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At least 361 records · Page 20Linked to original sources
PubMed2005

Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography.

OBJECTIVE: To evaluate a low field dedicated extremity MRI unit for detection of bone erosions, synovitis, and bone marrow oedema in wrist and metacarpophalangeal (MCP) joints, with a high field MRI unit as the standard reference. METHODS: In 37 patients with RA and 28 healthy controls MRI of the wrist and 2nd-5th MCP joints was performed on a low field MRI unit (0.2 T Esaote Artoscan) and a high field MRI unit (1.0 T Siemens Impact) on 2 subsequent days. MRI was performed and evaluated according to OMERACT recommendations. Additionally, conventional x ray, clinical, and biochemical examinations were performed. In an initial low field MRI "sequence selection phase", based on a subset of 10 patients and 10 controls, sequences for comparison with high field MRI were selected. RESULTS: With high field, spin echo MRI considered as the reference method, the sensitivity, specificity, and accuracy of low field 3D gradient echo MRI for erosions were 94%, 93%, 94%, while the corresponding values for x ray examination were 33%, 98%, and 83%. Sensitivity, specificity, and accuracy of low field MRI for synovitis were 90%, 96%, and 94%, and for bone marrow oedema 39%, 99%, and 95%. Intraclass correlation coefficients between low field and high field scores were 0.936 (p<0.005) for bone erosions and 0.923 (p<0.05) for synovitis. CONCLUSION: Low field MRI provides high accuracy for detection and grading of erosions and synovitis, with high field MRI as the standard reference. For bone marrow oedema, specificity is high, but sensitivity only moderate. Low cost, patient compliant, low field dedicated extremity MRI provides similar information on bone erosions and synovitis as expensive high field MRI units.

Adult↗
PubMed1997

Use of an objective measure of articular stiffness to record changes in finger joints after intra-articular injection of corticosteroid.

OBJECTIVE: (1) To measure objectively the subjective improvement in joint stiffness following intra-articular injections of corticosteroids, and (2) to record changes in joint stiffness in the first 24 hours after injection to look for changes in the physical properties of the joint that would be consistent with a crystal synovitis. METHODS: The study population consisted of 15 patients having 17 metacarpophalangeal joints injected as part of their routine care. Measurements were taken before injection, at 24 hours, and after one week. Outcome variables included articular stiffness, strength, joint range of movement, and subjective scores. RESULTS: At 24 hours, mean values for stiffness had increased (mean slope from 0.0085 to 0.0123 Nm degree-1; curve area from 0.1003 to 0.1555 units), but the increase was not significant. After one week a significant decrease in "elastic stiffness" had occurred (mean slope from 0.0085 to 0.0065 Nm degree-1; P = 0.025). Significant changes in grip, range of movement, and subjective scores were also found after one week (maximum grip from 75.3 to 85.9 N; flexion/extension range from 87.0 to 102.4 degrees; pain visual analogue scale (VAS) from 50 mm to 12 mm; stiffness VAS from 65 mm to 27 mm). CONCLUSIONS: An early increase in joint stiffness in some patients following intra-articular corticosteroids is consistent with a transient synovitis. Symptoms of joint stiffness generally correlate with mechanical measures which provide a useful objective index of acute changes in joint pathophysiology.

Adrenal Cortex Hormones↗
PubMed2003

[Rheumatoid arthritis in patients aged above 75 years old at onset].

Elderly onset rheumatoid arthritis (RA) is difficult to diagnose definitively when the patients note their first symptoms of arthritis above the age of 75 years old. In this report, we reviewed the clinical features of elderly onset RA and its diagnosis. The subjects included 4 females, aged 78, 83, 84 and 93 years, respectively. The onsets were abrupt in 2 cases and more slowly arriving in the other 2. Shoulder joints and wrist joints were involved in all cases. Knee joints, finger joints and foot joints were involved in 3 cases and the elbow was involved in one case. Anti-RA treatment quickly attenuated the acute and severe arthritis and brought down the high CRP level associated with vivid inflammatory activity of RA. The RAPA value was very high in all but one of the cases. Severe destructive findings in radiography was undetectable in the major joints (e.g. shoulder, hip and knee joints). Radiographic findings in wrist and finger joints were also very difficult to differentiate from arthrosis and osteoporosis. On the other hand, RA involvement in the cervical spine was certain in the radiographs; 1 case had anterior atlantoaxial subluxation and 2 cases had subaxial intervertebral erosion. Pathological radiographic findings in the cervical spine are useful for the diagnosis of elderly onset RA.

Aged↗
PubMed1989

Operation for collateral ligament ruptures of the metacarpophalangeal joints of the fingers.

Ten cases of complete rupture of the collateral ligaments of the metacarpophalangeal finger joints are reported. The nature of this injury, the pre-operative morbidity and the intra-operative pathology are analysed. In all cases surgery was performed with satisfactory results. Operation is indicated for joint stability, grip and pinch strength, pain control and early functional recovery.

Finger Joint↗
PubMed1992

Diagnostic efficacy of digitized images vs plain films: a study of the joints of the fingers.

Four hundred fifteen finger joints from 30 patients were evaluated for the presence of joint-space erosion, narrowing, and degenerative spurring on plain films, low-resolution digitized images (1024 x 840 bytes x 12 bit matrix), and high-resolution digitized images (2048 x 1680 bytes x 12 bit matrix). Three hundred four joints were abnormal. Low- and high-resolution digital images were displayed on a 1K x 1K monitor with the ability to change level, window, orientation, and brightness. Five radiologists interpreted images. The presence or absence of each abnormality was determined by consensus of two skeletal radiologists who did not otherwise participate in the study. Receiver-operating-characteristic analysis was used to obtain an area and a true-positive rate at a 0.10 false-positive rate for each interpreter. Randomized block analysis of variance with interpreters as blocks was used to compare areas and true-positive rates among imaging techniques for each type of abnormality; no statistically significant differences were found. In conclusion, the efficacy of display of digitized images on high- and low-resolution modes is not significantly different from that of plain films in the detection of erosions, joint-space narrowing, or degenerative spurring in small joints of the hands.

Analysis of Variance↗
PubMed2001

The adipofascial turnover flap for coverage of the exposed distal interphalangeal joint of the fingers and interphalangeal joint of the thumb.

The adipofascial turnover flap was used to cover exposed distal interphalangeal joints of 8 fingers and interphalangeal joints of 4 thumbs. The flap was raised from the dorsum of the injured digit with a base located at the edge of the defect. The flap has a random type of vascularity and was designed with a base-to-length ratio of 1:1.5 to 1:2. All flaps survived completely. Various other types of flaps that have been used to reconstruct dorsal digital skin defects were reviewed and compared with the adipofascial turnover flap.

Accidents, Occupational↗
PubMed2003

Long-term results of free vascularized second toe joint transfers to finger proximal interphalangeal joints.

PURPOSE: To review the long-term clinical results of free vascularized second toe joint transfers for severely damaged finger proximal interphalangeal (PIP) joints. METHODS: Eleven joints in ten patients (1 woman, 9 men) were reviewed between 10 and 22 years after surgery. The average patient age at the time of the surgery was 32 years. Patients were evaluated at a mean follow-up time of 15 years; evaluation included range of motion of the transferred PIP joints and the remaining healthy second toe PIP joints, grip strength, finger and toe pain, finger function, gait disturbance, patient satisfaction, and x-ray changes. RESULTS: The mean active range of motion was 47 degrees that lacks 41 degrees extension and flexes to 88 degrees. The mean grip strength was more than 80% that of the nonaffected hand, and no finger pain or gait disturbances were reported. All patients had some extension lag and flexion contractures but most were satisfied with the clinical and functional results of surgery. In all joints, the joint spaces were preserved, although 1 patient had arthritis and 3 had osteophytes. CONCLUSIONS: It is important to prevent extension lag and flexion contracture to get better results from free vascularized second toe joint transfers. The transferred toe PIP joint is durable.

Adult↗
PubMed1985

Limited joint mobility in diabetes mellitus.

The relationship of limited joint mobility and finger joint contractures in diabetics to age of onset, duration, and control of diabetes has not been established. We measured the mobility of metacarpophalangeal, wrist, elbow, and ankle joints and assessed the prevalence of finger joint contractures in 254 young diabetics and 110 controls. The presence of microvascular disease was assessed by ophthalmoscopy and urine analysis for proteinuria. An estimate of long-term diabetic control was obtained from a postal questionnaire. A generalised reduction in joint mobility was present in diabetics of all ages two years after diagnosis. The reduction in joint mobility in controls between the ages of 12 and 13 was exaggerated in the diabetics. Diabetics diagnosed before puberty were more severely affected than those with a postpubertal onset, independent of duration of diabetes. Finger joint contractures were a significant feature of longstanding diabetics (nine years or more duration) only.

Adolescent↗
PubMed1988

[A holding device for standardized roentgenologic detection of ulnar, palmar and radial capsule ligament lesions of the metacarpophalangeal joint of the thumb. Hyperextensometer for the index finger metacarpophalangeal joint for determining laxity of the ligament].

A device has been designed to hold the limb for standardized radiological demonstration of lesions of the ulnar and radial collateral and palmar ligaments of the metacarpophalangeal joint of the thumb. The device also serves as a hyperextensometer of the metacarpophalangeal joint of the index finger with which to measure joint laxity. The simple mechanism allows routine application. Standardized stressed roentgenograms allow exact quantification of the extent of all lesions and consequently leads to adequate treatment.

Finger Injuries↗
PubMed2005

Simultaneous dorsal dislocation of the interphalangeal joints in ring finger with proximal interphalangeal joint dislocation of the middle finger: case report and review of the literature.

A 30-year-old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints of the ring finger and of the proximal interphalangeal joint of the middle finger following a hyperextension injury. This was reduced under a local anaesthetic. Neighbour finger strapping and early mobilisation achieved an excellent functional outcome when reviewed at eight weeks after the initial injury.

Adult↗
PubMed1992

Dorsal fracture subluxation of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb treated by extension block splintage.

In a prospective study six patients with dorsal fracture subluxation of the IP joint of the thumb or the DIP joint of the finger were treated conservatively using an extension block splint. The fracture size varied from 22% to 47% of the articular surface of the volar base of the terminal phalanx. Good or excellent results were reported in all cases except for one, which was fair. Only one case in the study complained of any pain, and this was minimal. Conservative treatment using extension block splintage for this injury is as good as a surgical approach.

Adult↗
PubMed2006

HFE gene mutations are associated with osteoarthritis in the index or middle finger metacarpophalangeal joints.

OBJECTIVE: . To test the hypothesis that possession of either C282Y or H63D mutations in the HFE gene is associated with primary osteoarthritis (OA) in joints commonly affected in hemochromatotic arthropathy. METHODS: HFE genotyping was performed in 87 patients with radiologically proven OA in 3 joint regions: index or middle finger metacarpophalangeal joints (MCP2,3; n = 52), elbow joints (n = 8), ankle, intertarsal or tarsometatarsal joints (ankle/IT/TMT; n = 27); and in 56 patients with radiologically proven OA in finger interphalangeal (IP) joints, but not MCP2,3 joints (IP OA control group). HFE mutation frequencies in these groups were also compared to those in a similar population (Busselton population control group). RESULTS: A statistically significant association between HFE mutations and OA was observed for the MCP2,3 joints (p = 0.0001) and the ankle/IT/TMT joint group (p = 0.002) as well as for the 3 joint regions collectively (p = 0.0001), but not for the elbow joints (p = 0.062). Comparison with the Busselton population controls showed similar statistically significant associations, except for the elbow and ankle/IT/TMT groups, where similar trends were observed. CONCLUSION: HFE gene mutations are associated with OA in the MCP2,3 joints. These mutations may be markers for a polyarticular OA phenotype.

Adult↗
PubMed2005

[Pyrocarbon prosthesis for finger interphalangeal joint replacement. Experience after one year].

The long-term results of finger joint replacement, particularly the proximal interphalangeal (PIP) joint, have mostly been disappointing according to a review of the international literature and our own experiences. The recently developed pyrolytic carbon implants (Ascension Orthopedics, Austin, Texas) for replacing the PIP joint were evaluated retrospectively regarding range of motion, functionality, and relief of pain. In our hospital 17 PIP joints were replaced with pyrolytic carbon implants in 16 patients by an offset stem technique inserted without cement. This study included 13 patients; we excluded three patients because of follow-up <3 months. Prerequisites were adequate collateral ligaments, bone stability, and sufficient or at least reconstructable extensor tendons. The purpose of this study was to evaluate the 1-year outcome (minimum 270, maximum 360 days) regarding range of motion, implant stability based on radiological and clinical parameters, and relief of pain using a pre- and postoperative visual and verbal analogue scale.There was an improved range of motion of the PIP joint from 0-28-51 preoperatively to 0-22-77 postoperatively (average value). On the visual analogue scale (0 no pain, 10 incapacitating pain) we achieved pain relief at rest and in motion of 80%. On the verbal analogue scale there was an improvement of 62%. The results of this study demonstrate that pyrolytic carbon implants reduce pain and are functionally superior to arthrodesis. A precise and individual postoperative protocol is necessary for beneficial results.

Adult↗
PubMed2002

A biomechanical analysis of the rheumatoid index finger after joint arthroplasty.

OBJECTIVE: To determine the mechanisms responsible for the recurrence of ulnar drift after metacarpophalangeal joint arthroplasty in the rheumatoid hand. DESIGN: A three-dimensional biomechanical model of the index finger joints was used to predict the implant loads during several activities of daily living. BACKGROUND: Post-operative clinical evaluation of Sutter metacarpophalangeal prostheses shows a high incidence of fracture and recurrent deformity. METHODS: A six-component force transducer in conjunction with a six-camera motion analysis system were used to obtain kinematic and external loading data from eight patients with rheumatoid arthritis during several simulated activities. These data were used as input into a three-dimensional biomechanical model of the implant and interphalangeal joints of the index finger. Tendon lines of action and moment arms were obtained using a series of MRI scans and CAD modelling techniques. RESULTS: Implant forces were oriented in a radial and dorsal direction to resist the ulnarpalmarly pull of tendons associated with the metacarpophalangeal joint. CONCLUSIONS: The recurrence of ulnar drift is attributable to fatigue failure of the prostheses. After fracture the implant is unable to support the repetitive loading patterns experienced during activities of daily living. RELEVANCE: Understanding the mechanisms responsible for the recurrence of ulnar drift and implant failure is a step towards improving the prosthesis design, surgical procedures and ultimately the patient's prognosis.

Activities of Daily Living↗
PubMed2005

[Effect of tonic painful squeezing of the finger distal joint on the evoked potential of different spectral frequency ranges in electroencephalogram of humans].

EEG changes caused by the tonic squeezing of the distal joint of the little finger of both hands were investigated on 12 healthy volunteers, age 20-56 (average 35.5). Pain stimulation applied to the right hand was stronger than that applied to the left. Power spectra was measured in 7 EEG ranges: delta--2-4, theta1--4-6, theta2--6-8, alpha1--8-10.5, alpha2--10.5-13, beta1--13-20 and beta2--20-35 Hz. The increase of power in the different areas of the cerebral cortex was a dominant effect of pain influence in beta1 and beta2 as well as in both alpha-ranges. The pain stimulation influenced EEG-parameters bilaterally. It was supposed that increment of alpha-synchronization during peripheral pain reflected the inhibition processes in the thalamo-cortical system. This process most likely limited the area of afferent activation in the cortex. The topography of the significant power changes in alpha1- and alpha2-ranges was different during strong pain as well as after its cessation. Different parameters of functional brain activity during pain stimulation seemed to be reflected in alpha1- and alpha2-rhythms. The significant increment of spectral power in alpha-, beta- and theta2-ranges was demonstrated after cessation of strong pain in comparison to the pre-pain condition. Thus, the changes in EEG parameters reflect the latent and inertial character of the pain effects.

Adult↗