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We report 4 cases of a congenitally stiff metacarpophalangeal joint of the small finger that were treated satisfactorily with surgical release.
A rare case of isolated complex dorsal dislocation of the MP joint of the ring finger is described. Differences in the pathological findings between dislocations of the ring finger and other digits are discussed.
Complex dislocation of the index metacarpo-phalangeal joint almost always requires surgical intervention. Controversy exists as to the most suitable surgical approach to reduction: palmar or dorsal. We reviewed four cases and carried out dissections in eight cadaver hands to compare the surgical approaches. The interposed volar plate was found to be the most important obstacle to reduction. Both approaches were successful in obtaining reduction. The dorsal approach was simple and safe, but necessitated longitudinal division of the volar plate and may carry a theoretical risk of late instability. The palmar approach allows restoration of normal anatomy but the radial neurovascular bundle is always vulnerable.
Proprioceptive ability with the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the index finger in human subjects was examined using a method that could assess static-position sense independently of movement sense (Clark et al., 1985). The similarity in location and function of these joints would suggest similar proprioceptive mechanisms, but proprioceptive ability was found to be quite different for the two joints. The method of distinguishing a static-position sense from a movement sense was based on whether a subject's ability to detect a small change in joint position was impaired when the rate of rotation was progressively reduced. An awareness of static-position should not depend on the rate at which a joint is placed into position. However, if subjects use movement signals to detect changes in joint position, slowing the rate of displacement should reduce the intensity of these signals and make the displacements more difficult to detect. This method indicated a static-position sense with the MCP joint but only a movement sense with the PIP joint. It was confirmed that sensory input from regions of skin not stretched or deformed by rotation of the joint can influence proprioceptive sensibility with the fingers. Anaesthesia of the tip of the index finger or of the thumb blunted subject's perceptions of movement of the PIP joint of the index finger. However, anaesthesia of the PIP joint itself had no observable effect on the ability to sense movement of the joint.
Mobility of metacarpophalangeal joints (MP) of the three-phalangeal fingers was measured in university students (52 males and 49 females), senior citizens (30 males and 30 females), and pianists (21 males and 31 females). We consider the student data file to be a control group with hand mobility unchanged by external influence. Extension, flexion, and total abduction in this group are greater in the left than the right hand. Only extensions were greater in females compared to males. In seniors, all types of studied movements are, with the exception of total abduction in females, lesser that in the control group. The difference is more apparent in males than in females. Intersexual difference showing better MP joint mobility in females than males is thus greater in seniors than in students; however, greater mobility of MP joints in left compared to right hand is less noticeable. Compared to students, pianists show greater finger abduction, and--less markedly--also passive and active extensions, while we did not notice difference in finger flexion. Intersexual difference in MP joint mobility in pianists were not recorded, and better mobility on the left hand compared to the right hand was evident only in dorso-palmar movements in males (the exception was total finger abduction, which is greater for the left hand in males as well as in females). In the three studied series we did not register differences in interfinger abduction between the left and right hand or between sexes. Active dorso-palmar MP joint range of motion is greatest in the little finger and smallest in the index finger, smallest in seniors and greatest in pianists. In all three groups, the range is greater in the left than the right hand and in females compared to males.
A rare case of scissoring deformity after closed reduction of a dorsal subluxation of the MP joint of the middle finger is reported. The aetiology and treatment of this deformity are presented along with a modified classification of dorsal dislocations and subluxations of the MP joint.
OBJECTIVE: To determine if finger and hand joint prostheses or temporomandibular joint (TMJ) implants may be involved in the initiation of specific connective tissue diseases (CTD), a nationwide cohort in Denmark was followed prospectively to evaluate rates of CTD after receiving these implants. METHODS: Danish patients with finger and hand joint implants (n = 562) or TMJ implants (n = 351) were identified and followed for subsequent hospitalizations. Observed numbers of hospitalizations due to CTD were compared with expected numbers based on national CTD hospitalization rates. To avoid confounding by indication, patients with a hospital discharge diagnosis of a CTD prior to prosthetic surgery were excluded from the cohort. RESULTS: After 4142 person-years of followup in the finger and hand joint cohort, 9 hospitalizations due to CTD were found [standard hospitalization rate (SHR) = 1.5; 95% CI 0.7-2.9]. The TMJ cohort had 1500 person-years of followup and 2 hospitalizations due to CTD (SHR = 1.3; 95% CI 0.2-4.5). CONCLUSION: This is the first cohort study to examine the relations between these implants and CTD. Although the number of events was small, this systematic national study revealed no significant or large increase in risk of CTD after finger and hand joint implants or TMJ implants.
1. An anatomical peculiarity allows the hand to be positioned so that the terminal phalanx of the middle finger cannot be moved by voluntary effort. When positioned in this way only joint and cutaneous mechanisms subserve position sense. By altering the position of the hand the muscles are again engaged and able to move the finger. Moving the joint then also excites muscular afferents. 2. The position sense of twelve subjects was assessed with and without engagement of the muscles at the joint. Three tests were used in which either angular displacement, angular velocity or duration of displacement were held constant. 3. When muscular attachment was restored, performance in all tests was greatly enhanced. As engagement of the muscles caused little change in the 'stiffness' of the joint, it is unlikely that the improved performance resulted from increased discharges from the joint receptors. Cutaneous mechanisms are unlikely to mediate this improvement as they are likely to have been unaffected by engagement of muscles. It is concluded that intramuscular receptors are partly responsible for normal position sense. 4. In seven of the twelve subjects the test finger was anaesthetized to isolate the contribution of intramuscular receptors. This muscle sense was variable. In some subjects it provided accurate kinaesthetic information but in others the information was crude. If with the test finger anaesthetized subjects exerted voluntary tension with the muscles that move the joint the muscle sense was improved.
Snapping at the MP joint of the little finger can occur when the extended and ulnarly abducted MP joint is flexed. In musicians, this is characterized by an annoying loss of fluid motion, and discomfort. Clinical examination reveals radial subluxation of the connexus intertendineus across the head of the fifth metacarpal to be the underlying problem, and surgical exploration confirms this. Operative treatment for radial subluxation of the connexus intertendineus must preserve the delicate balance of the extensor assembly of the fingers, including the otherwise underestimated connexus intertendineus itself. A simple and effective surgical procedure is presented.
Periarticular osteopenia is the earliest radiographic sign of rheumatoid arthritis (RA). Recent studies using dual-energy X-ray absorptiometry (DXA) have indicated that the loss of periarticular BMD can be quantified by whole-hand bone mineral density (BMD) measurements. The aim of this study was to analyze periarticular BMD in more detail by DXA and quantitative ultrasound (QUS). In a cross-sectional study 23 women aged 30-76 years with early RA, mean disease duration 26 +/- 19 months, and 18 men aged 42-69 years, mean disease duration 24 +/- 25 months, were examined. All patients received antirheumatic therapy. The reference population consisted of 103 age-matched controls (68 females, 35 males) and young healthy controls. BMD measurements were performed using a DXA Expert XL densitometer (Lunar). BMD of the whole-hand and two subregions was determined: two subchondral regions of interest (S.CH.) were set within the trabecular bone, distal to the proximal interphalangeal joints of digits II and III excluding the dense subchondral bone of the metacarpophalangeal (MCP) joint and two metacarpal regions of interest (MCP) were set including the entire MCP joint of these fingers. QUS measurements at the proximal phalanges of digits II-V were performed using a DBM Sonic (Igea); amplitude-dependent speed of sound (Ad-SoS) was determined. In comparison with whole-hand BMD measurements, bone loss was pronounced in patients with a disease duration of 18-72 months at the subchondral regions of interest in both genders compared with age-matched controls (women: mean BMD loss S.CH. -23%, p<0.001, whole-hand -16%, p<0.001; men: mean BMD loss S.CH. -19%, p < 0.05, whole-hand -12%, p<0.05). The bone changes were also shown by QUS (women: Ad-SOS values of 1950 +/- 90 m/s in RA vs 2137 +/- 35 m/s in young healthy controls (p <0.005); men AD-SOS 1956 +/- 87 m/s in RA vs 2146 +/- 41 m/s in young healthy controls (p <0.05)). These results show that BMD and Ad-SOS values are significantly lowered in patients with early RA and indicate that periarticular osteoporosis in early RA might possibly be better detected using detailed hand scan analyses.
Pachydermodactyly (PDD) is a rare, benign form of digital fibromatosis characterized by an asymptomatic soft tissue swelling affecting the skin of the lateral aspects of the proximal interphalangeal joints of the fingers, and it sometimes can be misdiagnosed with some rheumatic condition. Recognition on these features should lead to its more frequent diagnosis. The purpose of our study is to report four additional cases of PDD and discuss the differential diagnosis.
Injuries about the PIP joint of the finger are commonly encountered by primary care physicians and are associated with significant morbidity, including pain, stiffness, instability, premature degenerative arthritis, and residual deformities. An accurate understanding of the regional anatomy and appreciation of the mechanism of injury allows for classification so that a treatment protocol can be formulated for each injury pattern. Emphasis on careful consideration of the implications of open reduction, rational splinting, and early, active, protected motion provides for the most favorable outcome.
Pachydermodactyly is a superficial benign, symmetrical and painless fibromatosis, characterized by a swelling of the proximal interphalangeal joints of the fingers. Histological examination shows epidermal hyperplasia increase of dermal collagen bundles and an increased number of fibroblasts. We report two cases of pachydermodactyly in male teenagers. The aetiology remains unknown. Pachydermodactyly has to be distinguished from knuckle pads.
This report describes 3 types of apparatus that were used to produce precise movements of a joint over a wide range of speeds and angles. The designs feature an ability for ultra slow rotation of the joint (fractions of a degree per min) with a minimum of extraneous cues. Two designs use servo-controlled DC motors configured as velocity servos and a third design uses a galvanometer motor configured as a position servo. Originally designed for use with humans in studies of proprioception with the ankle and two joints of the index finger (the metacarpophalangeal joint and proximal interphalangeal joint), the apparatuses should be useful in a variety of applications where precise control of velocity and position is needed.
Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease. These bands are illustrated in a small series of patients and a serious complication of a misdiagnosis of Dupuytren's disease is presented. The pathogenesis of these palmar bands in rheumatoid arthritis is discussed.
Pachydermodactyly is a benign condition characterized by symmetrical, painless, diffuse swelling of the skin on the lateral aspects of the proximal interphalangeal joints of the fingers. Histopathological examination shows epidermal hyperplasia, an increase of dermal collagen bundles and a slightly increased number of fibroblasts. We report three adolescent males with pachydermodactyly. We also review 20 published cases, and discuss the differential diagnosis, clearly distinguishing pachydermodactyly from 'true' and 'false' knuckle pads.
Principles, and not established rules, form the basis for treating children with painful, posttraumatic arthritis involving the hand and wrist. The authors' preference is to exhaust nonoperative measures unless the involved joints are unstable or grossly incongruent. The authors would also recommend a greater degree of cautious observation in young children because of reports of successful outcomes associated with remodeling. Once surgery is necessary, the authors prefer motion-preserving procedures, bearing in mind that arthrodesis is well tolerated in the thumb interphalangeal joint and the finger DIP joints. Some authors have presented novel treatments, including complex microvascular reconstructions, but these authors recommend these procedures only in special circumstances, and only by physicians who are experienced with the techniques.
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