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At least 937 records · Page 52Linked to original sources
PubMed2006

Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis.

We prospectively compared power Doppler ultrasound findings in 25 fingers with rheumatoid arthritis (RA) and 25 fingers with psoriatic arthritis (PsA). Erosive synovitis and tenosynovitis were seen in both groups. Extrasynovial changes were found in 21/24 (84%) fingers with PsA versus none of the fingers with RA. Of the 21 PsA fingers exhibiting extrasynovial changes, 15 (15/25, 60%) also had synovial changes. The extrasynovial changes reflected enthesitis or soft tissue inflammation, with the main patterns being capsular enthesophyte, juxtaarticular periosteal reaction, enthesopathy at the site of deep flexor tendon insertion on the distal phalanx, and subcutaneous soft tissue thickening of the finger pad or entire finger. In four fingers, ultrasonograhy showed pseudotenosynovitis, an underrecognized abnormality characterized by diffuse inflammation of the digital soft tissues. Pseudotenosynovitis may play a pivotal role in dactylitis (sausage digit), which is defined as diffuse uniform swelling of the entire finger. Our findings suggest that inflammation of the fibrous skeleton of the finger may lead to the clinical and radiological features that distinguish PsA from RA of the finger.

Adult↗
PubMed2005

A retrospective review of the management of Dupuytren's nodules.

PURPOSE: To evaluate the progression of Depuytren's nodules with more than 6 years of follow-up study. METHODS: Fifty-nine patients who presented initially with Dupuytren's nodules returned for physical examination at an average follow-up period of 8.7 years (range, 6-15 y). Patients were questioned regarding family history of Dupuytren's disease, family ethnicity, alcohol consumption, smoking, liver disease, seizures, diabetes, and signs of systemic disease such as knuckle pads and plantar nodules. Physical examination evaluated disease state, loss of extension of the finger joints, and disease location. RESULTS: Thirty of the 59 patients with previously diagnosed isolated nodules developed a cord. Twenty-two percent of patients presented with bilateral disease and another 26% developed bilateral disease. Of those patients whose disease progressed 43% had European heritage, 37% had disease onset before the age of 50 years, 30% had bilateral disease, 23% had a family history of Dupuytren's disease, and 13% had plantar nodules. Five patients lost extension averaging 60 degrees at the metacarpophalangeal joint and 40 degrees at the proximal interphalangeal joint. Three of these 5 had surgical excision because they had a flexion contracture of the metacarpophalangeal or proximal interphalangeal joints averaging 60 degrees and 43 degrees , respectively. Another 7 patients did not meet standard criteria but had surgery for persistent pain associated with grasping objects (without contracture). All surgically treated patients had at least 1 risk factor and 7 patients had more than 1 risk factor. In 7 patients the Dupuytren's nodule had resolved at the time of follow-up evaluation. CONCLUSIONS: The progression of the nodular form of Dupuytren's disease to cord-like disease is common but not inevitable. This evaluation of Dupuytren's nodules has shown that at an average of 8.7 years after diagnosis 5 patients met standard surgical criteria of metacarpophalangeal contracture of greater than 30 degrees or any proximal interphalangeal contracture. Age of onset (before 50 years) is correlated most closely with disease progression, and the disease regressed in 7 patients (12%).

Adolescent↗
PubMed2004

Surgery for Dupuytren's disease in Japanese patients and a new preoperative classification.

The surgical outcome of Dupuytren's disease was evaluated in 73 hands of 57 patients in a Japanese population. Subtotal fasciectomy was performed in all cases. Surgical results were evaluated using the percentage improvement of extension in each finger joint. Statistical analyses were performed on the risk factors associated with recurrence and extension. The surgical outcome depended on the degree of contracture of the proximal interphalangeal joint. Recurrence of disease occurred in eight patients (14%) and extension occurred in nine (16%). Recurrence and extension frequently occurred in those who had ectopic lesions or involvement of the radial side of the hand. The present results suggested that the Dupuytren's diathesis had an influence on recurrence and extension. We proposed a new classification of Dupuytren's disease that might help to predict the surgical outcome and facilitate surgical planning.

Adult↗
PubMed2005

Sonographically assisted percutaneous release of the a1 pulley: a new surgical technique for treating trigger digit.

This study introduces a sonographically assisted percutaneous technique for releasing trigger digits which provides direct visualization of the release and avoids the risks of incomplete release and injury to adjacent neurovascular structures associated with other percutaneous release techniques. The "safe zone" and an estimate of the size of the A1 pulley were determined in a separate cadaver study. We then used these landmarks in a prospective clinical study of 107 digits in 83 consecutive patients treated by this technique. During the follow-ups of between 9 and 15 months, we evaluated 104 digits in 80 patients. Pain was absent in 101 digits (97%) and considerably improved in the other three (3%). All mechanical problems had been resolved and none recurred during follow-up. This technique allows the surgeon to see and monitor, precisely, the percutaneous division of the A1 pulley without open surgery and, therefore, to avoid the inherent risks of percutaneous and open surgical release.

Adolescent↗
PubMedDate not supplied

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Acupuncture Points↗
PubMed2004

Various clinical presentations of tuberculosis in heart transplant recipients.

The purpose of this study was to clarify the various clinical presentations, incidence, and complications associated with tuberculosis (TB), as well as patient survival in heart transplantation (HTx) recipients. A retrospective review of 177 case records of HTx recipients from May 1989 to April 2003 were evaluated for their clinical course, diagnostic procedures, treatment, and survival. TB was diagnosed by culture. TB was proven in five (2.8%) patients. There were three pulmonary lesions and two extrapulmonary lesions. TB was diagnosed at 3.5 to 85 months after HTx. Pulmonary lesions were detected by cultures of sputum, bronchoalveolar lavage, or pleural effusion. For extrapulmonay lesions, one subject had neck lymphadenopathy shown by biopsy and culture to be TB; another suffered from swelling of the finger joints which upon culture of the aspirate proved to be TB. Treatment consisted of isoniazid (INH), rifampin (RIF), ethambutol, pyrazinamide, streptomycin (STR), ciprofloxacin (Ciproxin), and levofloxacin (Cravit). During the use of RIF, the daily dosage of cyclosporine (CsA) or tacrolimus was increased to maintain appropriate levels. Because of severe hepatotoxicity and interference with CsA, RIF was withdrawn and STR given in the last three patients. In addition, ciprofloxacin was given in the patient with miliary TB. Levofloxacin was given to the other two patients. All patients survived the TB infection under treatment with at least three drugs. There were five clinical presentations of TB in our HTx recipients. Because of the high incidence of hepatitis and severe drug interaction with CsA or tacrolimus on RIF treatment, avoiding the use of RIF but treatment with at least three drugs is recommended.

Adult↗
PubMed2003

Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects.

OBJECTIVE: To determine whether use of a robotic arm trainer for bilateral exercise in daily repetitive training for a 3-week period reduced spasticity and improved motor control in the arm of severely affected, chronic hemiparetic subjects. DESIGN: Before-after trial. SETTING: Community rehabilitation center in Germany. PARTICIPANTS: Consecutive sample of 12 chronic hemiparetic patients; minimum stroke interval 6 months; patients could maximally protract the affected shoulder, hold the extended arm, or slightly flex and extend the elbow. INTERVENTIONS: Additional daily therapy of 15 minutes with the arm trainer for 3 weeks; the 1 degree of freedom trainer enabled the bilateral passive and active practice of a forearm pronation and supination and wrist dorsiflexion and volarflexion; impedance control guaranteed a smooth movement. MAIN OUTCOME MEASURES: Patients' impressions, the Modified Ashworth Scale (MAS) score (range, 0-5) to assess spasticity, and the arm section of the Rivermead Motor Assessment (RMA) score (range, 0-15) to assess motor control were rated before therapy, after each 3-week interval, and at follow-up 3 months later. RESULTS: All patients had favorable impressions: the extremity felt more vivid, and 8 subjects noticed a reduction in spasticity, an ease of hand hygiene, and pain relief. The MAS score of the wrist and fingers joints decreased significantly (P<.0125) from a median of 3 (2-3) and 3 (3-4) to 2 (1-2) and 2.5 (2-3). The RMA score minimally increased in 5 cases without improvement in functional tasks. The median RMA score before therapy was 2.0 (1-2) and 2.0 (1-3.75) after therapy. There were no side effects. At follow-up, the effects had waned. CONCLUSIONS: The arm trainer made possible intensive bilateral elbow and wrist training of severely affected stroke patients. Future studies should address the treatment effect in subacute stroke patients and determine the optimum treatment intensity.

Adult↗
PubMed2002

The role of sub-maximal force production in the enslaving phenomenon.

When individuals perform a force task involving only one finger, they involuntarily move other fingers as well. This phenomenon is referred to as the enslaving force or the interdependency of fingers. Given that previous literature on the enslaving force has focused on maximal isometric force production, the present research was designed to study the role of sub-maximal force production in the enslaving phenomenon. To this end, we examined behaviorally three levels of force production with a constant rate of force development. We also examined the temporal organization of enslaving separating the achievement of the desired force (ramp phase) and its maintenance (static phase). During the static phase we found: (i) the amount of enslaving increased with the increment of nominal force level whether the index, middle, ring or little fingers were used as the master finger; (ii) enslaving is strongest in the finger directly adjacent to the master finger; and (iii) in terms of enslaving, the index finger was more 'independent' than the other three fingers, regardless of nominal force produced, followed by the little, middle, and ring fingers. In terms of temporal organization, we found that the time-lag of activation of 'slave fingers' during the ramp phase was reduced as the amount of force level increased. Overall, our data suggest that enslaving effect is a task specific phenomenon and depends on the amount of force produced by the master finger.

Adult↗
PubMed2003

A case of mixed connective tissue disease showing a lymphoid follicle in muscle pathology.

We report a 74-year-old man suffering from mixed connective tissue disease (MCTD) accompanied by a lymphoid follicle in muscle pathology. He showed proximal muscle weakness and arthritis in finger joints. His laboratory findings were characteristic of MCTD. Prednisolone administration favorably improved his symptoms. A lymphoid follicle is a rare pathological finding in inflammatory myopathies. The immunohistochemical findings suggest that the lymphoid follicle would be involved in the specific role for the pathogenesis of MCTD.

Aged↗
PubMed1979

The termination of flexor tendon sheaths.

Fifty-five preserved cadaver digits were injected to show the termination of the flexor tendon sheath. The angle between the termination of the sheath and the most proximal dorsal and ventral bony points of the distal phalanx was measured. Using this concept of angles, a clinical guide to the region containing the sheath is given.

Finger Joint↗