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At least 1,333 records · Page 74Linked to original sources
PubMed2005

Correction of long term joint contractures of the hand by distraction. A case report.

Joint contractures are a common complication of hand trauma. The conventional treatment consists of arthrolysis, tenolysis and occasionally arthrodesis. Frequently, this does not achieve a good result, particularly when there has been a long delay in presentation. Progressive lengthening of a joint by distraction (joint distraction) allows the release of joint contractures even in cases of failure of traditional methods. We present a case of a delayed (20 years) work related traumatic flexion deformity of the PIP joint of the left index and middle fingers. This was the result of a complete division of both flexor tendons of both fingers. The range of movements, both active and passive, was limited to 90/100 degrees in the index finger and 95/100 degrees in the middle finger. Following joint distraction using our lengthening device (Antãotrade mark, Portugal) the patient was able to achieve an active and passive range of movements of 10/100 degrees for the PIP joint of the index finger and 40/100 degrees of the middle. This clinical case shows the simplicity and application of our technique for the correction of joint contractures.

Adult↗
PubMed1979

The distribution of radiological joint damage in the rheumatoid hand.

We report a detailed study of the relative distribution of joint damage, as assessed by erosion and joint space scores, in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the rheumatoid hand. Hand radiographs of 30 patients with erosive rheumatoid arthritis were studied. There was significantly more damage in the dominant hand. The little-finger PIP joints were more damaged and the thumb interphalangeal (IP) joints less damaged than the other PIP joints. The index and middle finger MCP joints were more damaged than the other MCP joints. There was a significant negative correlation between the erosion scores of the PIP and MCP joints of each individual digit, when digits with only minimal damage were excluded. These findings support the concept that joint damage in the rheumatoid hand is greater in those joints that are subjected to greater mechanical stresses, and that in any digital ray the damage is concentrated at either the IPI or MCP joint.

Arthritis, Rheumatoid↗
PubMed1992

[Injury of the palmar fibrocartilage of the proximal interphalangeal joint of the long finger. Treatment and results within the scope of follow-up].

In 155 out of 389 patients with lesions of the fibrocartilage on the proximal interphalangeal (PIP) joint of the fingers, who were treated between January 1989 and 31 December 1989, a radiological and clinical follow-up was done after a mean interval of 1.5 years. In 82% a palmar lip fracture was diagnosed; the remaining 18% were attributed to a ligamentous lesion of the palmar fibrocartilate because of the clinical findings and negative X-ray results. Very good or good therapeutic results were achieved in 95%. Immobilization of the extended PIP joint for 2-3 weeks by a fingercast or plaster splint turned out to be the treatment of choice; surgical intervention was not indicated in any of these cases.

Cartilage, Articular↗
PubMed1989

The contribution of articular receptors to proprioception with the fingers in humans.

1. Whether joint receptors contribute demonstrably to proprioception has remained uncertain. Therefore, we tested whether an articular contribution to movement sense could be revealed if the total sensory input available to signal joint movement were reduced by eliminating movement signals from muscles. With a reduced sensory input, whatever contribution articular receptors made to proprioception ought to assume a greater-than-normal importance, and any effect of eliminating articular inputs should become more apparent. The distal interphalangeal joint of the middle finger was used, because the muscles could be decoupled from this joint by positioning the fingers to slacken the tendons. 2. To further enhance the possibility for observing an effect of eliminating articular contributions, we planned to test movement sense at positions of the joint in which the articular receptors would be most active. However, the response properties of receptors in primate finger joints were unknown, so we examined activity of receptors in finger joints of monkeys prior to testing humans. 3. Activity of receptors in interphalangeal joints of monkeys was measured over a wide range of positions before and during local anesthesia of the joint. Little response was seen over intermediate positions, but activity increased as the joint approached full flexion or full extension in much the same manner as responses previously observed with receptors in the knee, elbow, wrist, and hip joints. Local anesthetic injected into the joint space abolished the nerve activity. 4. Proprioception was tested in humans before and during local anesthesia of the joint using a movement-detection paradigm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

[Bone and soft tissue loss of the proximal interphalangeal joint of the long fingers: emergency treatment with a Swanson implant: prospective study of ten patients with mean 2.7 year follow-up].

PURPOSE OF THE STUDY: Injury of the proximal interphalangeal joint (PIP) with loss of bone and soft tissue (joint surface, tendon, skin cover) can compromise finger vascularization. Fusion or amputation is often proposed. We report our experience with another solution, emergency implantation of the Swanson implant. MATERIAL AND METHODS: Thirteen patients, mean age 47.4 years (range 18-76) underwent emergency surgery between 1997 and 2003. In twelve patients, the finger injury occurred when working with wood. For ten of the thirteen patients, the injury occurred during recreational activity. The index was involved when only one ray was injured. The thumb was spared in all patients. Joint tissue was lost in all patients. The head of P1 was injured in all cases creating a situation incompatible with fusion without loss of finger length. All patients underwent an emergency surgery for complete reconstruction of the PIP joint with Swanson implant, tendon reconstruction or suture, and skin cover performed during the same procedure. RESULTS: Ten patients, 16 implants, were reviewed at mean 2.7 years (range 1-6 years). Mean flexion reached 41.8 degrees (range 20-80 degrees). Maximal amplitude of flexion was achieved at one year and remained unchanged thereafter. There were no cases of infection, or secondary amputation. Two implant fractures were noted with no functional impact at six years. There were four cases of instability. DISCUSSION: Most reports in the literature concern composite blast or firearm injuries. Ours appears to be the first series involving injuries occurring while working with wood. Most of the lesions caused by the circular saw were tangential, damaging the dorsal aspect of several PIP joints. Classically, it would be logical to propose arthrodesis if the bone and cartilage loss is not excessive, but with the loss of joint motion provided by implants. Like Nagle, we propose emergency implantation of a Swanson prosthesis if soft tissue and tendon reconstruction can be achieved, avoiding amputation. Although the technique is relatively simple, implantation of a Swanson prosthesis implies certain prerequisites, particularly ligament repair and correct alignment. Oversized implants appear to be better. We did not have to perform any secondary arthrodesis.

Adolescent↗
PubMed1991

Contracture of the proximal interphalangeal joint in Dupuytren's disease.

The correction of fixed flexion deformity at the P.I.P. joint in Dupuytren's disease is often difficult. This paper reports an anatomical study of this joint in fingers amputated because of this condition. all the joints would extend fully after release of the accessory collateral ligaments and volar plate. Lateral and dorsal structures showed severe secondary damage and it is suggested that these changes may explain the poor results of corrective surgery to this joint in Dupuytren's disease.

Amputation, Surgical↗
PubMed1994

Central slip attenuation in Dupuytren's contracture: a cause of persistent flexion of the proximal interphalangeal joint.

This paper stresses the importance of central slip attenuation in the management of Dupuytren's contracture. Such attenuation occurs in patients who have had prolonged proximal interphalangeal joint contractures and is a common problem when the flexion contracture exceeds 60 degrees. The diagnosis can be made at the time of surgical correction by a tenodesis test. If central slip attenuation is confirmed, the postoperative regime described here will give a better correction of what at first might appear to be an intractable proximal interphalangeal joint flexion deformity.

Dupuytren Contracture↗
PubMed1998

Palmar metacarpophalangeal joint dislocation.

Palmar dislocations of the long finger metacarpophalangeal joint are extremely rare and easily missed at the first clinical examination. We describe a palmar metacarpophalangeal dislocation of the long finger following a hyperflexion injury. The presentation, aetiology and treatment are discussed.

Female↗