but the deviations are small. For the force measurement, it was found that total finger force increases as cylinder size decreases, and the phalangeal force centres are not located at the mid-points of the phalanges. The data obtained in this experiment would be useful for muscle force predictions and for the design of handles.