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The typical hand deformity of Parkinsonism consists of metacarpophalangeal joint flexion and interphalangeal joint extension. An unusual case of a claw hand deformity in a patient with Parkinson's disease is described with hyperextension in the metacarpophalangeal joints and flexion in the interphalangeal joints. The operative technique to improve the marked limitation in hand function is described.
12 hands with congenital short finger in 11 patients were treated with various types of metacarpal bone lengthening. These included three patients with brachydactyly, seven with transverse deficiency, and one with constriction ring syndrome. All cases involved metacarpal lengthening and surgery was performed 16 times in 15 digits. Single-stage lengthening was performed in seven cases, on-top plasty in three cases, and distraction lengthening in six cases. The length gained ranged from 2 to 10 mm in single-stage lengthening, 3 to 17 mm in on-top plasty, and 12 to 30 mm in distraction lengthening. Delayed union and malunion occurred in single-stage lengthening or on-top plasty. After metacarpal lengthening, pinch function was improved in seven out of eight patients with either transverse deficiency or constriction band syndrome, and aesthetic improvement was achieved in three patients with brachydactyly.
The claw hand deformity, resulting from low ulnar or combined low ulnar and median nerve palsy, is an incapacitating situation. The splint described herein reverses the clawing by substituting for the lumbricals and interossei. If started early, it not only prevents the permanent stiffness of fingers in the claw position, but also effectively restores function without hampering day to day work because it is a surface splint.
Hand deformities cause severe discomfort and functional limitations to patients with Parkinson disease (PD) and related disorders. In clinical practice the problem is often overlooked or misdiagnosed. This paper reports on four cases whose characteristics are discussed.
We report the prevalence of sensory loss and hand deformity in 63 patients with Hansen's disease in American Samoa. Open ulceration, the most common deformity, was present in 41% of patients; sensory abnormalities were present in 54% and were bilateral in 65%. The presence of abnormal sensibility correlated with a high percentage of other deformities. Hand abnormalities were most prevalent in lepromatous patients and were related to a prolonged duration of disease. Nerve thickening did not appear to be a helpful clinical finding to assess the degree of sensory loss.
Eighteen adult patients with spastic hand deformities underwent release of the flexor-pronator origin and step-cut lengthening of the flexor pollicis longus to improve prehensile hand function. The goal of surgery was to provide active grasp release in order to improve hand function. Using a previously published grading scale, patients were graded before and after operation. At follow-up after an average of 35 months (range 24-64 months), all had improved by at least two functional levels.
A 23-year-old woman from Honduras was diagnosed to have hepatoerythropoietic porphyria. She had photosensitive skin of early onset, hypertrichosis, and severe scleroderma-like lesions of the hands. Erythrocyte uroporphyrinogen decarboxylase activity was reduced to about 10% of the normal activity.
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Palmar and finger prints are recovered in children with congenital malformed hands. The skin ridges of various hand abnormalities are compared with normal dermatoglyphics. We have found a relationship between the embryogenesis of the hand and the epidermal ridge arrangement. Dermatoglyphics are a clinically useful information for the diagnosis of amniotic disease or agenesis and for the chronology of the congenital malformation of limbs.
In a prospective study of 125 patients with SLE, three females developed fixed hand deformities. All had arthritis for more than 10 years, and had been treated with a mean daily dose of 15 mg of prednisone. The hand deformities consisted of irreducible metacarpophalangeal (MCP) subluxation and/or dislocation without erosion or destruction of the MCP joints, resulting in hyperflexion of the fingers in the palm. Two patients had dislocation of the carpometacarpal joints in both hands. On patient developed reducible swan-neck deformities in the second to fifth fingers of both hands and a second patient developed Boutonniere deformities in two fingers of one hand and clinodactyly of both fifth fingers. Because the deformity at the MCP joints resulted from soft tissue contractures in the intrinsics and long flexors, and because the cartilage of the MCP joint was preserved, a joint replacement was not considered. Metacarpal osteotomy and shortening was performed to decompress the contracted soft tissues. At follow-up (18-96 months), the hands remained corrected and all patients were able to perform normal activities.
The Freeman-Sheldon-Syndrome is a rare complex of malformations with typical deformities of face, hands and feet. The individual variability of the characteristics seems to be very big, as could see in our own patients (9 cases) as well as in literature (43 cases). The most frequent and most important characteristics are discussed, mainly the deformity of the hand. Six hands have been operated on for functional improvement; different methods were used. The primary objective of our treatment was the correction of thumb deformity.
The recessive form of dystrophic epidermolysis bullosa creates severe hand deformities with disabling functional limitations in the main daily activities. Typically, the thumb is contracted in adduction, the first web space is obliterated, the palm and digits are contracted in flexion and interdigital spaces are lost (pseudo-syndactyly). In this paper, we present our experience with a protocol based on the association of various internationally developed techniques: brachial plexus anesthesia with ketamine sedation, dynamic splinting and coverage of the wounds with allogenic keratinocytes sheets. The overall results obtained in the first 13 patients showed a good tolerance of the procedure, no anesthesiologic complication and marked improvement of the hand deformities. The long-term follow-up revealed a recurrence before 2 years in 2 hands, between 2 and 4 years in 7 hands and after 4 years in 6 hands. The conclusion is that an aggressive surgical attitude, along with an adequate intra and post-operative rehabilitation, ensures a good restoration of hand function and a satisfying delay of inevitable recurrence.
Over the past 25 years, 83 patients have been treated at our hospitals for poisonous snakebites of the hand. Prior to 1970, polyvalent antivenin was used, either alone or in conjunction with cryotherapy, steroids, or incision and suction methods. Hand deformities, due to tissue necrosis, were encountered in 15 of 22 patients (68%) treated by these methods. In contrast, excisional therapy, without the use of polyvalent antivenin, was the sole method of treatment in 61 patients seen since 1970. The incidence of hand deformity in them was 8.2%. We have concluded that early excision of the envenomated tissues will not only curtail systemic toxicity from the injected venom, but will also minimize the extent of local tissue damage.
The author's experience shows that in a number of patients with deformities of the hand following burns alloplasty can provide a considerable improvement, and even sometimes a complete recovery of functions including damages of nerve trunks, with disturbed innervation of muscles and sensitivity of the hand. He believes that the alloplasty should be performed under the restored normal skin and be often combined with other restorative-reconstructive surgery.
Scarring in recessive epidermolysis bullosa results in disability through hand deformities. Surgical treatment is complicated by technical and anaesthesiological problems due to the fragility of the skin and mucosa. In its dystrophic form epidermolysis bullosa leads to pseudosyndactyly and finger and palm contracture resulting in a "closed hand". Surgical treatment consists of resecting the contractures and opening the inter-digit webs, the uncovered areas healing under a close tulle gras dressing. Our technique differs from techniques which have already been reported. The dressing is changed only once a week, reducing the number of anaesthetics and allowing the child to attend our Day Hospital. Healing is complete within five weeks. Prevention of recurrence avoids the necessity of further surgery before five years of age. Post-operative open-hand splinting is well tolerated, delaying further contracture. Surgery is undertaken sometimes under general anaesthesia but more often under regional anaesthesia. We report the results of our experience.
Jaccoud's arthropathy is a syndrome of chronic progressive painless deformity of the hands and feet with surprisingly well preserved functions. The arthropathy has been known to develop subsequently to episodes of rheumatic fever. a patient is presented in this report with a clinical and radiologic finding indistinguishable from that of the Jaccound's arthropathy. However, the only associated illness is chronic lung disease.
The prevention of contractures of the burned hand is an arduous problem in the young pediatric burn patient. Difficulty in applying splints, along with the time-consuming fabrication of complex splints, led to the development of the "sandwich" splint. This easily produced splint provides a means of preventing and treating hand deformities in this patient age group. Positive results have been noted with the use of this splint in conjunction with the patient's usual active physical therapy program.