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At least 109 records · Page 6Linked to original sources
PubMed1994

Defining osteoarthritis of the hand for epidemiological studies: the Chingford Study.

OBJECTIVES: To explore the relative merits of clinical and radiological examination in defining hand osteoarthritis (OA) for epidemiological purposes. METHODS: A total of 976 women aged 45-64 years were selected from the general population and underwent a structured interview, clinical examination of the hand joints and radiography of the hands and knees. The inter-relationship of the clinical and radiological findings was examined, and also the association of each with hand symptoms and the presence of knee OA. RESULTS: Clinical and radiographic signs of hand OA generally correlated with each other, and each was associated with hand symptoms to a similar degree. When analysed in combination, they were only marginally better at predicting symptoms than when tested individually. However, when they were examined in relation to radiographic features of knee OA, there was a significantly stronger association with radiographic features of hand OA than with clinical features. CONCLUSIONS: Hand radiology provides a better overall assessment of osteoarthritis than physical examination of the interphalangeal joints or carpo-metacarpal joint; in situations where radiology is not available clinical examination is a viable substitute.

England↗
PubMed2006

Coordinative structure of manipulative hand-movements facilitates their recognition.

Manipulative hand movements involve coordinated movements of the fingers to manipulate an object within the hand, and are classified as either simultaneous or sequential. Simultaneous hand movements are characterized by single coordinated patterns of digit movements, while sequential hand movements involve sequences of such patterns. Here, we investigate the extent of the coordination among 15 hand-joints during simultaneous hand movements, and demonstrate that it leads to a concise representation that facilitates movement recognition. Principal component analysis (PCA), performed in the 15-dimensional (15-D) joint-space, indicates that the first principal-component captures more than 98% of the variability in individual hand movements. Consequently, the first principal direction provides a 15-D feature-vector that describes the underlying-coordination and can be used for automatic recognition. We evaluated this recognition strategy on a set of nine simultaneous hand-movements using a database of six users, each performing six sessions. A dedicated classifier for each user resulted in recognition rates of 97.0 +/- 4.7% during testing, while a single generic classifier achieved 95.2 +/- 2.5% recognition rates. We conclude that the suggested feature-vector captures the invariant structure of simultaneous hand-movements, facilitates their recognition, and may provide insight into motor planning.

Artificial Intelligence↗
PubMedDate not supplied

Fatigue fracture of the ulna occurring in pitchers of fast-pitch softball.

We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.

Adolescent↗
PubMed2003

Diagnostic value of high-resolution B-mode and doppler sonography for imaging of hand and finger joints in rheumatoid arthritis.

OBJECTIVE: High-resolution sonography enables a detailed assessment of intraarticular and extraarticular soft tissue abnormalities of joints affected by rheumatoid arthritis (RA). This study was undertaken to evaluate the diagnostic value of B-mode sonography and power Doppler compared with that of clinical examinations and conventional radiography. METHODS: The study group comprised 47 patients (14 men, 33 women) with different grades of RA; 31 patients were rheumatoid factor (RF) positive, and 16 were RF negative. The wrists, first through fifth metacarpophalangeal joints, and second through fifth proximal interphalangeal joints of these patients were scored with ultrasound in B-mode and power Doppler application, using a standardized technique. Involvement and severity of inflammation, as well as vascularization, were scored according to a new 3-point scale. The results were correlated with benchmarks of the clinical and radiologic investigations. Clinical status and conventional radiologic status were determined according to the Disease Activity Score and the Larsen score. RESULTS: After preliminary studies in 15 patients, 39% of 704 joints were found to be abnormal by clinical investigation. Erosions were detected by radiography and sonography in 23% and 43% of joints, respectively. Hypervascularization was observed in 34% of 704 joints by power Doppler application. There was a significant correlation (P < 0.001) between the different methods for the detection of the severity of lesions. Use of a modern, state-of-the-art power Doppler program was necessary for semiquantification, and a standardized investigation technique and scoring system provided sufficient quality measures. CONCLUSION: Sonography detects 20% more abnormalities than does radiography, and sonography has the potential to provide simple grading of disease activity. The rate of detection of abnormalities was slightly higher with clinical examination compared with sonography.

Adult↗
PubMed2000

Pattern of advancement in the zone of calcified cartilage detected in hand osteoarthritis.

OBJECTIVE: Using high definition macroradiography the pattern of advancement in the zone of calcified cartilage (termed a ZCC step) was detected in osteoarthritic hand joints of patients and compared to the joint space width (JSW) measurement. DESIGN: X5 macroradiographs were obtained of the osteoarthritic hands of 44 patients at baseline and at 18 months. The incidence of ZCC steps, identified as an advancement in the mineralized cartilage front into articular cartilage, was assessed at each articular surface. JSW was measured and was used to determine the difference in JSW between hands and groups of joints with and without ZCC steps at both X-ray visits. RESULTS: ZCC steps were found at the convex articular surfaces in only 42 (48%) hand joints in 28 (64%) patients. Here, ZCC steps were present in 36 joints in the non-dominant hand, compared with 30 joints in the dominant hand. In the former, they were present in 22 DIP, six PIP and eight MCP joints and in 12 DIP, eight PIP and 10 MCP joints in the dominant hand. By 18 months, new ZCC steps had formed in 15 hands with and 17 hands without previous ZCC steps. At both X-ray visits no statistically significant difference in JSW was found between the hands and joint groups with and without ZCC steps. CONCLUSION: In patients with ZCC steps, the pattern of distribution in the hand appeared to be related to that due to vascular changes, such as hyperlipidaemia, rather than to that associated with mechanical forces.

Calcinosis↗
PubMed2006

Relationship of global assessment of change to AUSCAN and pinch and grip strength among individuals with hand osteoarthritis.

OBJECTIVE: This study assessed the utility and construct validity of a new patient global assessment of symptom change for hand osteoarthritis (OA) by examining its associations with change over time in grip strength, pinch strength, and AUStralian CANadian Osteoarthritis Hand Index (AUSCAN). METHODS: Participants (N=531, 80% female, mean age=68) were part of a study on the Genetics of Generalized Osteoarthritis (GOGO) and completed two assessments (average 4 years apart). At the second assessment, participants described change in their right and left hand pain, aching, and stiffness on a 15-point scale with descriptors ranging from "Great deal worse" to "Great deal better". Linear regression models examined associations of global change scores with changes in hand strength and AUSCAN, controlling for age, gender, number of hand joints with OA, and time between assessments. RESULTS: Both right and left hand global assessment of change scores were significantly associated with change in AUSCAN, grip strength, and right hand pinch strength (P<0.05), and approached significance for left hand pinch strength (P=0.06). The strongest associations were between global change scores and AUSCAN change (right hand: beta=0.29, P<0.001; left hand: beta=0.27, P<0.001). Associations of change scores with grip and pinch strength were stronger among participants with greater radiographic OA severity at baseline. CONCLUSION: Results support the validity of this new global assessment of symptom change. This measure is particularly useful for assessing change over time when no baseline data are available. Additional research should examine this measure's responsiveness in the context of clinical trials.

Aged↗
PubMed1997

New era of reconstructive microsurgery.

Hopfner performed the first successful experimental limb replantation in 1903, and Malt performed the first successful clinical replantation for an above-elbow amputation in 1962. Since then the range of applications for reconstructive microsurgery has expanded rapidly, and it is now widely used for repair of nerves, vessels and lymphatics. In 1972 the first successful case of free flap transfer was performed. Many new applications followed including: (1) coverage of extensive wound defects with exposure of bones, joints, tendons and major vessels which can not be covered with local tissue; (2) vascularized bone transfer for bone defects; (3) vascularized joint transfer for hand joints and the temporomandibular joints; (4) functioning muscle transfer to replace the muscles of the upper limbs and face; (5) toe transfer for missing fingers and thumbs; (6) reconstruction following tumor ablation; (7) reconstruction of congenital anomalies; (8) reconstruction of chest, pharynx and cervical esophagus; (9) transfer of gliding tissue, fascia and sensory flaps for certain injuries. The goals of future reconstructive microsurgery include refinement of procedures, enhancement of functional and aesthetic results, and minimization of the morbidity of donor sites. Improvements of instruments, sutures and computer imaging systems will enable surgeons to perform more accurate reconstructions. Endoscopic harvesting of flaps will be widely used. Surgery will be performed on newborns with certain congenital anomalies. Microsurgery will be increasingly used in conjunction with a prosthesis to improve the function of the prosthesis. Microarthroscopy will be used in operations involving small joints. Advances in microsurgery techniques may also change the results of vascular surgery and tumor resection.

Humans↗
PubMed1999

Advancement in the zone of calcified cartilage in osteoarthritic hands of patients detected by high definition macroradiography.

OBJECTIVE: High definition macroradiography permits the advancement in the zone of calcified cartilage (described as a ZCC step) to be detected in osteoarthritic (OA) hand joints of patients. The pattern of their incidence and distribution was determined and compared to the joint space width (JSW) measurement. DESIGN: Macroradiographs, x5 magnification, were obtained of the OA hands of 44 patients at baseline and at 18 months. The incidence of ZCC steps, identified as an advancement in the mineralized cartilage front into articular cartilage, was assessed at each articular surface. JSW was measured and was used to determine the difference in JSW between hands and groups of joints with and without ZCC steps at both X-ray visits. RESULTS: ZCC steps were only found at the convex articular surfaces in 42 (48%) of hand joints in 28 (64%) patients. Here, ZCC steps were present in 36 joints in the non-dominant hand compared to 30 joints in the dominant hand. In the former, they were present in 22 DIP, six PIP and eight MCP joints and in 12 DIP, 8 PIP and 10 MCP joints in the dominant hand. By 18 months new ZCC steps had formed in 15 hands with and 17 hands without previous ZCC steps. At both X-ray visits no statistically significant difference in JSW was found between the hands and joint groups with and without ZCC steps. CONCLUSION: Although ZCC steps and JSW loss were greater at the PIP joints, supporting a mechanical hypothesis for ZCC formation, their presence in joints, where JSW was larger, and their greater incidence in the non-dominant PIP joints, suggest that factors associated with vascular changes, related to subchondral bone remodeling, are responsible.¿copy¿

Aged↗
PubMed1981

[Semiquantitative determination of destruction dynamics at the joints of hands and feet in rheumatoid arthritis-two roentgenological methods controlling the course of the disease as part of treatment studies (author's transl)].

The article discusses briefly the problem of classifying the degree of severity in rheumatoid arthritis. The selection of the X-ray film criteria which are best representative of the destruction dynamics, is explained. Two measurement methods are described which can be used to visualise and to measure the dynamics of the destructive processes. The destruction dynamics can be visualised graphically in a co-ordinate system or as a quotient series via calculatory or planimetric evaluation - at a later stage, this can be done photometrically. It is stated that both methods, namely, the one using the standardised evaluation foil and the one utilising the special transparent foil, can yield information on the extent and progress of joint destructions.

Arthritis, Rheumatoid↗
PubMed2005

Association of radiological hand osteoarthritis with bone mineral mass: a population study.

OBJECTIVES: A number of previous studies have reported an inverse relationship between osteoarthritis and osteoporosis. However, the association has remained controversial because osteoarthritis in hand joints seems to associate differently from osteoarthritis in weight-bearing joints with bone mineral mass. We studied osteoarthritis in distal interphalangeal (DIP) joints and osteoarthritis in the base of the thumb (CMC-1) for their cross-sectional associations with metacarpal cortical bone mineral mass, and for their prediction of calcaneal broadband ultrasound attenuation. METHODS: A population sample of 8000 Finns aged 30 yr and over was invited to a comprehensive health examination in 1978-1980; 90% complied. Hand radiographs were taken from 3568 participants to diagnose osteoarthritis in various hand joints, and to determine two indicators of cortical bone mineral mass, the combined cortical thickness (CCT) and the metacarpal index (MCI). Calcaneal broadband ultrasound attenuation was measured 20 yr later in 340 of these participants with the Sahara sonometer. RESULTS: In the cross-sectional setting, osteoarthritis in the DIP joints and osteoarthritis in the base of the thumb (CMC-1) were significantly associated with low CCT and low MCI. These associations were proportional to the radiological severity of osteoarthritis. In the follow-up setting, symmetrical DIP osteoarthritis adjusted for age, sex, body mass index, smoking, education, workload and MCI significantly predicted low values of broadband ultrasound attenuation. CONCLUSIONS: Our results indicate a direct relation of both radiological DIP osteoarthritis and CMC-1 osteoarthritis with low cortical bone mineral mass, in proportion to the severity of osteoarthritis. The presence of symmetrical DIP osteoarthritis, a possible indicator of generalized osteoarthritis, suggests an increased risk of osteoporosis over time.

Adult↗
PubMed2005

Systematic review of therapies for osteoarthritis of the hand.

OBJECTIVE: To systematically review published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA), with an emphasis on trial methodology. METHODS: RCTs published between 1966 and August 2004 were identified by searching several electronic data sources as well as by searching reference lists. Details of study demographics, methodology, quality and outcomes were analyzed. A meta-analysis was planned, if feasible. RESULTS: Thirty-one RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this systematic review. When compared with hip and knee OA, there are surprisingly few published RCTs in hand OA. Generally, these RCTs are of low quality. RCTs are weakened by a lack of consistent case definition and by a lack of standardized outcome assessments. The methods used for randomization, blinding, and allocation concealment were rarely described. The number and location of symptomatic hand joints per treatment group at baseline was usually not stated. The number and location of evaluated hand joints at the end of the study was also usually not stated. A meta-analysis could not be performed since most of the treatments studied did not have more than one identical comparison to allow pooling of the data. CONCLUSION: It is apparent that hand OA is a more complex area in which to study the efficacy of therapies when compared to hip and knee OA. Consensus guidelines are urgently needed to help improve the design and conduct of RCTs in hand OA. Additional RCTs of high quality that follow consensus recommendations are needed to evaluate the wide range of possible therapeutic options available for patients with hand OA.

Aged↗
PubMed2005

Regression analysis of overdispersed correlated count data with subject specific covariates.

A robust likelihood approach for the analysis of overdispersed correlated count data that takes into account cluster varying covariates is proposed. We emphasise two characteristics of the proposed method: That the correlation structure satisfies the constraints on the second moments and that the estimation of the correlation structure guarantees consistent estimates of the regression coefficients. In addition we extend the mean specification to include within- and between-cluster effects. The method is illustrated through the analysis of data from two studies. In the first study, cross-sectional count data from a randomised controlled trial are analysed to evaluate the efficacy of a communication skills training programme. The second study involves longitudinal count data which represent counts of damaged hand joints in patients with psoriatic arthritis. Motivated by this study, we generalize our model to accommodate for a subpopulation of patients who are not susceptible to the development of damaged hand joints.

Arthritis, Psoriatic↗
PubMed1988

[Clinical aspects and classification of primary osteoarthrosis deformans].

The authors reported the results of investigation of 70 patients with osteoarthrosis deformans followed up for 3-10 yrs. They defined 3 variants of a course of the disease: with rapid progression, slow progression, without noticeable progression. These variants differed in disease spreading, the frequency of arthrotic synovitis and the presence of hereditary predisposition. Signs of erosive arthrosis of the distal and proximal digital hand joints were noted in 12 patients with nodular polyosteoarthrosis. A characteristic signs in this group of patients was hereditary predisposition combined with local vegetative-vascular disorders and a strain on the digital hand joints, and degenerative affection of the cervical spine with the radicular syndrome.

Atrophy↗
PubMed1996

[MR imaging in seronegative spondyloarthritis].

In twenty-five patients with a clinical diagnosis of suspected sacroiliitis conventional radiography, CT and MRI were performed. In ten patients no abnormalities were demonstrated. In thirteen cases CT and MRI revealed sacroiliitis. In two patients with normal plain films and CT para- and intraarticular changes of signal intensity suggested suspicious sacroiliitis. MRI can be considered as an important imaging modality for early diagnosis of sacroiliitis. In eighteen patients with a firm diagnosis of ankylosing spondylitis and plain films of the thoracolumbar junction suggesting destructive Romanus and Anderson inflammatory lesions MRI was done. Two distinct groups of inflammatory changes were found. In ten patients MRI findings compatible with active inflammatory enthesitis were revealed at the disco-vertebral junction. In eight cases focal and linear changes of signal intensity within the intervertebral disks suggested an active inflammation. Using MRI the spectrum of inflammatory changes in sero-negative spondylitis can be presented. In sixteen patients with definite clinical diagnosis (psoriatic arthritis--thirteen cases and Reiter's syndrome--three cases) plain films and MRI of small hand joints were performed. The patients fell into two distinct groups. In the first MRI findings could not be differentiated from those seen in rheumatoid arthritis. In nine cases the distribution and extent of soft tissue findings were different, similar to changes seen in enthesitis. Therefore, on the basis of MRI findings in small peripheral joints easier differential diagnosis between sero-negative spondyloarthritides and rheumatoid arthritis is possible. In five patients with a diagnosis of Reiter's syndrome having clinical signs of enthesitis plain films and MRI of calcaneus were done. MRI revealed findings compatible with active inflammation which resembled those seen at the attachment of the annulus fibrosus and collateral ligaments of the small hand joints.

Adult↗