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At least 649 records · Page 36Linked to original sources
PubMed2000

Kinematics of the proximal interphalangeal joint of the finger after surface replacement.

Nine fresh-frozen normal human cadaveric long fingers were used to compare the kinematics of the proximal interphalangeal joint (PIP) before and after a resurfacing metal-polyethylene prosthetic replacement (Avanta prosthesis, San Diego, CA) using the magnetic Isotrak system (Polhemus Navigational Systems, Colchester, VT). The kinematics of the PIP joint after replacement were similar to that of the normal joint. The maximum angular displacement was 5 degrees for lateral deviation and 9 degrees for rotation during the passive flexion and extension motion. The center of rotation after implant insertion was nearly identical to the center of rotation of the normal joint. This anatomically designed PIP prosthesis has potential to restore normal motion to the finger PIP joint while resisting physiologic out-of-plane forces such as pinch and grasp.

Arthroplasty, Replacement↗
PubMedDate not supplied

The level of anti-topoisomerase I antibodies highly correlates with metacarpophalangeal and proximal interphalangeal joints flexion contractures in patients with systemic sclerosis.

BACKGROUND: It is found that an antibody directed against DNA topoisomerase I (anti-topo I abs) is detected almost exclusively in systemic sclerosis (SSc). These antibodies are predictors of pulmonary fibrosis and peripheral vascular disease. OBJECTIVE: Metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints flexion contractures are assessed as markers of active SSc. The aim of this study was to find out is there any relationship between anti-topo I abs and MCP and PIP joints flexion contractures. METHODS: Twenty-eight patients with active disease who fulfilled the American College of Rheumatology criteria for SSc were included in this study. Twenty eight healthy control subjects were also investigated. Clinical and radiological assessments of the hands were carried out. The flexion ranges in the 8 finger joints by goniometric measurement were obtained. Anti-topo I abs with an enzyme linked immunosorbent assay (ELISA) were measured. RESULTS: MCP and PIP joints flexion contractures and the levels of anti-topo I abs were significantly higher in patients with systemic sclerosis than in healthy control. The anti-topo I abs were found in 16 of 28 patients with systemic sclerosis. Sixteen of 28 patients with active disease had MPC and proximal PIP joints flexion contractures. In 16 SSc patients with anti-topo I abs, 13 had metacarpophalangeal and proximal interphalangeal joints flexion contractures. In only 3 patients of 16 with the flexion contractures the levels of anti-topo I abs were negative. The patients with MPC and PIP joints flexion contractures had higher mean value of anti-topo I abs titers (53.718 +/-50.977 vs 8.127 +/- 8.915, P < 0.0001) than did those with no contractures. Furthermore, the titers of anti-topoisomerase I antibody positively correlated with the flexion contractures (r = 0.4252, P = 0.0241). Radiologically, joint space narrowing and flexion contractures of the fingers were seen significantly more frequently in the SSc patients with anti-topo I abs (P < 0.05). CONCLUSION: Serum level of anti-topoisomerase I antibodies is in direct relationship with MPC and PIP joints flexion contractures.

Adult↗
PubMed1987

[Hand injuries in Alpine skiing].

In the Innsbruck University Clinic for Traumatology during the years 1978-1985, altogether 17,999 patients received initial treatment for injuries incurred through Alpine skiing. 3240, or 18% of these injuries were trauma to the hand. The most frequently injured area was the thumb, with 1995, or 61.6% of the cases. The most common hand injury in skiing is the socalled "ski thumb", the lesion of the ulnar ligament of the metacarpal-phalangeal joint. Finger injuries accounted for 262 cases, or 8%. The capsule-ligament lesions predominated, especially the palmar capsule lesion of the proximal interphalangeal joint. The most common ligament lesion was the rupture of the radial collateral ligament of the metacarpal-phalangeal joint of the small finger. The metacarpal region was involved in 192 (6%) of the patients. The 4th and 5th metacarpal fractures were often combined with volar dislocation of the caput; the 2nd and 3rd metacarpals showed more often torsion fractures. Luxated fractures were found in all carpal-metacarpal joints. Carpal injuries were the least common, with 2.2%; the bony and ligamentous injuries in this region were, however, more serious. 40 scaphoid fractures were found, along with fractures of the triquetrum, trapezium, hamatum, and pisiform, as well as luxations and luxated carpus fractures. The injuries of the wrist are worthy of more attention. They include lesions of the distal radial-ulnar joint and distal radius fractures, and made up 22.2% of all hand injuries. More emphasis should be placed on diagnostic, therapeutic, and prophylactic measures for these injuries.

Athletic Injuries↗
PubMed2005

Kinematic and dynamic synergies of human precision-grip movements.

We analyzed the adaptability of human thumb and index finger movement kinematics and dynamics to variations of precision grip aperture and movement velocity. Six subjects performed precision grip opening and closing movements under different conditions of movement velocity and movement aperture (thumb and index finger tip-to-tip distance). Angular motion of the thumb and index finger joints was recorded with a CyberGlove and a three-dimensional biomechanical model was used for solving the inverse dynamics problem during precision grip movements, i.e., for calculating joint torques from experimentally obtained angular variations. The time-varying joint angles and joint torques were analyzed by principal-component analysis to quantify the contributions of individual joints in kinematic and dynamic synergies. At the level of movement kinematics, we found subject-specific angular contributions. However, the adaptation to large aperture, achieved by an increase of the relative contribution of the proximal joints, was subject-invariant. At the level of movement dynamics, the adaptation of thumb-index finger movements to task constraints was similar among all subjects and required the linear scaling of joint torques, the synchronization of joint torques under high velocity conditions, and a flexible redistribution of joint torques between the proximal joint of the thumb and that of the index finger. This work represents one of the first attempts at calculating the joint torques during human precision-grip movements and indicates that the dynamic synergies seem to be remarkably simple compared with the synergies found for movement kinematics.

Adult↗
PubMed1998

Spondyloepiphyseal dysplasia with accumulation of glycoprotein in the chondrocytes: spondyloepiphyseal dysplasia, Stanescu type.

OBJECTIVE: To clarify the phenotype in a bone dysplasia termed "spondyloepiphyseal dysplasia with accumulation of glycoprotein in the chondrocytes" by Stanescu et al. DESIGN AND PATIENTS: Subjects comprised two definitive cases of one family and one probable case of another family. Histologic examination in one patient warranted the diagnosis of the first family, whereas the diagnosis of the second family was based solely on clinical and radiologic grounds. RESULTS: Pedigrees revealed an autosomal dominant mode of transmission. All three patients shared painful large joints with joint restriction, progressive contracture with osseous expansion of the finger joints, and normal height despite the presence of a short trunk. Moderate platyspondyly, hypoplastic ilia, epiphyseal flattening with metaphyseal splaying of the tubular bones, and most characteristically, broad, elongated femoral necks with striking coxa valga were identical in all patients, but the patient of the second family showed severe brachydactyly unlike the other two patients. Histologic examination revealed PAS-positive, amylase-resistant intracytoplasmic inclusion bodies in the chondrocytes, corresponding to dilated rough endoplasmic reticulum filled with moderately electron-dense materials found by electron microscopy. CONCLUSION: The manifestations of our patients are sufficiently characteristic to constitute a distinct entity.

Adolescent↗
PubMed2003

[The Mantero technique for flexor tendon repair - an alternative?].

PURPOSE: Regaining free tendon gliding after reconstruction of flexor tendons is essential to restore full function to the affected finger. Mantero et al. described a pull-out suture technique for the repair of flexor digitorum profundus (FDP) lesions in zone 1, allowing early postoperative active mobilisation and thus minimizing the risk of tendon adhesions. In a retrospective study we examined the results after Mantero tendon repair and compared these with the results after different reconstructive procedures in the literature. METHODS AND MATERIAL: Between 1995 and 2001, the FDP tendon in zone 1 and distal half of zone 2 distal to the chiasma respectively the flexor pollicis longus (FPL) tendon were reconstructed in 96 patients using the Mantero technique. 87 (90 %) patients, with a male to female ratio of 2 : 1, were re-examined an average of 43 (4 to 84) months postoperatively. We evaluated the isolated function of the finger joints, the total range of motion of the affected finger and grip strength and compared all values to the contralateral healthy side and assessed the functional results according to the Buck-Gramcko score and the patients' satisfaction according to the DASH score. Special attention was directed to the influence of the patients' age, gender, art of trauma, accompanying injuries or level of the lesion on the postoperative results. Furthermore, we evaluated whether clinical results depended on which finger was injured. RESULTS: 71 % (n = 62) of all injuries were found in the distal zone 2 or distal zone Th 2 in the thumb. While 81 % (n = 70) were caused by a clean cut, 10 % (n = 9) were due to a circular saw injury and 9 % (n = 8) due to a crush injury. The average DASH score value was 5.4 (0 to 37.5) with excellent and good results according to the Buck-Gramcko score in 90.8 % (n = 79) of all patients. Only the patients' age (> 50 years vs. < 20 years) and the digit involved (little finger vs. index, middle and ring fingers) had a significant influence on the postoperative results. Aside from superficial skin necrosis in 10 % of all cases, in which no further operative therapy was necessary, no other complications occurred. Interestingly, no ruptures of the sutured tendons were found, although active mobilisation was initiated immediately. Compared to the literature, the 90,8 % excellent and good results are equivalent to those of other studies concerning reconstruction after flexor tendon injuries using the Mantero technique and tend to be better than other reconstructive procedures. CONCLUSION: Based on our results, we consider the Mantero technique to be a good alternative to other forms of flexor tendon reconstruction in zone 1 and distal zone 2. Advantages include the possibility of immediate postoperative mobilisation and placing a secure tendon suture, even if the distal tendon stump is very short.

Adolescent↗
PubMed1994

Changes in stiffness following short- and long-term application of standard physiotherapeutic techniques.

A computer-controlled MCP joint arthrograph was developed to measure the stiffness of finger joints objectively. This was used to study the short-term (one application) and long-term (multiple applications over 6 weeks) effects of several physiotherapeutic methods on the reduction in joint stiffness. The techniques used were hot wax baths, pulsed ultrasound alone, wax baths plus pulsed ultrasound and exercise. In the short-term (i.e. after each application) wax plus ultrasound produced a statistically significant reduction in elastic torque range (P < 0.01) and dissipated energy (P < 0.05). However, the reductions in these stiffness parameters were temporary. Long-term no significant reductions in stiffness were measured. In other words, stiffness was reduced by each therapy session, but it then increased again before the next session. Wax, ultrasound alone or exercise produced no short- or long-term effects.

Adult↗
PubMedDate not supplied

[Surgical treatment of hand deformities in hereditary dystrophic bullous epidermolysis].

In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Academy, 18 patients. 12 male and 6 female, with hereditary dystrophic epidermolysis bullosa (HDEB) and hand deformities were surgically treated, to achieve the complete separation of fingers, correction of the thumb adduction contracture and flexion or extension contracture of finger joints. The period of wound healing on flat surfaces after surgery, and the period between two operations was estimated. The most common deformity was the flexion contractures of metacarpophalangeal (MP) joints (45%) and one or both interphalangeal (IP) joints (types A1, A2). In 20% of the hands MP joint was stretched with the flexion contracture in distal interphalangeal (DIP) or both IP joints (types B1, B2). In 35% of hands MP joint was in hyperextension with folded proximal interphalangeal (PIP) or both IP joints (C1 i C2). The adduction deformity of the thumb type 1, without the possibility of abduction, was present in 15%, type 2, when the thumb was placed above the palm in 60% and type 3, when the thumb was fused in the palm in 25%. Pseudosyndactyly of the first degree (till PIP joint) was found in 30% of hands, the second degree (till DIP joint) in 25%, and the third degree (the whole finger length) in 45% of hands. Fingers were completely separated and stretched surgically. The period of spontaneous healing was 15 days on the average. EBDC represents great medical and social problem that requires multidisciplinary approach of physicians of various specialties (surgeons, dermatologists, pediatrists, geneticists, nutritionists, physiatrists, ophthalmologists, dentists, ENT, as well as specially trained persons and families). The efficient specific systemic therapy aiming to increase the skin resistance to mechanical trauma does not exist yet, and should be developed in the field of gene therapy. The surgical correction of hand deformities, acrylate glove use in the longer post operative period combined with physiotherapy, the active use of hands, the protection of injuries and skin care are the measures which prolong the period between the recurrence of contractures.

Child↗
PubMed1991

Superficialis finger reconstruction: a new look at a last-resort procedure.

The anatomic two-tendon, three-joint finger cannot always be restored to normal after a severe flexor tendon injury. An effective alternative to consider is reconstruction of superficialis finger function or one-tendon to two-joint function. This principle has been applied to two-stage flexor tendon reconstruction in severe salvage situations to provide a good working arc of digital flexion. The surgical procedure, postoperative considerations, and biomechanical principles are discussed.

Finger Injuries↗
PubMed1989

Management of the traumatized joint of the finger.

Selection of the reconstructive technique for the traumatized joint requires a careful consideration of the condition of the injured and adjacent joints, the needs and desires of the patient, and an understanding of the advantages and disadvantages of the available options. The MP joint is the key to a useful arc of motion, providing 77 per cent of the total arc of flexion. Every effort should be made to preserve its maximum pain-free movement. PIP joint motion, although important in maintaining grip strength, can more readily be sacrificed to provide stability when MP joint motion is normal. Arthrodesis provides a pain-free stable joint with a sacrifice of motion. It may be indicated in young patients in whom heavy loading is likely; in joints with a fixed, painful deformity, instability, or loss of motor; and in the salvage of failed implant arthroplasty. Arthrodesis is generally contraindicated where physes are open. PIP joint arthrodesis is well tolerated in the index finger with minimal morbidity. Motion of MP joints and PIP joints of the long, ring, and small fingers, however, should be preserved using other techniques when possible. Resection arthroplasty may be useful in selected cases of post-traumatic arthroplasty where other treatment techniques are not available. Soft tissue interposition techniques are useful in specific cases. Eaton volar plate arthroplasty provides good results where 50 per cent of the articular surface is preserved. The technique, however, requires precision to avoid rotational malalignment. Perichondrial resurfacing provides a reasonable alternative in patients younger than 40 years of age who have a relatively well maintained joint contour, preferably involving a single joint surface. Prior infection is a relative contraindication. MP joints generally produce better results than PIP joints. Swanson interposition arthroplasty remains the most widely accepted implant technique, providing improved stability and earlier motion than simple resection arthroplasty. Reported arcs of motion range from a minimum of 29 degrees to a maximum of 85 degrees, with results generally better for MP than for PIP joints. Complications are common and include implant fracture, lateral instability of the PIP joint, and, occasionally, synovitis. Patient satisfaction, however, has been consistently reported as high. The use of Swanson arthroplasty in acute cases remains controversial, although several authors report favorable results. Silicone arthroplasty is contraindicated in joints with open physes. Allograft small joint reconstruction provides replacement bone and articular surface without donor site morbidity. Experience with the technique, however, has been limited. Increasing concern over the transmission of infectious diseases may make this option less desirable.(ABSTRACT TRUNCATED AT 400 WORDS)

Arthroplasty↗
PubMed1988

Prevalence of radiologically defined osteoarthritis in the finger and wrist joints of adult residents of Tecumseh, Michigan, 1962-65.

Radiographs of the fingers and wrists of adult participants in the Tecumseh Community Health Study in 1962-65 were examined for signs of osteoarthritis (OA). The severity of OA for each of 32 joints of the fingers and wrists was recorded for each individual. Attention was restricted to the 3035 participants who were 32 years of age or older and for whom a diagnosis of OA was available for each of 32 joints. Joint-specific prevalence rates of OA increased sharply with age for both sexes, and at the older ages, the prevalence rates for most joints were higher for females. Older individuals with OA also had a greater number of affected joints, with females having a greater number of affected joints than males. Of those individuals aged 44 years or younger, only 6.2% had one or more joints affected with OA. The percentages were 21.6 and 42.0% for those aged 45-59 years and 60 or more years, respectively. The distal interphalangeal (DIP) joints were the most frequently affected joints in all age categories for both sexes and OA in the proximal interphalangeal (PIP) joints was positively associated with OA in the DIP joints. However, controlling for the number of affected DIP joints, the PIP joints of older subjects were more likely to exhibit OA than the PIP joints of younger subjects. Though there is an association between OA in the DIP and PIP joints, there was only a small, nonsignificant association (OR = 1.24, 95% CI = 0.83, 1.84) between disease in the DIP and PIP joints of the same finger.

Adult↗