Another cause of irreducible dislocation of the proximal interphalangeal joint of a finger.
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QUESTIONS: In case of Heberden's nodes the osteoarthritis starts with a so called tidemark flaking as a reaction to a subchondral ossification. The question was, if a differentiation in relation to a control group by an objective score is possible. METHODS: 218 finger joints from 56 cadavers were investigated morphologically (score). RESULTS: The osteoarthritis starts with a subchondral ossification. At this time the surface of the cartilage is not destroyed yet. Reactive tidemark flaking is the beginning of the general degradation. In relation to a control group a significant differentiation by a histological score is possible. CONCLUSIONS: In case of Heberden's nodes the osteoarthritis starts with the subchondral ossification. Because Heberden's nodes are the specific manifestation of the Generalized Osteoarthritis on the distal finger joints, further studies have to assess, if the same pathogenetic mechanism can be seen in osteoarthritis of the large joints.
X-rays of 20 finger joints, 10 foot joints and 2 wrists of 50 female patients with seropositive rheumatoid arthritis of 10-15 years' duration from 1962, 1972, 1982 and 1992 were evaluated blindly for erosions. A highly significant decline was observed in erosions in finger joints. Erosions had also declined in wrists and in foot joints, though less than in fingers. This may indicate improvement in the long-term outcome of rheumatoid arthritis.
OBJECTIVE: To compare the quantitative and qualitative information obtained by Doppler ultrasound (US) measurements of the wrist joints and the small joints of the hand with the information obtained by postcontrast magnetic resonance imaging (MRI) and to correlate the imaging results with clinical observations in patients with rheumatoid arthritis (RA). METHODS: Twenty-nine consecutive RA patients were studied; 196 joints (29 wrist and 167 finger joints) were examined by both US and MRI. Parameters of inflammation were the color fraction and the resistance index (RI) obtained with color Doppler US and the thickness of enhanced synovium (in mm) and the MRI score obtained with postcontrast MRI. Clinical examination and measurements of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were performed on the same day as the imaging studies. RESULTS: There was a highly significant association between US indices of inflammation and postcontrast MRI scores. The mean values for both the color fraction and the RI were significantly different in the group without joint swelling compared with the other groups. The mean RI values were significantly different in the group without joint tenderness compared with the other groups. The mean thickness of enhanced synovium on postcontrast MRI was significantly different between the group without joint swelling and the other groups, but this difference was statistically significant only for the comparison of the group without joint tenderness versus the group with maximum tenderness. No association between the MRI or US estimates of inflammation and values on the visual analog scale for pain, Health Assessment Questionnaire, duration of morning stiffness, ESR, or CRP was found. CONCLUSION: Estimates of synovial inflammatory activity by Doppler US and postcontrast MRI were comparable. Estimation of synovial inflammatory activity by the RI and color fraction parameters of US appears to be a promising method of detecting and monitoring inflammatory activity in patients with RA.
This study aimed at a possible classification of climacteric arthroses of the hand. 132 females suffering from arthralgias of the wrist and finger joints who had consulted our outpatient department originally because of climacteric complaints, were examined while asking them to complete a questionnaire with clinical criteria for classifying arthroses of the hand. The requisite number of criteria required for classification as ¿arthrosis of the hand¿ were attained in all three groups of females (premenopausal and postmenopausal women without operation, as well as hysterectomised and/or ovarectomised women¿, although the ex-ray showed no signs of degenerative arthritis. The subjective complaints voiced by the patients are opposed to the x-ray finding, so that it is not permissible to classify climacteric arthralgias of the wrist and finger joints as ¿arthritis¿.
OBJECTIVE: In accordance with the literature, our previous epidemiological, clinical and genetical investigations have confirmed a correlation between generalized osteoarthritis (GOA) and Heberden's nodes. Heberden's nodes can be considered as genetic markers for the existence of a generalized osteoarthritic predisposition. The present study's concern was to establish whether there are special histological features in this disease. METHODS: Layered sections of 218 distal finger joints from 56 deceased persons were investigated using a histological-histochemical score modified by Mankin. RESULTS: In Heberden's nodes, we found all the typical degradative sequences of the osteoarthritic process but also some specific modifications. The osteoarthritis (OA) starts with a subchondral ossification and manifests a reactive tidemark flaking. At this time, the surface of the cartilage is not yet destroyed. Later on, there is progression of general degradation. Significant differentiation from the control group is possible using a histological score. CONCLUSIONS: In patients with Heberden's nodes, the OA starts with the subchondral ossification. Heberden's nodes are the specific manifestation of GOA in the distal finger joints. Further studies are therefore required to assess whether the same pathogenetic mechanism can be seen in OA of the large joints in GOA.
It would appear to us that the patients with rheumatoid arthritis (RA), in whom articular bone lesions were confined to the wrist and/or carpal joints in X-ray films, may follow a milder disease activity than do the patients with the hand and finger joint lesions. To clarify it, the present study was performed retrospectively. RA patients showing stage II or more lesions in the wrists and/or carpal joints but no lesions over stage II in any hand and finger joint (MCP, IP and PIP) radiologically after 5 years or more duration were regarded as the carpal type (C type). The clinical and laboratory data were compared between 44 patients of the C type RA and 44 patients of other type RA, matched in the sex, age and disease duration. Significant differences were observed in the following parameters between the 2 groups; the functional class, Lansbury's activity index, number of the affected joints, ESR, CRP and hemoglobin values, and ADL scores. That is, Hb values and ADL scores were higher, but the others were lower, in the C type RA group than in other type RA group. The positive percentage and titer of rheumatoid factor were not significantly different between the 2 groups. It was concluded that C type RA patients are milder in the activity and fewer in the number of affected joints than other type RA patients. Furthermore it was suggested that C type RA patients may have milder clinical course and better prognosis than other type RA patients.
Symptoms and signs of rheumatoid arthritis vary within the day and from day to day. Interesting and possibly important observations can be missed when evaluations are based only on outpatient measurements, which are likely to be made at only one time and at infrequent intervals. We have found that patients can measure their own grip strength and finger joint sizes at home, and simultaneously assess overall pain and stiffness on numerical scales. Measurements made by patients were reproducible when made at the same time of day if on the same treatment. The patient's subjective assessment of pain and stiffness is a useful measure of the severity of rheumatoid arthritis. These pain and stiffness ratings were found to be well correlated with the patient's objective measurements of finger joint size and grip strength. Information not otherwise available can be collected by studying patients at home with these self-measurement techniques. These have allowed the demonstration of circadian variations in the signs and symptoms of rheumatoid arthritis and improved the evaluation of drugs studied in clinical trials.
A comprehensive population study of women aged 44-46 was carried out in Göteborg, Sweden in 1974-75. The mean erythrocyte sedimentation rate (ESR) and the rate of high ESR values (defined as ESR greater than or equal to 30 mm) were higher in women with manifestations of joint diseases than in other women, the differences being statistically significant for women with swollen or deformed finger joints and symptoms from the wrists. Women with manifestations of active joint disease at the time of the examination had even higher ESR values, the differences being statistically significant also for women with symptoms from the finger joints. High ESR values were more common in women with a positive serological test for rheumatoid factor and joint manifestations indicating arthritis and osteoarthrosis. The "arthritis" and "osteoarthrosis" groups each included about one-third of the subjects with rheumatoid factor. It is concluded that although ESR values are moderately increased in subjects with different manifestations of joint disease, the vast majority of such subjects have ESR values less than 30 mm.
Intraarticular fractures with marked comminution or irreparable defects lead to deformity and painful restriction of movement. Repair by means of arthrodesis or arthroplasty results in loss of motion and strength in the injured fingers. In a few cases only implantation of a prosthesis is indicated. Reconstruction of the joint by implantation of a cortico-cancellous homograft is proposed as an alternative to arthroplasty.
Chip avulsions of the palmar plate are divided into four degrees (Hintringer). Conservative treatment is preferred for degree I and II and in some cases in degree III. Only a short immobilization for six or seven days is necessary, then the patient will begin with active movement of the fingers. It is important to avoid hyperextension of the joint. Analysis of results in 69 cases with only conservative treatment showed very good results in 72%, good results in 20.4%, and satisfactory results in 4.5%. The results in one case (Hintringer III) was poor.
The author reviews the pathophysiological mechanisms of rheumatoid deformations of the long fingers' MP joint. He considers the different possibilities of surgical treatments; then focusing on arthroplasty, he compares and comments on technical points (incision, resection of the MP head, section of intrinsic muscles, size of the implant, joint capsule and ligament reconstruction, dressing, postoperative care) and results (mobility, implant fracture, ulnar deviation and palmar dislocation) achieved by various authors. He concludes that the Swanson implant remains at present the best therapeutic treatment of rheumatoid arthritis of the long fingers' MP joint. However, in order to improve the results obtained, and to avoid long term complications, research should be pushed until we can avail ourselves of a true prosthetic arthroplasty based on other principles and new materials.