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PubMedDate not supplied

Compression arthrodesis of finger joints.

Compression arthrodesis is useful for treatment of finger and thumb joints in arthrosis, scleroderma, hypermobile joints, paralytic deformities, and rheumatoid arthritis. A dorsal incision exposes the joint. Its surfaces are prepared in a ball-and-socket arrangement using a high-speed burr. A longitudinal pin 1.1 mm in diameter is passed distally and then retrograde to determine the angle of fusion and to prevent migration of bone ends as the longitudinal compression is applied. Transverse pins 1.5 mm in diameter are put in one-third of the distance from the joint. A Charnley clamp, as modified by Micks and Hager, is applied and tightened. At 6 weeks, the arthrodesis is checked for solidity and, if stable, X-rays are examined for new bone. When solid, the joints should be protected by external splinting for an additional 2 weeks to be sure that the fusion is complete. Compression arthrodesis was obtained in 49 of 54 joints. Solid fusion was usually attained within 6 weeks, without loss of mobility of other joints.

Adolescent↗
PubMed2001

Imaging of finger joints in a whole-body MR system using a simple and low-cost solenoidal coil.

This work considers the design and operation of a solenoid radiofrequency (RF) coil for magnetic resonance (MR) mini-imaging of finger joints using a whole-body system. The considerations were focused on the requirements of high sensitivity, easy patient access, and cost-effectiveness. The proposed design is a short, two-turn solenoidal coil that accomplishes high spatial uniformity over a 2-cm region of interest (ROI). The coil resembles an oversized ring, and easily fits fingers that are spread. An experimental demonstration of the proposed approach is given by imaging the proximal interphalangeal joint in healthy volunteers using a 2.5-cm field of view (FOV). Spin-echo and gradient-recalled-echo T1-weighted sequences, and a 3D spoiled-gradient-echo sequence were used.

Cost-Benefit Analysis↗
PubMed1994

Low level laser therapy is ineffective in the management of rheumatoid arthritic finger joints.

Low level laser therapy (LLLT) is a relatively new and increasingly popular form of electrotherapy. It is used by physiotherapists in the treatment of a wide variety of conditions including RA despite the lack of scientific evidence to support its efficacy. A randomized, double-blind and placebo-controlled study was conducted to evaluate the efficacy of LLLT. The patient sample consisted of chronic RA patients with active finger joint synovitis. Forty RA patients with involvement of some or all of MCP or PIP joints were recruited. Following random allocation they received either active or placebo laser three times a week for 4 weeks. Measurements were taken prior to entry, after the treatment, 1 month and 3 months at follow-up. The groups were well matched in terms of age, sex, disease duration and severity. Few significant differences were noted in grip strength, duration of morning stiffness, joint tenderness, temperature of inflamed joints, range of movement or pain either within or between groups. Using these irradiation parameters the efficacy of LLLT is ineffective.

Adult↗
PubMed2004

Chronic finger joint instability reconstructed with bone-ligament-bone graft from the iliac crest.

Five patients with chronic instability of digital joints presented with instability and functional disability. Two patients had ulnar collateral ligament damage of the thumb metacarpophalangeal joint and another had chronic multidirectional instability due to radial collateral ligament, dorsal capsule and palmar plate laxity of the metacarpophalangeal joint of the thumb. The fourth patient had a lax radial collateral ligament and palmar plate of the proximal interphalangeal joint of the little finger and the fifth had chronic laxity of the ulnar collateral ligament of the interphalangeal joint of the thumb. All were reconstructed with bone-ligament-bone graft harvested from the iliac crest. The graft was fixed with screws and joint stability was achieved intra-operatively in all patients. All patients achieved a stable joint with improved functional performance at final follow-up.

Adult↗
PubMed1980

Resultant finger joint loads in selected activities.

The intersegmental loads transmitted by the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the index finger are presented in activities involving application of a twisting moment by the hand. Twenty normal subjects, ten males and ten females were included in the studies. A six component load transducer was incorporated in each of the two fixtures representing a water tap and a jar cap 70mm in diameter and the maximal loading on the fingers was monitered in applying an isometric twisting moment to these structures. Two different hand configurations were studied for each activity: the spatial position and orientation of the finger segments were determined using two orthogonally positioned still cameras, and specially designed stick markers were utilized to highlight anatomical landmarks. The results confirm the use of the finger in a complex three-dimensional manner with no significant differences between the male and female subjects. Forces recorded in the jar cap activity were larger than those applied in the tap activity, the maximum being around 100 N and in general the abduction/adduction moments developed at both joints were of comparable magnitude to flexion/extension. Torques as high as 0.6 Nm and 1.0 Nm were calculated at the PIP and MCP joints respectively.

Adult↗
PubMed2002

Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints.

OBJECTIVE: To carry out a prospective two year follow up study comparing conventional radiography, three-phase bone scintigraphy, ultrasonography (US), and three dimensional (3D) magnetic resonance imaging (MRI) with precontrast and dynamic postcontrast examination in detecting early arthritis. The aim of the follow up study was to monitor the course of erosions during treatment with disease modifying antirheumatic drugs by different modalities and to determine whether the radiographically occult changes like erosive bone lesions of the finger joints detected by MRI and US in the initial study would show up on conventional radiographs two years later. Additionally, to study the course of soft tissue lesions depicted in the initial study in comparison with the clinical findings. METHODS: The metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints (14 joints) of the clinically more severely affected hand (soft tissue swelling and joint tenderness) as determined in the initial study of 49 patients with various forms of arthritis were examined twice. The patients had initially been divided into two groups. The follow up group I included 28 subjects (392 joints) without radiographic signs of destructive arthritis (Larsen grades 0-1) of the investigated hand and wrist, and group II (control group) included 21 patients (294 joints) with radiographs showing erosions (Larsen grade 2) of the investigated hand or wrist, or both, at the initial examination. RESULTS: (1) Radiography at the two year follow up detected only two erosions (two patients) in group I and 10 (nine patients) additional erosions in group II. Initial MRI had already detected both erosions in group I and seven (seven patients) of the 10 erosions in group II. Initial US had depicted one erosion in group I and four of the 10 erosions in group II. (2) In contrast with conventional radiography, 3D MRI and US demonstrated an increase in erosions in comparison with the initial investigation. (3) The abnormal findings detected by scintigraphy were decreased at the two year follow up. (4) Both groups showed a marked clinical improvement of synovitis and tenosynovitis, as also shown by MRI and US. (5) There was a striking discrepancy between the decrease in the soft tissue lesions as demonstrated by clinical findings, MRI, and US, and the significant increase in erosive bone lesions, which were primarily evident at MRI and US. CONCLUSIONS: Despite clinical improvement and a regression of inflammatory soft tissue lesions, erosive bone lesions were increased at the two year follow up, which were more pronounced with 3D MRI and less pronounced with US. The results of our study suggest that owing to the inadequate depiction of erosions and soft tissue lesions, conventional radiography alone has limitations in the intermediate term follow up of treatment. US has a high sensitivity for depicting inflammatory soft tissue lesions, but dynamic 3D MRI is more sensitive in differentiating minute erosions.

Adult↗