Hand disorders in the course of systemic and chronic diseases: a review.

Systemic and chronic diseases frequently affect function of many organs and systems, not only those from which they derive. The hand is a very complicated structure in the human body and its normal activity is related to undisturbed function of many factors. Therefore, the hand is frequently exposed to harmful effects of systemic diseases. The article reports on disorders and functional disturbances of the hand that, more frequently than in an average population, accompany selected systemic diseases: rheumatoid arthritis, gout, and scleroderma. Hand diseases related to diabetes are a subject of a separate paper. This study reviews typical disorders involving hand structures: joints, tendons and nerves. Their prevention and management is described.

Outcomes, treatment effectiveness, efficacy, and evidence-based practice: examples from the world of splinting.

Calls for outcome studies and evidence-based practice leave many therapists bewildered as to the meaning of various types of terminology. The objectives of this paper are to 1) review the structure of outcome reports and research; 2) describe the background and discuss the terms "treatment efficacy, "effectiveness," and "evidence-based practice"; 3) discuss these concepts as they apply to selected studies found in the literature that report the use of splints for patients with ailments that affect the use of their hands; and 4) provide some reflections that place these terms in the context of scientific inquiry and clinical practice. It is concluded that health care is being reviewed on an increasingly more systematic and grand scale. While studies that include large numbers of subjects are needed to substantiate the effectiveness of splinting, studies involving smaller numbers of subjects can contribute greatly as well, so long as they are performed with the highest level of study design and use standardized outcome measures that are valid for answering the designated research questions.

Plaster of Paris: the forgotten hand splinting material.

This article examines the concept of tissue adaptation in response to the application of plaster of Paris splints and casts. A review of the history of plaster of Paris and its composition, its working properties, and precautions for its use introduces the reader to this oft-forgotten material. Four designs are described for plaster of Paris application-circumferential padded casts, digital unpadded casts, plaster slabs, and contour molds. The discussion of clinical application of plaster of Paris covers joint tightness, arthritis, contracted joints due to spasticity, muscle-tendon tightness, skin tightness, skin and joint tightness, and edema reduction. In addition, a new application called casting motion to mobilize stiffness (CMMS), developed by the author, is discussed. The use of plaster of Paris to improve postoperative flexor tendon glide is also discussed. This review article intends to stimulate the reader to use plaster of Paris splinting or casting more frequently to solve clinical problems.

A medieval casebook: hand cures documented in the Icelandic Sagas of bishops.

The Sagas of Icelandic bishops composed in and around the 13th century reveal something of the incidence and treatment of various hand conditions in the medieval period. A selection from the relevant material is translated and discussed.

An 11-year-old boy with swelling and progressive deformity of his finger.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first two pages. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

[Treatment of radial club hand with double articulated external fixators]. / Tratamiento de la mano zamba radial mediante doble montaje articulado con fijadores externos.

Congenital absence of the radius is a rare malformation, characterized by radial deviation of the hand to more than 90 degrees. Early treatment with plaster cast use to be enough to correct radial deviation, making easier surgical correction on several years later. We report a case of a newborn with radial club hand absence of the thumb of the right hand, bilateral hydronephrosis and bilateral cryptorchidism. Was treated with a new procedure, permitting wrist centralization, coupled with osteotomy and callostasis of the ulnar diaphysis using external fixation. We obtained an important success with this serial lengthening of the ulna.

Management of simple camptodactyly.

From a review of 57 patients with flexion deformity of the fingers (camptodactyly), 21 patients with 38 digits treated operatively had 18% good or excellent results, whereas 14 patients (41 digits) treated conservatively had 66% good or excellent results. Mild deformities responded well to splints and stretching. Moderate deformities treated operatively gained extension but at the loss of finger flexion. Severe deformities had improvement in extension (averaging 19 degrees in operative cases and 27 degrees in conservative), but there was significant loss of flexion in the operative group. Overall, 16 of 21 patients had loss of flexion after operative treatment. Conservative treatment of camptodactyly is recommended for digits with less than 60 degrees lack of extension. Operative treatment should be reserved for failed conservative treatment. Early joint motion post-operatively appears essential and surgical procedures that immobilize the P.I.P. joints should be avoided.

[Role of orthosis in the treatment of stiffness of the hand]. / Le rôle de l'orthèse dans le traitement des raideurs de la main.

The statistical analysis of results obtained with splinting treatment of finger and hand stiffness, and derived from a series of 635 motion range measurements taken on 249 hand joints, provided us with sufficient data to identify the various factors likely to have an impact on the therapeutic outcome. A mean increase of 25.8% in the range of movements is enough to justify the use of orthosis, although this figure actually varies substantially with the patient's age, the duration of the stiffness, the latter's degree and origin, the joint involved, and the duration of the orthotic treatment. An analysis of the time factor enabled us to establish the date beyond which changes for recovery are quite limited, whereby allowing to schedule surgical mobilization.