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PubMedDate not supplied

Roentgenographic aspects of calcium pyrophosphate dihydrate crystal deposition disease (pseudogout).

A comprehensive review of the roentgenographic features of calcium pyrophosphate crystal deposition disease (pseudogout) is presented. The roentgenographic techniques are reviewed. Those recommended as optimal are as follows: for small peripheral joints, industrial Type M film with contact exposure; for large central joints, direct radiographic magnification (3-4 X) with a microfocus tube. The classic appearances of articular chondrocalcinosis in fibrocartilage, hyaline cartilage, and capsular structures are discussed. Distinctive features of pyrophosphate arthropathy, including the distribution of involvement and the degree of destruction, are emphasized. Finally, the relationship among articular chondrocalcinosis, arthropathy, microscopic crystals, and symptoms is discussed.

Adult↗
PubMed1997

The palpable tendon friction rub: an important physical examination finding in patients with systemic sclerosis.

OBJECTIVE: To evaluate the clinical and prognostic significance of palpable tendon friction rubs in patients with systemic sclerosis (SSc). METHODS: SSc patients evaluated prospectively at the University of Pittsburgh were examined serially for the presence of tendon friction rubs on physical examination. Demographic, clinical, and laboratory features of disease were obtained by patient examination, annual patient questionnaire, and medical record review. Patients were classified as having limited or diffuse scleroderma according to standard definitions. The prognostic significance of the presence of tendon friction rubs was determined using this comprehensive database. RESULTS: The SSc patients (n = 1,305) were first evaluated during 1972 through 1991 and were followed up for a mean of 6.3 years. Tendon friction rubs were detected most frequently in patients who had or who developed diffuse cutaneous involvement. There were strong correlations between the presence of tendon friction rubs and symptoms and signs typical of diffuse scleroderma, including more severe skin thickening, more frequent heart and kidney involvement, and decreased survival. In multiple regression analyses, the presence of 1 or more tendon friction rubs was one of the best predictors of both evolution to diffuse scleroderma and reduced survival. CONCLUSION: The palpable tendon friction rub is an easily detected, inexpensively obtained physical examination finding which is highly associated with diffuse cutaneous scleroderma and decreased survival. This observation should lead to the early diagnosis of diffuse scleroderma and should identify patients at high risk for serious visceral involvement who are thus candidates for potential disease-modifying therapy.

Ankle Joint↗
PubMed1979

Multiple loose bodies in rheumatoid arthritis.

Intra-articular loose bodies are usually secondary to osteochondral fractures, osteochondritis dissecans, synovial osteochondromatosis, and degenerative arthritis. The authors report four patients with longstanding rheumatoid arthritis and multiple loose bodies in a variety of joints. All patients have remained active despite their disease, suggesting that the loose body production was secondary to trauma of continued activity superimposed on joints containing pannus and eroded cartilage.

Ankle Joint↗
PubMed1984

Gouty arthritis: a prospective radiographic evaluation of sixty patients.

A prospective analysis of 60 patients with gout was undertaken to evaluate the radiographic spectrum of gouty arthritis in patients treated in the era of hypouricemic therapy. Twenty-two of these patients were clinically tophaceous; 36 were considered to have radiographic findings diagnostic of gouty arthritis by strict radiographic criteria. Up to 24% of the patients denied symptoms in joints with radiographic changes of gout; 42% with no evidence of tophi on clinical examination had radiographic changes characteristic of gout. Radiographic assessment can be extremely helpful in the management of gout by documenting the degree and extent of bony involvement, particularly in patients with limited symptoms or without clinical tophi.

Ankle Joint↗
PubMed2005

Joint angle variability in 3D bimanual pointing: uncontrolled manifold analysis.

The structure of joint angle variability and its changes with practice were investigated using the uncontrolled manifold (UCM) computational approach. Subjects performed fast and accurate bimanual pointing movements in 3D space, trying to match the tip of a pointer, held in the right hand, with the tip of one of three different targets, held in the left hand during a pre-test, several practice sessions and a post-test. The prediction of the UCM approach about the structuring of joint angle variance for selective stabilization of important task variables was tested with respect to selective stabilization of time series of the vectorial distance between the pointer and aimed target tips (bimanual control hypothesis) and with respect to selective stabilization of the endpoint trajectory of each arm (unimanual control hypothesis). The components of the total joint angle variance not affecting (V(COMP)) and affecting (V(UN)) the value of a selected task variable were computed for each 10% of the normalized movement time. The ratio of these two components R(V)=V(COMP)/V(UN) served as a quantitative index of selective stabilization. Both the bimanual and unimanual control hypotheses were supported, however the R(V) values for the bimanual hypothesis were significantly higher than those for the unimanual hypothesis applied to the left and right arm both prior to and after practice. This suggests that the CNS stabilizes the relative trajectory of one endpoint with respect to the other more than it stabilizes the trajectories of each of the endpoints in the external space. Practice-associated improvement in both movement speed and accuracy was accompanied by counter-intuitive lack of changes in R(V). Both V(COMP) and V(UN) variance components decreased such that their ratio remained constant prior to and after practice. We conclude that the UCM approach offers a unique and under-explored opportunity to track changes in the organization of multi-effector systems with practice and allows quantitative assessment of the degree of stabilization of selected performance variables.

Adult↗
PubMedDate not supplied

Two unusual cases of distal interphalangeal joint Dupuytren's contracture.

Following trauma, two Caucasian males presented with Dupuytren's contracture affecting the distal interphalangeal joint of the little finger and extending onto the dorsum of the digit to insert into the nail bed. Complete excision of the cords and appropriate physiotherapy helped the patients achieve excellent postoperative results.

Aged↗
PubMed1996

Sympathetic vasomotor dysfunction in leprosy patients: comparison with electrophysiological measurement and qualitative sensation testing.

Testing of skin vasomotor reflexes (VRs) by laser Doppler flowmetry (LDF) is now a recognised method of measuring peripheral dysautonomia. To assess its specificity as an indicator of impairment to unmyelinated autonomic fibres, VR testing at the fingerpulp was compared with standard qualitative sensation (QST) and with sensory electrophysiological (SNVC) measurements in 39 Iranian leprosy patients. There was a significant relationship between VR and SNCV values (but not QST): these were jointly measurable in 38.5% of fingers, and jointly absent in 35.3% of fingers which also showed significantly reduced LDF perfusion and skin temperatures. However, in 10.3% of fingers, predominantly index and otherwise apparently healthy, VRs were absent but SNCV present, suggesting early sub-clinical autonomic impairment. In a further 16% of fingers, predominantly ulnar and with poor microcirculation, intact (though impaired) VRs could be recorded despite the absence of SNCV responses, suggesting sparing or regeneration of these fibres. This evidence suggests that where there is heterogeneity of nerve damage a combination of VR and electrophysiological testing can indicate the functional status of distinct fibre types.

Adolescent↗
PubMed1990

A complication of the buried suture.

A buried suture used in the repair of the central slip of a digital extensor resulted in an erosive lesion of the proximal interphalangeal joint of the long finger. In a review of the literature I can find no other reports describing this unusual complication.

Adult↗
PubMed1993

Wrist arthrodesis in post-traumatic arthritis: a comparison of two methods.

The Arbeitsgemeinschaft für Osteosynthesefragen arthrodesis technique is compared with the proximal row carpectomy technique with radiocapitohamate arthrodesis for patients with traumatic and degenerative arthritis of the wrist. Both techniques gave satisfactory functional and x-ray film results in 85% of the patients. Grip strength measured on the Jamar dynamometer at settings 1-5 was 77-83% of the opposite in the dominant extremities and 56-82% of the opposite in the nondominant extremities. Despite the decrease in grip strengths after wrist fusion, grip strength curve patterns were similar for operated and nonoperated extremities. There were no statistically significant differences in grip strength between the two groups. Patients who did not have index and long ray carpometacarpal joints fused had pain at that level requiring a second procedure to arthrodese the joints. Index and long finger carpometacarpal joint arthrodesis at the time of wrist arthrodesis is recommended in patients with heavy labor jobs.

Adult↗
PubMed2006

Joint-specific prevalence of osteoarthritis of the hand.

PURPOSE: To quantify the prevalence of radiographic hand osteoarthritis (OA) among a group of community-dwelling individuals. Joint-specific prevalence rates/100 of radiographic OA of the hand were quantified and reported by age, gender, and dominant hand. METHODS: Data from a community-based, longitudinal study designed to follow the natural history of OA were used. Participants were ambulatory men and women, ages 40 years and older, with and without radiographic hand OA (N = 3327). Bilateral hand OA was examined at three joints: second distal interphalangeal joints (DIP), third proximal interphalangeal joints (PIP), and first carpometacarpal joint of the thumb (CMC). The ordinal scale of Kellgren and Lawrence (0-4) was used to determine OA status (grades 2+). RESULTS: Radiographic hand OA status was determined for all persons in the study group comprised of 2302 women (69%) and 1025 men (31%). The sample sizes for the age groups (years) were 532 (40-49), 905 (50-59), 998 (60-69), 749 (70-79), and 143 (80+). Overall, the DIP joint demonstrated the highest OA prevalence, while the PIP joint showed the lowest prevalence. Joint-specific hand OA prevalence rates for second DIP, third PIP, and first CMC were 35%, 18%, and 21%, respectively. Expectedly, hand OA prevalence for all joints increased with age. With exceptions, women demonstrated higher hand OA prevalence rates for the three sites examined. However, among men aged 40-49, the second DIP joint OA rate was higher (13%) compared with women (8%). Additionally, men in that age group demonstrated an elevated first CMC joint OA rate (9%) compared with women (5%). Gender-specific hand dominance analyses demonstrated that the majority of individuals with unilateral second DIP or third PIP OA presented in their dominant hand. However, among those with unilateral first CMC OA, both genders displayed a tendency to present in their nondominant hand. CONCLUSION: These findings suggest the need for further investigation of the role gender can play in the development of hand OA in populations under 60 years of age. Additional epidemiological studies addressing hand OA will serve to bridge the gap between the current levels of knowledge about the knee and the hand. The disease burden of hand OA affects a large percentage of the population. Research efforts that more exhaustively characterize the prevalence of hand OA may contribute toward interventions that, ultimately, impact a rapidly growing segment of our population.

Adult↗
PubMed1990

Erosive osteoarthritis: is it a separate disease entity?

Erosive osteoarthritis (EOA) characteristically involves the hands of middle-aged women. The diagnosis is essentially radiological and depends upon the presence of articular surface erosions. This study investigates whether this radiological feature is a marker of a specific clinical entity. From a series of 500 consecutive patients attending a rheumatology clinic with symptomatic limb joint osteoarthritis, 24 were identified by radiological criteria to have EOA. These were age-sex matched with 24 patients from the same series who presented with osteoarthritis of the hand. Those with EOA had nearly twice as many radiographically abnormal joints in the hands as the controls (274: 144). This was almost entirely due to an increase in distal (134: 68) and proximal (79: 24) interphalangeal joint involvement, 71% of which were erosive. Erosions were found apart from the hands in both elbows of one patient with EOA. Otherwise only minor differences were present between the two groups in terms of distribution and incidence of osteoarthritic changes. There were no distinguishing serological or other clinical differences. This study has demonstrated that erosions in EOA are associated with more severe hand disease but are not apparently a marker of a separate disease entity. EOA appears to be an aggressive acute form of hand osteoarthritis and may represent the hand equivalent of similar forms of osteoarthritis in the shoulder, hip and knee.

Adult↗
PubMed1990

Synovial chondromatosis in the distal interphalangeal joint.

A case of synovial chondromatosis of the distal interphalangeal joint of the long finger with an 8-year follow-up is presented. The lesion recurred 4 years after simple synovectomy, requiring a second operation with arthrodesis.

Chondromatosis, Synovial↗
PubMed1979

Clinical results of a cross-over treatment with pyridoxine and placebo of the carpal tunnel syndrome.

Clinical evaluation was made of cross-over treatments by pyridoxine and a placebo of patient 22 having the carpal tunnel syndrome. Extraordinary monitoring of the specific activities of the erythrocyte glutamic oxaloacetic transaminase proved a severe vitamin B6 deficiency, which was partially corrected by the Recommended Dietary Allowance of 2 mg, and completely corrected by 100 mg. The severity of the syndrome diminished on the Recommended Dietary Allowances and the patient was asymptomatic at the higher dosage. On placebo, both the vitamin B6 deficiency and syndrome reappeared. Retreatment with 100 mg again corrected both the deficiency and syndrome. Measurements (total n = 19) of flexion of proximal interphalangeal joints of the index fingers by a goniometer, and of pinch by the Preston gauge revealed objective normalization. Scores of 17 symptoms revealed reductions at both the 2- (P less than 0.01) and 100-mg (P less than 0.001) dosages. Conduction through the carpal tunnels had improved by electromyography. These and previous data on a total of 22 patients showed the concomitant presence of a deficiency of vitamin B6 and the carpal tunnel syndrome; a causal relationship is apparent.

Adult↗
PubMed1992

Age-dependent changes in position sense in human proximal interphalangeal joints.

Using a position matching paradigm, the ability of subjects to detect displacements at the proximal interphalangeal joint of the index finger was tested. These displacements were imposed at an angular velocity of 2 degrees per minute which is below the threshold for movement detection. An older group of subjects whose mean age (+/- s.e.m.) was 56.6 +/- 3.2 years showed significantly poorer performance in detecting the position of the index finger than a group of younger subjects (23.7 +/- 0.5 years). Analysis of the correlation between age and magnitude of matching error gave a positive correlation coefficient of 0.466 which was statistically significant. However, there was no systematic bias in judgements of finger position by the older group. These results indicate that the sense of position of the fingers decrements with age.

Adult↗