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At least 505 records · Page 28Linked to original sources
PubMed2006

Safety of intra-articular injection of etanercept in small-joint arthritis: an uncontrolled, pilot-study with independent imaging assessment.

This study was conducted to test the safety of intra-articular tumor necrosis factor alpha (TNF-alpha) antagonists in small joints with arthritis. A dose of 2-8 mg etanercept was given intra-articularly guided by ultrasonography (US) in 26 patients with a flare of arthritis in a particular joint (16 wrists, two elbows, two ankles, six finger joints). Primary end points were imaging analyses by independent investigators: US-Doppler measurements were performed in all patients before and after the injection and MRI before and after were obtained in nine patients. The only adverse event was a case of swelling of the hand lasting 2 days after a wrist injection. Two patients had a supplementary glucocorticoid injection and were excluded from efficacy analysis after 4 days and 3 weeks, respectively. VAS for pain decreased after 1 week in 23 of 25 patients (median 0.62), and after 1 month in 14 of 24 patients (median 0.60). No significant changes were seen in erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). On MRI, all nine cases tested had a reduction in synovial thickness (P=0.008) and US Doppler signals diminished after treatment (resistance index (RI) P=0.02, pixels P=0.09). In conclusion, intra-articular injection of etanercept gave no noticeable adverse events.

Adult↗
PubMed2005

MR imaging of the metacarpophalangeal joints of the fingers: evaluation of 38 patients with chronic joint disability.

OBJECTIVE: To report the MR imaging findings of painful injured metacarpophalangeal (MCP) joints of the fingers. DESIGN AND PATIENTS: MR imaging of 39 injured MCP joints in 38 patients was performed after a mean delay of 8.8 months. The MR images were obtained with the fingers in extended and flexed positions using T2-weighted and T1-weighted sequences before and after intravenous injection of a gadolinium compound. Ten patients were treated surgically. Mean clinical follow-up was 1.8 years. RESULTS: Tears of the collateral ligaments were the most common lesion (30/39), most being radial in location. Contrast-enhanced axial T1-weighted images with the MCP joint in a flexed position showed these lesions optimally. Ten tears were partial and 20 were complete. In 13 patients, MR images showed 17 associated lesions including injuries of the extensor hood (10/17), interosseous tendon (3/17), palmar plate (3/17), and an osteochondral lesion (1/17). Sagittal MR images were essential to highlight palmar plate tears. CONCLUSION: Partial or complete tears of the collateral ligaments are prevalent MR imaging findings in patients with chronic disability resulting from injuries to the MCP joints. Although conservative treatment generally is sufficient for isolated injuries of the collateral ligaments, surgical repair is often required in cases of more extensive injuries. MR imaging may clearly delineate associated lesions of and about the MCP joints.

Adolescent↗
PubMed1988

Adaptive mechanisms in perceptual-motor coordination: components of prism adaptation.

Aftereffect measures of visual shift and proprioceptive shift were obtained for prism exposure conditions in which, at the end of a sagittal pointing movement, most of the arm was visible (concurrent exposure) or only the first finger joint was visible (terminal exposure). Intermediate exposure conditions permitted view of the hand or the first two finger joints. Under the concurrent exposure condition, proprioceptive shift was greater than visual shift but, as view of the pointing hand decreased, the relative magnitude of the two components gradually reversed so that, under the terminal exposure condition, visual shift was greater than proprioceptive shift. These results are discussed in terms of a model of perceptual-motor organization (Redding, Clark, & Wallace, 1985) in which the direction of coordinative linkage between eye-head and hand-head systems determines the locus of discordance and adaptive recalibration.

Journal Article↗
PubMed1991

Free vascularized whole joint transfer in children.

Reconstruction of the traumatized finger joint with epiphyseal destruction has long been problematic. Since free vascularized whole joint transfer was introduced as a treatment for joint and epiphyseal destruction, this procedure has been selected as an alternative treatment because it may provide a growing epiphysis. We have reviewed our series of 19 joint transfers. Mean age at operation was 6.2 years (range 3 to 12). Average active range of motion was 31 degrees/61 degrees for the group with posttraumatic reconstruction (n = 12) and 21 degrees/43 degrees for the group with reconstruction of a congenital deformity (n = 7), with an overall average of 27 degrees/54 degrees. Average range of motion following transfer of an metatarsophalangeal (MTP) or metacarpophalangeal (MCP) joint to an MCP joint position was 39 degrees/75 degrees (n = 4); proximal interphalangeal (PIP) to PIP transfer was 22 degrees/39 degrees (n = 13); and PIP to MCP transfer was 38 degrees/51 degrees (n = 2). The proximal phalanges in MCP joints transferred to the MCP position grew an average of 7.0 mm, and the middle phalanges of joints transferred to the PIP position grew 4.3 mm. Almost normal growth was observed in all transferred joints except two that showed premature epiphyseal closure. Indications for this procedure and techniques to improve range of motion are described.

Arthroplasty↗
PubMed1999

Biomechanical stimulation therapy. A novel physiotherapy method for systemic sclerosis.

To improve the mobility of joints, particularly of the finger joints and the mandibular joint, and to reduce the edema of the skin, various physical therapies have to be used in patients with SSc. As the quality of patients' life depends on the use of their fingers and of their mouth, these therapeutics belong to the basic measures in the treatment of SSc. In addition to the manually performed lymph drainage a new method, the biomechanical stimulation therapy, has proven to be efficacious to improve the mobility of the joints and to reduce the edema in SSc-patients. By devices of various size, longitudinal vibrations are transduced to patients' body: finger, hand, face, mandibular joint, the oral mucosa, the legs and the trunk. In 6 patients we found: significant (p < 0.05) increase of skin score, grip strength, mobility of joints (10-30%). No side effects were observed. We conclude from these data, that skin, mucosa, joints and patients' quality of life are improved by the biomechanical stimulation therapy in a clinical relevant degree.

Adult↗
PubMed2003

[Endoprostheses of the hand].

In 1890, the German surgeon T. Gluck was the first to implant an ivory arthroplasty into a wrist which was being destroyed by tuberculosis. The finger joints were first replaced with endoprostheses in 1940 by Burman. Indications for the procedure are degenerative, posttraumatic or arthritis related destruction of the joints of the hand.Nowadays, several more or less comparable prosthetic designs are available. The replacement of single bones of the wrist has not been of lasting success. Occasionally, an indication for arthroplasty of the trapezium-metacarpal joint of the thumb may exist. The metacarpophalangeal joint of the thumb should, in our experience, be fused when the need arises. Up until the present, the silastic spacer of Swanson for the metacarpophalangeal and proximal interphalangeal joints has not shown any substantial development, although a variety of designs have been introduced. Questions related to the complicated biomechanics of these articulations in combination with problems concerning the material to be used, intraosseous fixation, the articulation of the prosthesis components and the design of the stems have not yet been solved convincingly. The Swanson spacers in mid- to long-term follow-ups show little active range of motion, although the subjective patient satisfaction is very high and the potential for removal at its best. We do not see an indication for arthroplasty in the distal interphalangeal finger joints.

Arthroplasty↗
PubMed1993

Calcific periarthritis of the finger verified by X-ray diffraction of apatite.

The authors describe a 24-year-old woman presenting with swelling and pain of several finger joints. Roentgenograms showed periarticular, calcific deposits at all locations of swelling. One such deposit revealed the presence of hydroxyapatite crystals on X-ray diffraction. After two injections of corticosteroids in and around one deposit its size and density diminished rapidly, whereas the uninjected corresponding site of the other hand showed no initial improvement; after two years no difference was discernible. Under systemic and topic NSAIDs, pain and swelling improved similarly in all joints. In conclusion, periarthritis of the fingers associated with radiopaque deposits responded favourably to NSAID therapy, while local corticosteroid injections showed no additional benefit.

Adult↗
PubMed1992

A kinematic model of the human hand to evaluate its prehensile capabilities.

A kinematic model has been developed for simulation and prediction of the prehensile capabilities of the human hand. The kinematic skeleton of the hand is characterized by ideal joints and simple segments. Finger-joint angulation is characterized by yaw (abduction-adduction), pitch (flexion-extension) and roll (axial rotation) angles. The model is based on an algorithm that determines contact between two ellipsoids, which are used to approximate the geometry of the cutaneous surface of the hand segments. The model predicts the hand posture (joint angles) for power grasp of ellipsoidal objects by 'wrapping' the fingers around the object. Algorithms for two grip types are included: (1) a transverse volar grasp, which has the thumb abducted for added power; and (2) a diagonal volar grasp, which has the thumb adducted for an element of precision. Coefficients for estimating anthropometric parameters from hand length and breadth are incorporated in the model. Graphics procedures are included for visual display of the model. In an effort to validate the predictive capabilities of the model, joint angles were measured on six subjects grasping circular cylinders of various diameters and these measured joint angles were compared with angles predicted by the model. Sensitivity of the model to the various input parameters was also determined. On an average, the model predicted joint flexion angles that were 5.3% or 2.8 degrees +/- 12.2 degrees larger than the measured angles. Good agreement was found for the MCP and PIP joints, but results for DIP were more variable because of its dependence on the predictions for the proximal joints.

Algorithms↗
PubMed1985

Immediate free vascularized joint transfer from second toe to index finger proximal interphalangeal joint: a case report.

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.

Adult↗
PubMed1979

Assessment of past results and current practice in the treatment of rheumatoid metacarpophalangeal joints. Five year review.

A new design of prosthetic finger joint for the rheumatoid patient, and the technique for its insertion is described, which has now been in use for five years. The technique includes the soft tissue correction of the ulnar deviation. Results are reported for all the cases performed in one year giving a two year follow up, assessing flexion strength, pinch strength and the degree of recurrence of ulnar drift associated with loss of pinch strength.

Arthritis, Rheumatoid↗
PubMed1993

The functional significance of the long extensors and juncturae tendinum in finger extension.

To determine the role of the long extensors and soft tissues in the extension and interaction of the fingers, we applied traction to the extensors and measured the angles of the finger joints. The tendons, juncturae tendinum and intertendinous fascia, and the web between the fingers were sequentially sectioned, and the effects on the joints were again determined with tendon traction. Traction produced hyperextension of the metacarpophalangeal joints and some extension of the interphalangeal joints, although the latter remained partially flexed, producing a clawhand. Cutting the long extensor tendons had no effect on the interaction between adjacent fingers. Traction on the extensor digitorum communis to the index and the extensor indicis proprius produced the same extension of index finger joints and adjacent digits. Traction on the extensor digitorum communis to the index produced 32% of the maximal extension of the long finger MP joint. We reduced this to 22% by cutting the juncturae and intertendinous fascia and to 5% by cutting the web. The interaction between fingers was greater on the ulnar half of the hand because of the juncturae but was similarly reduced by ablative cuts of these structures.

Adult↗
PubMed1979

[Prevalence of osteoarthrosis of the hip and other joints in Japanese population (author's transl)].

A population study on osteoarthrosis (OA) was made in Iwata district of Kamitonda Wakayama. In the present survey, 1335 inhabitants aged 30 years and over were surveyed from August 1972 to May 1974. The completion rate was 69.1%. The examinations consisted of measurements of blood pressure, body height and weight, blood and urine test and radiographs of hand, cervical spine and pelvis. Osteoarthrotic changes of wrist and finger joint, cervical spine and hip joint were detected and assessed according to Kellgren and Lawrence's criteria by two observers respectively. The results obtained were as follows. 1) The prevalence of OA of the hip joint in this population sample of 737 persons was 0.94%. 2) Primary OA of hip joint was found in 0.27% of the same sample. 3) Compared with Caucasians, the incidence of OA of hip joint was low and similar to that of the Chinese in Hong Kong. 5) The incidnece of radiological osteoarthrosis of wrist, finger joints and cervical spine was comparable in the British studied by Kellgren and Lawrence. 6) The incidence of OA of the first carpometacarpal joint was very low in Japanese regardless the sex.

Adult↗
PubMed2006

Metacarpal shaft fractures of the fingers: treatment with interosseous loop wire fixation and immediate postoperative finger mobilisation in a wrist splint.

It is widely believed that interosseous loop wire fixation of metacarpal shaft fractures alone is not rigid enough to allow immediate postoperative mobilisation. In this report, the author reviews the results in 36 cases of metacarpal shaft fractures of the fingers treated by interosseous loop wire fixation and immediate postoperative mobilisation of all finger joints. The study included 30 males and six females, with a mean age of 31 (range 12-52) years. The fracture pattern was transverse in 26 and oblique, or spiral, in the remaining 10 patients. Following loop wire fixation, the wrist was immobilised using a volar plaster splint for 3 weeks but all finger joints were mobilised immediately after surgery. After a mean follow-up of 8 weeks, all patients, except two, had regained full range of motion of the fingers and no complications were noted. It was concluded that interosseous loop wire fixation of metacarpal shaft fractures is rigid enough to allow immediate postoperative finger mobilisation in a wrist splint and achieve good functional results.

Bone Wires↗
PubMedDate not supplied

[Early detection of limited joint mobility in diabetic children and adolescents].

Limited joint mobility (LJM) is a common complication of juvenile diabetes, usually assessed by a clinical method, the prayer test. Recently, the interest of the use of a goniometer in measuring subclinical joint limitation has been shown in adult diabetic patients. Joint mobility has been systematically assessed with a goniometer in 58 consecutive diabetic children (mean age = 12.8 yrs, mean duration of diabetes = 3.6 yrs) and compared to 119 normal children, for elbows, wrists, metocarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the 5th finger, in order to detect subclinical anomalies. The results showed a significant loss of the MCP flexion and extension, of the PIP flexion and of the DIP extension in diabetic children when the values were analysed according to the physiological variation with age. The prayer test detected LJM in three patients only. The degrees of elbow and DIP extension, and wrist flexion, decrease when the duration of diabetes increases, independently of the age. Anomalies of the 5th finger joint mobility were found to be correlated with microvascular anomalies of retinal angiography and nailfold capillaroscopy. However, no correlation was found with the measure of HbA1c performed at the time of the joint assessment. The measure of joint mobility with a goniometer has detected a decrease of finger mobility in diabetic children, early in the course of diabetes. These preliminary data should be confirmed in a longitudinal study that will be performed in a larger setting, in order to propose diagnostic criteria of infraclinical diagnosis of LJM.

Adolescent↗
PubMed1981

Locking of the metacarpophalangeal joints in degenerative disease.

Nine cases of locking of the metacarpo-phalangeal joint are described. The previously asymptomatic middle finger joint in an elderly person was most likely to be affected. Radiology of the joint has shown degenerative changes in all cases. In two patients, spontaneous unlocking of the joint occurred and in a further six operative release was undertaken. The important anatomical features of the condition are discussed in relation to the mechanism of locking and the surgical treatment.

Aged↗
PubMed1996

The wear of cross-linked polyethylene against itself.

Cross-linked polyethylene (XLPE) may have an application as a material for an all-plastic surface replacement finger joint. It is inexpensive, biocompatible and can be injection-moulded into the complex shapes that are found on the ends of the finger bones. Further, the cross-linking of polyethylene has significantly improved its mechanical properties. Therefore, the opportunity exists for an all-XLPE joint, and so the wear characteristics of XLPE sliding against itself have been investigated. Wear tests were carried out on both reciprocating pin-on-plate machines and a finger function simulator. The reciprocating pin-on-plate machines had pins loaded at 10 N and 40 N. All pin-on-plate tests show wear factors from the plates very much greater than those of the pins. After 349 km of sliding, a mean wear factor of 0.46 x 10(-6) mm3/N m was found for the plates compared with 0.021 x 10(-6) mm3/N m for the pins. A fatigue mechanism may be causing this phenomenon of greater plate wear. Tests using the finger function simulator give an average wear rate of 0.22 x 10(-6) mm3/N m after 368 km. This sliding distance is equivalent to 12.5 years of use in vivo. The wear factors found were comparable with those of ultra-high molecular weight polyethylene (UHMWPE) against a metallic counterface and, therefore, as the loads across the finger joint are much less than those across the knee or the hip, it is probable that an all-XLPE finger joint will be viable from a wear point of view.

Biocompatible Materials↗