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PubMed2002

[Sclerodermic acrosyndromes].

In patients with systemic sclerosis, two main subsets of vascular acrosyndromes can be found: Raynaud's phenomenon and digital ulcerations. A severe Raynaud's phenomenon is found in almost every patient with systemic sclerosis. Most often, it is the first sign announcing the emergence of the disease and the hypothesis of subclinical scleroderma should be evaluated in every patient with apparently isolated Raynaud's phenomenon. Digital ulcerations can show several clinical aspects: ischemic micro-ulcerations and pitting scars of the finger tips, nailbed and nailfold lesions and digital necrosis, but also chronic ulcerations of the dorsal skin surface of the finger joints and ulcerated dermal calcifications, the origin of which is not only ischemic. First line treatment of such acro-syndromes is based upon cold avoidance and calcium-blocking agents. In the most severe cases, hospitalization in specialized centers is required, where customized physiotherapy and perfusions of prostaglandins or dextrans will be performed.

Calcium Channel Blockers↗
PubMed2005

Chondroprotective drugs in degenerative joint diseases.

Catabolic cytokine and anabolic growth factor pathways control destruction and repair in osteoarthritis (OA). A unidirectional TNF-alpha/IL-1-driven cytokine cascade disturbs the homeostasis of the extracellular matrix of articular cartilage in OA. Although chondrocytes in OA cartilage overexpress anabolic insulin-like growth factor (IGF) and its specific receptor (IGFRI) autocrine TNF-alpha released by apoptotic articular cartilage cells sets off an auto/paracrine IL-1-driven cascade that overrules the growth factor activities that sustain repair in degenerative joint disease. Chondroprotection with reappearance of a joint space that had disappeared has been documented unmistakably in peripheral joints of patients suffering from spondyloarthropathy when treated with TNF-alpha-blocking agents that repressed the unidirectional TNF-alpha/IL-1-driven cytokine cascade. A series of connective tissue structure-modifying agents (CTSMAs) that directly affect IL-1 synthesis and release in vitro and down-modulate downstream IL-1 features, e.g. collagenase, proteoglycanase and matrix metalloproteinase activities, the expression of inducible nitric oxide synthase, the increased release of nitric oxide, and the secretion of prostaglandin E(2), IL-6 and IL-8, have been shown to possess disease-modifying OA drug (DMOAD) activities in experimental models of OA and in human subjects with finger joint and knee OA. Examples are corticosteroids, some sulphated polysaccharides, chemically modified tetracyclines, diacetylrhein/rhein, glucosamine and avocado/soybean unsaponifiables.

Antirheumatic Agents↗
PubMed1976

[Static and dynamic studies on finger arthrodeses].

Some general techniques in arthrodesis of finger joints are described. Then biomechanical measurements were made after compression arthrodesis with screws, crossed KIRSCHNER wires, tension band wiring, compression plates (Swiss AO), and self compression plates, creascent shaped (MITTELMEIER). By screws, a maximal compression between 25 and 34 kp is achieved. Using a selfcompressing, bent, crescent shaped plate, one gets a compression of about 18 kp. This osteosynthesis resists a high deflection momentum if edgewise inserted.

Arthrodesis↗
PubMed2003

Comparative evaluation of effectiveness of different motor muscles in modified lasso procedure for correction of finger clawing.

A retrospective study was carried out to compare the effectiveness of different muscles as motors in modified lasso procedures for correction of finger clawing in leprosy. It was observed that palmaris longus and extensor carpi radialis longus were more suitable than the flexor digitorum superficialis. In some patients, removal of superficialis is associated with complications which could not be predicted before surgery. Extensor carpi radialis longus has advantages over palmaris longus in selected cases.

Adolescent↗
PubMed2000

The digital extensor mechanism of the hand.

In summary, there is a complex interplay between the extrinsic and intrinsic components of the digital extensor mechanism. Numerous examples of dynamic anatomy and pathology of the extensor mechanism in common clinical settings have been described. Treatment principles have been outlined. This review should provide the orthopaedic surgeon with a framework for management of common hand problems.

Diagnosis, Differential↗
PubMed1985

[Therapy of severe hand infections with local penicillin-streptomycin administration].

The primary goal of treatment of severe hand infections (finger joint infection, tenosynovitis, infections of the palm and the dorsum of the hand) is nowadays not only a matter of bringing the infection under control, but also trying to get a good functional result. To reach good results the author regards two steps in treating severe hand infections as indispensable: a) the principle of early operation (the average interval between the first examination in the hospital and surgery was only 0,5 days) and b) the local instillation of antibiotics in high concentration (penicillin and streptomycin). Over a period of three years 187 patients with severe hand infections were treated. 11 (5.8%) patients required a second operation and 5 (2.6%) patients a finger amputation. The functional result was in 85% of cases very good or good and in 15% poor.

Administration, Topical↗
PubMed2001

Hand synergies during reach-to-grasp.

An emerging viewpoint is that the CNS uses synergies to simplify the control of the hand. Previous work has shown that static hand postures for mimed grasps can be described by a few principal components in which the higher order components explained only a small fraction of the variance yet provided meaningful information. Extending that earlier work, this study addressed whether the entire act of grasp can be described by a small number of postural synergies and whether these synergies are similar for different grasps. Five right-handed adults performed five types of reach-to-grasps including power grasp, power grasp with a lift, precision grasp, and mimed power grasp and mimed precision grasp of 16 different objects. The object shapes were cones, cylinders, and spindles, systematically varied in size to produce a large range of finger joint angle combinations. Three-dimensional reconstructions of 21 positions on the hand and wrist throughout the reach-to-grasp were obtained using a four-camera video system. Singular value decomposition on the temporal sequence of the marker positions was used to identify the common patterns ("eigenpostures") across the 16 objects for each task and their weightings as a function of time. The first eigenposture explained an average of 97.3 +/- 0.89% (mean +/- SD) of the variance of the hand shape, and the second another 1.9 +/- 0.85%. The first eigenposture was characterized by an open hand configuration that opens and closes during reach. The second eigenposture contributed to the control of the thumb and long fingers, particularly in the opening of the hand during the reach and the closing in preparation for object grasp. The eigenpostures and their temporal evolutions were similar across subjects and grasps. The higher order eigenpostures, although explaining only small amounts of the variance, contributed to the movements of the fingers and thumb. These findings suggest that much of reach-to-grasp is effected using a base posture with refinements in finger and thumb positions added in time to yield unique hand shapes.

Adult↗
PubMed2001

A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke.

OBJECTIVE: To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. METHODS: This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. RESULTS: Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. CONCLUSION: The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).

Aged↗
PubMed2003

[Epidemiology of injuries in juvenile handball players].

INTRODUCTION: Aim of the study was to elucidate epidemiological aspects and injury mechanisms in juvenile team handball. METHOD: A standardized questionnaire was used to evaluate the injuries of 100 juvenile players (50 male, 50 female, year of birth 1982/83). RESULTS: A total of 130 injuries were recorded of 73 players. Most of the injuries (73.1%) occurred between the age of 15 and 18. Approximately two thirds of the injuries (69.2%) occurred in a competition and most of them in an offensive situation. Backcourt players (29.0%), line players (27.5%), and goalkeepers (17.0%.) were the player positions to be most injured. Female goalkeepers were three times more often injured than male ones at the same age. Most injuries applied to the foot and the ankle (32.0%), followed by the finger joint (26.9%) and the knee (24.6%). The most frequent ankle injuries were ruptures of the lateral ankle ligaments. The knee joint was affected by the most severe injuries with the need of surgical therapy. The most common injury concerning the knee joint was rupture of the anterior cruciate ligament (ACL). Eleven ACL tears were recorded in the age between 15 and 18 years (12-14 years: 1; 8-12 years: 0). The most typical game situation at the point of injury was catching a ball (38.5%), contact situation with the opponent (34.5%), or landing after a jump (26.2%). CONCLUSIONS: This study allows conclusions concerning prevention of injuries in juvenile team handball. There is apparently a difference in muscle strength and coordination of the youth handball player, especially at the age of 15-18 years, which has to be addressed. Therefore the authors recommend a proprioceptive training program as well as exercises to improve jumping techniques. Special strengthening training for the finger muscles might help to prevent finger injuries. The frequency of contact injuries underlines the importance of a "fair play" campaign among young players.

Adult↗
PubMed1993

[Multiple myeloma presenting with amyloid arthropathy].

Amyloid arthropathy rarely occurs in patients with multiple myeloma (MM) or primary amyloidosis (PA). Amyloid infiltration in and about the joints may be so extensive as to simulate the findings of rheumatoid arthritis. Some cases have been reported in which the articular manifestations were present for many months prior to the diagnosis of amyloid arthropathy. The delay of the diagnosis can result in the development of a fatal complication of MM or PA, which is not always unavoidable. We have encountered an unusual case of MM which the articular manifestations were present prior to the diagnosis of MM. A 59-year-old woman had a four-month history of hypesthesia in the median-nerve distribution of both hands and polyarthralgia. Far advanced renal insufficiency was evident, but its etiology was not determined. The patient was maintained on hemodialysis. The shoulders, wrists, hips and finger joints were symmetrically involved with articular swelling. All of these joints showed the avid uptake of Tc-99m (V) DMSA. The serum and urine immunoelectrophoresis demonstrated the presence of IgG-lambda type M-component and lambda type Bence Jones proteins, respectively. The bone marrow findings and bone roentgenograms supported the diagnosis of MM. Biopsy specimens from the synovial membrane revealed amyloid deposition. Her condition was much improved with melphalan and prednisolone.

Amyloidosis↗
PubMed1987

Histology and ultrastructure of the human flexor tendon sheath.

Twenty human flexor tendons and their sheaths were studied to determine the gross, microscopic, and ultrastructural morphology of their surfaces. Specimens were obtained at the time of autopsy or at the time of reconstructive and reparative surgery. The flexor tendon sheath consists of a noninterrupted layer of parietal synovium reinforced externally at intervals by dense bands of collagen, the annular and cruciform pulleys, and the palmar plates of the respective finger joints. The sheath contents are independently covered by a second similar layer of visceral synovium. These two layers are continuous at the proximal cul-de-sac, the vincula origins, and the tendon insertions. While the synovial cells lining the pulleys and tendons differ quantitatively from those of the membranous portion of the sheath, they are morphologically identical. The presence of a visceral synovial layer covering each tendon may indicate a key role of the synovial cell in tendon healing.

Cytoplasm↗
PubMed1990

[Clinical anatomy of the digital connective tissue cord of the ulnar side of the little finger].

A fibrous cord with a length of nearly 60 mm and a width of 3 mm consistency starts near the insertion of the abductor digiti minimi muscle at the ulnar border of the little finger. The fibers pass parallel to the longitudinal direction of the little finger and at the level of the osseous ridges on the palmar side of the flexion-extension axis of the finger joints. Proximally the cord receives fibers from the periosteum at the base of the proximal phalanx, from the ulnar end of the natatory ligament, and from the pretendinous fibers of the A1 pulley. Distally the digital cord has connections to the cutaneous ligaments of Grayson and Cleland. The cord also joins the flexor tendon sheath, the neurovascular bundles, and the skin. Sometimes these cords are involved in Dupuytren's contracture.

Adult↗
PubMed2002

[Medial and volar approach to fractures of the base of the fifth metacarpus].

A medial and volar approach to the base of the fifth metacarpus for exposing finger joint fractures is described. The dorsal approach does not expose well the joint surface of the base of the fifth metacarpus, hindering reconstruction of this important articulation. Carpometacarpal mobility of the ulnar joints contributes significantly to ulnar stability and grip force. An inverted "J" incision is made along the hypothenar eminence. The insertion of the tendon of the extensor carpi ulnaris is identified and the anterior fibers are disinserted. Capsulotomy is performed in front of the anterior border of the extensor carpi ulnaris tendon. This approach exposes well the medial two-thirds of the base of the fifth metacarpus. There is no risk of injury to the ulnar vessels nor to the dorsal sensitive branch of the ulnar nerve.

Dissection↗