Observations on the joints of the human finger.
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Fetus↗
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[Injuries of finger bones and joints].
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Finger Injuries↗
Forces transmitted by the finger and thumb joints.
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Finger Joint↗
The use of titanium miniplates in arthrodesis of the interphalangeal joints and a metacarpal neck fracture.
Fractures of the metacarpals and phalanges are the most common fractures of the upper extremity. Hand fractures can be complicated by deformity because of no treatment, stiffness due to overtreatment, and both due to inappropriate treatment. "Boxer's" fractures of the fifth metacarpal neck are rarely seen in professional boxers, they are fare more common in people who hit solid objects such as walls. Controversy exists regarding the optimum treatment. General indications for arthrodesis of hand joints of the hand include pain, instability, or deformity combined with a loss of motor control or bony stock sufficient to support arthroplasty. When all previous attempts to restore painless motion fail, arthrodesis of the joint becomes the method of choice. The most commonly arthrodesed finger joints are distal interphalangeal (DIP), proximal interphalangeal (PIP) and the interphalangeal (IP) joint of the thumb. The position of joint arthrodesis should be individual depending on the patient's needs. (Fig. 13, Ref. 6).
Arthrodesis↗
Limited joint mobility and diabetic retinopathy demonstrated by fluorescein angiography.
The association between limitation of finger joint mobility (LJM) and diabetic retinopathy demonstrable by fluorescein angiography was examined in 311 subjects aged 6-27 years. The relationship of these two complications was highly significant (P less than 0.0001). This was not the result of the effect of diabetes duration on both complications; interaction of LJM, retinopathy, and duration was not significant (P greater than 0.3). The presence of LJM was predictive of associated retinopathy at the level of clinical recognition (more than ten microaneurysms); 43% of those with LJM and duration beyond 4 years had retinopathy while only 15% of this duration group without LJM had clinical retinopathy.
Adolescent↗
The effects of exercise on finger extension of CVA patients.
The choice of activity to improve finger extension of post-CVA patients is based on untested assumptions and hypotheses. In this study, using electromyography of the extrinsic finger muscles and electrogoniometry of wrist and finger joints, the effects of five types of exercise on the finger extension of post-CVA patients were documented. Results indicated that resisted and rapid exercises recruited high percentages of output of all three muscles. Slow, unresisted extension exercises preferentially recruited the extensor digitorum. No exercise caused significant immediate changes in range of motion (ROM), flexor/extensor balance, time required to open the hand, or level of activity of the extensor digitorum during opening of the hand. Resisted grasp did not limit the patients' ability to extend the fingers. Variability in percent of motor output among the subjects of this study indicates the need to monitor each patient during therapy.
Cerebrovascular Disorders↗
Detections of movements imposed on finger, elbow and shoulder joints.
The angular displacements necessary for 70% correct detection were determined in normal subjects at the shoulder and elbow joints and at the terminal joint of the middle finger. Angular velocities of displacement between 0.125 degrees and 160 degrees/s were tested. Each joint was tested in the mid-range of its normal excursion. The joints were carefully supported for testing and the muscles acting at the joints were relaxed. When assessed in terms of angular displacements and angular velocities, proprioceptive performance at the shoulder and elbow joints was superior to that at the finger joint. Optimal performance at the finger joint was attained over the range of angular velocities from 10 degrees to 80 degrees/s. Optimal performance at both more proximal joints was optimal over a wider range (2 degrees-80 degrees/s). Active pointing movements made without vision of the moving part were performed at each joint at velocities within the range of optimal proprioceptive performance. However, when detection levels and displacement velocities were expressed in terms of linear displacements and velocities at the finger tip for all three joints, the finger joint gave the best performance and the shoulder the worst. In practical terms, therefore, displacements of a given linear extent are best detected if they move distal joints and worst if they move proximal joints. For the elbow and finger joints the detection level and velocity data were expressed also in terms of proportional changes in the lengths of muscles operating at these joints, and as proportional changes in the distance between the points of attachment of the joint capsules. Analysis in terms of proportional changes of muscle length showed remarkably similar performance levels at both joints. This suggests that intramuscular receptors are important determinants of proprioceptive performance. Analysis in terms of joint capsular displacement did not unify the data: on this form of analysis proprioceptive performance at the elbow joint was superior.
Adult↗
Prevalence of mutilans-like hand deformities in patients with seropositive rheumatoid arthritis. A prospective 20-year study.
This study examined radiographically the prevalence of arthritis mutilans hand deformities in an inception cohort of 68 rheumatoid arthritis (RA) patients. Hand deformities of 103 RF-positive RA patients were evaluated after 8 years, 83 patients after 15 years and 68 patients 20 years after entry. The grade of destruction in the hand joints was assessed by the Larsen method and Larsen scores of 0-50 were determined for both PIP (+IP) and MCP joints. At the end point, 3 patients had Larsen scores > or =40 for both PIP and MCP joints. These three patients had severe resorption in most of the finger joints, but did not demonstrate classical opera-glass hand. The prevalence of mutilans-like hand deformities with RA was 3/68 (4.4%) in a prospective 20-year study.
Adolescent↗
Prediction and compensation by an internal model for back forces during finger opening in an overarm throw.
Previous studies have indicated that timing of finger opening in an overarm throw is likely controlled centrally, possibly by means of an internal model of hand trajectory. The present objective was to extend the study of throwing to an examination of the dynamics of finger opening. Throwing a heavy ball and throwing a light ball presumably require different neural commands, because the weight of the ball affects the mechanics of the arm, and particularly, the mechanics of the finger. Yet finger control is critical to the accuracy of an overarm throw. We hypothesized that finger opening in an overarm throw is controlled by a central mechanism that uses an internal model to predict and compensate for movement-dependent back forces on the fingers. To test this idea we determined whether finger motion is affected by back forces, i.e., whether larger back forces cause larger finger extensions. Back forces were varied by having subjects throw, at the same fast speed, tennis-sized balls of different weights (14, 55, and 196 g). Arm- and finger-joint rotations were recorded with the search-coil technique; forces on the middle finger were measured with force transducers. Recordings showed that during ball release, the middle finger experienced larger back forces in throws with heavier balls. Nevertheless, most subjects showed proximal interphalangeal joint extensions that were unchanged or actually smaller with the heavier balls. This was the case for the first throw and for all subsequent throws with a ball of a new weight. This suggests that the finger flexors compensated for the larger back forces by exerting larger torques during finger extension. Supporting this view, at the moment of ball release, all finger joints flexed abruptly due to the now unopposed torques of the finger flexors, and the amplitude of this flexion was proportional to ball weight. We conclude that in overarm throws made with balls of different weights, the CNS predicts the different back forces from the balls and adjusts finger flexor torques accordingly. This is consistent with the view that finger opening in overarm throws is controlled by means of an internal model of the motor apparatus and the external load.
Adaptation, Physiological↗
Scintigraphy of rheumatoid peripheral joints. Reliability of visual assessment vs. computerized methods.
99mTc-methylene diphosphonate (99mTc-MDP) scintigraphy of peripheral joints was studied by visual evaluation (Visual Assessment) of the scintigrams and by a computerized region-of-interest (ROI) method without, or with a reference region (ROI method or Corrected ROI method). Sixteen rheumatoid patients and a total of 477 peripheral joints were studied and the results compared with clinical joint activity evaluated by joint palpation. The ROI method without a reference proved to be insensitive and hence unsuitable for clinical use. The results of Visual Assessment and the Corrected ROI method correlated well with each other and with clinical joint activity. The sensitivity of the methods in detecting a clinically inflamed finger joint was: ROI 6%, Corrected ROI 71% and Visual Assessment 75%. The corresponding figures for peripheral joints of the feet were as follows: 28%, 41% and 58%. We conclude that, for clinical use, Visual Assessment of the scintigram is adequate and the method of choice.
Adult↗
Double dislocation of the interphalangeal joints in the finger. Case report and review of publications.
A 66-year-old woman presented with a painful swollen finger and was shown radiographically to have dorsal dislocation of both interphalangeal joints, which responded to immobilisation and physiotherapy. Unlike single dislocations of finger joints double dislocations are rare, only 52 cases have been reported between 1874 and 1992 to our knowledge.
Adolescent↗
Rheumatoid arthritis in Singapore: carpal predominance and lower incidence of erosive changes.
Radiographs of the hand and wrists in 33 patients with a diagnosis of classic or definite rheumatoid arthritis were reviewed. The mean duration of disease was about five years. A scoring system for quantitative analysis was used to assess the presence and severity of erosions, joint space narrowing and deviation of joint alignment. No radiological abnormality was seen in 30% of patients while in another 30%, only minor radiological changes were seen. Moderate to severe radiological abnormality was seen in only 40% and in this group of patients all showed more severe disease in the wrists than in the finger joints. Erosions in the fingers were only seen in 21% of patients and erosions in the wrists were present in 57%. Previous reports have indicated that disease in the wrists can be more severe than the hands in up to 60% while the incidence of erosions can be expected to range from 40% at 3 months to 95% at 10 years. Although the sample size in this study is small, the findings suggest that the radiological pattern of rheumatoid in the hands in Singapore is quite different from that classically described in temperate countries as the incidence of erosions appears lower while disease in the wrists can be expected to be more severe than in the fingers in almost all cases. The usual radiological criteria used to aid diagnosis of the disease may not be applicable.
Adult↗
Irreducible dorsal dislocation of the small finger distal interphalangeal joint: the importance of roentgenograms--case report.
Irreducible dorsal dislocations of the distal interphalangeal joints of the fingers are uncommon injuries. They are almost always the result of an athletic injury. Although usually open, these can be subtle, closed injuries. Proper diagnosis requires clinical awareness and mandatory roentgenograms of all interphalangeal joint injuries.
Adult↗
Free vascularized toe joint transfer to the hand. A technique for simultaneous reconstruction of the soft tissue.
Twelve patients underwent reconstruction of injured finger joints using our technique of a vascularized transfer of the second toe proximal interphalangeal joint. The age of the patients at operation ranged from 7 to 47 years and the postoperative follow-up was 9 to 48 months. All the joint transfers survived and united with resolution of the preoperative joint pain, deformity and instability. The average range of motion of the reconstructed joints was 59 degrees in the proximal interphalangeal and 54 degrees in the metacarpophalangeal joints. No patient complained of pain or functional deficits in the donor foot.
Adolescent↗
Metacarpophalangeal joint injuries in fingers.
Although uncommon, injuries to the MP joints of fingers must not be ignored. A loss of function in even a single MP joint can seriously impair overall hand function. The potential dire consequences of these injuries can be avoided by an accurate diagnosis at the time of injury and the institution of appropriate treatment.
Finger Injuries↗
[Imaging methods in rheumatology: imaging in psoriasis arthritis (PsA)].
Conventional radiography is still the standard method of imaging in PsA since it displays many joints at the same time, thereby allowing different types of joint involvement to be recognized. Moreover, thanks to the high resolution of radiography, bony changes in a single joint are depicted in a brilliant way. Several features of psoriatic arthritis allow the distinction from rheumatoid arthritis, including the frequent involvement of the distal interphalangeal joints, asymmetry of joint involvement, axial involvement of finger joints, oligoarticular involvement; however, symmetric polyarthritis is also possible. At the level of the single joint, there are signs of severe destructive changes potentially leading to mutilation and at the same time signs of periostal bone proliferation and ankylosis may be present. Bony proliferation and/or osteolysis are not restricted to the joint region but can affect also the total phalanx with bone apposition or concentric osteolysis which may lead to a complete disappearance of phalanxes. For purposes of quantification of radiographic changes scoring methods are used that were originally developed for rheumatoid arthritis. So far, there is only one validated scoring method that was specifically designed for PsA and that takes into account both features of PsA, damage as well as proliferation of bone. In contrast to conventional radiography, MRI and sonography are able to visualize inflammatory processes within the soft tissue (joint capsules, tendon sheaths, tendon insertions, etc.), allowing an estimation of disease activity. Scintigraphy is nonspecific and can only be used to detect clinically silent inflammatory spots. The relatively frequent spinal (axial) involvement is similar to that seen in ankylosing spondylitis. However, unilateral sacroiliitis, asymmetry of syndesmophytes and development of parsyndesmophytes may distinguish PsA from ankylosing spondylitis. While conventional radiography demonstrates the bony consequences of inflammation in the spine, MRI also shows the active inflammatory changes in sacroiliacal joints and vertebrae.
Arthritis, Psoriatic↗
Osseointegration from the perspective of the plastic surgeon.
This review summarizes some aspects of osseointegration. The principles, implant type and design, surgical technique, and results are reviewed. A large number of patients have been followed after intraoral reconstruction using osseointegrated implants. The success rates are 95 percent in the maxilla and 99 percent in the mandible. In craniofacial reconstruction, results vary from 98 percent success in the temporal area to as low as 48 percent in the radiated orbit. Some early experience with finger joint reconstruction, bone-anchored finger prostheses, and major amputations are reviewed.
Equipment Design↗
Experimental vascularized total joint autografts--a primate study.
Autogenous vascularized and nonvascularized total joint transfers were studied in the hands of Macaca fascicularis monkeys. Nine second toe proximal interphalangeal joints were transferred as a vascularized free graft to the hand, and the excised finger joints were transferred to the foot as a nonvascularized free graft. The grafts were examined clinically and histopathologically at 16 weeks to 10 months. Two of the nonvascularized free grafts were amputated because of infection and necrosis. Three had chronic infections. The four surviving nonvascularized grafts demonstrated necrosis of the hyaline cartilage and degenerative changes. Of the nine vascularized joints, one developed a wound infection that required amputation, another failed at 2 weeks because of wound dehiscence, and the remaining seven survived with preservation of the hyaline articular surfaces. The experimental technique was designed to be easily applied to clinical use. A skin island is provided as a "patency/viability monitor." The extensor mechanism is included in the graft for early function.
Animals↗