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At least 613 records · Page 34Linked to original sources

Biomechanical model predicts directional tuning of spindles in finger muscles facilitates precision pinch and power grasp.

Humans have a sense of static limb position derived primarily from the output of secondary muscle spindle endings. The features of finger pose these proprioceptors signal best were predicted by singular value decomposition of a kinematic model of the human long finger and the six muscles that actuate it. The analysis indicated that muscle spindles signal the location of the fingertip with less error than they signal angles of individual finger joints. The fingertip displacements for which proprioceptors have greatest sensitivity were also predicted. These fingertip displacements seem to correspond to the fine positioning of an object pinched between the fingertip and distal phalanx of the thumb. The analysis also predicted the directions in which subjects can displace the fingertip most rapidly. The directions seem to correspond to rapid closure of precision pinch or power grasp.

Biomechanical Phenomena↗

A mother and three daughters with congenital dislocation of the hip and a characteristic facial appearance: a new syndrome?

We describe a mother and her three daughters who all have bilateral congenital dislocation of the hip. The mother has had no other medical problems and is on the 90th centile for height. Her three daughters resemble each other strongly with facial characteristics which include hypertelorism, epicanthic folds, puffiness around the eyes, a flat mid-face and a carp-shaped mouth. All three daughters are on the 3rd centile for height, with their head circumference on a higher centile and all had an ASD. Other features include congenital dislocation of one knee (one), congenital inguinal hernia (one) and vesico-ureteric reflux (one). They also have clinodactyly and hyperextensible finger joints, both features also seen in their father, whose height is on the 3rd centile and who had bilateral congenital inguinal herniae. Collagen studies of skin and ligament were normal. This family does not appear to fit with any of the recognized congenital dislocation syndromes and we suggest that they may represent a previously undescribed syndrome.

Adult↗

Boxer's knuckle--dorsal capsular rupture of the metacarpophalangeal joint of a finger.

An injury to the dorsal aspect of the metacarpophalangeal joint of a finger usually damages the sagittal fibers of the extensor tendon mechanism. Rupture of the underlying joint capsule, a far more serious injury, has received scant attention in the medical literature. The problem is often unrecognized because the extensor tendon may remain in its normal midline position. Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. Most of the injuries occurred in professional boxers.

Adult↗

LOCKED FINGER.

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Arthritis, Rheumatoid↗

New variant of cytochrome b5 reductase deficiency (b5RKurashiki) in red cells, platelets, lymphocytes, and cultured fibroblasts with congenital methemoglobinemia, mental and neurological retardation, and skeletal anomalies.

A Japanese man with cytochrome b5 reductase (b5R) deficiency in various blood cell lineages (red cells, platelets, and lymphocytes) and in cultured fibroblasts demonstrated congenital methemoglobinemia associated with mental and neurological retardation, and various skeletal anomalies, such as spondylosis deformans and finger joint deformations, which have never been described in association with this enzyme deficiency. Cytochrome b5 reductase deficiency was most severe in red cells (0.3-4%) and less marked in platelets (13-27%), lymphocytes (18-31%), and fibroblasts (50%). The present case appears to be a new variant of cytochrome b5 reductase deficiency (b5RKurashiki).

Adult↗

Remitting seronegative symmetrical synovitis with pitting edema of the hands: ultrasound, color doppler ultrasound, and magnetic resonance imaging findings.

OBJECTIVE: To assess the value of gray-scale ultrasound (US), color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging (MRI) in the diagnostic evaluation of the hands in patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE). METHODS: Eight patients (5 men, 3 women; mean +/- SD age 69.3 +/- 7.2 years) with clinical diagnosis of RS3PE syndrome underwent US, CDUS, contrast-enhanced CDUS, and MRI. US was performed with a linear array transducer operating at 12 MHz. The US contrast agent (SHU 508; Levovist, Schering, Germany) was intravenously infused in a concentration of 300 mg/ml at a rate of 1 ml/minute. RESULTS: All patients showed symmetric subcutaneous edema and synovitis of tendons and finger joints on both US and MRI. Vascularity was detected subcutaneously in tendon sheaths and in the joint synovia on CDUS and MRI. Detection of increased vascularity was improved after contrast administration compared with unenhanced CDUS (P < 0.01). CONCLUSION: Ultrasound, CDUS, contrast-enhanced CDUS, and MRI are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE. Contrast-enhanced CDUS is superior to CDUS in assessment of inflammatory edema, effusion, and synovitis.

Aged↗

Evaluation of early excision of dorsal burns of the hand.

To determine the best method for treating deep second- and third-degree burned hands in our institution, a prospective study comparing early excision and grafting with nonsurgical treatment was undertaken. The patients were randomly assigned to two groups, and the hands in the first group were excised and grafted within 5 days after the burn. In the second group, burns were treated with topical chemotherapy and hydrotherapy, and the eschar was allowed to separate spontaneously and heal. Some required skin grafting, forming a subgroup. All hands in the study received the same vigorous physical therapy twice daily, and splints were applied according to the patient's individual needs to maintain an anti-deformity position. Grip strength, power pinch, and accurate range-of-motion measurements of each finger joint were measured upon discharge and 1, 2, 3, 6, and 12 months after the burn. A mean total degrees of motion (including flexion and extension) in each joint and strength values were determined for comparison among the three groups. At discharge, the spontaneously healed hands had the best range of motion and function. Although the rate of improved function was greatest in the interval from discharge to 6 months in all groups, by 1 year there was no statistical difference in function regardless of the initial treatment. Thus in deep second- and third-degree burns of the dorsum of the hand, care may be individualized according to other systemic factors without fear of sacrificing ultimate function.

Adolescent↗

Urate-mediated inflammation in nodal osteoarthritis: clinical and roentgenographic correlations.

We studied 25 patients with crystal-proven gout or roentgenographic evidence of gouty arthritis, or both, in finger joints involved with nodal osteoarthritis (OA). These patients were elderly (mean age 71.4 years), and 72% of them were receiving diuretic therapy. Roentgenographic findings, in addition to features typical of OA, included soft tissue densities (tophi), with or without calcification, large intraarticular erosions, characteristic nonmarginal cortical erosions, and periarticular osteolysis. We conclude that urate crystals mediate episodes of acute inflammation in certain patients with nodal OA. This association is noted primarily in elderly patients of both sexes, especially in those receiving diuretic therapy.

Acute Disease↗

Serum uric acid and patterns of radiographic osteoarthritis--the Ulm Osteoarthritis Study.

OBJECTIVE: To assess the association between uric acid and patterns of osteoarthritis (OA). METHODS: OA patterns were studied in 809 patients with arthroplasty due to hip or knee OA. Patients with OA were categorized as having bilateral or generalized OA according to the presence of radiographic OA in the contralateral or different finger joints. Odds ratios (OR) and 95% confidence intervals (CI) for thirds of serum uric acid and OA patterns were estimated with multivariable logistic regression. RESULTS: Eighty-five percent of the participants had bilateral OA and 26% generalized OA. A positive association between serum uric acid and generalized OA was observed in patients with hip OA (highest versus lowest tertile OR=3.5; 95% CI: 1.3-9.1), but not among patients with knee OA (corresponding OR = 1.1). Serum uric acid was not associated with bilateral OA. CONCLUSION: Our results suggest a possible role of elevated serum uric acid in the multifactorial etiology of generalized OA.

Aged↗

Simultaneous dorsal dislocation of both interphalangeal joints in a finger.

Following simultaneous dorsal dislocation of both interphalangeal joints of a finger, attention must be paid to the risk of a long period of recovery because of the severity of the lesion. Approximately one year after such an accident to a footballer arthrodesis was performed on the proximal interphalangeal joint, as the patient was still suffering from constant pain in the finger.

Adult↗

[Autoplastic foot-to-hand joint transplantations].

Our surgical experience in the field of total and partial foot-to-hand joint transplants has evolved over the past 9 years (1973). In the case of serious traumatic injury of finger joints of the hand, we don't suggest any surgical solution other than that of arthrodesis or arthroplasty of the damaged joint. In our experience joint transplantation is a reconstructive operation of the whole functionality of the injured finger. This operation partially restores the active function of the finger involved and gives both the patient and the surgeon the possibility of an alternative to arthrodesis, arthroplasty or painful instability of the destroyed joint, thus avoiding their characteristic disabilities. The transplantation guarantees a true stability of the joint and in the majority of cases the disappearance of pain. The technique described are the result of our experience in treating our clinical cases which consist of 20 patients treated, over more than 9 years at the Division of Hand Surgery of Traumatologic and Orthopaedic Center of Turin. The total number of transposed joints is 22, 16 of which are hemiarticular grafts. The operations have concerned 8 M.P. and 14 PIP joints of the fingers.

Adult↗

SACRAH: a score for assessment and quantification of chronic rheumatic affections of the hands.

OBJECTIVES: To establish a questionnaire to quantify the extent of the function and activities of the hand in patients with degenerative or inflammatory disease of the hand and finger joints. METHODS: One hundred and seventy-two patients with osteoarthritis (OA, n = 69) or rheumatoid arthritis (RA, n = 103) completed a new questionnaire, the SACRAH, that included 23 visual analogue scales covering the extent of hand function, stiffness and level of pain. SACRAH scores may range from 0 to 100. RESULTS: Comparing all studied patients, there was no significant difference in SACRAH scores between OA and RA patients (34 vs 32, not significant). Scores for both patient groups differed significantly from those for 30 healthy controls. Among patients taking NSAIDs only, individuals suffering from OA (n = 50) scored significantly lower than RA patients (n = 42) (36 vs 48, P < 0.004). Sixty-one RA patients taking DMARDs scored lower than the RA patient group treated with NSAIDs only (20 vs 48, P < 0.0001). Thirty-two RA patients were evaluated longitudinally at their first visit and 3 months after the initiation of DMARDs. Following therapy, SACRAH scores were significantly reduced from 50 to 11 (P < 0.0001). CONCLUSIONS: The questionnaire enables the quantification of compromised hand function, stiffness and pain in OA and RA patients, and is sensitive to therapy-related changes in RA patients.

Adult↗

Validation of an algofunctional index for osteoarthritis of the hand.

Although hand osteoarthritis is common, it has been the focus of few therapeutic trials. In addition to the problems raised by clinical trials in osteoarthritis in general and to the difficulties due to the unforeseeable course of osteoarthritis of the trapezometacarpal and finger joints, the lack of a clinical tool for assessing pain and function over time is an additional obstacle. We propose an algofunctional index designed for evaluation and symptomatic follow-up of patients with digital osteoarthritis. The index is based on a physician-administered questionnaire on 10 daily activities involving the hands. The patient is asked to answer each item using a 4-point verbal scale, from "possible without difficulty" (0) to "impossible" (3 points); thus, total scores range from 0 to 30. This index has been used in a few clinical placebo-controlled trials and was found sensitive to change. The aim of this study was to assess the metrological qualities of this index, including consistency (internal and external), sensitivity and specificity (by scoring the index in different groups of subjects), intra-observer reproducibility, and ease of use. Three hundred patients were recruited by 25 rheumatologists: 100 had a painful attack of digital and/or trapezometacarpal osteoarthritis (mean age: 64.9 years) with a score of more than 40 mm on a visual analog scale for overall pain severity (mean: 57.3 +/- 14 mm), 100 had "inactive" hand osteoarthritis (mean age 67.0 years), and 100 had no diseases of the upper limbs. Specificity/sensitivity: the mean index score was 12.41 +/- 5.41 in patients with painful OA, 4.28 +/- 3.87 in "inactive" cases, and 0.59 +/- 1.23 in controls. External consistency: the overall mean score was well correlated with pain severity: r = 0.49 (p < 0.001). Internal consistency: principal component analysis identified a primary axis responsible for 44.2% of the variance and two secondary axes each responsible for slightly more than 9% of the variance. None of the questions seemed redundant. Intra-observer reproducibility: two evaluations done one hour apart in symptomatic patients yielded the following scores: 12.32 +/- 5.41 and 12.5 +/- 5.51 (correlation: 0.95; mean difference: 0.17 +/- 1.64; coefficient of variation: 9.32%). Kappa values for both measurements of each item ranged from 0.68 to 0.87. Ease of use: mean time needed to determine the score 2.5 +/- 2 min. The scoring process was considered simple by 100% of investigators and easy/very easy by 98% of patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

[Arthropathy in idiopathic hemochromatosis].

In 22 of 35 patients (63%) with idiopathic hemochromatosis arthropathy could be demonstrated. In 20 patients the metacarpophalangeal joints (mainly II and III) with preference of the right hand were affected. Chondrocalcinosis of the wrist and knee was found both in two patients with metacarpophalangeal joint disease and in two patients without metacarpophalangeal disease. Further joints affected were the wrists (14), the other finger joints (11), and the knees (6). The dominant clinical complaint was pain in motion. Swelling and redness were rare findings only in case of acute exacerbations. The radiologic changes in the metacarpophalangeal joints were narrowing of the joint spaces, subchondral cysts, sclerosis of subchondral bone of metacarpal heads, and marginal osteophytic appositions at the joints. In one third of the patients arthropathy was evident before the diagnosis of idiopathic hemochromatosis was made. Histocompatibility testing confirmed that HLA-A3 is significantly more frequent in patients with idiopathic hemochromatosis than in normal persons. A statistically significant difference concerning HLA-phenotypes between patients with arthropathy and patients without arthropathy could not be detected. There was no case of arthropathy when 98 relatives of the patients were examined. However, idiopathic hemochromatosis was first detected in ten persons of this group.

Chondrocalcinosis↗