[Therapeutic restoration of deformed hands in patients with rheumatoid arthritis].
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Arthritis, Rheumatoid↗
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[Dermatoglyphics of deformed hands].
Palmar and finger prints are recovered in children with congenital malformed hands. The skin ridges of various hand abnormalities are compared with normal dermatoglyphics. We have found a relationship between the embryogenesis of the hand and the epidermal ridge arrangement. Dermatoglyphics are a clinically useful information for the diagnosis of amniotic disease or agenesis and for the chronology of the congenital malformation of limbs.
Dermatoglyphics↗
The fixed lupus hand deformity and its surgical correction.
In a prospective study of 125 patients with SLE, three females developed fixed hand deformities. All had arthritis for more than 10 years, and had been treated with a mean daily dose of 15 mg of prednisone. The hand deformities consisted of irreducible metacarpophalangeal (MCP) subluxation and/or dislocation without erosion or destruction of the MCP joints, resulting in hyperflexion of the fingers in the palm. Two patients had dislocation of the carpometacarpal joints in both hands. On patient developed reducible swan-neck deformities in the second to fifth fingers of both hands and a second patient developed Boutonniere deformities in two fingers of one hand and clinodactyly of both fifth fingers. Because the deformity at the MCP joints resulted from soft tissue contractures in the intrinsics and long flexors, and because the cartilage of the MCP joint was preserved, a joint replacement was not considered. Metacarpal osteotomy and shortening was performed to decompress the contracted soft tissues. At follow-up (18-96 months), the hands remained corrected and all patients were able to perform normal activities.
Adult↗
[Hand deformities in Freeman-Sheldon syndrome and their surgical treatment].
The Freeman-Sheldon-Syndrome is a rare complex of malformations with typical deformities of face, hands and feet. The individual variability of the characteristics seems to be very big, as could see in our own patients (9 cases) as well as in literature (43 cases). The most frequent and most important characteristics are discussed, mainly the deformity of the hand. Six hands have been operated on for functional improvement; different methods were used. The primary objective of our treatment was the correction of thumb deformity.
Abnormalities, Multiple↗
A new protocol for the treatment of hand deformities in recessive dystrophic epidermolysis bullosa (13 cases).
The recessive form of dystrophic epidermolysis bullosa creates severe hand deformities with disabling functional limitations in the main daily activities. Typically, the thumb is contracted in adduction, the first web space is obliterated, the palm and digits are contracted in flexion and interdigital spaces are lost (pseudo-syndactyly). In this paper, we present our experience with a protocol based on the association of various internationally developed techniques: brachial plexus anesthesia with ketamine sedation, dynamic splinting and coverage of the wounds with allogenic keratinocytes sheets. The overall results obtained in the first 13 patients showed a good tolerance of the procedure, no anesthesiologic complication and marked improvement of the hand deformities. The long-term follow-up revealed a recurrence before 2 years in 2 hands, between 2 and 4 years in 7 hands and after 4 years in 6 hands. The conclusion is that an aggressive surgical attitude, along with an adequate intra and post-operative rehabilitation, ensures a good restoration of hand function and a satisfying delay of inevitable recurrence.
Activities of Daily Living↗
A mucolipidosis III patient presenting characteristic sonographic and magnetic resonance imaging findings of claw hand deformity.
Mucolipidosis III (ML-III), or pseudo-Hurler polydystrophy, is an autosomal recessive Hurler-like disorder without mucopolysacchariduria. The diagnosis is challenging for rheumatologists since the musculoskeletal presentation is similar to some rheumatic diseases. We report a case of ML-III in a 16-year-old Taiwanese boy. The characteristic findings of sonography and magnetic resonance imaging (MRI) of claw hand deformity are described. A 16-year-old boy was referred to our rheumatologic clinic because of progressive claw hand deformity, multiple joint stiffness and tightness of the skin over the fingers at the age of 6 years. Sonography and MRI examination disclosed tendon sheath thickening over extensor tendons of both wrists and fingers without features of active inflammation over tendons or joints nor thickening of skin. Urinary glycosaminoglycans were normal. The diagnosis of ML-III was confirmed by the presence of elevated activities of beta-glucuronidase (2141.99 nmol/mg protein/hour), arylsulfatase A (1237.7 nmol/mg protein/hour) and alpha-fucosidase (52.95 nmol/mg protein/hour) in his plasma and decreased activity of these lysosomal enzymes in cultured skin fibroblasts. Sonography and MRI screening for claw hand deformity may offer important clues enabling early diagnosis of ML-III.
Adolescent↗
Hand deformity in Parkinson's disease: case report.
Hand and foot deformities were originally described in Parkinson's disease (PD) in 1864, although their pathogenesis still remains to be clarified. Typical hand deformities are flexion in metacarpopharyngeal joints and hyperextension in interphalangial joints, sometimes accompanied by ulnar deviation. Unlike rheumatoid arthritis (RA), there is no swelling and stiffness in joints. In this report, a case that was previously misdiagnosed as RA due to deformities in the hand and whose PD was detected upon presentation to our clinic is presented, and the differential diagnosis of the disease is discussed.
Aged↗
Casting, splinting, and physical and occupational therapy of hand deformity and dysfunction in cerebral palsy.
The treatment of hand deformity and associated dysfunction is a major focus of physical and occupational therapy for people with CP, as poor grasp and manipulation has potential to impact on many aspects of daily life. To assist therapists in analyzing patterns of movement of the wrist, finger, and thumb musculature at rest and during functional activities, five patterns of deformity commonly seen in the hypertonic hand are described. Interventions that impact on hypertonicity and associated contracture and that facilitate functional use of the hand in the presence of these deformities are discussed. The paucity of evidence from clinical trials on intervention strategies reflects in part the diversity of people with CP and the highly individual functional problems they encounter. While further research is needed on the many possible interventions and how they contribute to maximizing hand function, there is increasing evidence of the value of therapy that is directed to functional outcomes relevant to the individual.
Casts, Surgical↗
Hand deformities in patients with snakebite.
Over the past 25 years, 83 patients have been treated at our hospitals for poisonous snakebites of the hand. Prior to 1970, polyvalent antivenin was used, either alone or in conjunction with cryotherapy, steroids, or incision and suction methods. Hand deformities, due to tissue necrosis, were encountered in 15 of 22 patients (68%) treated by these methods. In contrast, excisional therapy, without the use of polyvalent antivenin, was the sole method of treatment in 61 patients seen since 1970. The incidence of hand deformity in them was 8.2%. We have concluded that early excision of the envenomated tissues will not only curtail systemic toxicity from the injected venom, but will also minimize the extent of local tissue damage.
Hand Deformities, Acquired↗
[Tendon alloplasty in hand deformities after burns].
The author's experience shows that in a number of patients with deformities of the hand following burns alloplasty can provide a considerable improvement, and even sometimes a complete recovery of functions including damages of nerve trunks, with disturbed innervation of muscles and sensitivity of the hand. He believes that the alloplasty should be performed under the restored normal skin and be often combined with other restorative-reconstructive surgery.
Adolescent↗
Recessive dystrophic epidermolysis bullosa--management of hand deformities.
Scarring in recessive epidermolysis bullosa results in disability through hand deformities. Surgical treatment is complicated by technical and anaesthesiological problems due to the fragility of the skin and mucosa. In its dystrophic form epidermolysis bullosa leads to pseudosyndactyly and finger and palm contracture resulting in a "closed hand". Surgical treatment consists of resecting the contractures and opening the inter-digit webs, the uncovered areas healing under a close tulle gras dressing. Our technique differs from techniques which have already been reported. The dressing is changed only once a week, reducing the number of anaesthetics and allowing the child to attend our Day Hospital. Healing is complete within five weeks. Prevention of recurrence avoids the necessity of further surgery before five years of age. Post-operative open-hand splinting is well tolerated, delaying further contracture. Surgery is undertaken sometimes under general anaesthesia but more often under regional anaesthesia. We report the results of our experience.
Child↗
Hand deformities in a patient with chronic lung disease; Jaccoud's arthropathy.
Jaccoud's arthropathy is a syndrome of chronic progressive painless deformity of the hands and feet with surprisingly well preserved functions. The arthropathy has been known to develop subsequently to episodes of rheumatic fever. a patient is presented in this report with a clinical and radiologic finding indistinguishable from that of the Jaccound's arthropathy. However, the only associated illness is chronic lung disease.
Diagnosis, Differential↗
Have you tried the sandwich splint? A method of preventing hand deformities in children.
The prevention of contractures of the burned hand is an arduous problem in the young pediatric burn patient. Difficulty in applying splints, along with the time-consuming fabrication of complex splints, led to the development of the "sandwich" splint. This easily produced splint provides a means of preventing and treating hand deformities in this patient age group. Positive results have been noted with the use of this splint in conjunction with the patient's usual active physical therapy program.
Burns↗
Osteogenesis imperfecta: a case with hand deformities.
In a 51-year-old woman with a history of fractures and dislocations after low intensity trauma in childhood, intensive blue sclera, short stature, and hearing loss, the diagnosis of osteogenesis imperfecta (OI) was suspected. She was referred to our clinic with hand deformities and left knee pain and stiffness. She had difficulty in walking and reported a history of immobilization for 6 months because of knee pain. She had bilateral flexion contracture of the elbows which occurred following dislocations of the elbows in childhood. She had Z deformity of the first phalanges, reducible swan-neck deformity of the third finger of the left and the second finger of the right hand, flexion contracture of the proximal interphalangeal joint of the fifth finger of the left hand, and syndactyly of the third and fourth fingers of the right hand. Flexion contractures of both knees were observed. Pes planus and short toes were the deformities of the feet. Acute phase reactants of the patient were normal. She had no history of arthritis or morning stiffness. Bone mineral density evaluated by dual-energy X-ray absorptiometry (DEXA) showed severe osteoporosis of the femur and lumbar vertebrae. She had radiographic evidence of healed fractures of the left fibula, the third metacarpal, and the fourth and fifth middle phalanges of the right hand. OI, affecting the type I collagen tissue of the sclera, skin, ligaments, and skeleton, presenting with ligament laxity resulting in subluxations and hand deformities may be misdiagnosed as hand deformities of rheumatoid arthritis.
Female↗
The surgical treatment of hand deformities in systemic lupus erythematosis.
Ten patients with systemic lupus erythematosis hand deformities were studied. Wrist involvement included distal ulnar subluxation in 14 wrists (with four requiring excision) and various degrees of carpal instability in 12 wrists (usually asymptomatic). Metacarpophalangeal (MP) joint subluxation treated by soft tissue procedures for passively correctable deformities in 30 joints had a failure rate of 70%. MP joint arthroplasties performed in 33 joints gave fair results in 16 joints with fixed deformities and good results in 17 joints with passively correctable deformities. Thumb deformities always involved all three joints, and maintenance of carpometacarpal (CMC) joint stability was the key to thumb reconstruction. CMC joint stabilization with ligamentous reconstruction gave good results in three of four thumbs. Four CMC joint fusions and two CMC joint implant arthroplasties gave good results. Each was accompanied by appropriate procedures on the MP joint or interphalangeal joint.
Finger Joint↗
Treatment of hand deformities in a long-term survivor with dermolytic bullous dermatosis-recessive (DBD-R).
Treatment of hand deformities in a long-term survivor with dermolytic bullous dermatosis-recessive is described. An "open method" is sufficient for dealing with volar skin defects. There is still no effective treatment for perfect control of blister formation. But appropriate surgery, followed by careful post-operative rehabilitation can give reasonable hand function.
Adult↗
Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities.
PURPOSE: Previous studies have found that function and pain are the main factors that persuade physicians to recommend surgical reconstruction to patients with rheumatoid arthritis (RA). The factors that influence patients to choose surgical reconstruction, however, are not known fully. The purpose of this study was to determine how function, pain, and aesthetics rank in order of importance to RA patients who are considering metacarpophalangeal (MCP) joint arthroplasty for rheumatoid hand deformities. METHODS: Study participants are part of a larger National Institutes of Health-sponsored study. Participants who are eligible to receive MCP joint arthroplasty are enrolled in our study using defined inclusion and exclusion criteria. All patients have RA and MCP joint extensor lag and/or ulnar deviation. Study participants choose whether they want to enroll in a surgical group to receive MCP joint arthroplasty or in a nonsurgical group. At enrollment all participants complete the Michigan Hand Outcomes Questionnaire. Function, pain, and aesthetic domains from the Michigan Hand Outcomes Questionnaire were used in a logistic regression model as predictors to determine the factors associated with patients choosing reconstruction for rheumatoid hand deformities. RESULTS: Younger age and female gender were associated significantly with an increased likelihood for choosing MCP joint arthroplasty surgery. The age- and gender-adjusted odds ratios of choosing MCP joint arthroplasty were 0.50 for function, 1.47 for pain, and 0.83 for aesthetics. Patients with less function and greater pain were more likely to choose MCP joint arthroplasty. Aesthetic consideration was not a statistically significant predictor. CONCLUSIONS: Impaired function had the strongest association with patients choosing reconstruction and pain relief was the next most important factor. Although aesthetic consideration was less important, it may prove to be an important factor in determining patient satisfaction after surgery. Understanding which factors are associated with choosing rheumatoid hand reconstruction is an essential component of patient preoperative counseling.
Activities of Daily Living↗