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At least 397 records · Page 22Linked to original sources
PubMed1998

[One hundred years of orthopedics in the Netherlands. VI. Surgical treatment of rheumatoid arthritis].

The prevalence of rheumatoid arthritis is about 1%. Loss of independence during daily activities is closely related to the multiple joint involvement of these patients. Also, chronic systemic autoimmune diseases and the extra-articular lesions cause considerable comorbidity. Goal of medical treatment is to reduce disease activity and local joint destruction. The surgical treatment consists of joint protective surgery and joint reconstructive surgery. The former procedure inhibits rapid progression of joint destruction by eradicating the bulk of synovial tissue. The latter procedure compensates for functional loss of an extremity by arthroplasties (both endoprostheses and arthrodeses) to increase the patient's independence. The perfect long-lasting functional prosthesis is available for some joints (hip and knee), but still in development for other joints (e.g. finger joints). In case of surgical reconstruction, a plan for possible complications (e.g. loosening) and their functional implications for the specific patient, should be part of the surgical indication policy. The outcome after a surgical procedure is closely related to preoperative patient factors (e.g. joint destruction) and the surgical expertise. Co-ordination of the treatment plan has to be done by the rheumatologist in close conjunction with the orthopedic/rheuma surgeon.

Arthritis, Rheumatoid↗
PubMed1998

Analysis of voluntary finger movements during hand tasks by a motion analyzer.

Finger movements have primarily been classified by the final position of the hand and finger during deliberate hand activities, rather than as a description of the movement process. In addition, as of yet there have been no reports based upon objective data from the analysis of the motion of three finger joints during movement, and no reports exist that describe the relationship of the three joints' motion during these movements. This paper describes the relationship of the three finger joints during simple finger movements and hand tasks using measurements and analysis from a two-dimensional motion analyzer. Two prehensile movements were examined in 15 healthy volunteers: pure finger extension from finger flex position in different wrist positions (dorsi-flexion position, neutral position and palmar-flexion position of the wrist joint) and the grasping of discs of different diameter (10, 11, 12 and 13 cm). In the sequence of pure finger extension, where the grasping task was not requested, results showed that the movement was started from the proximal joint and extended to the distal joint of the finger, and full finger extension accomplished from distal to proximal, one after another, in any wrist position in most subjects. With the grasping of a disc, however, joint movement was initiated from distal to proximal and the final motion for grasping was carried to completion from the proximal to distal joints of the finger in most subjects. In addition, it was recognized that the proportion of the angular change in each of the three joints was different, as were the time duration of the joint motion and the pattern of the angular change. From these results, it is suggested that deliberate activities of the finger and sophisticated joint movements provided delicate adjustments to fit the fingers to the size of the object, as compared to the simple finger extension movement.

Adult↗
PubMed2000

[Experiences with the alloplastic joint prosthesis of the interphalangeal joint].

The replacement of finger joints, especially of the proximal interphalangeal joint (PIP), remains an unsolved problem. Long-term results of conventional reconstructive procedures as well as previously available artificial joint implants have been disappointing. In a controlled study, 12 PIP-joints were replaced by a new type of total endoprosthesis as an alternative to joint fusion. The cementless prosthesis is unhinged and consists of metal joint surfaces. After a follow-up of 18 months, implantation of this metal prosthesis resulted in almost complete pain relief and an active range of movement of 58 degrees. The absolute gain in mobility, however, was only 6 degrees. A swan-neck deformity was found in nine out of 12 cases but corrective surgery was not required. The proximal half of the implant had to be exchanged in two cases due to loosening. All patients were satisfied with the result. The disparity between subjective acceptance by the patients, who clearly prefer joint replacement to fusion, and objective results demonstrates the necessity for further development in this field. The type of prosthesis used in this study seems to be a useful baseline tool which could be turned into a ingenious PIP-joint replacement by further development aiming at reduced abrasion, increased initial stability, a more individual configuration, to name just a few goals.

Equipment Failure Analysis↗
PubMed2000

Design of a surface replacement prosthesis for the proximal interphalangeal joint.

A surface replacement finger joint prosthesis was designed specifically for the proximal interphalangeal joint (PIPJ). The two-piece design consisted of a bi-condylar proximal phalangeal head and a conforming bi-concave middle phalangeal base. The bearing surfaces were designed as close to the original anatomy of the PIPJs as possible, using detailed information obtained from a previous anatomical study of 83 PIPJs by the present authors. Four sizes of prosthesis were designed with maximum head diameters of 7, 8, 9 and 10 mm. Fixation of the joint prosthesis was achieved by an interference fit between the stems of semicircular cross-section and the phalangeal bone shafts. The main considerations for the stem designs were the offset from the centre of rotation, angle of inclination, length, and cross-sectional shape and size. It is proposed that the two components will be made from cross-linked polyethylene (XLPE) because it can be injection moulded to produce the complex shapes of the joint prosthesis. In addition, XLPE against itself has shown comparable wear rates with stainless steel against ultra-high molecular weight polyethylene from previous work by Joyce et al.

Biocompatible Materials↗
PubMed1988

Closed complex dorsal dislocation of the middle finger metacarpophalangeal joint: anatomic considerations and treatment.

A rare complex isolated metacarpophalangeal joint dislocation of the middle finger is described, and the pathology is reviewed. The dorsal longitudinal incision used in this case provided excellent exposure for the reduction and helped avoid injury to the digital nerves on the palmar side of the injury. Early mobilization with extension blocking is advocated to maximize joint range of motion postoperatively.

Aged↗
PubMed2000

Finger motion, wrist motion and tendon travel as a function of keyboard angles.

OBJECTIVE: This study assessed the impact of keyboard angles (in terms of Pitch, Roll and Yaw) on tendon travel and wrist and finger joint kinematics for the flexor digitorum profundus and flexor digitorum superficialis.DESIGN. A repeated measures, laboratory study was conducted. Independent variables were three Pitch angles, three Roll angles, three Yaw angles, and three keyboard separation distances. Dependent variables were tendon travel, wrist deviation, wrist and finger joint kinematics, and Borg comfort rating. BACKGROUND: The increased usage of computers and the risk of cumulative trauma disorders have led to the development of alternate keyboards. This study is a biomechanical assessment of several keyboard designs.METHODS. Lightweight wrist and finger goniometers were used to measure motion of the wrist in three planes, and for three finger joints. Fifteen experienced typists (eight women, seven men) typed a standard text on 30 keyboard conditions. Regression equations were used to calculate tendon travel from joint positions. RESULTS: Tendon travel is sensitive to changes in Pitch, Roll and Yaw angles with approximately 13% difference between the minimal and maximal tendon travel. A flat keyboard produced more tendon travel than keyboards with greater Pitch and Roll angles.CONCLUSIONS. There is a trade-off between wrist and finger positions; as the wrist extends more, the finger joints flex more to compensate. Keyboards imposed different trade-offs between the wrist and finger positions, affecting the overall tendon travel. Relevance Alternate keyboard designs can significantly affect tendon travel and may address reduced repetitiveness in typing by reducing the amount of tendon travel.

Adult↗
PubMed1995

A survey of radiation synovectomy in Europe, 1991-1993.

The prevalence of radiation synovectomy practice is unknown. As new particulate radiopharmaceuticals offering many potential advantages are being developed, it seems prudent to appraise the extent, frequency and variation in radiation synovectomy practice. We have evaluated radiation synovectomy practice in Europe over the period 1991-1993 by means of a postal questionnaire. More than 2300 European members of the European Association of Nuclear Medicine were questioned about the number of treated patients and joints, disease prevalence in their patients and the use of radiopharmaceuticals. Overall, 119/490 (24%) of centres replying to the survey practised radiation synovectomy during the 3 years. There were 13,450 different joint injections in 8578 patients. Rheumatoid arthritis was the most prevalent disease in patients treated (71%) and the most frequently treated joints were knee (46%) and finger joints (20%). Eight different radiopharmaceuticals were employed. Yttrium-90 colloids were most frequently and widely (100/119 centres) used, mainly employed for knee synovectomy but were also used to treat most appendicular joints. Erbium-169 colloid was almost exclusively used to treat finger joints (31/33 centres). Corticosteroid was routinely co-injected in 36/60 (60%) centres. Radiation synovectomy was widely practised throughout Europe during 1991-1993. There are variations in practice illustrated by the diversity of treated arthritides and injected joints and by the use and application of different radiopharmaceuticals.

Anti-Inflammatory Agents↗
PubMed2003

Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries.

PURPOSE: The purpose of this study was to detail the pathomechanics and pathoanatomy of fracture dislocations of the ring finger and small finger carpometacarpal (CMC) joint by duplicating the pathomechanics of the fist blow. METHODS: A custom-made jig was used to position 20 fresh-frozen cadaver upper extremities in forearm neutral rotation, 90 degrees of elbow flexion, 20 degrees of wrist extension, and 20 degrees and 30 degrees of flexion at the ring and small finger CMC joint, respectively. First 7.7 kg of weight were dropped from a height of 0.76 m to 1.1 m to axially load the ring and small metacarpal (MC) heads through a custom-made apparatus. Fluoroscopic examination before and after loading, and detailed dissection after loading, were used to identify any osseous and/or ligamentous injuries. RESULTS: The most common fractures were a dorsal capitate fracture and a middle MC dorsal base fracture. The most common combinations of fractures were the dorsal capitate and dorsal hamate fractures. Multiple fractures often were identified in a number of locations including dorsally: the capitate, hamate, and index through small metacarpal bases, and volarly: the hook of the hamate and the middle through the small MC bases. CONCLUSIONS: The patterns of injuries encountered at the ring and small CMC joints can be explained by the direction and force of the applied load, position of the CMC joint at the time of loading, and the constraints imposed by specific CMC ligaments. A detailed analysis of the fracture patterns and associated ligament anatomy suggests that the typical ring and small carpometacarpal fracture dislocations are a more complex combination of fractures than identified by plain radiographs alone. The complexity of these injuries is greater than previously recognized and is most likely the result of a combination of axial load and shear stresses resulting in carpal fractures and ligament avulsions as well as fracture dislocations. This study suggests that computed tomography may be the preferred diagnostic imaging method for complete assessment of these injuries.

Aged↗
PubMed1993

Multiallelic polymorphism of the cartilage collagen gene: no association with osteoarthrosis.

OBJECTIVES: To determine whether any of the type II collagen alleles are associated with generalised osteoarthrosis or osteoarthrosis of the finger joints in the genetically isolated Finnish population. METHODS: Two patient cohorts with evidence for only primary osteoarthrosis and a cohort of healthy control subjects were selected from the Helsinki University Central Hospital and the Rheumatism Foundation Hospital in Finland. Forty one patients with primary generalised osteoarthrosis, 49 patients with osteoarthrosis of the finger joints, and 48 control subjects were included. Two markers of the type II collagen gene, a PvuII polymorphism and a VNTR polymorphism, were analysed from each subject. RESULTS: Four different alleles of the VNTR marker were observed and the relative risks associated with the different VNTR alleles varied between 0.39 and 1.24 among the patients with generalised osteoarthrosis and between 0.67 and 2.33 among the patients with osteoarthrosis of the finger joints. The PvuII polymorphism detected two different alleles and the associated relative risks were 0.82 and 1.82 for the patients with generalised osteoarthrosis, and 1.04 and 0.96 for the patients with osteoarthrosis of the finger joints. CONCLUSIONS: A major predisposing allele of the type II collagen gene as the causative factor for osteoarthrosis could be excluded in this population. A spectrum of mutations associated with different alleles of this gene could not be excluded, however. Further, these two forms of cartilage disease can be caused by gene defects with reduced penetrance and the effect of such an allele is easily masked under the high frequency of normal alleles.

Alleles↗
PubMed2003

The biomechanical properties of the finger metacarpophalangeal joints to varus and valgus stress.

PURPOSE: The purpose of this study was to determine the normal biomechanical properties of the passive capsuloligamentous structures about the finger metacarpophalangeal (MCP) joints subjected to dynamic varus/valgus loading and to equate these findings to the clinical situation. METHODS: The finger MCP joints from 9 fresh-frozen cadaver hands were tested in a custom-designed testing apparatus that applied a varus/valgus force in each direction. Testing was performed at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of MCP joint flexion. Load-displacement curves were generated for each specimen. A nonlinear hysteresis curve was apparent on loading and unloading. A region of collateral ligament laxity was identified whereby minimal torque (< 0.5 Nm) caused progressive joint angulation. Subsequently incremental load was required to produce further joint angulation. The slope of this region was used to calculate early and late collateral ligament stiffness. RESULTS: The index and long fingers showed a significant decrease in the region of collateral ligament laxity between 0 degrees and 90 degrees. The long finger collateral ligament laxity also diminished significantly between 30 degrees and 90 degrees. The collateral ligament laxity did not significantly change in the ring and small digits throughout MCP joint flexion. The early or late phase of collateral ligament stiffness was not affected by the amount of MCP joint flexion across any of the digits, except in late radial collateral ligament stiffness of the long finger between 0 degrees and 60 degrees. CONCLUSIONS: The additional stability and clinical observation of tightening of the MCP in flexion appears related to the decreased laxity of the collateral ligaments and not to alterations in the biomechanical properties of the collateral ligaments.

Biomechanical Phenomena↗
PubMed2003

Early surgical treatment for collateral ligament rupture of metacarpophalangeal joints of the fingers.

PURPOSE: Thumb metacarpophalangeal (MCP) collateral ligament ruptures are well-known injuries but those occurring in the other fingers seem to be infrequent according to the literature. We undertook this study to evaluate the real incidence of this type of injury and the results of surgical treatment. METHOD: During a 2-year period care was taken to detect all the patients presenting to our emergency unit with a complete rupture of a collateral ligament of a finger and to perform surgery on them as soon as possible. Clinical reassessment was made regularly until maximal recovery and 2 years after surgery. RESULTS: Ten patients with 12 complete MCP collateral ligament rupture of the fingers were seen during this period. Most of the fingers undergoing surgery regained full mobility within 10.7 weeks on average with no residual instability or pain and with no further problems at 2-year follow up evaluation. CONCLUSIONS: Complete ruptures of the MCP collateral ligaments of the fingers are far more frequent than indicated in the literature. Early surgery was found to give highly satisfactory results and may be justified in cases of gross instability of the finger MCP joint.

Collateral Ligaments↗
PubMed2005

Epiphyseal fractures of the finger middle joints in young sport climbers.

OBJECTIVE: As competition climbing becomes increasingly popular, younger climbers are entering the sport, and some are among the top-level athletes. This early start combined with intensive training methods can lead to radiographic changes in the fingers and even osteoarthrosis. Since 1994, we have been observing an increasing number of nontraumatic epiphyseal fractures in young athletes. METHODS: Twenty-four cases of young climbers with nontraumatic epiphyseal fractures of the finger middle joints are presented. RESULTS: The average age of the climbers was 14.5 (+/- 0.9) years; 23 were boys, and 1 was a girl. Eight (33%) fractures were in an early stage, whereas in 16 (67%) a longer time interval elapsed between the onset of symptoms and the presentation for evaluation. All radiographs showed an epiphyseal fracture of the dorsal base of the middle phalanx of the finger; 20 patients presented a Salter-Harris III fracture and 4 presented a Salter-Harris II epiphysiolysis. An acute injury was not evident in any of the patients. All fractures were thus fatigue fractures caused by repetitive stress. CONCLUSIONS: Chronic finger pain in young and intensively training climbers must be carefully evaluated, and radiographic studies need to be performed. The risk of epiphyseal injuries must be minimized by eliminating intensive power training in the schedules of athletes of this age.

Adolescent↗
PubMed1995

Magnetic resonance imaging protocol optimization for evaluation of hyaline cartilage in the distal interphalangeal joint of fingers.

RATIONALE AND OBJECTIVES: To identify a single magnetic resonance imaging (MRI) protocol that will provide optimal signal-to-noise ratio, resolution, and image contrast with minimal susceptibility artifacts and that will allow clear delineation and visualization of cartilage, fluid, bone, tendons, and ligaments within the distal interphalangeal (DIP) joint of the human hand. METHODS: A highly optimized 2.4 T MRI system was constructed from a 31-cm horizontal bore magnet, using a solenoid radiofrequency coil. This was used to study the DIP joints of 16 healthy, asymptomatic volunteers. RESULTS: A range of image contrast protocols were explored, including spin-echo T1 and T2, field echo, chemical shift suppression to give water only images, and magnetization transfer. Susceptibility variations were explored by changing the field strength from 0.6 to 2.4 T. A spin-echo protocol with TR = 1500 msec and TE = 30 msec can routinely produce images with resolution 0.075 x 0.150 for a slice thickness of 1 mm in 13 minutes. That protocol can visualize simultaneously compact and trabecular bone, two layers of cartilage, synovial fluid, and synovium within the joint, tendons and ligaments, and the volar plate. CONCLUSIONS: Although the contrast is not fully optimized for any one tissue, the spin echo protocol (TR = 1500, TE = 30) provides sagittal MR images, which clearly delineate the major structures of interest within the DIP joint, and which will be used in future studies to compare changes in the DIP joint because of aging or osteoarthritis. Experience gained by applying the above methods to a total of 16 healthy, asymptomatic volunteers has enabled a single sequence to be identified, which although not optimized for any one tissue, nevertheless visualized simultaneously and clearly delineated compact and trabecular bone, two layers of cartilage, synovial fluid, and synovium within the joint.

Adult↗
PubMed2006

Fashioning a new radial collateral ligament during arthroplasty of the finger metacarpophalangeal joints in rheumatoid arthritis.

We describe a technique for reconstructing the radial collateral ligament of the finger metacarpophalangeal joints in patients with rheumatoid arthritis during arthroplasty. This technique is used in cases where the original collateral ligament is unfit for imbrication. In this method, a new collateral ligament is created using the volar plate of the concerned metacarpophalangeal joint. The technique is surgically simple, has the advantage of using locally available tissue, and has produced results that are both clinically and radiologically satisfactory. These advantages make this procedure a useful tool to have in one's surgical armamentarium.

Arthritis, Rheumatoid↗
PubMed1984

Consideration of connective tissue dysfunction in the fragile X syndrome.

Eleven cytogenetically documented patients with the fragile X syndrome were evaluated for hyperextensibility of the finger joints and the presence of other manifestations of connective tissue dysfunction. All of the patients had hyperextensibility of several finger joints and many had features such as flat feet, highly arched palate and the ability to voluntarily dislocate finger joints. These traits, particularly hyperextensibility of the joints, are a useful aid in the clinical diagnosis of the fragile X syndrome.

Abnormalities, Multiple↗