RESUMEN
OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
Asunto(s)
Artritis Psoriásica , Articulaciones de los Dedos , Índice de Severidad de la Enfermedad , Ultrasonografía , Humanos , Artritis Psoriásica/diagnóstico por imagen , Reproducibilidad de los Resultados , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Ultrasonografía/métodos , Masculino , Femenino , Técnica Delphi , Sinovitis/diagnóstico por imagen , Sinovitis/patología , Persona de Mediana Edad , Variaciones Dependientes del Observador , Entesopatía/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Cadáver , Estudios de Factibilidad , Adulto , Anciano , Dedos/diagnóstico por imagen , Dedos/patologíaRESUMEN
The incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex.
Asunto(s)
Tuberculosis Osteoarticular , Humanos , Masculino , Adulto , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/tratamiento farmacológico , Antituberculosos/uso terapéutico , Antituberculosos/administración & dosificación , Diagnóstico Diferencial , Mano , Articulaciones de los Dedos/patologíaRESUMEN
Dupuytren disease is a common benign fibromatosis of the palmar and finger fascia caused by pathological cord formation. As both the retrovascular and lateral cords are jointly responsible for the flexion contracture of the distal interphalangeal (DIP) joint, isolated DIP joint contracture caused by Dupuytren disease is rare. We present a 34-year-old right-hand-dominant male patient with a 6-month history of an isolated DIP joint flexion contracture in the right ring finger due to Dupuytren disease. Surgical fasciotomy of the retrovascular cord improved the contracture without adverse events. It is important to pay attention to the anatomical relationships between the pathological cord and neurovascular bundle to avoid neurovascular injury during fasciotomy in patients with Dupuytren disease, especially in isolated DIP joint contracture cases. Level of Evidence: Level V (Therapeutic).
Asunto(s)
Contractura de Dupuytren , Humanos , Masculino , Adulto , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/cirugía , Articulaciones de los Dedos/cirugía , Articulaciones de los Dedos/patología , Dedos/cirugía , Dedos/patología , Mano , FasciaRESUMEN
Camptodactyly is a relatively rare hand deformity presenting as the proximal interphalangeal joint's nontraumatic and progressive flexion contracture. Most cases are limited to the fifth finger. The severity and type of camptodactyly should be considered to optimize treatment. Since many structures at the finger base can be involved in the pathogenesis of the deformity, surgical treatment for this particular type of deformity is challenging. This paper aims to bring insight into camptodactyly's pathogenesis and treatment options. We discuss the indication and pitfalls of surgical treatment options for particular camptodactyly types and present a case of a fourteen-year-old boy who was admitted to our department with proximal interphalangeal joint flexion contracture of the left fifth digit.
Asunto(s)
Contractura , Deformidades Congénitas de la Mano , Masculino , Humanos , Adolescente , Articulaciones de los Dedos/patología , Articulaciones de los Dedos/cirugía , Contractura/etiología , Contractura/cirugía , Deformidades Congénitas de la Mano/cirugía , Dedos/cirugíaRESUMEN
OBJECTIVES: To investigate the appropriate timing, useful findings and combination of magnetic resonance imaging (MRI) and ultrasound (US) for predicting the radiographic progression in early rheumatoid arthritis (RA). METHODS: Forty-four active RA patients, who examined by both of MRI and US in the symptomatic wrist and finger joints, were recruited in Nagasaki University Hospital from 2010 to 2017 and treated by the treat-to-target therapeutic strategy for 1 year. MRI was evaluated by RA MRI scoring and US by Outcomes Measures in Rheumatology Clinical Trial, respectively. Plain radiographs were assessed by the Genant-modified Sharp score for the symptomatic side in the same manner as MRI and US. Radiographic progression was defined as an annual increase ≥0.75 at 1 year. Factors associated with radiographic progression were analysed. Also, the optimal combination of MRI and US at each timepoint was considered. RESULTS: Logistic regression model revealed that MRI-proven bone marrow oedema at baseline and 6 months and joint counts of power-Doppler grade ≥2 articular synovitis at 3 or 6 months were significantly associated with radiographic progression at 1 year. CONCLUSION: This study may suggest the favourable timing and combination of MRI and US at each point to predict radiographic progression in patients with early-stage RA.
Asunto(s)
Artritis Reumatoide , Enfermedades de la Médula Ósea , Sinovitis , Humanos , Médula Ósea , Progresión de la Enfermedad , Imagen por Resonancia Magnética/métodos , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Sinovitis/diagnóstico por imagen , Sinovitis/etiología , Enfermedades de la Médula Ósea/etiología , Enfermedades de la Médula Ósea/complicaciones , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/patología , Edema/diagnóstico por imagen , Edema/etiologíaRESUMEN
OBJECTIVE: To detect dorsally located osteophytes (OP) on lateral x-ray views and to correlate their presence with the extent of structural joint damage, determined by histologic grading (cartilage damage and synovial inflammation) and radiographic scoring in hand osteoarthritis (HOA). METHODS: Distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints were obtained from post mortem specimens (n = 40). Multiplanar plain x-rays were taken (dorso/palmar (dp) and lateral views). Radiographic OA was determined by the Kellgren and Lawrence classification. Joint samples were prepared for histological analysis and cartilage damage was graded according to the Mankin scoring system. Inflammatory changes of the synovial membrane were scored using the general synovitis score (GSS). Spearman's correlation was applied to examine the relationship between histological and radiographical changes. Differences between groups were determined by Mann-Whitney test. RESULTS: Bony proliferations that were only detectable on lateral views but reminiscent of OPs on dp images were termed dorso-ventral osteophytes (dvOPs). All joints displaying dvOPs were classified as OA and the presence of dvOPs in DIP and PIP joints correlated with the extent of histological and radiographic joint damage, as well as with patient age. Joint damage in osteoarthritic DIP and PIP joints without any dvOPs was less severe compared to joints with dvOPs. Synovial inflammation was mainly present in joints displaying dvOPs and correlated with joint damage. CONCLUSION: dvOPs are associated with increasing structural alterations in DIP and PIP joints and can be seen as markers of advanced joint damage. Detecting dvOPs can facilitate the diagnosis process and improve damage estimation in HOA.
Asunto(s)
Articulaciones de la Mano , Osteoartritis , Osteofito , Humanos , Cartílago/patología , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Mano , Articulaciones de la Mano/patología , Inflamación/diagnóstico por imagen , Inflamación/patología , Osteoartritis/diagnóstico por imagen , Osteoartritis/patología , Osteofito/diagnóstico por imagen , Osteofito/patologíaRESUMEN
OBJECTIVES: To investigate whether Fluorescence Optical Imaging (FOI) enhancement and MRI-defined synovitis are associated with pain and physical function in hand OA patients. METHODS: Bilateral FOI scans and MRI of the dominant hand were available for 221 patients. Finger joints were examined for tenderness on palpation. Pain in individual finger joints during the last 24 h and last 6 weeks and hand pain intensity by the Australian/Canadian hand index and Numeric Rating Scale were self-reported. On joint level, we applied logistic regression with generalized estimating equations to examine whether FOI enhancement and MRI-defined synovitis were associated with pain in the same joint. On subject level, we applied linear regression to assess whether FOI and MRI sum scores were associated with pain intensity and physical function. RESULTS: Metacarpophalangeal and thumb base joints were excluded from analyses due to little/no FOI enhancement. Finger joints with FOI enhancement on the composite image had higher odds (95% CI) of pain during the last 6 weeks [grade 1: 1.4 (1.2-1.6); grade 2-3: 2.1 (1.7-2.6)]. Similar results were found for joint pain during the last 24 h and joint tenderness in fingers. Numerically stronger associations were found between MRI-defined synovitis and finger joint pain/tenderness. FOI and MRI sum scores demonstrated no/weak associations with hand pain and physical function. CONCLUSION: FOI enhancement and MRI-defined synovitis were associated with pain in the same finger joint. None of the imaging modalities demonstrated consistent associations with pain, stiffness and physical function on subject level.
Asunto(s)
Articulaciones de la Mano/diagnóstico por imagen , Osteoartritis/diagnóstico por imagen , Artralgia/diagnóstico por imagen , Artralgia/patología , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Articulaciones de la Mano/patología , Fuerza de la Mano , Humanos , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Imagen Óptica , Osteoartritis/patología , Gravedad del PacienteRESUMEN
Knuckle pads are benign painless papules and nodules that most commonly appear on the extensor surfaces of the proximal interphalangeal joints. Knuckle pads are frequently misdiagnosed due to their location overlying joints, which can lead to costly interventions and patient discomfort for a relatively harmless condition. We describe a 44-year-old woman who presented with mildly painful nodules on multiple bilateral proximal interphalangeal joints. The patient did not have a family history of fibromatosis and the rheumatoid factor was negative. Histology showed mild epidermal hyperkeratosis, papillomatosis, and acanthosis with a deep dermal, poorly circumscribed, proliferative nodule made of spindled myofibroblasts without cytological atypia. The diagnosis of knuckle pads was established based on the clinical and morphological presentation of the nodules. Treatment with intralesional triamcinolone acetonide injection produced significant clinical improvement. Our findings highlight the challenging diagnosis of knuckle pads and the importance of increasing the familiarity of knuckle pads in modern medical practice.
Asunto(s)
Fibroma/diagnóstico , Articulaciones de los Dedos/patología , Dermatosis de la Mano/diagnóstico , Queratosis/diagnóstico , Adulto , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Fibroma/patología , Dermatosis de la Mano/patología , Humanos , Queratosis/patología , Papiloma/diagnósticoRESUMEN
BACKGROUND: Joint denervation of the wrist, basal joint of the thumb, and the finger is an option for patients with chronic pain. Compared with other surgical treatment options, function is preserved and the rehabilitation time is limited. A systematic review and meta-analysis were performed for each joint to determine whether the choice of technique and choice of denervation of specific articular sensory branches lead to a different outcome. METHODS: Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar database searches yielded 17 studies with reported outcome on denervation of the wrist, eight on the basal joint of the thumb, and five on finger joints. RESULTS: Overall, the level of evidence was low; only two studies included a control group, and none was randomized. Meta-analysis for pain showed a 3.3 decrease in visual analogue scale score for wrist pain. No difference was found between techniques (total versus partial denervation), nor did different approaches influence outcome. The first carpometacarpal joint showed a decrease for visual analogue scale score for pain of 5.4. Patient satisfaction with the treatment result was 83 percent and 82 percent, respectively. Reported pain in finger joints decreased 96 percent in the metacarpophalangeal joints, 81 percent in the proximal interphalangeal joint, and 100 percent in the distal interphalangeal joint. The only reported case in the metacarpophalangeal joint of the thumb reported an increase of 37 percent. CONCLUSIONS: Only denervation of the metacarpophalangeal joint of the thumb reported an increase in pain; however, this was a single patient. Wrist and first carpometacarpal joint and finger joint denervation have a high satisfaction rate and decrease the pain. There was no difference between techniques.
Asunto(s)
Artralgia/cirugía , Dolor Crónico/cirugía , Desnervación/métodos , Artralgia/complicaciones , Artralgia/patología , Articulaciones Carpometacarpianas/inervación , Articulaciones Carpometacarpianas/patología , Articulaciones Carpometacarpianas/cirugía , Dolor Crónico/diagnóstico , Dolor Crónico/etiología , Dolor Crónico/patología , Desnervación/efectos adversos , Articulaciones de los Dedos/inervación , Articulaciones de los Dedos/patología , Articulaciones de los Dedos/cirugía , Humanos , Articulación Metacarpofalángica/inervación , Articulación Metacarpofalángica/patología , Articulación Metacarpofalángica/cirugía , Dimensión del Dolor , Satisfacción del Paciente , Articulación de la Muñeca/inervación , Articulación de la Muñeca/patología , Articulación de la Muñeca/cirugíaAsunto(s)
Acrodermatitis , Corticoesteroides/administración & dosificación , Artralgia , Articulaciones de los Dedos , Falanges de los Dedos de la Mano , Metotrexato/administración & dosificación , Acrodermatitis/sangre , Acrodermatitis/diagnóstico , Acrodermatitis/tratamiento farmacológico , Acrodermatitis/fisiopatología , Antirreumáticos/administración & dosificación , Artralgia/diagnóstico , Artralgia/etiología , Artritis Psoriásica/diagnóstico , Diagnóstico Diferencial , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Falanges de los Dedos de la Mano/irrigación sanguínea , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/patología , Dermatosis de la Mano/sangre , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/tratamiento farmacológico , Dermatosis de la Mano/fisiopatología , Humanos , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/etiología , Imagen de Perfusión/métodos , Radiografía/métodos , Resultado del Tratamiento , Ultrasonografía Doppler/métodos , Adulto JovenRESUMEN
ABSTRACT: The aim of this analysis was to re-examine the classical concept of distal interphalangeal joint (DIP) psoriatic arthritis (PsA) as an entheseal-driven disease. Two cadaveric fingers with severe psoriatic arthritis were analyzed. Our results demonstrate that inflammation of DIP PsA is multifocal without interconnection between entheses and articular cartilage of the DIP. We found a clear association between synovitis and focal loss of articular cartilage at the head of the intermediate phalanx. By contrast, the articular cartilage adjacent to the zone of severe enthesitis did not show notable damage. Fibrocartilaginous destructions of enthesis were characterized by either a multifocal lymphocytic inflammation, accompanied by osteoclastic resorption, beginning on the interface between the uncalcified and calcified fibrocartilage and then extending into the bone or a subchondral bone inflammation which insidiously destroyed first the bone and then the fibrocartilage. Some sections well showed an inflammation either mild or prominent starting at the level of vascular foramina of flexor enthesis, with secondary invading into the interface between bone and enthesis. The different anatomic sites examined showed a slight predominance of CD8+ T cells over CD4+ T cells: 52% up to 63% for CD8+ T cells vs. to 36% up to 48% for CD4+ T cells. Sparse interspersed CD1a+cells and PS100+cells were also seen with a predominance of PS100+ cells on CD1a+ cells. CD20+ B cells, plasmocytes, neutrophils, and mastocytes were absent or rare. CD123 positive cells were not observed. In DIP PsA, 3 findings predominate: (1) cartilage invasion by the thin pannus offers a more rational explanation for the focal joint destruction than does inflammation of the enthesis which is independent from articular cartilage, (2) the thick ventral plate and to a lesser extend the thin dorsal plate constitute a barrier between the inflamed entheses and the articular cartilage, and (3) an unusual form of minute vascular foramen contributes to the early stage of enthesitis. This small study suggests that DIP PsA is a complex disease. It affects anatomical micro sites which, although close, are in fact relatively independent of each other. Further studies are needed to test this hypothesis.
Asunto(s)
Artritis Psoriásica/patología , Entesopatía/patología , Articulaciones de los Dedos/patología , Sinovitis/patología , HumanosRESUMEN
KEY MESSAGES: No difference between both hands was observed for clinical and radiographical presentations in EHOA patients. A bilateral and symmetrical relationship was found between hand joints. HIGHLIGHTS: EHOA have symmetrical distribution and specific association in structural lesions. This study aims to analyse the preferential topographical distribution of clinical and structural lesions between the dominant and non-dominant hands in erosive hand osteoarthritis (EHOA) patients. Both hands were assessed via radiography in EHOA patients. A comparative analysis of the clinical features and structural lesions between the dominant and non-dominant hands was performed. The structural lesions were assessed according to the anatomical radiographic score of Verbruggen-Veys (VV). Next, a principal component analysis was performed to describe and highlight the relationships observed between the joints. Sixty patients were included in this study: there were 57 women, and the mean age was 66.1 (± 7.6) years. For the distal interphalangeal (DIP) joints, nodes were observed more frequently on the dominant hand (4 vs 3; p = 0.005). No difference in structural lesions was observed between the two hands except for the 2nd proximal interphalangeal (PIP) (p = 0.045). A principal component analysis with varimax rotation described relationships between the 2nd PIP, 3rd PIP, 4th PIP, 4th DIP and 5th DIP joints in both hands. No significant differences between dominant and non-dominant hands were observed for clinical and structural lesions in our sample of EHOA patients. A bilateral and symmetrical injury was observed in most EHOA joints. Trial registration Clinical trial registration number: NCT01068405.
Asunto(s)
Articulaciones de los Dedos/patología , Osteoartritis/patología , Anciano , Método Doble Ciego , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Mano , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Radiografía , Índice de Severidad de la EnfermedadRESUMEN
We present a case of volar rotatory subluxation of index finger proximal interphalangeal joint (PIPJ) following a skiing accident. The injury was initially perceived to be a central slip rupture and treatment was directed as such. After the initial delay in the diagnosis, the patient underwent surgery during which his radial collateral ligament was found to be avulsed from the proximal origin, the radial lateral band palmarly subluxed and was interposed in the joint space. This structure was also adhered to the uninjured volar plate.PIPJ volar rotatory subluxation could be readily missed in the acute setting. Without surgery, the functional outcome could be mediocre and to the patient's detriment.
Asunto(s)
Ligamentos Colaterales/lesiones , Traumatismos de los Dedos/diagnóstico , Luxaciones Articulares/diagnóstico , Esquí/lesiones , Adulto , Ligamentos Colaterales/diagnóstico por imagen , Ligamentos Colaterales/patología , Ligamentos Colaterales/cirugía , Diagnóstico Tardío , Traumatismos de los Dedos/etiología , Traumatismos de los Dedos/cirugía , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Articulaciones de los Dedos/cirugía , Humanos , Periodo Intraoperatorio , Luxaciones Articulares/etiología , Luxaciones Articulares/cirugía , Masculino , Diagnóstico Erróneo , Placa Palmar/diagnóstico por imagen , Placa Palmar/patología , Placa Palmar/cirugía , Rango del Movimiento Articular , Factores de Tiempo , Adherencias Tisulares/diagnóstico , Adherencias Tisulares/etiología , Adherencias Tisulares/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: Erosive hand osteoarthritis (OA) is a severe and rapidly progressing subset of hand OA. Its etiology remains largely unknown, which has hindered development of successful treatments. This study was undertaken to test the hypothesis that erosive hand OA demonstrates familial clustering in a large statewide population linked to genealogical records, and to determine the association of potential risk factors with erosive hand OA. METHODS: Patients diagnosed as having erosive hand OA were identified by searching 4,741,840 unique medical records from a comprehensive statewide database, the Utah Population Database (UPDB). Affected individuals were mapped to pedigrees to identify high-risk families with excess clustering of erosive hand OA as defined by a familial standardized incidence ratio (FSIR) of ≥2.0. The magnitude of familial risk of erosive hand OA in related individuals was calculated using Cox regression models. Association of potential erosive hand OA risk factors was analyzed using multivariate conditional logistic regression and logistic regression models. RESULTS: We identified 703 affected individuals linked to 240 unrelated high-risk pedigrees with excess clustering of erosive hand OA (FSIR ≥2.0, P < 0.05). The relative risk of developing erosive hand OA was significantly elevated in first-degree relatives (P < 0.001). There were significant associations between a diagnosis of erosive hand OA and age, sex, diabetes, and obesity (all P < 0.05). CONCLUSION: Familial clustering of erosive hand OA observed in a statewide database indicates a potential genetic contribution to the etiology of the disease. Age, sex, diabetes, and obesity are risk factors for erosive hand OA. Identification of causal gene variants in these high-risk families may provide insight into the genes and pathways that contribute to erosive hand OA onset and progression.
Asunto(s)
Articulaciones de la Mano/diagnóstico por imagen , Osteoartritis/genética , Linaje , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Análisis por Conglomerados , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Articulaciones de la Mano/patología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteoartritis/epidemiología , Osteoartritis/patología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Utah/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: Digital joints affected by rheumatoid arthritis often have severe deformity and/or dislocation, and arthrodesis in a functional position is required. METHODS: Arthrodesis was performed using intraosseous wiring (modified Lister's method) from January 2011 to December 2015, and we investigated the union rate, postoperative complications, and patient satisfaction with the operation at the final follow-up. The DASH score, grip power, and pinch power were also investigated before the operation and at the final follow-up. RESULTS: Arthrodesis was performed for 90 digital joints in 56 patients. Bone union was obtained in 85 of 89 joints (96%). Wire removal was needed due to subcutaneous protrusion in 20 joints and superficial infection in five joints. The mean preoperative DASH score of 50.5 improved to 45.2 at the final follow-up. The pulp pinch power of the index fingers through the little fingers changed significantly. In the questionnaire regarding the operated digit using a visual analogue scale (VAS, 0 [worst] to 100 [best]), the overall satisfaction was 70. CONCLUSION: With this approach, we achieved painless stability as well as deformity correction. A restored prehensile pattern and improvement in the activities of daily life can thus be expected after surgery.
Asunto(s)
Artralgia , Artritis Reumatoide , Artrodesis , Articulaciones de los Dedos , Deformidades Adquiridas de la Articulación , Anciano , Artralgia/etiología , Artralgia/terapia , Artritis Reumatoide/complicaciones , Artritis Reumatoide/fisiopatología , Artritis Reumatoide/cirugía , Artrodesis/efectos adversos , Artrodesis/instrumentación , Artrodesis/métodos , Hilos Ortopédicos , Femenino , Articulaciones de los Dedos/patología , Articulaciones de los Dedos/cirugía , Humanos , Deformidades Adquiridas de la Articulación/etiología , Deformidades Adquiridas de la Articulación/cirugía , Masculino , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Estudios RetrospectivosRESUMEN
Pachydermodactyly (PDD) is a rare, benign disease associated with progressive swelling of the periarticular soft tissue of phalangeal hand joints typically treated with local steroid injections. We present a case of a 37-year-old man with PDD treated with local steroid injections. He later developed heterotopic ossification and para-articular calcifications in the injection sites. Heterotopic ossification is not associated with PDD nor is it a recognised complication of local steroid injections. This is the first case in literature of heterotopic ossification occurring after local steroid injection and brings to attention a new potential complication of a widely performed procedure.
Asunto(s)
Articulaciones de los Dedos/patología , Deformidades Adquiridas de la Articulación/tratamiento farmacológico , Osificación Heterotópica/inducido químicamente , Esteroides/efectos adversos , Adulto , Humanos , Inyecciones Intraarticulares , Masculino , Ilustración Médica , Esteroides/administración & dosificaciónRESUMEN
RATIONALE: The extensor tendon of the proximal interphalangeal (PIP) joint is highly complex, and failure to ensure suitable balance during treatment following an injury is likely to produce poor outcomes. We have achieved good outcomes with the primary repair of neglected extensor tendon rupture in the PIP joint, and thus report the case along with a review of the relevant literature. PATIENTS CONCERN: A 40-year-old right-handed female who works at a meat shop visited our clinic due to pain and active limitation of the range of motion (ROM) of the PIP joint of her left long finger. She had previously experienced a cut on the dorsal aspect of the third PIP joint while cutting meat about a year earlier but did not receive any specific treatment for the injury. DIAGNOSIS: The patient was diagnosed with complete rupture of the central slip and lateral band in the PIP joint after investigation. INTERVENTION: We successfully debrided the ruptured tendon and performed extensor tendon repair using the modified Kessler technique and epitendinous cross-over repair technique. OUTCOME: At the 12-month follow-up, the patient was completely asymptomatic and had optimal PIP joint ROM (0°-90°) in her left long finger. LESSONS: Although the treatment of an extensor injury of the PIP joint area is difficult, satisfactory outcomes can still be achieved, even in cases of injuries which are neglected for over a year, using a repair technique that can properly balance the length and tension between the central slip and lateral bands with the selection of appropriate postoperative treatment strategies.