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Joint replacement in the hand has developed on the basis of improved understanding of the pathophysiologic and the biomechanical factors involved in normal and diseased joints. Compromises are required in prosthetic design and surgical reconstruction, but function and appearance in deformed hands are susceptible to surgical improvement.
The hand joint is a multi-joint formation, including the wrist, carpal, intercarpal, carpometacarpal, intermetacarpal, distal radioulnar joints. Features of hand joint and periarticular tissue disease were studied in 536 workers exposed to local vibration and functional overstrain. The most prevalent diseases are arthroses with deformation of the wrist, radiocarpal, carpometacarpal joints, often with involvement of the triangular fibrous disk and carpals, periarthroses of the hand joint with compression neuropathy of the median and ulnar nerves.
Joint imaging with 99m-Tc-Polyphosphate was carried out in 21 patients having inflammatory or degenerative diseases of the joints of the hands. A comparison was made between 99m-TcPP, xeroradiography and radiography. In a total of 630 different joints 237 positive scans, 132 positive roentgenograms and 183 positive xeroradiograms were obtained. In the early stage of inflammatory joint disease only the scintigraphic results are positive, in the later stage 99mTcPP-imaging was less sensitive than xeroradiography and radiography. The reason for the increased concentration at the site of acute joint inflammation is probably the increased uptake in the soft tissues of the joints. The best time for scanning after the application of 99m-TcPP seemed to be at 3 hours.
OBJECTIVE: To determine the influence of body weight throughout the life course on the development of clinical hand osteoarthritis (OA). METHODS: A British national survey was used to perform a prospective cohort study of 1,467 men and 1,519 women born in 1946. Weight was measured at birth and at subsequent followup visits through childhood and adulthood. The main outcome measure was the odds ratio for the presence of hand OA at the age of 53 years. RESULTS: Two hundred eighty men (19%) and 458 women (30%) had OA in at least 1 hand joint. Hand OA was significantly associated with increased weight at ages 26 years, 43 years, and 53 years and with decreased weight at birth in men. Birth weight and adult weight showed independent effects, such that men with the highest risk for OA represented those who had been heaviest at age 53 years and lightest at birth. These findings were not explained by grip strength. There was no significant relationship between weight and hand OA in women. CONCLUSION: The results of this study show that increased adult weight is associated with, and may precede, development of hand OA in men. An association between hand OA and weight was not observed in women. The relationship between hand OA and decreased birth weight is a new finding and may reflect the persisting influence of prenatal environmental factors on adult joint structure and function.
The long-term investigation of the influence of physical exercise upon the structure of human skeleton revealed certain peculiar features in the process of developmental reconstruction of joints of the upper (humeral joint, hand joints) and lower (knee joint, the joints of the foot) extremities resulting from the occupation of the persons under study. Roentgen-anatomical studies performed in 433 industrial and 430 office workers established the fact of retardation and deceleration of ageing of the extremities bone system in representatives of physical labour as compared with office workers. So the significance of spectal physical exercises compensating the progressing with age hypodynamia in persons of non-physical labour gets special importance.
Twenty-five patients with sepsis of 26 hand joints were treated by urgent debridement, antibiotics and early hand therapy. We reviewed 15 patients (16 joints) in a clinic and three patients by postal questionnaire after a mean follow-up of 54 (range 10-94) months. Of the 26 involved joints, 14 had restricted motion at discharge. Stiffness increased with increase in delay between onset and treatment. At final review, one joint with painful degenerative changes had been fused. Seven patients had regained full movements. The remaining six had some stiffness but, nevertheless, had undergone significant improvement in the ranges of movement. There were two cases with radiological joint degeneration in this group of six patients. Three patients had mild, intermittent pain. No patient had significant disability. While there is significant loss of motion after this joint pathology in the early recovery period, overall motion and function appears to improve over the longer term.
OBJECTIVES: First to determine the range of motion (ROM) of selected foot and hand joints with a goniometer, 2.) to determine joint limitation by prayer sign and 3.) to compare both methods used. METHODS: Maximal active ROM was measured by goniometry (Method 1) in 50 patients with Type 1 diabetes and in 44 healthy controls, respectively. The lower limits for normal ranges were defined as mean minus 2 SD. To elicit the prayer sign (Method 2) subjects were asked to put their hands together in a praying position with the fingers fanned. The number of missing joint contacts between the fingers was counted and correlated to ROM. RESULTS: The ROM of all joints measured, except that of the thumb, was significantly smaller in diabetic patients than in control subjects. The degree of the prayer sign was well correlated to the ROM of most hand joints, but was solely correlated in feet to ankle ROM. In diabetic patients the prevalence of limited joint mobility (LJM) measured by goniometry ranged from 2 to 20% in hand joints and from 10 to 14% in foot joints. By the prayer sign 33% of the diabetic patients had LJM. CONCLUSION: With both methods, diabetic patients had more limitations in joint motion than control subjects, as was their prevalence of LJM higher. Since the prayer sign was correlated to exactly measured ROMs, we would suggest using the prayer sign as a simple clinical indicator for LJM in diabetic subjects.
We selected 500 patients randomly from a total of 1300 patients seen in our Hand Rehabilitation Center between 1971 and 1975; 212 of the 500 presented with a chief complaint of stiff hand joints. Of the 212 patients treated non-operatively, 173 responded sufficiently to this treatment alone. Of the 789 stiff joints, 686 responded sufficiently to this treatment alone. The results of this regime of non-operative treatment of stiff joints provide excellent functional improvement in most patients, with a large saving of money through the reduction in disability payments required.
A survey is given on the applicability of the AO/ASIF Small Fragment Instrumentarium in the arthrodesis of the hand joints. Indications for these operations and technical aspects are dealt with too. They stress, that these procedures-if correctly performed-have a definite advantage over the arthrodesis by K-wire fixation.
OBJECTIVE: To relate weakness of grip to loss of forearm muscle bulk, hand joint deformity, and hand joint tenderness in patients with rheumatoid arthritis (RA). METHODS: Using anthropometric data we have estimated the anatomical cross-sectional area (CSA) of forearm muscles in 100 subjects with RA compared with 100 aged and sex-matched normal subjects. We also recorded hand joint tenderness using a modification of the Ritchie articular index, and a simple index of hand joint deformity. RESULTS: We found a significant reduction in anatomical CSA in RA (forearm CSA in normal subjects 29.7 cm2 and in RA 25.9 cm2; p = 0.002). In simple linear regression we found that 46.3% of the variation in grip strength in normal subjects was explained by variation in muscle CSA; in RA this figure decreased to 33.4%. Adding terms for joint deformity and pain in a multiple regression model improved the amount of variation explained to 37.9%. CONCLUSIONS: Although there is significant muscle wasting in RA, it is likely that reduction in strength is also attributable to joint deformity and pain leading to inhibition of grip directly and, indirectly, by arthrogenous muscle inhibition. Doubts remain about the quality of muscle in RA.
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This is the second in a series of articles on arthroscopy of small joints. Hand instrumentation for small joint arthroscopy has been adapted from instruments previously developed for large joint arthroscopy. They have been downsized and altered for use in the smaller confines of joints such as the radiocarpal, temperomandibular, and midcarpal articulations. Although smaller, the instruments must remain strong and easy to use. Each instrument should perform a simple function. Their shape must conform to the joint and they should be smooth to minimize the risk of articular cartilage damage. We have found several instruments that have been helpful in arthroscopic surgery of the wrist.
OBJECTIVE: To investigate the prevalence and pattern of radiographic osteoarthritis (ROA) of the hand joints and its association with self reported hand pain and disability. METHODS: Baseline data on a population based study (age >/=55 years) were used (n = 3906). Hand ROA was defined as the presence of Kellgren-Lawrence grade >/=2 radiological changes in two of three groups of hand joints in each hand. The presence of hand pain during the previous month was defined as hand pain. The health assessment questionnaire was used to measure hand disability. RESULTS: 67% of the women and 54.8% of the men had ROA in at least one hand joint. DIP joints were affected in 47.3% of participants, thumb base in 35.8%, PIP joints in 18.2%, and MCP joints in 8.2% (right or left hand). ROA of other joint groups (right hand) co-occurred in 56% of DIP involvement, 88% of PIP involvement, 86% of MCP involvement, and 65% of thumb base involvement. Hand pain showed an odds ratio of 1.9 (1.5 to 2.4) with the ROA of the hand (right). Hand disability showed an odds ratio of 1.5 (1.1 to 2.1) with ROA of the hand (right or left). CONCLUSIONS: Hand ROA is common in the elderly, especially in women. Co-occurrence of ROA in different joint groups of the hand is more common than single joint disease. There is a modest to weak association between ROA of the hand and hand pain/disability, varying with the site of involvement.
The diagnosis of organic disease of the temporomandibular joint is often based on radiographic findings. The relationship between the radiographic findings in this joint and in hand joints, and clinical findings in the masticatory system, was analysed. The results showed that patients with crepitation of the temporomandibular joint frequently have radiographic abnormalities in this joint and in hand joints. Subcortical sclerosis and reduced joint space were significantly correlated with the number of occluding pairs of molar teeth.
If clinically evident synovitis causes erosions, then the two should be highly correlated within individual joints. Separate hand joints (total 2064) were examined for the presence of synovitis (the simultaneous presence of soft-tissue swelling and tenderness) on nine occasions over 2 yr. The cumulative synovitis score was compared to the change in the Larsen score over the same period. The mean correlation between synovitis and erosion progression was r = 0.248 (explained variance = 6%). Of the 216 joints which showed progressive X-ray damage, 44% had a cumulative synovitis score of < 3. When all the joints of one hand were taken together, the correlation was increased to r = 0.418 and for all the joints of both hands taken together it was further increased to r = 0.424. These results argue against there being a direct causal relationship between clinically inflamed synovitis and erosions in rheumatoid arthritis, and question the assumption that erosions and the signs of synovitis represent the same pathological process.
We describe a method of cup and cone arthrodesis using Coughlin concave and convex reamers, which we have used in a series of 22 hand joints in 19 patients. These reamers, originally designed for use in the foot, can be used in the hand to give very accurate preparation of bone surfaces. This results in maximum bone contact and the ability to fuse the joint in any desired position. The procedure is simple, rapid and forgiving. Union was achieved in all 22 cases, usually within 3 months.
Radiographs of hand and hip joints of 15 hemodialysis patients taken annually over at least 15 years were evaluated in this retrospective study. We looked for signs of A beta 2M-amyloidosis such as lucencies, erosions, and soft tissue swelling. The femoral head-soft tissue distance (FHSTD) was used to estimate the soft tissue swelling of the hips. The number and size of lucencies, the number of erosions, and the FHSTD increased during dialysis. Both hyperparathyroidism and failure of renal allograft transplantation influenced the development of lucencies and erosions after 15 years. The FHSTD at the start of the dialysis appeared to be an independent prognostic factor for the lucencies of the hips and hands. We conclude that the radiological signs of A beta 2M-amyloidosis are influenced not only by the duration of dialysis, but also by age, failure of renal transplantation, hyperparathyroidism and the FHSTD at the start of dialysis.
A possible link is suggested between hepatic diseases and rheumatic disease. Polyarthralgia and polyarthritis may be seen during the prodromal period of acute viral hepatitis, especially in hepatitis B virus (HBV). The symptoms of arthritis, mild, localized or generalized, mostly involve the small joints of hands. Joint symptoms frequently precede the onset of jaundice, no residual joint deformities. Circulating immune complexes are believed to play a causative role in the development of vasculitis and arthritis. Hemochromatosis is an antosomal recessive disorder of iron. About 43%-81% of patients with hemochromatosis have arthritis. The common extrahepatic manifestations of autoimmune hepatitis are arthralgia and skin rash. The reported prevalence of symptomatic inflammatory arthropathy in patients with primary biliary cirrhosis ranges from 4% to 50%. Skeletal involvement with Wilson's disease is common. Such patients may complain of pain and stiffness, mainly in the knee, wrist, or other large joints. Shwachman's syndrome is a disorder of pancreatic exocrine. Symmetric bone lesions have been reported in 10% to 15% of patients. They are involved predominantly at the femoral neck. Rheumatic symptoms are seen in one third of adult patients with cystic fibrosis and arthritis in 2.5% to 12% of patients. The arthritis caused by pancreatic panniculitis is usually symmetrical and involves the small joints of the hand, wrist, and feet, but may involve such larger joints as the elbow, ankle, and knee.