Movable surface models of hand joints using visible korean / Modelos de superficies móviles de articulaciones de manos utilizando visible Korean

SUMMARY: The human hand can make precise movements utilizing several joints of various articular types. To understand hand movements more accurately, it is essential to view the actual movements of bones and muscles considering the X, Y, and Z axes in the joints. This study aimed to investigate the joint movements in a hand using movable surface models, including these axes. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints. To achieve this aim, 70 surface models were adopted from a Visible Korean model. Using Maya software, 20 virtual joints with X, Y, and Z axes included nine distal and proximal interphalangeal joints, five metacarpophalangeal joints, five carpometacarpal joints, and one wrist joint were created. Bone surface models were elaborately polished to maintain their original shape during movement. Muscle surface models were also processed to display the deformation of the muscle shape during movement. The surface models of the hand joints were moved by virtual control of the joints. We saved 87 movable surface models of the hand, including bones, muscles, and joint axes in stereolithography format, and compiled a Portable Document Format (PDF) file. Using the PDF file, the joint movements in a hand could be observed considering the X, Y, and Z axes alongside the stereoscopic shapes of the bones and muscles. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints.

RESUMEN: La mano humana puede realizar movimientos precisos utilizando varias articulaciones de diferentes tipos articulares. Para comprender los movimientos de las manos con mayor precisión, es esencial ver los movimientos reales de los huesos y los músculos considerando los ejes X, Y y Z de las articulaciones. Este estudio tuvo como objetivo investigar los movimientos articulares en una mano utilizando modelos de superficies móviles, incluidos estos ejes. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina de los movimientos de la mano alrededor de las articulaciones. Para lograr este objetivo, se adoptaron 70 modelos de superficie de un modelo coreano visible. Con el software Maya, se crearon 20 articulaciones virtuales con ejes X, Y y Z que incluyeron nueve articulaciones interfalángicas distales y proximales, cinco articulaciones metacarpofalángicas, cinco articulaciones carpometacarpianas y una articulación de muñeca. Los modelos de superficie ósea se pulieron minuciosamente para mantener su forma original durante el movimiento. También se procesaron modelos de superficie muscular para mostrar la deformación de la forma del músculo durante el movimiento. Los modelos de superficie de las articulaciones de las manos se movieron mediante el control virtual de las articulaciones. Guardamos 87 modelos de superficies móviles de la mano, incluidos huesos, músculos y ejes articulares en formato de estereolitografía, y compilamos un archivo en formato de documento portátil (PDF). Usando el archivo PDF, los movimientos de las articulaciones en una mano se pueden observar considerando los ejes X, Y y Z junto con las formas estereoscópicas de los huesos y músculos. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina sobre los movimientos de la mano alrededor de las articulaciones.

Anastomosis Patterns between the Median and Ulnar Nerves in the Upper Limbs

There are four types of anastomoses between themedian and ulnar nerves in the upper limbs. It consists of crossings of axons that produce changes in the innervation of the upper limbs, mainly in the intrinsic muscles of the hand. The forearm has two anatomical changes ­ Martin-Gruber: branch originating close to the median nerve joining distally to the ulnar nerve; and Marinacci: branch originating close to the ulnar nerve and distally joining the median nerve. The hand also has two types of anastomoses, which are more common, and sometimes considered a normal anatomical pattern ­ Berrettini: Connection between the common digital nerves of the ulnar and median nerves; and Riche-Cannieu: anastomosis between the recurrent branch of the median nerve and the deep branch of the ulnar nerve. Due to these connection patterns, musculoskeletal disorders and neuropathies can be misinterpreted, and nerve injuries during surgery may occur, without the knowledge of these anastomoses. Therefore, knowledge of them is essential for the clinical practice. The purpose of the present review is to provide important information about each type of anastomosis of the median and ulnar nerves in the forearm and hand.

Hallazgos ultrasonográficos en articulaciones de muñecas y manos de pacientes con sospecha clínica de artritis reumatoide en fase temprana / Ultrasonographic findings in wrists and hands of patients with clinical suspicion of early phase rheumatoid arthritis

La Artritis Reumatoide (AR) es una enfermedad crónica y autoinmune cuyo primer año de evolución es considerado por el Colegio Americano de Reumatología como su fase temprana. Con el objetivo de describir los hallazgos ultrasonográficos en las articulaciones de muñecas y manos de pacientes con sospecha clínica de AR en fase temprana referidos de la consulta de Reumatología del Hospital Central Universitario Dr. Antonio María Pineda durante el lapso junio-agosto de 2018, se realizó un estudio descriptivo transversal evaluando 126 articulaciones de 21 pacientes según la escala modificada del OMERACT. Los pacientes se caracterizaron por un promedio de edad de 51,4 ± 11,1 años, siendo el grupo etario más afectado el de 41-50 años y 51-60 años. Hubo un predominio del sexo femenino (85,7%) y una media de inicio de síntomas de 5,2 ± 2,8 meses. Las principales alteraciones encontradas fueron derrame sinovial (54,7%), engrosamiento sinovial (28,5%), tenosinovitis en el grupo extensor (28,5%), erosiones óseas (11,1%) y tenosinovitis en flexores (9,5%). Los hallazgos mostraron mayor afectación de las articulaciones radiocarpianas; 12,7% y 7,9% mostraron hipertrofia sinovial y sinovitis grado I, 15% derrame sinovial grado 1 y 2 y 7,9% erosiones óseas pequeñas. El 8,7% de las II metacarpofalángicas mostraron hipertrofia sinovial grado I, 6,3% sinovitis, 13,4% derrame sinovial y 1,5% erosiones óseas medianas; el 0,79% de las II interfalángicas proximales presentaron derrame sinovial grado 1. Se observó tenosinovitis grado 1 en 25,4% de extensores y 7,9% de flexores. En conclusión, la ultrasonografía es una herramienta complementaria en el diagnóstico y seguimiento de la enfermedad reumatoide en fase temprana por lo que se sugiere fomentar su uso evitando gastos innecesarios y retrasos en el inicio del tratamiento(AU)

Rheumatoid Arthritis (RA) is a chronic and autoimmune disease whose first year of clinical manifestations is considered the early phase of the disease according to the American College of Rheumatology. With the aim of describing the ultrasonographic findings in the wrists and hands of patients with clinical suspicion of early phase RA referred to the Rheumatology Service of the Hospital Central Universitario Dr. Antonio Maria Pineda during the period June-August 2018, a cross-sectional descriptive study was conducted evaluating 126 joints of 21 patients according to the modified scale of the OMERACT. Patients had an average age of 51.4 ± 11.1 years and the most affected age groups was the 41-50 years and 51-60 years. Predominance of female sex (85.71%) as well as an average of 5.2 ± 2.8 months of time of symptoms onset was observed. The main alterations observed were synovial effusion (54.7%), synovial thickening (28.5%), tenosynovitis in extensor tendons (28.5%), bone erosions (11.1%) and tenosynovitis in flexor tendons (9.52%). The radiocarpal joints were the most affected showing grade 1 synovial hypertrophy and synovitis in 12.7% and 7.9% of joints, respectively; grade 1 and 2 synovial effusion was observed in 15% of joints and small bone erosions in 7.9%. For the second metacarpophalangeal joint, grade I synovial hypertrophy was found in 8.7% of joints, synovitis in 6.3%, synovial effusion in 13.4% and medium-sized bone erosions in 1.5%; in 0.79% of the proximal interphalangeal joints grade I synovial effusion was observed. Tenosynovitis grade 1 was observed in 25.4% of extensor tendons and 7.9% flexors. The use of ultrasonography should be encouraged as a complementary tool for the diagnosis of RA, avoiding unnecessary expenses and delay in treatment(AU)

Reconstrução tardia na mão traumatizada com perda de múltiplos dedos / Late reconstruction of a traumatized hand with loss of multiple fingers

As lesões mutilantes de mão são um desafio para o cirurgião de mão e o paciente. O cirurgião deve tomar decisões desde o debridamento inicial, escolhendo quais dedos e articulações serão preservadas e uso apropriado das partes a serem retiradas. A reconstrução tardia é a segunda parte dessa difícil tarefa. Dificuldade que se atribui à particularidade de cada lesão, do grande número de possibilidades de tratamento e seus diversos níveis de complexidade que devem ser adequados à necessidade e motivação pessoal de cada paciente. Este relato de caso apresenta uma reconstrução tardia de mão com perda de indicador e dedo médio com transplante de articulação metacarpofalângica de indicador para função de interfalangeana proximal de dedo médio.

Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger.

Ganglión de la articulación radiocubital distal: un cistadenoma apocrino / Ganglión de la articulación radiocubital distal: un cistadenoma apocrino

El ganglión es la nodulación benigna del tejido blando más frecuente en la mano y el puño. Se origina de la cápsula articular y en las vainas tendinosas. Su presentación más frecuente es en el dorso del pun˜ o, pero puede provenir de cualquier articulación de la mano. Su diagnóstico requiere de la evaluación clínica y el estudio imagenológico. En este reporte se muestra un caso donde el diagnóstico clínico, imagenológico e intraoperatorio fue «ganglión¼ de la articulación radio cubital distal, cuyo estudio histopatológico reportó un cistadenoma apocrino.

The ganglion cyst is the most common type of soft tissue benign mass that occurs in the hand and wrist. Gangliamay result fromany joint capsule or tendon sheath. They most often occur at the dorsum of the wrist, but they may arise from any joint of the hand. Ganglion cysts require a clinical and diagnostic imaging assessment to be diagnosed. In this case, the clinical, imaging tests and macroscopic surgical diagnosis was a "ganglion cyst" of the distal radioulnar joint, however, histopathology led to diagnosis of an apocrine cystadenoma.

A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients / Novo sistema de escore ultrassonográfico (US10) musculoesquelético das articulações das mãos e punho para avaliação de pacientes com artrite reumatoide em fase inicial

ABSTRACT Objective: To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Methods: Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0–1) and semi-quantitatively (grades 0–3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Results: Mean duration of symptoms was 7.58 ± 3.59 months. Significant correlations (p < 0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p < 0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up. Conclusion: The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.

RESUMO Objetivo: Propor um novo sistema de escore ultrassonográfico das articulações da mão e punho (US10) para a avaliação de pacientes com artrite reumatoide (AR) e correlacionar o US10 com variáveis clínicas, laboratoriais e funcionais. Métodos: Foram submetidos 48 pacientes com AR em fase inicial a avaliações clínicas e laboratoriais, bem como a exames cegos de ultrassom (US) no início do estudo e com 3, 6 e 12 meses. O sistema US10 proposto envolveu a avaliação do punho e das articulações metacarpofalângicas e interfalângicas proximais do segundo e terceiro dígitos. O escore consistiu em parâmetros inflamatórios (proliferação sinovial [PS], Power Doppler [PD] e tenossinovite [TN]) e parâmetros de danos articulares (erosão óssea [EO] e danos na cartilagem [DC]). PS, PD, EO e DC foram pontuados qualitativamente (0 a 1) e semiquantitativamente (graus 0 a 3). A tenossinovite foi pontuada como presença/ausência. A avaliação envolveu também o escore 28-Joint Disease Activity (DAS28), o Health Assessment Questionnaire (HAQ) e o nível de proteína C-reativa (PCR). Resultados: A duração média dos sintomas foi de 7,58 ± 3,59 meses. Foram encontradas correlações estatisticamente significativas (p < 0,05) entre os parâmetros de inflamação e a PCR no início do estudo e entre as mudanças nessas variáveis ao longo do estudo. Foram encontradas também correlações significativas (p < 0,05) entre o escore DAS28 e a PD e TN no início do estudo e entre as mudanças no escore DAS28 e PS e TN em todo o seguimento. Além disso, foram encontradas correlações significativas entre as mudanças no escore dos parâmetros de inflamação e no escore HAQ ao longo do seguimento. Conclusão: O sistema de escore US10 proposto provou ser uma ferramenta útil para monitorar a inflamação e o dano articular em pacientes com AR em fase inicial, demonstra correlações significativas com as alterações longitudinais na atividade da doença e no estado funcional.

Giba carpiana, una patología frecuente / Carpal Boss a Frequent Pathology

Carpal boss o giba carpiana es una patología que se ha descrito desde hace más de 200 años; no obstante, a pesar de ser una entidad reconocida por mucho tiempo, su incidencia es desconocida y no se ha podido establecer su etiología. Se han propuesto varias teorías al respecto, como el proceso degenerativo de la articulación carpo-metacarpiana, o periostitis en la inserción del tendón del músculo extensor carpi radialis longus secundaria a trauma repetitivo, entre otros. Clínicamente, el paciente puede ser asintomático y el hallazgo puede resultar incidental; o puede ser sintomático, siendo el dolor el síntoma más común. En el examen físico, el médico puede sentir un abultamiento en la parte dorsal de la mano, que es más común en la mano dominante. Las imágenes ayudan a saber si el abultamiento es una lesión intra- o extra-ósea y, para tal efecto, se pueden utilizar radiografías, tomografía computarizada (TC) y resonancia magnética (RM). El ultrasonido es útil para ayudar en el diagnóstico diferencial. Algunos de los diagnósticos diferenciales tienen origen benigno, como el ganglión o el lipoma, pero también hay tumores y entidades pseudotumorales, como el tumor de células gigantes. El tratamiento puede ser médico o quirúrgico.

Carpal boss is a pathology that has been described for more than 200 years; nevertheless, despite being a condition recognized for a long time, its incidence and etiology are unknown. Several theories have been proposed, including degeneration of the carpometacarpal joint, and periostitis at the insertion of the tendon of extensor carpi radialis longus secondary to repetitive trauma, among others. Clinically, the patient may be asymptomatic and the finding may be incidental; or he/she may be symptomatic, pain being the most common symptom. On physical examination, the doctor may feel a lump on the back of the hand, which is more common in the dominant hand. Images help to clarify whether the lump is an intra- or extra-osseous lesion; for this purpose, radiography, CT and MR imaging can be used. Ultrasound is useful to aid differential diagnosis. Some of the differential diagnoses has benign origin, such as ganglion cyst or lipoma, but there are also tumors and tumor-like entities, such as giant cell tumor. Treatment may be medical or surgical.

Association of Metabolic Factors with Symptomatic Hand Osteoarthritis in the Chinese Han Population Aged 40 Years and above / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The relationship between hand osteoarthritis (HOA) and systemic metabolic factors is unclear. The aim of this study was to investigate the prevalence of systemic metabolic factors including obesity, hypertension, diabetes mellitus, and atherosclerosis in symptomatic patients with HOA and the association between these systemic metabolic factors and symptomatic HOA in the Chinese Han population aged 40 years and above.</p><p><b>METHODS</b>A cross-sectional survey was conducted on Chinese Han population aged 40 years and above in six centers in China. The sociodemographic features, lifestyle of the participants, and medical history of hypertension, diabetes mellitus, and atherosclerosis were collected. The cases with hand symptoms underwent anteroposterior radiographic examination of both hands to obtain a diagnosis. The correlations between systemic metabolic factors and symptomatic HOA were analyzed using Logistic regression analysis.</p><p><b>RESULTS</b>Overweight (39.3% vs. 30.5%, P< 0.001), hypertension (34.7% vs. 18.6%, P< 0.001), diabetes mellitus (11.2% vs. 3.3%, P< 0.001), and atherosclerosis (19.8% vs. 8.3%, P< 0.001) were more prevalent in symptomatic patients with HOA than those in the population without HOA. Overweight (odds ratio [OR] = 1.35, 95% confidence interval [CI]: 1.10-1.65, P = 0.005), hypertension (OR = 1.47, 95% CI: 1.18-1.83, P < 0.001), and diabetes mellitus (OR = 2.45, 95% CI: 1.74-3.45, P< 0.001) were associated with a higher prevalence of symptomatic HOA and the OR of symptomatic HOA significantly increased with the accumulated number of the three metabolic factors. Symptomatic HOA was associated with a higher prevalence of atherosclerosis (OR = 1.39, 95% CI: 1.05-1.85, P = 0.023).</p><p><b>CONCLUSIONS</b>Overweight, hypertension, and diabetes mellitus were associated with a higher prevalence of HOA, showing cumulative effects. Atherosclerosis risk should be assessed in patients with HOA.</p>

Spontaneous renal artery dissection in Ehlers-Danlos syndrome / 영남의대학술지

Primary dissection of the renal artery is rare. Spontaneous renal artery dissection can be associated with diseases such as medial degeneration, neurofibromatosis, syphilitic arteritis, tuberculosis, polyarteritis nodosa, Marfan syndrome, fibromuscular dysplasia, or Ehlers-Danlos syndrome (EDS). Among these causes, EDS related renal artery dissection is very rare worldwide and has not been previously reported in Korea. EDS are a group of heritable connective tissue disorders characterized by fragility of the skin and hypermobility of the joints. We describe the case history of a young man who presented with left side flank pain, hypermobility of the hand joints and showed left renal artery dissection on computed tomography and angiography that turned out to be the first complication of vascular type EDS.

Avaliação da destreza manual em indivíduos com artrite reumatoide / Evaluation of manual dexterity in individuals with rheumatoid arthritis

Objetivo: Analisar a destreza manual de pacientes com AR em função do nível de atividade da doença. Métodos: Foram avaliados 23 indivíduos com AR, com média de idade de 54,78 ± 12,54 anos. Todos os participantes foram submetidos a uma entrevista para coleta dos dados de identificação e história clínica, coleta de sangue para análise da Proteína C-Reativa, determinação do nível de atividade da doença por meio do Disease Activity Score (DAS-28) e avaliação da destreza manual pelo Moberg Picking-Up Test (MPUT). Para descartar problemas de sensibilidade tátil dos indivíduos, foi aplicado o teste de sensibilidade dos monofilamentos de Semmes-Weinstein. Resultados: Foi observado que o grupo classificado em moderada atividade da doença apresentou maior tempo para execução do MPUT com olhos abertos na mão dominante, quando comparado ao grupo em baixa atividade. O grupo em alta atividade da doença também demorou mais para realizar o MPUT com os olhos fechados na mão dominante, em comparação ao grupo em baixa atividade. Adicionalmente, houve uma correlação positiva entre o DAS-28 e o tempo de realização do MPUT com os olhos fechados na mão dominante. Conclusão: A destreza manual de indivíduos com AR pode estar prejudicada em função do nível de atividade da doença, repercutindo na dificuldade para a realização das atividades de vida diária. Estes dados podem contribuir para a determinação de estratégias de tratamento visando a melhoria da qualidade de vida de pacientes com AR

Objective: To analyze the manual dexterity of patients with RA based on the level of disease activity. Methods: The study evaluated twenty-three individuals with RA, of both sexes, aged 54.78 (± 12.54) years. All participants underwent an interview for data collection for identification and medical history, blood collection for dosage of C-reactive protein (CRP), determination of disease activity level through the Disease Activity Score-28 (DAS-28), and evaluation of manual dexterity with the Moberg Pickup Test (MPUT). The Semmes-Weinstein Monofilaments were applied to discard any problems of tactile sensitivity. Results: It was observed that the group ranked as having moderate disease activity took longer to perform the MPUT with the dominant hand and open eyes, in comparison with the group ranked as having low disease activity. The group ranked as having high disease activity also took longer to perform the MPUT with the dominant hand and closed eyes, in comparison with the group ranked as having low disease activity. In addition, there was a positive correlation between the DAS-28 and the time to perform the MPUT with the dominant hand and closed eyes. Conclusion: Manual dexterity can be impaired by the level of disease activity in individuals with RA, generating difficulties in performing activities of daily living. These results can contribute to identifying better treatment strategies in order to improve the quality of life of these patients

Rhupus syndrome

No abstract available.

[Subclinical Involvement of hands and feet joints in psoriasis patients: ultrasonography and magnetic resonance imaging study]

Objective: To evaluate musculoskeletal ultrasound [MSUS] in the detection of subclinical hands and feet joint involvement in psoriasis patients by comparison with magnetic resonance imaging [MRI]

Methods: Thirty Patients with plaque psoriasis with no clinical or radiological signs of arthritis attending outpatient dermatology clinic of Assiut University Hospitals were enrolled in the study. All patients underwent clinical examination [including dermatological and rheumatological examination], MSUS, RI, X-ray evaluation of the hands and feet joints

Results: Both MSUS and MRI were sensitive in detecting subclinical joint inflammation [synovitis], and bone abnormalities in psoriatic patients with normal conventional radiographs. Of the total examined is [2520], synovitis was detected by MSUS in 23.69%, erosions in 9.04%, and bone proliferation in 22.14%. MRI detected synovitis in 15.83%, erosions in 0.75%, and bone marrow edema in 1.35%. A significant correlation was found between the subclinical psoriatic arthritis detected by MSUS with the presence of nail psoriasis

Conclusion: Both MSUS and MRI were sensitive in detecting significant prevalence of subclinical involvement in hands and feet joints of psoriasis patients, this suggests that PsA could be a much more common disorder than was previously suspected. When comparing MSUS with MRI, MSUS identified more synovitis and erosions, and osteoproliferation was only detected by MSUS, whereas bone marrow edema was detected only by MRI

Aspects radiologiques de la polyarthrite rhumatoide au Bénin

Objectif :préciser les caractéristiques radiologiques des poignets et des mains dans la polyarthrite rhumatoïde au Centre National Hospitalo-Universitaire de Cotonou. Patients et méthode :Etude rétrospective à visée descriptive portant sur des dossiers médicaux de patients hospitalisés dans le service de rhumatologie du CNHU de Cotonou et présentant une polyarthrite rhumatoïde sur la base des critères de l'ACR 1987 entre janvier 1997 et Décembre 2011. Nous avons analysé les lésions radiologiques des poignets et des mains à l'aide du score de Larsen. Résultats :Sur 6450 patients hospitalisés dans la période, 53 présentaient une PR, soit 0.8%. La sex-ratio était de 0,38. L'âge moyen des patients était 42,39±8,3 [14-71] ans. 70,6% des patients présentaient des déformations caractéristiques de la PR et plus de la moitié des patients avait un score de Larsen supérieur à 40. Conclusion :Les lésions radiologiques de la PR font la gravité de la maladie. L'absence de traitement bloquant la progression radiologique de cette maladie en Afrique, pose un réel problème éthique. Il conviendra donc de faire un plaidoyer auprès des décideurs politico-administratifs pour rendre disponible la biothérapie

A Case of Pachydermodactyly

Pachydermodactyly is a form of digital dermal fibromatosis of unknown etiology, characterized by asymptomatic soft tissue swelling on the lateral aspects of the proximal interphalangeal joints of the hands. It usually affects young men and often associated with repetitive mechanical trauma. As a rule, it is a benign condition and a specific therapy or extensive investigation is not necessary in most cases. However, pachydermodactyly is not well recognized by physician. So it can be confused with other rheumatic conditions, such as rheumatoid arthritis or juvenile idiopathic arthritis. A prompt diagnosis is crucial for preventing inappropriate or possible toxic treatment. We describe a case of pachydermodactyly in a 20-year-old military man, who had painless swellings of the hand joints.

Observation on the efficacy of acupuncture and fire needle therapy for hand osteoarthritis / 中国针灸

<p><b>OBJECTIVE</b>To verify the clinical efficacy of shu-stream point acupuncture combined with fire needle therapy in the treatment of hand osteoarthritis.</p><p><b>METHODS</b>Eighty cases were randomized into an acupuncture group (shu-stream point acupuncture combined with fire needle therapy) and a medication group(votalin emulgel). For the 42 cases in the acupuncture group, acupuncture at shu-stream points on the three yang meridians of the hand including Sanjian (LI 3), Zhongzhu (TE 3), Houxi (SI 3) and fire needle at Ashi points were applied, the treatments were given once every other day, 15 times as a treatment course. For the 38 cases in the medication group, votalin emulgel was prescribed for local embrocation, twice a day, 30 days as a treatment course. The visual analogue scale (VAS) of arthralgia, joint function score and the duration of morning stiffness, joint tenderness, swelling were observed before and after treatment in both groups.</p><p><b>RESULTS</b>After two courses of clinical treatment, the VAS score of arthralgia, joint function score and the duration of morning stiffness, joint tenderness, swelling were statistically significant differences as compared with before treatment (all P < 0.01 ), the efficacy in the acupuncture group was superior to that in the medication group (all P < 0.01 ). The cured-markedly effective rate and total effective rate were 61.9% (26/42) and 95.2% (40/42) in the acupuncture group, and 36.8% (14/38) and 76.3% (29/38) in the medication group respectively, with statistically significant differences between the two groups (both P < 0.05).</p><p><b>CONCLUSION</b>Shu-stream point acupuncture combined with fire needle therapy achieves a significant efficacy in the treatment of hand osteoarthritis.</p>

Análise da confiabilidade e reprodutibilidade da goniometria em relação à fotogrametria na mão / Analysis of the reliability and reproducibility goniometry photogrammetry regarding the hand

OBJETIVO: Avaliar a confiabilidade intra e interexaminadores e a reprodutibilidade da goniometria em relação à fotogrametria na mão, comparando os ângulos da abdução de polegar, flexão da AIFP do II dedo e flexão da AMCF do V dedo. MÉTODOS: PARTIciparam deste estudo 30voluntários foram divididos em 3 grupos, um grupo de 10 estudantes de Fisioterapia, outro por 10 fisioterapeutas e o terceiro com 10 terapeutas da mão. Cada avaliador realizou as medidas no mesmo molde de mão, utilizando o goniômetro e em seguidadois softwares de fotogrametria, o CorelDraw® e o ALCimagem®. RESULTADOS: Os resultados revelaram que os grupos e os métodos propostos apresentam confiabilidade interexaminadores no geral classificada como excelente (ICC 0,998 I.C. 95% 0,995 - 0,999). Na avaliação intraexaminadores, foi encontrado excelente nível de confiabilidade entre os três grupos. Na comparação entre os grupos para cada ângulo e cada método, observou-se que não houve diferença significativa entre os grupos para a maioria das medidas. CONCLUSÃO: A goniometria e a fotogrametria são métodos confiáveis e reprodutíveis para avaliação de medidas na mão. Porém, pela escassez de referências semelhantes, necessita-se de estudos aprofundados para definição de parâmetros de normalidade entre os métodos nas articulações da mão. Nível de Evidência II, Estudo Diagnóstico.

OBJECTIVE: To evaluate the intra and inter and reproducibility of goniometry compared to photogrammetryin hand, comparing the angles of abduction of thumb flexion, flexion of proximal interphalangeal joint of the index finger and flexion of the metacarpophalangeal joint of the fifth finger. METHODS: The study included 30 volunteers were divided in to three groups, one group of 10 students of physiotherapy for 10 physiotherapist sand other third with 10 therapist shand. Each examiner performed the measure mentsin the same mold by hand, using the goniometer and then two photogrammetry software, Corel Draw® and ALCimagem®. RESULTS: The results revealed that the groups and the methods proposed inter examiner reliability have generally rated as excellent (ICC 0.99895% CI0.995 to 0.999) In assessing rater was found excellent level of reliability among the three groups. Incomparison between groups for each angle and each method, we found that there was no significant difference between groups for most measures. CONCLUSION: Goniometry and photogramme tryare reliable and reproducible methods to evaluate measures in hand. However, the scarcity of similar references, it requires detailed studies to define normal parameters of the methods in the joints of the hand. Level of Evidence II, Diagnostic Study.

Proportions of hand segments / Proporciones de los segmentos de la mano

The analysis of proportions of hand segments has been carried out on the basis of X-ray films of 66 adult patients without developmental abnormalities. There were hand joint topographies determined proceeding from the data obtained. There were suggested methods of practical utilization of the obtained data in the field of medicine.

Se analizaron en radiografías de 66 pacientes sin anomalías del desarrollo las proporciones de los diferentes segmentos de la mano. De acuerdo a los datos obtenidos se determinó una topografía de las articulaciones. Se proponen modos de empleo en la medicina de los datos obtenidos en este estudio.

Instrumentos de avaliação funcional da mão em pacientes com artrite reumatóide / Hard functional assessment in patients with rheumatoid arthritis

Introdução: O uso das mãos está presente em um grande número de atividades realizadas pelo homem, inclusive nas atividades básicas da vida diária. Na artrite reumatóide (AR), mais de 90 por cento dos pacientes têm as articulações das mãos acometidas. Nesse contexto, a avaliação funcional precoce da mão é de fundamental importância para fornecer dados que auxiliem na decisão de uma estratégia terapêutica e na avaliação da eficácia de um tratamento realizado. Objetivos: Os objetivos deste estudo foram identificar e descrever os instrumetnos de avaliação funcional da mão utilizados em pacientes com AR. Metodologia: Foi Feito um levantamento bibliográfico nos idiomas inglês e português, nas bases de dados Lilacs, Medline, Pubmed e Cochrane, no período entre 1990 e 2007. Resultados: Foram encontrados 33 trabalhos que descreviam, citavam ou utilizavam os instrumentos de avaliação funcional de mão. Conclusão: Embora vários instrumentos tenham sido propostos, não encontramos, na literatura pesquisada, um método considerado padrão ouro para avaliação funcional da mão em pacientes com AR.

Erosive Arthropathy with Osteolysis As a Typical Feature in Polyfibromatosis Syndrome: A Case Report and a Review of the Literature

Polyfibromatosis syndrome is a rare disease entity that is characterized by various clinical features such as palmar, plantar, and penile fibromatoses, keloid formations of the skin, and erosive arthropathy. Its precise pathophysiology or etiology remains unclear. In addition to distinctive diverse skin manifestations, patients with polyfibromatosis have been previously reported to show erosive arthropathy with significant limitation of movement at affected joints. However, the presence of erosive polyarthropathy in polyfibromatosis has not emphasized in previous cases. Here, we report a case of polyfibromatosis syndrome combined with painless massive structural destruction of hand and foot joints, and review the characteristics of erosive arthropathy in previous cases.