J.N.A.L. Leijnse

The hand of the musician: The kinematics of the bidigital finger system with anatomical restrictions

Tendons of the fingers are frequently interconnected by anatomic structures that limit the displacements of these tendons relative to each other. In this paper a bidigital finger system in which such interconnections between tendons are present is kinematically modelled. Using this model, an exhaustive description of the effects on finger movement of connections between the different tendons of the fingers is given. The study provides a context for the interpretation of typical difficulties of finger coordination in musicians, especially in pianists and string players.

Biomechanics of the finger with anatomical restrictions - The significance for the exercising hand of the musician

Exercise and teaching of musicians presupposes in the individual the constitutive ability to freely execute the finger movements required in the playing of the instrument. However, in the hand anatomical restrictions may exist that limit the mobility of the fingers and, thereby, the possibility to determine their movements voluntarily. In this article we investigate the kinematics of a monodigital system in which restrictions are present.

Anatomical factors predisposing to focal dystonia in the musician's hand--principles, theoretical examples, clinical significance.

In this paper, anatomical interconnections between tendons, between tendons and their environment, and anatomical constraints on joint mobility are considered as possible causes of focal dystonia in the hand of the musician. By hypothesis, focal dystonias arise when the constraints on movement resulting from these anatomic limitations impede playing movements with sufficiently low energy expenditure. This hypothesis is modelled for connections between the deep finger flexors. The displacements, forces, stresses, and work per volume in the finger motors in some common piano playing movements are calculated. The results indicate that with mentioned connections, in certain movements the extensor and lumbrical, and in others the lumbrical and interossei are most strained, while the interossei may become the main power source in loaded instrumental movements. Also discussed are compensatory movements. The biomechanical principles of surgical and conservative treatment are summarised.

A two-dimensional kinematic model of the lumbrical in the human finger

The functioning of the lumbrical muscle in the human finger is difficult to visualise. This is mainly due to the fact that the origin and insertion of the lumbrical is on tendons of other motors (the deep flexor and the extensor assembly, respectively), instead of on bone. In this paper the functioning of the lumbrical in the human finger is kinematically investigated by explicitly considering the slackness or tautness of tendon parts which are in parallel or in series with the lumbrical, and by deriving from a standard finger model equivalent representations from which the functioning of the lumbrical is visually more clear. These models are used to review and interpret the results of previous studies. Further, it is indicated that the lumbrical is in an ideal position to contribute to the control of certain fast movements, as may be of importance for the musician, and that its role in other fast movements may be limited because of its large displacements (contraction speed).

Connections between the Tendons of the Musculus flexor digitorum profundus Involving the Synovial Sheaths in the Carpal Tunnel

In the carpal tunnel anatomical interconnections between the tendons of the musculus flexor digitorum profundus are systematically present. These interconnections limit the mutual tendon displacements, which decreases finger independence and may be problematic in a musicians hand. The present study investigates a possible role of the synovial sheaths in the formation of these intertendinous connections in the carpal tunnel. To this end a morphological model is provided which correlates the often distinctly fibrous structure of the deep flexor tendons in the carpal tunnel and the frequent exchange of tendon fibres between the tendons to the different fingers, with the tendency of the synovial membranes to strongly adhere to the tendons. This model is validated by gross dissection results, and by cross sections of the flexor tendons in the carpal tunnel. In agreement with the model, the anatomic data show that the synovial membranes tend to invade and become trapped in tendons made up from individualised tendon strands, and also strongly adhere to the substantial amounts of tendon fibres which may be exchanged between the flexor tendons proximal to the lumbrical origins. These fibres and the synovial membranes may form a strong fabric able to withstand substantial stretching forces of interconnected oppositely pulled flexor tendons.

Measuring force transfers in the deep flexors of the musician's hand: Theoretical analysis, clinical examples

In the present paper the anatomical and functional interdependencies which regularly exist between the deep flexor tendons of the different fingers are modelled. The model results are validated by measurements on real hands. The results show that intertendinous force transfers may be caused by (i) coactivation of muscle fibres inserting in different tendons, and (ii) passive connections between tendons or muscle bellies. The coactivation is validated by the measuring results of a hand in which all intertendinous connections were surgically removed. The present models and measurements are currently used for diagnosis of hand problems in musicians at our hand clinic.

Anatomic Basis for Individuated Surface EMG and Homogeneous Electrostimulation With Neuroprostheses of the Extensor Digitorum Communis

The extensor digitorum communis (ED) is generally regarded as a fairly undiversified muscle that gives extensor tendons to all fingers. Some fine wire electromyographic (EMG) investigations have been carried out to study individuation of the muscle parts to the different fingers. However, individuated surface EMG of the ED has not been investigated. This study analyses the anatomy of the ED muscle parts to the different fingers in detail and proposes optimal locations for surface or indwelling electrodes for individuated EMG and for electrostimulation with neuroprostheses. The dissections show that the ED arises from extensive origin tendons (OT), which originate at the lateral epicondyle and reach far in the forearm. The ED OT is V-shaped with shorter central tendon fibers but with a long radial and an even longer ulnar slip. The ED parts to the individual fingers consistently arise from distinct OT locations: the ED3 (medius) arises proximally, the ED2 (index) from the radial slip distal to ED3, the ED4 (ring finger) from the ulnar slip distal to ED3, and the ED5 (to ring/little finger) from the ulnar slip distal to ED4. This lengthwise widely spaced arrangement of ED parts compensates to some degree for the narrow ED width and suggests that ED parts should be individually assessable by indwelling and even by surface EMG electrodes, albeit in the latter case with variable mutual cross-talk. Conversely, the anatomic spacing of ED parts warrants that electromyographic stimulation with neuroprostheses by a single implanted electrode cannot likely homogeneously activate all ED parts.

Kinematic evaluation of the finger’s interphalangeal joints coupling mechanism—variability, flexion–extension differences, triggers, locking swanneck deformities, anthropometric correlations

The human finger contains tendon/ligament mechanisms essential for proper control. One mechanism couples the movements of the interphalangeal joints when the (unloaded) finger is flexed with active deep flexor. This studys aim was to accurately determine in a large finger sample the kinematics and variability of the coupled interphalangeal joint motions, for potential clinical and finger model validation applications. The data could also be applied to humanoid robotic hands. Sixty-eight fingers were measured in seventeen hands in nine subjects. Fingers exhibited great joint mobility variability, with passive proximal interphalangeal hyperextension ranging from zero to almost fifty degrees. Increased measurement accuracy was obtained by using marker frames to amplify finger segment motions. Gravitational forces on the marker frames were not found to invalidate measurements. The recorded interphalangeal joint trajectories were highly consistent, demonstrating the underlying coupling mechanism. The increased accuracy and large sample size allowed for evaluation of detailed trajectory variability, systematic differences between flexion and extension trajectories, and three trigger types, distinct from flexor tendon triggers, involving initial flexion deficits in either proximal or distal interphalangeal joint. The experimental methods, data and analysis should advance insight into normal and pathological finger biomechanics (e.g., swanneck deformities), and could help improve clinical differential diagnostics of trigger finger causes. The marker frame measuring method may be useful to quantify interphalangeal joints trajectories in surgical/rehabilitative outcome studies. The data as a whole provide the most comprehensive collection of interphalangeal joint trajectories for clinical reference and model validation known to us to date.

Etiological musculo-skeletal factor in focal dystonia in a musician's hand: A case study of the right hand of a guitarist.

A case study is presented in which a focal hand dystonia seems to have developed in the right hand of a classical guitarist as a result of a neuromuscular peripheral defect caused by trauma. The trauma was a near total perforation of the first web space by a splinter. Healing was uneventful without apparent functional complications. Two years later the patient noticed difficulties in extending the index in playing, for which he received various unsuccessful treatments during seven years. However, we found more severe dystonic symptoms (cocontractions) in the thumb than in the index during playing, which correlated with an undiagnosed insufficiency in the flexor pollicis brevis (FPB). This defect allowed proposing a biomechanical analysis of compensations for diminished thumb control in playing, which would explain the dysfunction in the index in playing as overcompensation for the thumb problem. If this analysis is correct, the etiology of the case can be traced back to underlying multiarticular control problems in the thumb caused by an insufficient FPB. This defect was considered irrepairable. It was concluded that even with knowledge of the underlying cause, a potentially successful treatment of the dystonia might not exist in this case. The case would demonstrate that task‐specific hand dystonias can arise as overcompensations for (peripheral) neuro‐musculoskeletal defects. The case is illustrated by videos of playing and functional thumb tests.

Why the lumbrical muscle should not be bigger - A force model of the lumbrical in the unloaded human finger

The present paper investigates the forces and the stresses in the lumbrical and the other finger motors in an unloaded human finger model, with and without the ab-adduction degree of freedom of the MCP joint. Unique solutions are obtained by minimization of the maximal muscle stress calculated with a normal and a variable lumbrical physiological cross-sectional area. It is concluded that in the model with biaxial MCP joint, a stronger than normal lumbrical is not useful in unloaded finger control, and will merely result in spare lumbrical capacity. Also the natural synergism of the lumbrical and the ulnar interosseus in the control of the finger in the sagittal plane is pointed out.