As early as 1910, in the Presidential Address at the American Psychological Association meeting in Minneapolis, Walter B. Watson explained thought as nothing more than speech-related sensory–motor processes: “according to my view, thought processes are really motor habits in the larynx” (Watson, 1913, p. For example, in the early part of the 20th century, Margaret Floy Washburn proposed a motor theory of mental imagery (Washburn, 1914, 1916), and John B. In a review of the literature, we did not find a report of a mirror hand where duplication extended proximal to the elbow joint and where the patient had not been treated before adulthood.Motor theories of cognition have a long history in psychology (Scheerer, 1984), dating back at least to Berkeley's ( 1709) motor interpretation of depth perception, and have been proposed as explanations for a wide range of mental processes. These variants are probably intermediate between the classic ulnar dimelia and multiple deformities of the hand as the duplication of the hand is incomplete. Barton et al 2 described a variant with multiple fingers, two ulnae (one vestigial) and a radius. Yang et al 5 reported a case with multiple fingers but with a distinct radius and ulna. 3 King and Hoyes 4 described a case with eight digits in the hand and a forearm with an ulna and a distinguishable radius. There may be complete duplication of the hand including the thumb with a normal radius and ulna. There are few descriptions of mirror hand in the literature. He did not return for follow-up examination and we suspect that he returned to Afghanistan.
The wounds were cleaned and a short arm thumb spica was applied. The most lateral finger was pollicised ( Fig. The medial finger was amputated at the level of the carpometacarpal joint and the second and third lateral fingers were amputated at the metacarpal base.
#EIGHT HAND MIRROR SKIN#
The most medial and second and third lateral fingers were amputated and filletted skin flaps were preserved. Prior to surgery angiography was undertaken but the findings did not alter the nature of the surgical treatment. All eight digits had the usual triphalangeal appearance with the metacarpals having their growth plates at the distal ends ( Fig. There was a single radius with well defined proximal and distal ends. They were fused in their distal two thirds but separated into two ulnar heads. There were two ulnae, one of which was vestigial. The distal humerus was almost normal in appearance except for hypoplasia of the capitellum. Radiographs showed a duplicated humeral head ( Fig. The hand had eight well-formed digits arranged symmetrically as mirror images on either side of a presumptive sagittal axis ( Fig. There was a fixed pronation deformity with no active rotation of the forearm. The wrist had a fixed flexion deformity of 30° and further flexion of 50° was possible. The forearm on the affected side was short in comparison with the normal left forearm ( Fig. The elbow had a fixed flexion deformity of 30° and further flexion of 120° was possible ( Fig. On internal rotation his hand reached his sacrum and external rotation was to 70°. He was left handed and worked as a labourer.įlexion of the shoulder was to 60° and abduction to 45°. There was no family history of congenital anomalies. He was the fourth child of a nonconsanguineous marriage by full-term vaginal delivery. Case reportĪ 20-year-old Afghan man presented with a congenital abnormality of the right upper limb. We describe another variant of ulnar dimelia in which there is incomplete fusion of two ulnae (one vestigial), one radius and multiple fingers and an extension of duplication proximal to elbow joint with duplication of the proximal humerus. Multiple fingers with one ulna and one hypoplastic radius, 1 multiple fingers with two ulnae (one vestigial) and one radius, 2 and complete duplication of the hand including the thumb with a distinct radius and ulna in the forearm 3 have been described. Over the years, there have been several case reports in the literature and some variations of the deformity have been described. Characteristically there is duplication of the ulna, an absent radius, and multiple fingers which are symmetrical around the midline. Mirror hand (ulnar dimelia) is an exceedingly rare congenital anomaly of the upper limb.
0 kommentar(er)
