第14巻 2018年6月　第3号

■臨床および実験報告

内在筋に着目した中指橈側尺側外転訓練―母指CM関節症の手術後療法としての効果と作用機序の検証
我妻　朋美¹, 萩原　祐介^{2, 3}, 伏屋　洋志⁴, 菅野　麻希¹, 高橋　美香¹, 松元　秀次^5
1日本医科大学千葉北総病院リハビリテーション科
²医療法人社団湧水方円会稲田病院整形外科
³日本医科大学千葉北総病院整形外科
⁴東京都リハビリテーション病院
⁵日本医科大学大学院医学研究科リハビリテーション学分野

Middle Finger Abduction Exercise Focusing on the Intrinsic Muscles as Components of the Hand Arch
Tomomi Wagatsuma¹, Yusuke Hagiwara^{2, 3}, Hiroshi Fuseya⁴, Maki Sugano¹, Mika Takahashi¹ and Shuji Matsumoto^5
1)Department of Rehabilitation Medicine, Nippon Medical School Chiba Hokusoh Hospital
²⁾Department of Orthopaedic Surgery, Inada Hospital
³⁾Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital
⁴⁾Department of Rehabilitation Medicine, Tokyo Metropolitan Rehabilitation Hospital
⁵⁾Department of Rehabilitation and Physical Medicine, Graduate School of Medicine, Nippon Medical School

Background: We have observed that patients with restricted thumb opposition sometimes develop dysfunction of the intrinsic muscles around the metacarpal joint of the middle finger. Therefore, we developed a middle finger abduction exercise program which focuses on improvement of intrinsic muscle function during post-operative rehabilitation after thumb carpometacarpal arthroplasty. We report on the efficacy of the program herein.
Methods: Three patients with Eaton stage III-IV thumb carpometacarpal arthritis were included in the study. The effects of the exercise program were recorded. Ultrasonography and surface electromyography were used to evaluate the effects of the exercise in two healthy volunteers.
Results: Five minutes of exercise resulted in a 1- to 2-point improvement in the Kapandji opposition score, and a 1- to 3-cm improvement in thumb opposition to the base of the small finger. Ultrasonography and electromyography revealed that adductor pollicis, abductor pollicis brevis, opponens pollicis, and abductor digiti minimi contractions became more synchronous.
Conclusion: Our middle finger abduction exercise program improves thumb opposition significantly. The program may be particularly useful for post-operative rehabilitation after thumb surgeries: thumb opposition can be improved without thumb motion, which can be painful in the early post-operative period.

日医大医会誌 2018; 14(3), 125-130

Key words
intrinsic muscles, hand arch, thumb carpometacarpal arthritis, middle finger abduction exercise, opposition improvement

Correspondence to
Yusuke Hagiwara, Department of Orthopaedic Surgery, Inada Hospital, 46 Omori-cho, Nara-shi, Nara 630-8131, Japan
E-mail：yskh1231@gmail.com

受付：2018年3月14日　受理：2018年5月16日