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We report a case of gout with monoarticular tophaceous involvement of the proximal interphalangeal joint of the middle finger, emphasizing MR findings. To the best of our knowledge, the MR appearance of gout is not commonly known.
The short-term effect of neuroma-in-continuity resection in obstetrical brachial plexus palsy was evaluated to test the hypothesis that the neuroma does not contribute to useful limb function. Twenty-six patients with obstetrical brachial plexus palsy underwent resection of the neuroma-in-continuity and interpositional nerve grafting, and 17 patients underwent neurolysis only. The preoperative and postoperative active movement scores were recorded using an eight-point scale for 15 joint motions in each patient. Data analysis examined the change in total limb motion scores over time within patients undergoing neuroma-in-continuity resection and a comparison with those patients undergoing neurolysis. Compared with preoperative assessment, limb motion scores after neuroma resection were significantly decreased at 6 weeks, not significantly different by 3 months, and significantly improved at 12 months postoperatively. In comparison to patients undergoing neurolysis only, limb motion scores after neuroma resection were not significantly different at 3, 6, and 12 months postoperatively. These findings are unlikely to be accounted for by axonal regeneration across interpositional nerve grafts. Nerve regeneration or recovery in the nongrafted segment of the plexus must be sufficient to reproduce preoperative motion. Resection of the neuromas-in-continuity in obstetrical brachial plexus palsy does not significantly diminish motor activity.
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Peripheral joint mobility was assessed in a group of fifty-one dental students using a modification of the Carter and Wilkinson Index. Mandibular border positions were measured both actively and passively with the aid of a millimetre ruler. The purpose of the investigation was to study possible relationships between generalized joint (hyper-)mobility and (hyper-)mobility of the temporomandibular joints. Only a few weak correlations were found between the mandibular border position measurements (active and passive mouth opening, active and passive, left and right, laterotrusions and active protrusion) and the peripheral joint mobility measurements. Differences between the sexes were illustrated in peripheral joint mobility with females showing a greater joint mobility than males, especially when only the passively measured joints were considered. The mandibular border positions were significantly correlated with each other (P less than 0.05-P less than 0.001) for the males, but few and then only weak relationships between these measurements could be found for the females in this group. The concept of temporomandibular joint 'end-feel' in relation to joint mobility is discussed.
1. Recordings were made of the natural discharges of 388 pallidal neurones in awake, free-to-move monkeys in order to describe the discharge properties of such neurones in relation to normal movement performance. 2. Of the 388 neurones, 156 discharged only in association with one direction of movement of the forelimb about a specific joint. If that movement was not taking place the neurone would not discharge. 3. All joints and directions of movement for the upper limb were represented by clusters of cells within the pallidal population. 4. Twenty-nine per cent of neurones co-varied with movement of both contralateral and ipsilateral limb for the same direction of movement about a given joint; distal movements were represented with similar frequency to proximal movements in this group. 5. Afferent information provided by natural stimulation of peripheral receptors did not directly influence either the discharging or non-discharging pallidal neurones. 6. Movement related neurones were regionally organized and were found in the posterior part of the pallidum.
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Two patients with scleroderma demonstrated intra-articular calcification, which is rarely observed in this disease. The authors suggest that intra-articular calcification and erosion of adjacent cartilage and bone are related.
The radiographic findings in 13 joints successfully reconstructed with free perichondrial grafts from the rib are reported. Radiography was performed during a period of 13 to 40 months postoperatively. Definite cortical demarcation occurred after 8 to 11 months and had increased 11 to 16 months following surgery. In 3 cases the final examination of 2 metacarpophalangeal joints and one proximal interphalangeal joint was completed with arthrography which demonstrated that the articular surfaces appeared even although the cortical bone contours were somewhat irregular. The extent of the joint spaces largely resembled that in healthy controls.
Altogether 105 rheumatic patients, 35 in each of three groups, took part in a double-blind parallel study comparing naproxen (Naprosyn, Syntex) 500 mg suppositories with oxyphenbutazone (Tanderil, Geigy) 250 mg suppositories and placebo in postoperative pain and swelling after joint surgery. Medication was administered twice daily for 3 1/2 days, starting the night before operation. Ketogan (Ketobemidonhydrochloride, 3 dimethylamino-1-diphenylbuten-(1)-hydrochloride) injections and Paralgin Forte (Paracetamol, codein phosphate) tablets were allowed as escape medication. Each day clinical assessments including pain-score, oedema-score and circumference of operated joint were performed and amount of escape medication recorded. A physical test was performed on day seven after operation. No statistically significant difference between groups was observed for most parameters. In general the tendency for all parameters seems to favour naproxen. For pain-score the difference was significant (p = 0.02) in arthrodesis/arthroplasty patients day 1 and for need for Ketogan injections (p less than 0.001) in all patients day 0. Only two side effects were recorded during the study. In the present study no significant difference between the groups could be observed for most parameters measured. The tendency seems to favour naproxen, but a larger number of patients will be needed to investigate whether this observation is of significance.
Joint hypermobility is a clinical entity that has been little studied in Southeast Asia in contrast to the many studies that have been conducted in the West. A pioneer study was conducted in Singapore involving 306 subjects from the three major races i.e. Chinese, Malays and Indians. Their ages ranged from 15 to 39 years. The objective was to ascertain the joint mobility profile in a study sample representative of the Singapore population and the prevalence of joint hypermobility amongst normal individuals. Joint mobility was assessed using criteria according to Carter and Wilkinson modified by Beighton et al. The distribution of the three major races in the study sample was based on the 1990 census of the Singapore population. The prevalence of joint hypermobility was found to be 17%. The results showed that joint mobility decreases with age and that females had consistently higher degree of joint mobility compared to males throughout the age group. Among the racial groups, Malays had the highest degree of joint mobility followed by Indians and Chinese.
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The sensitivity of the Median Nerve Stress Test (Stress Test) described by La Ban et al. and performed hyperextending for one minute the supinated wrist and the distal interphalangeal joint of the index finger and looking for pain in the proximal forearm was evaluated in 140 arms with Carpal Tunnel Syndrome confirmed electrophysiologically. The Stress Test was positive in 60 hands (42.8%), the Phalen's sign in 79 (56.4%) and the Tinel's sign in 59 (42.1%). Hypoaesthesia to pinprick in the distribution of the median nerve was found in 45 hands (32.1%) and weakness or hypotrophia of thenar eminence in 17 (12.1%). In spite of his low sensitivity, in some cases the Stress Test was the only clinical positive sign and, in addition to electrophysiological examination, may be helpful in clinical practice.
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