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At least 199 records · Page 11Linked to original sources
PubMed1982

[External fixation--rare indications, combination of internal and external osteosynthesis technics, secondary operations].

The rare application of external stabilisation requires special knowledge of its indications and surgical assembly, which are closely linked to usually serious bone and soft-tissue damage, topographical prerequisites and biomechanical requirements. This paper differentiates the indications for external osteosynthesis of the femur, immobilisation using external fixation to bridge a joint, unstable fractures of the pelvic girdle, osteosynthesis and application of the fixateur externe in the region of the knee, hip and hand joints, as well as the foot. Combinations of internal and external osteosynthesis techniques in the femur and tibia are presented and discussed. Criteria are discussed for changing from primary external to final internal osteosynthesis, as well as osteotaxis indicated solely by the soft tissue or in plastic surgery.

Adult↗
PubMed2000

Evolution of the human hand: approaches to acquiring, analysing and interpreting the anatomical evidence.

The discovery of fossil hand bones from an early human ancestor at Olduvai Gorge in 1960, at the same level as primitive stone tools, generated a debate about the role of tools in the evolution of the human hand that has raged to the present day. Could the Olduvai hand have made the tools? Did the human hand evolve as an adaptation to tool making and tool use? The debate has been fueled by anatomical studies comparing living and fossil human and nonhuman primate hands, and by experimental observations. These have assessed the relative abilities of apes and humans to manufacture the Oldowan tools, but consensus has been hampered by disagreements about how to translate experimental data from living species into quantitative models for predicting the performance of fossil hands. Such models are now beginning to take shape as new techniques are applied to the capture, management and analysis of data on kinetic and kinematic variables ranging from hand joint structure, muscle mechanics, and the distribution and density of bone to joint movements and muscle recruitment during manipulative behaviour. The systematic comparative studies are highlighting a functional complex of features in the human hand facilitating a distinctive repertoire of grips that are apparently more effective for stone tool making than grips characterising various nonhuman primate species. The new techniques are identifying skeletal variables whose form may provide clues to the potential of fossil hominid hands for one-handed firm precision grips and fine precision manoeuvering movements, both of which are essential for habitual and effective tool making and tool use.

Animals↗
PubMed1977

Bone-to-bone, joint-to-bone and joint-to-joint ratios in normal and diseased skeletal states using region-of-interest technique and bone-seeking radiopharmaceuticals.

Bone-to-bone, iliosacral joint-to-os sacrum and joint-to-joint ratios were computed using the region-of-interest technique 2 to 3 hrs. after injection of 99mTc Sn-methylene-diphosphonate or 99mTc Sn-pyrophosphate in 139 patients with skeletal diseases (bone tumours, degenerative changes of the spine and joints, inflammatory changes of joints) as well as in 123 patients with normal skeletal states. In the latter group, iliosacral joint-to-os sacrum ratios decreased with increasing age of the patients. In patients with osseous metastases of the spine ratios of 0.80 to 4.0 occurred ( reference area second vertebra below or above the affected vertebra). In degenerative changes of the spine values of 0.80 to 1.69 were computed. These results show, that 74% of the spine metastases could not be differentiated from benign changes of the spine by determining their relative amounts of bone uptake. In bone tumours of the extremities and in rheumatoid or gouty arthritis of the small joints (hands and feet) the highest ratios, i.e. contrasts, occurred referring to a contralateral reference area. Osteoarthritic and inflammatory alterations of the big joints could not be differentiated because of percentual distribution of the increased joint-to-joint ratios turned out to be nearly identical.

Adult↗
PubMed1989

Mycetoma of the hand.

Mycetoma or maduromycosis is a rare chronic granulomatous disease caused by a fungus infection. We report a rare case of mycetoma in the hand; to our knowledge this is the first report in the United States of mycetoma caused by Nocardia asteroides. The patient had had 2 years of chronic drainage and edema of the left hand after a penetrating injury sustained in the shipyards. After surgical debridement he was treated with co-triamazole, 1 tablet orally four times a day for 6 months. The chronic drainage has ceased but most of his wrist and hand joint movements are restricted.

Hand↗
PubMed1993

[Degenerative changes in the small joints of the hand in adults].

Based on a macroscopic investigation of 137 joints of humans aged 50-90 years, using necroptic material from the Institute of Anatomy, the authors describe the course of the degenerative process and its localization on the contact surfaces of different joints. Concurrently the author describes also changes of the synovial layer of the articular capsule in relation to changes of the articular cartilage.

Aged↗
PubMed1997

[A case of amyopathic dermatomyositis associated with interstitial pneumonitis].

A patient (47-year old female) who had erythema similar to Gottron's sign on bilateral finger joints since two years ago, started to have polyarthralgia on bilateral knee and shoulder on the spring of 1993. Polyarthralgia was extended to both wrist and hand joints on Oct. of 1995. On the middle of Dec. 1995, she began to have exertional dyspnea and was referred and admitted in our hospital on 18th, Dec., 1995. Chest X-ray and CT scan showed the shadow for active interstitial pneumonitis on bilateral lower lung fields. Blood gas analysis indicated hypoxia (PaO2: 62.8 mmHg) and low % DLCO (64.7%). Skin eruption of face (heliotrope-like erythema) and hands (Gottron's sign) and skin biopsy (right hand) findings were compatible with that in dermatomyositis. The analysis in blood biochemistry showed no elevation for muscle enzymes. The diagnosis for amyopathic dermatomyositis (ADM) was made according to the criteria proposed by Euwer & Sontheimer (1993). The steroid pulse therapy and 50 mg per day of cyclophosphamide were immediately administered. The dyspnea and dermatitis were improved within two weeks after therapy. She is presently in remission until Jan. 1997 with the maintenance dosis of 10 mg per day of oral prednisolone.

Anti-Inflammatory Agents↗
PubMed1999

Radiographic assessment. Introduction: existing methodology.

Plain radiograph is the most accepted imaging technique to assess structural changes of osteoarthritis and it is proposed as 'surrogate' of outcome of the disease process. The existing radiographic methodology is well standardized with respect to its technique for investigation of hip, knee and hand joints, including advice on the most appropriate views, patient positioning, X-ray beam alignment, quality control. Quantitation of joint space narrowing is currently proposed as the primary variable in studies of disease progression for hip and knee, while semi-quantitation of this same parameter or of bone changes by published atlases have to be intended as secondary variables, or outcomes in hand studies. Unfortunately, the review of studies that evaluated the longitudinal rate of joint space narrowing indicates that the yearly change may be very small (<0.1mm/year) and of doubtful clinical significance. This underlines the need for further refinement in the definition of the radiographic outcome in prospective clinical trials.

Decision Making↗
PubMed2006

Performance of an automated computer-based scoring method to assess joint space narrowing in rheumatoid arthritis: a longitudinal study.

OBJECTIVE: To compare the diagnostic performance of a computer-based method for measuring joint space width with the Sharp joint space narrowing (JSN) scoring method in patients with rheumatoid arthritis (RA). METHODS: A random sample of patients with early RA, for whom sequential hand radiographs and Sharp scores were available, was selected from the National Data Bank for Rheumatic Diseases. Hand joint space width was measured using an automated, computer-based method in random order and with blinding for clinical information. We constructed a receiver operating characteristic curve and compared the diagnostic performance of the computer-based and Sharp methods based on the areas under the curve. RESULTS: One hundred twenty-nine patients with early RA who underwent serial radiography were included. Changes in the computer-based and Sharp methods were highly correlated (r = 0.75, P < 0.001). The computer-based method was significantly more discriminant than the Sharp JSN subscale. The area under the curve of the computer-based method was 0.96 (95% confidence interval [95% CI] 0.94, 0.99) compared with 0.93 (95% CI 0.89, 0.96) for the Sharp subscale (P = 0.024). At the most discriminant cutoff, specificity of the computer-based method was 88.4% compared with 81.4% for the Sharp subscale (P = 0.11); sensitivity was 87.6% for the computer-based method compared with 82.2% for Sharp subscale (P = 0.19). The signal-to-noise ratio for the computer-based method was 83% compared with 70% for the Sharp subscale (P = 0.013). CONCLUSION: The computer-based method for measuring joint space width is more discriminant than the semiquantitative Sharp JSN subscale.

Adult↗
PubMed2001

Arthritis in sarcoidosis.

AIMS AND METHODS: Sarcoidosis is systemic granulomatous disorder. Articular manifestations have received little attention in the literature. Case records of patients with sarcoidosis, presenting with articular symptoms between 1990-1999, were retrospectively analysed. RESULTS: Twenty nine patients, 15 males and 14 females, median age 44 years (range 15-67 years) and median duration of articular symptoms of eight months diagnosed clinically (n=9) and on biopsy (n=20) were studied. Twenty five patients had arthritis as the presenting manifestation. Fifteen patients had chronic arthritis (> six months). Lofgren's syndrome was seen in 7% of the patients. Acute arthritis was episodic (n=4), more common in males (M:F = 9:5), predominantly affected lower limb joints and mimicked reactive arthritis. Chronic arthritis was more frequently observed in females (M:F = 1:2) and presented with involvement of bilateral symmetric hand joints, mimicking rheumatoid arthritis. Extra-articular manifestations like neuropathy and constitutional symptoms were observed in acute arthritis. Skin plaque, splenomegaly and interstitial lung disease were seen with chronic arthritis. At a median follow up of 12 months, 10/14 and 5/15 achieved complete remission whereas 2/14 and 9/15 achieved partial remission of the articular symptoms in the acute and chronic groups, respectively. CONCLUSION: Arthritis in sarcoidosis is an early manifestation of disease and may mimic reactive or rheumatoid arthritis. Unsatisfactory response in chronic arthritis highlights the need for immunosuppressive drugs in addition to steroids.

Adolescent↗
PubMed1976

Radionuclide imaging of the bones and joints of the hand. A definition of normal and a comparison of sensitivity using 99mTc-pertechnetate and 99mTc-diphosphonate.

Normal radionuclide patterns of the hand obtained with 99mTcO4 and 99mTc-Sn-EHDP are described and their validity supported by clinical, radiographic, and laboratory examinations performed to exclude articular disease in the control group. Comparison of the 99mTcO4 and 99mTc-Sn-EHDP images in patients with various articular diseases demonstrated higher sensitivity of 99mTc-Sn-EHDP in detection of involved joints; this was also true when the radionuclide images were compared with fine-detail radiographs in patients with rheumatoid arthritis.

Adolescent↗
PubMed1996

Cervical spine involvement in rheumatoid arthritis: prevalence and relationship with overall disease severity.

Rheumatoid arthritis (RA) affects the cervical spine in 20-90% of patients in Western countries. We report the prevalence of cervical spine involvement in RA and its relationship with duration of disease, seropositivity, hand joint erosions and symptoms and signs suggestive of cervical spine involvement. 100 patients with RA criteria were included. Apart from clinical history and examination, study included X-rays of the cervical spine in AP, open mouth and lateral views and posteroanterior view of hands and rheumatoid factor estimation. All X-rays were read by a radiologist who was unaware of the clinical details. Cervical spine involvement was seen in 65% of patients. The commonest abnormality was erosions of the odontoid process (47%), followed by atlanto-axial dislocation and apophyseal joint involvement (24%). Only 5% of patients had abnormalities of spinous processes or vertebral bodies. Patients with abnormal cervical spine radiographs had higher prevalence of rheumatoid factor and erosions on hand radiographs. Severity of cervical spine changes was related to duration of disease (> 5 years). No correlation was seen between symptoms and radiological abnormalities except when neurological deficit was present. Patients with seropositivity, erosive disease and disease duration greater than five years should be screened for cervical spine disease.

Adolescent↗
PubMed1997

Somatotopy in the human motor cortex hand area. A high-resolution functional MRI study.

Fine-scale somatotopic encoding in brain areas devoted to sensorimotor processing has recently been questioned by functional neuroimaging studies which suggested its absence within the hand area of the human primary motor cortex. We re-examined this issue by addressing somatotopy both in terms of functional segregation and of cortical response preference using oxygenation-sensitive magnetic resonance imaging at high spatial resolution. In a first step, spatial representations of self-paced isolated finger movements were mapped by using motor rest as a control state. A subsequent experimental design studied the predominance of individual finger movements by using contrasting finger movements as the control task. While the first approach confirmed previous reports of extensive overlap in spatial representations, the second approach revealed foci of differential activation which displayed an orderly mediolateral progression in accordance with the classical cortical motor homunculus. We conclude that somatotopy within the hand area of the primary motor cortex does not present as qualitative functional segregation but as quantitative predominance of certain movement or digit representation embedded in an overall joint hand area.

Adult↗
PubMed1989

Reconstruction of the burned hand.

Several basic principles of burned hand care must be kept in mind at all times. Intervention should be early and aggressive, small splints should be placed within 24 hours, and early tangential excision of the burn should be done within 72 hours. Hemostasis should be absolutely meticulous prior to grafting. Depending upon the availability of donor site skin, full-thickness skin grafts, split-thickness grafts, or meshed split-thickness grafts (expanded or not expanded) are preferred. I have found the functional and cosmetic results to decrease with use in exactly the order stated. The skin graft should be placed with stent or bolster dressings and observed for "take" early. Light active range of motion is usually begun on the tenth postoperative day. Escharotomy or fasciotomy should be performed for any signs of ischemia. In order to control edema, one should be meticulous in the positioning of burned hands, emphasizing elevation, and early range of motion exercises. Pressure garments may be employed when the wound is stable and should continue for 6 to 12 months to control hypertrophic scar formation. Linear scars should not cross any hand joints; Z-plasties are employed over the web spaces. Whenever possible, flaps should be employed to preserve all web spaces and skin grafts used to cover the remainder of the hand. I am aggressive in releasing and reconstructing late deformities such as extension contractures of the wrist, the metacarpal hand, absence of the thumb, finger contractures, and burn syndactyly. These are listed in order of treatment priority. Only in this manner can the patient be returned to "normal life." Patient self-esteem will thus be increased markedly, as will quality of life. It is strongly urged that the surgeon be "captain of the team." The key person in this treatment regimen is the hand therapist, who uses appropriate splints, range of motion exercises, and desensitization programs. I encourage the use of multiple personnel on the "burn team." This may include psychotherapists and, in children, teachers with extraordinary qualities.

Burns↗
PubMed2004

[Primary Swanson metacarpophalangeal joint arthroplasty in major hand traumas. A report of two cases at 14 years follow-up].

In major hand injuries, destroyed joints may be treated by joint transfer, arthroplasty or fusion with or without temporary external fixation. Four immediate digital metacarpophalangeal joint Swanson implants in two patients with amputation or devascularizated near-amputation were reviewed with a 14 years follow-up. No infection was noted. Prostheses were stable with a 31 degrees active range of motion and grip strength was 42% of the opposite side. Functional results were "useful" with patients satisfaction. In one patient, heavy manual worker, implants were replaced fourteen years after trauma because of recent pain on one joint and implants fragmentation. The other patient was painless. Immediate Swanson arthroplasty in major hand injuries may be an alternative in metacarpophalangeal joints destruction.

Adult↗
PubMed2002

Synovial lipomatosis (lipoma arborescens) affecting multiple joints in a patient with congenital short bowel syndrome.

Synovial lipomatosis is a rare, synovial based disorder that typically affects a single knee. Magnetic resonance imaging and synovial biopsy established this diagnosis in a patient who presented with a 20 year history of painless swelling of the knees, wrists, and hands. Such extensive involvement, particularly of hand joints and tendon sheaths, has not been described previously. Superimposed on this chronic soft tissue joint swelling were acute knee effusions, which responded to intraarticular steroid injections. The co-occurrence with congenital short bowel syndrome may have etiological implications for this disorder of inappropriate fat deposition.

Adult↗
PubMed1991

[Evaluating occupational stress on the hand].

In order to achieve objective data to eventually measure the dexterity of hands, we examined 210 hands in 105 persons. These persons were divided into two groups: one group of people with jobs demanding unusual dexterity (musicians, typists, etc.), and another group with average occupational demands on the hand. As expected, we found that hand length and breadth and wrist circumference are always greater in the dominant hand of any individual. The thumb and small finger are always longer in the dominant hand. Joints' active range of motion are significantly higher in individuals whose occupations were particularly demanding.

Fingers↗