[UNUSUAL DISLOCATION OF THE METACARPO-PHALANGEAL JOINT OF THE MIDDLE FINGER].
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Finger Injuries↗
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[The deepithelialized cross-finger flap: a good method for covering large dorsal finger defects].
BACKGROUND: Injuries to the dorsum of the finger are common. Combination with exposure of important deeper structures needs reconstruction with a flap. The deepithelialized cross-finger flap is a good possibility for covering large dorsal finger defects. PATIENTS AND METHODS: From March 2003 to October 2003 six patients (two female, four male) underwent this procedure. RESULTS: Neither flap loss nor infection was observed. All defects were covered adequately, and no donor site problems occurred. One week after flap division, the function of the involved finger joints had the same range of motion as the contralateral finger joints. CONCLUSION: The deepithelialized cross-finger flap is a good and safe method for defect cover in large dorsal finger defects. The good postoperative range of motion supports the indication for this two-step reconstruction procedure.
Adult↗
Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI.
OBJECTIVE: To compare dedicated low-field MRI (lfMRI) with conventional MRI (cMRI) in the detection and scoring of synovitis, tenosynovitis and erosions in patients with rheumatoid arthritis. PATIENTS AND METHODS: The wrist and finger joints of 17 patients with rheumatoid arthritis (median (range) disease duration 8 years (7-12); Disease Activity Score 3.3 (2.6-4.5)) were examined by 0.2 T lfMRI and 1.5 TcMRI. The protocols comprised coronal spin-echo and three-dimensional gradient-echo sequences before and after contrast medium administration. Synovitis of the metacarpophalangeal and proximal interphalangeal joints 2-5 and the wrist joints was scored according to Outcome Measures in Rheumatology recommendations. Tenosynovitis and erosions were scored using 4-point and 6-point scales, respectively. The results were analysed by calculating kappa values and performing McNemar's test intra-individually on a joint-by-joint basis. RESULTS: Agreement between the two MRI techniques was good to excellent for synovitis and erosions, and moderate for tenosynovitis. Of the 306 joints evaluated, 245 and 200 joints showed synovitis in lfMRI and cMRI, respectively. Scoring of synovitis of the finger joints yielded kappa values from 0.69 to 0.94. Of the 68 flexor tendons evaluated, tenosynovitis was diagnosed by lfMRI in 24 and by cMRI in 33 instances. Of the 391 bones evaluated, 154 and 139 showed erosions in lfMRI and cMRI, respectively. kappa values for erosion scores were between 0.65 and 1. CONCLUSION: Dedicated, lfMRI shows high agreement with cMRI in diagnosing and scoring synovitis, tenosynovitis and erosions in rheumatoid arthritis when using standardised scoring systems.
Adult↗
[Treatment of septic arthritis of the hand using temporary intermittent immobilization with an external fixator].
OBJECTIVE: To evaluate the treatment of a bacterial infection of a finger joint with incision, drainage and intermittent immobilization using external fixation apparatus. DESIGN: Retrospective, descriptive. SETTING: Department of Surgery, St Elisabeth Hospital, Tilburg. METHOD: In eight males and two females (median age 37 years) with acute bacterial arthritis of a finger joint, this joint was opened surgically, washed out and then immobilized using mini-external fixation equipment, for about 3 weeks. The fixator was unscrewed daily so that the patient could move the finger in water, with the purpose of mechanical cleansing of the joint; the intermittent pressure that occurs in the cartilage during movement is supposed to promote the removal of debris. Subsequently, the finger was fixed in alternating positions to prevent adhesions. Mean duration of follow-up was 48 months (11-78). RESULTS: Arthrodesis had to be carried out in one patient because of persistent arthritis and tissue necrosis, while in one other, part of the finger was amputated. The other eight patients showed good final results, without symptoms. CONCLUSION: In bacterial arthritis of a finger joint, temporary intermittent immobilization using external fixation equipment is certainly worth consideration.
Adult↗
Palmar dislocation of the metacarpophalangeal joint of the finger.
We report a case of palmar dislocation of a finger metacarpophalangeal joint. Disruption of all the supporting structures of this joint and rupture of the flexor tendon sheath caused marked instability. Treatment was by open reduction and repair of the collateral ligaments.
Female↗
Multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis. Report of results at the end of three years.
A controlled multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis followed 59 patients for 3 years. Finger joints and knees were studied. After 1 year synovectomized joints were better than controls in several features. After 3 years these differences had disappeared in the fingers, but swelling remained less in synovectomized knees. Recurrences were as frequent in synovectomized as in control finger joints, but were slightly less frequent in synovectomized than in control knees. Radiologic bony erosions in fingers and knees of both groups progressed equally during the 3 years.
Arthritis, Rheumatoid↗
[Hippocratic fingers with joint disease, of pulmonary origin; effect of treatment with cortisone].
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Cortisone↗
Ipsilateral complex dorsal dislocations of the index and long finger metacarpophalangeal joint.
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Accidental Falls↗
[Discussional comments of all participants on arthrodeses of the finger and wrist joints].
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Arthrodesis↗
Computer-based methods for measuring joint space and estimating erosion volume in the finger and wrist joints of patients with rheumatoid arthritis.
OBJECTIVE: This study was conducted 1) to determine the feasibility of using computer programs to measure radiographic joint space width and estimate erosion volume in the hands of patients with rheumatoid arthritis (RA), and 2) to compare the new computer-based methods with established scoring methods. METHODS: To measure the joint space width in the finger and wrist joints of RA patients, hand and wrist radiographic films were scanned using a tabletop scanner and analyzed with programs written using the "macro" capabilities of NIH Image software. Estimation of erosion volume was determined by utilizing gray-scale intensity to calibrate bone density units per mm3, which made possible comparisons between the erosions and noneroded, anatomically similar sites. RESULTS: In 3 sets of duplicate measurements of joint space width on 79, 48, and 48 finger and wrist joints, the mean absolute deviation from the mean of the 2 measurements was 0.036 mm (SD 0.034), 0.032 mm (SD 0.049), and 0.021 mm (SD 0.016), respectively. Joint space measurements and scoring of joint space narrowing both demonstrated a difference between active treatment and placebo in an old trial set on gold therapy (P = 0.03 and P = 0.01, respectively). Two repeated measurements of bone density units in the bones of 3 different hands differed from the mean of the measurement by 2.29-4.04%. In 2 experiments, estimates of erosion volume showed a greater difference between gold therapy and placebo than did erosion scores in the trial set (P = 0.049 and P = 0.016 versus P = 0.27). CONCLUSION: Computer-based methods for measuring finger and wrist joint spaces and estimating erosion volume in patients with RA agree with the results of radiographic scoring of erosions and joint space narrowing.
Arthritis, Rheumatoid↗
[Technique and diagnostic value of musculoskeletal ultrasonography in rheumatology. Part 6: ultrasonography of the wrist/hand].
Sonography of the hands is especially helpful in the diagnosis of early arthritis. Sonography allows for a very sensitive detection of small joint-effusion, tenosynovitis and small erosive bone lesions earlier than conventional radiography. Musculoskeletal sonography is also helpful in morphological analysis of changes of the median nerve in patients with carpal tunnel syndrome. The following standard scans are suggested for the sonographic evaluation of the wrist: 1. dorsal longitudinal scan along the radio-carpal joint, 2) along the ulno-carpal joint, and 3) dorsal transverse scan along the wrist to detect joint fluid collection, synovitis, tenosynovitis, ganglia, irregularities of the bone surface in osteoarthritis, and erosions due to inflammatory disease, 4) volar longitudinal scan along the radio-carpal joint, and 5) along the ulno-carpal joint, and 6) volar transverse scan along the wrist to diagnose the same objective as the above mentioned scans and to evaluate the median nerve in cases of carpal tunnel syndrome. Optional scans are the following: 7) ulnar longitudinal 8) transverse scan along the ulnar joint space and the extensor carpi ulnaris muscle to detect tenosynovitis and caput ulnae syndrome, 9) radial longitudinal, and 10). transverse scan along the joint space to diagnose synovitis and tenosynovitis. The following standard scans are suggested for the sonographic evaluation of the fingers: 1) volar longitudinal, 2) volar transverse scan in extension along the finger joints to detect effusion and synovial proliferation, tenosynovitis, irregularities of the bone surface (osteophytes, erosions), 3) dorsal longitudinal scans in extension and flexion >70 degrees along the CMC I, MCP, PIP and DIP joints to evaluate effusion and synovial proliferation, tenosynovitis or tendinitis, irregularities of the bone surface (osteophytes, erosions), and 4) dorsal transverse scans along the finger joints to evaluate these structures in an additional dimension. Optional 5) scans include the following: medial longitudinal scan along the MCP I, II, PIP and DIP joints, and 6) lateral longitudinal scan along the MCP V, PIP and DIP joints to evaluate the erosive bone process and joint instability. A linear transducer with a frequency of between 7.5 and 12 MHz is recommendable. The anterior distance between the bone and the joint-capsule of the wrist is > or = 3 mm in probable and > or = 4 mm in definite synovitis or effusions. Synovitis or effusions are probable if the difference between right and left wrist is > or = 1 mm, and they are definite if the difference is > or = 2 mm. A carpal tunnel syndrome is probable with a cross-sectional area of the median nerve of > or = 12 mm(2).
Arthritis, Rheumatoid↗
[A rare arthrosis of the metacarpophalangeal joints--a degenerative disease in heavy manual labor].
We identified eight patients (10%) suffering from metacarpophalangeal (mcp) osteoarthritis in a group of 81 men doing hard manual labor for more than 10 years. There was no case of mcp osteoarthritis in a group of 65 men which had not performed hard manual labor. The most essential clinical symptom was mild to moderate pain in all cases, followed by deformities, stiffness, reduced subjective grip strength, decreased range of motion, and soft-tissue swelling, listed in order of decreasing frequency. In the first group, we found a higher frequency of other localizations of interphalangeal osteoarthritis. It seems remarkable that in three patients the osteoarthritis of the mcp joints was isolated, without degenerative changes of the other finger-joints. The typical localization of the mcp osteoarthritis was the second and the third fingers, most frequently of the right hand in patients with known right-handedness (but the finding lacks statistical significance). Radial, hook-like osteophytes, and ulnar, blunt-shaped osteophytes were recorded as morphologic characteristics. Extreme stress of the finger joints by intense gripping and handling of heavy tools, and microtrauma caused by vibrating tools are discussed as causative factors.
Adult↗
The B lymphocyte in rheumatoid arthritis: recirculation of B lymphocytes between different joints and blood.
In order to search for further evidence for a pathogenetic role of recirculating, antigen-driven B cell clones in rheumatoid arthritis (RA) rearranged VH genes were analysed for clonal relationship and somatic mutations from synovial tissue and peripheral blood of a patient with RA undergoing synovectomy of several finger joints. DNA was prepared from the synovial tissue of two finger joints and blood. PCR for the different VH families was performed with one specific oligonucleotide for each VH family and a mixture of JH-specific oligonucleotides. The PCR products were separated on a high resolution acrylamide gel differentiating one base pair difference of length. Transfer of the products onto a nylon membrane and hybridization with an oligonucleotide specific for the FR3 region revealed a polyclonal representation of rearranged VH1, VH3, VH4 and VH5 genes. The VH6 family, which is encoded by a single germline gene, was represented by few distinct bands, with some bands of identical height for both joints and blood. DNA from these bands of interest was eluted, reamplified by PCR, cloned and sequenced. Sequence analysis of 27 independent bacterial colonies allowed distribution of the different VH genes to seven B cell clones (A-G). Members of clone A were found in both joints and blood, clones B and C in one joint and blood, clone D in both joints, and clones E, F and G only in one joint. The VH regions were somatically mutated with characteristic patterns for the different clones. In conclusion, our findings confirm the systemic character of RA, because they show that not only expansion and affinity maturation of B cells occur in synovial membranes but antigen-specific B cells recirculate between different joints and blood.
Adult↗
[The distraction method in reconstructive surgery of the thumb and fingers].
The distraction method proves successful in reconstructive surgery of the hand: 1. For reconstruction of the thumb and fingers after amputation. 2. For elongation of a hypoplastic thumb or finger. 3. In cases of congenital deformities of the hand including correction of contractures, dislocation, and clinodactyly. 4. For reduction of old dislocations of finger joints.
Adult↗
[Evaluation criteria in follow-up studies of flexor tendon therapy].
A comparison of results in flexor tendon repair is of value only if standard methods of measurement and recording are used. The function of the involved finger(s) can be judged by measurement of the distance between the finger tip and the distal palmar crease, the total maximum flexion at all three finger joints (composite flexion), the lack of extension as an aggregate of the minimum angles which can be achieved at each of the three finger joints (composite extension deficit), and the total amount of movement (composite flexion minus composite extension deficit). Each of these measurements graded according to a scale of values (table 2 and 3); the sum of these values gives a final classification (excellent, good moderate and poor). In a series of 157 follow-up examinations with 223 fingers with flexor tendon repair this method of recording the results of flexor tendon repair was evaluated.
Anthropometry↗
Joint contractures and diabetic retinopathy.
It has been suggested that joint contractures may be an early marker of microangiopathy, especially retinopathy, in diabetic patients. To investigate this possibility, the prevalence of contractures of the finger joints, as assessed by the painted hand technique, was compared in 106 diabetic patients without, and 105 with retinopathy (proliferative in 66%). There was an increased prevalence of contractures in those with diabetes (25.2%) as compared with an age-matched control of 106 subjects (7.5%, P less than 0.01). The prevalence of contractures was similar in those diabetics with and without retinopathy (29.5% v. 20.8%, P less than 0.1), and did not vary with the type of retinopathy. The contracture prevalence rate was also similar in those with a diabetes duration of 5 or more years (retinopathy 29.3%, no retinopathy, 30%) or of similar diabetic duration (retinopathy 20.8%, no retinopathy, 25%). Diabetic control, as assessed by HbA1, was similar in retinopathic patients with or without contractures. We conclude that although finger joint contractures are more prevalent in adult diabetic patients, they are not necessarily a reliable early indicator of the development of retinopathy of any specific type.
Adult↗
Prevalence of rheumatoid arthritis, osteoarthritis, chondrocalcinosis and gouty arthritis at age 79.
The prevalence of rheumatic diseases was studied in representative subsamples by interview (n = 134), and by physical (n = 89) and radiographic (n = 81) examination in a representative sample of 79-year-olds in Göteborg, Sweden. The prevalence of rheumatoid arthritis (3-8 ARA criteria) was 10%. Radiographic osteoarthritis (OA) was diagnosed in wrists and/or finger joints of 65% of the probands and in knee joints of 14%. The first metacarpophalangeal (MCP I) joint was more frequently involved in males than in females (p less than 0.05). In females palpable enlargement of distal (DIP) and proximal interphalangeal finger joints correlated (p less than 0.01) to radiographic OA. The degree of heavy work in previous occupations was correlated to radiographic OA of DIP II-V in females (p less than 0.05 and of MCP I in males (p less than 0.05) but not to radiographic or clinical OA in knee joints. Symptoms of OA were reported by 6.1% in the knee and in 4.5% in hip joints. The prevalence of chondrocalcinosis averaged 15% (23% of females and 6% of males). Chondrocalcinosis of the hands occurred in 21% of females but in no males. The prevalence of hyperuricemia was 15% (women 6%, men 29%), and gouty arthritis was found in one woman.
Aged↗
[An unusual case of Heberden arthrosis in a young man].
Heberden nodes affect mainly middle-aged women. Inheritance is autosomal dominant in female and autosomal recessive in male patients. We report the case of a young man who presented already with 12 years of age with pain in the distal finger joints. There were no other clinical or serological signs for other rheumatoid diseases, like psoriatic or rheumatoid arthritis. Radiologic findings were consistent with Heberden's osteoarthritis of the finger joints. The joint changes remained clinically and radiologically stable during a time period of more than 15 years. The HLA typing revealed the haplotype HLA A1, B8 and DR4, in accordance with former studies which reported a higher frequency of HLA A1, B8 in families with primary osteoarthritis (early onset osteoarthritis of the large joints in combination with Heberden nodes).
Adolescent↗