Luxação dorsal complexa da articulação metacarpofalangeana dos dedos longos: relato de caso e revisão da literatura / Complex dorsal dislocation of the metacarpophalangeal joint of the long fingers: case report and literature review

As luxações dorsais da articulação metacarpofalangeana dos dedos são lesões raras, vistas com mais frequência em pacientes jovens, secundárias a trauma por hiperextensão forçada do dedo na mão que estende. São classificadas como simples, quando a redução fechada é possível; ou complexas, quando a redução por métodos fechados não é possível devido à interposição de estruturas periarticulares. É importante distinguir entre uma luxação simples e uma complexa porque sua abordagem e tratamento são diferentes. O objetivo deste estudo é atualizar a abordagem clínica e as diferentes técnicas cirúrgicas utilizadas no tratamento das luxações complexas. Foi realizada uma revisão bibliográfica sobre a luxação dorsal metacarpofalangeana dos dedos longos, excluindo os do polegar, incluindo o Medline (interface PubMed), SciELO e bancos de dados acadêmicos do Google. Todos os artigos revisados concluem que as tentativas de redução incruenta nesses tipos de lesões costumam ser malsucedidas e levar a complicações adicionais. A redução cirúrgica aberta é o método de escolha, permitindo a recuperação anatômica articular com o menor risco de complicações. A imobilização pós-operatória com uma tala de travamento dorsal é recomendada por duas semanas, seguida por reabilitação por terapia ocupacional, esperando-se uma amplitude de movimento normal em seis semanas. A baixa frequência somada ao desconhecimento do médico emergencista ao realizar a manobra de redução pode, muitas vezes, levar à transformação de um simples deslocamento em complexo, tornando-o irredutível e lesionando estruturas adjacentes, por isso, acreditamos ser fundamental conhecer o manejo desta lesão.

Dorsal dislocations of the metacarpophalangeal joint of the fingers are rare injuries that are seen more frequently in young patients secondary to trauma due to forced hyperextension of the finger on the extending hand. They are classified as simple when closed reduction is possible, or complex when reduction by closed methods is not possible given the interposition of peri-articular structures. It is important to distinguish between a simple and complex dislocation because their approach and treatment differ. The objective of this study is to update the clinical approach and the different surgical techniques used in the treatment of complex dislocations. We conducted a bibliographic review on metacarpophalangeal dorsal dislocation of the long fingers, excluding those of the thumb, including the Medline (PubMed interface), SciELO and academic google databases. All the articles reviewed conclude that attempts at closed reduction in these types of injuries are often unsuccessful and often lead to additional complications. Open surgical reduction is the method of choice, allowing joint anatomical recovery with the lowest risk of complications. Postoperative immobilization using a dorsal locking splint is recommended for two weeks followed by rehabilitation by occupational therapy, expecting a normal range of motion at six weeks. The low frequency added to the ignorance of the emergency physician when performing the reduction maneuver can often lead to transform a simple dislocation into a complex one, making it irreducible and injuring adjacent structures, which is why we believe it is essential to know the management of this injury.

Lower hand grip in rheumatoid arthritis patients is associated with low finite element analysis using high resolution peripheral quantitative computed tomography scan of the 2nd metacarpophalangeal joint.

AIM: To evaluate hand function by hand grip test in rheumatoid arthritis (RA) patients, and its association with bone erosions and the estimated bone strength (finite element - FE analysis) through the analysis of the 2nd metacarpal head of the dominant hand using high resolution peripheral quantitative computed tomography (HR-pQCT). METHOD: Eighty-two female RA patients between 18-50 years old were selected. Demographic data, Health Questionnaire Assessment Disability Index (HAQ), Disease Activity Score of 28 joints (DAS)-28, simplified disease activity index (SDAI) and the hand grip test were set. The HR-pQCT scans of 2nd metacarpophalangeal joints of the dominant hand of all patients were performed according to SPECTRA group protocols. The images were used to assess bone erosions and FE analysis. The hand grip test was categorized in 2 groups and separately compared (< 18 vs ≥18 kgf). A logistic regression was performed using hand grip test <18 kgf as a dependent variable. RESULTS: A significant difference was found between the 2 groups regarding HAQ, inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), DAS-28, SDAI, total volume of erosion and bone strength parameter (FE analysis - Failure Load [F.Load]). The logistic regression analysis showed that the risk factors associated with hand grip test <18 kgf were higher SDAI (odds ratio [OR] 0.912; 95% CI 0.837-0.993) and lower values of bone strength parameter (F.Load) (OR 1.007; 95% CI 1.002-1.012). CONCLUSION: Lower values of hand grip test were associated with higher disease activity score-SDAI and lower bone strength of 2nd metacarpal bone head of the dominant hand evaluated here through a FE analysis using HR-pQCT scan.

Prevalence, coincidence and distribution patterns of sesamoid bones of the hand / Patrones de prevalencia, coincidencia y distribución de los huesos sesamoideos de la mano

SUMMARY: The aim of this study is to identify the prevalence and distribution patterns of sesamoid bones at the metacarpophalangeal (MCP) and interphalangeal (IP) joints and to determine if there is an association between the distribution patterns and age, gender, and hand side. Patients who had a direct radiograph of the hand obtained between 2019-2020 were retrospectively evaluated. All radiographs were evaluated in terms of the prevalence, coincidence, and distribution patterns of sesamoid bones. Presence of an association between distribution patterns and age, sex and side was also assessed. A total of 1501 hand radiographs were included into the study. There were 12 different patterns of sesamoid bone distribution. The most common distribution pattern was the presence of sesamoid bone at the first MCP joint only (25.8 %). There was a positive correlation between the second and third MCP, second and fifth MCP, second and first IP, third and fourth MCP and fifth MCP and first IP joints. The pattern with a sesamoid bone at the first MCP joint only was more prevalent among males, whereas the pattern involving coincidence of sesamoid bones at the first, second, fifth MCP and first IP joints was more prevalent among females (p<0.001, p=0.031). A positive correlation was observed between age and the number of MCP joints with sesamoid bones (p<0.001). The number of MCP joints with sesamoid bones was found to be higher in females (p<0.001). This study is important in that it provided anatomical data that can be guiding for clinicians in terms of diagnosis and management of hand disorders.

RESUMEN: El objetivo de este estudio fue identificar la prevalencia y los patrones de distribución de los huesos sesamoideos en las articulaciones metacarpofalángicas (MCF) e interfalángicas (IF) y determinar si existe una asociación entre los patrones de distribución y la edad, el sexo y el lado de la mano; fueron evaluadas retrospectivamente radiografías de la mano obtenidas en 2019- 2020. Todas las radiografías se evaluaron en términos de prevalencia, coincidencia y patrones de distribución de los huesos sesamoideos. También se evaluó la presencia de una asociación entre los patrones de distribución y la edad, el sexo y el lado. Se incluyeron en el estudio un total de 1501 radiografías de mano. Se observaron 12 patrones diferentes de distribución de los huesos sesamoideos. El patrón de distribución más común fue la presencia de hueso sesamoideo solo en la primera articulación MCF (25,8 %). Hubo una correlación positiva entre la segunda y la tercera MCF, la segunda y la quinta MCP, la segunda y la primera IF, la tercera y cuarta MCF y la quinta MCF y las primeras articulaciones IF. El patrón con un hueso sesamoideo en la primera articulación MCF fue más prevalente entre los hombres, mientras que el patrón de coincidencia de los huesos sesamoideos en la primera, segunda, quinta articulación MCF y la primera articulación IF fue más prevalente entre las mujeres (p <0.001, p = 0,031). Se observó una correlación positiva entre la edad y el número de articulaciones MCF con huesos sesamoideos (p <0,001). El número de articulaciones MCF con huesos sesamoideos era mayor en las mujeres (p <0,001). Este estudio es importante debido a que proporcionó datos anatómicos que pueden ser una guía para los médicos en el diagnóstico y tratamiento de los trastornos de la mano.

Palpation of the lateral bands of the extensor apparatus of the fingers. Anatomy of a neglected clinical finding.

This study aimed to determine by ultrasonography, and cadaveric dissection, whether the firm cords felt by palpation at the sides of the proximal phalanx (PP), actively flexing, and extending the proximal interphalangeal (PIP) joint while keeping the metacarpophalangeal (MCP) joint extended are the lateral bands (LBs) of the extensor apparatus. If so, palpation of the LBs could help evaluate hand conditions that impact the digits' intrinsic muscles. To this end, the PP of the middle and ring fingers of the dominant hand of seven subjects were studied by palpation on both sides. Ultrasonography (US) was performed with a hockey-stick transducer placed on the ulnar side. Five cadaveric hands were dissected, exposing the dorsal extensor apparatus. On palpation, a firm cord was consistently felt at the PP's sides in all subjects. These cords moved widely forward on PIP flexion and backward with PIP extension. By US scanning, the cords corresponded to the LBs. However, the forward movement had only a median of 1.8 mm (range 0.7-3 mm) in the middle finger and a median of 1.1 mm (range 0.3-2.7 mm) in the ring finger compared with an estimated 5-10 mm upon palpation. Cadaveric dissection confirmed the forward movement of the LBs in PIP flexion. We concluded that the firm cords felt at the PP sides are the LBs of the extensor apparatus. We confirmed their movement with the active flexion/extension of the PIP joint. Comparing the wide palpatory and the meager US motion, a haptic illusion of motion may be present.

Ultrasound and clinical findings in the metacarpophalangeal joint assessment of show jumping horses in training.

BACKGROUND: Physical exercise is known to cause significant joint changes. Thus, monitoring joint behavior of athletic horses is essential in early disorders recognition, allowing the proper management. OBJECTIVES: The aims of this study were to determine the morphological patterns, physical examination characteristics and ultrasound findings of show jumping horses in training and to establish a score-based examination model for physical and ultrasound follow-ups of metacarpophalangeal joint changes in these animals. METHODS: A total of 52 metacarpophalangeal joints from 26 horses who were initially in the taming stage were evaluated, and the horses' athletic progression was monitored. The horses were evaluated by a physical examination and by B-mode and Doppler-mode ultrasound examinations, starting at time zero (T0), which occurred concomitantly with the beginning of training, and every 3 months thereafter for a follow-up period of 18 months. RESULTS: The standardized examination model revealed an increase in the maximum joint flexion angles and higher scores on the physical and ultrasound examinations after scoring was performed by predefined assessment tools, especially between 3 and 6 months of evaluation, which was immediately after the horses started more intense training. The lameness score and the ultrasound examination score were slightly higher at the end of the study. CONCLUSIONS: The observed results were probably caused by the implementation of a training regimen and joint adaptation to physical conditioning. The joints most likely undergo a pre-osteoarthritic period due to work overload, which can manifest in a consistent or adaptive manner, as observed during this study. Thus, continuous monitoring of young athlete horses by physical and ultrasound examinations that can be scored is essential.

An unusual presentation of metacarpophalangeal joint instability of the thumb.

Thumb injuries are not as common as those occurring in the fingers. The authors present the case of a patient who had an isolated avulsion of the extensor pollicis brevis that resulted in metacarpophalangeal joint instability, with intact radial and ulnar collateral ligament.

Lesões no polegar não são tão comuns como aquelas nos dedos. Os autores um caso em que a paciente sofreu uma avulsão isolada do extensor curto do polegar que resultou em instabilidade da articulação metacarpofalângica do polegar, com ligamento colateral ulnar e radial intacto.

Rheumatic hand's clinical, functional and imagiological correlations following metacarpophalangeal joint silicone arthroplasty.

OBJECTIVE: Evaluation of rheumatoid hand-associated metacarpophalangeal joint silicone arthroplasty most often relies on functional scores alone. This study aimed to understand the correlation between perceived and observed function, strength, and alignment. METHODS: Cross-sectional study including all 11 women (15 hands) submitted to second to fifth metacarpophalangeal joint arthroplasty due to rheumatoid arthritis involvement for a time period of seven years. Measurements relied on the Michigan Hand Outcomes Questionnaire, Lafayette Purdue Pegboard, pinch and grip strength, and analysis of a lateral "OK-sign" X-ray view. Correlation analysis used Spearman's coefficient, assuming statistical significance for p-values < 0.05. RESULTS: Objective function was strongly correlated with all other variables (p < 0.05), while perceived function failed to correlate with articular alignment in both measurements (p = 0.240 and p = 0.354). Strength and alignment were also strongly correlated (p < 0.05). CONCLUSIONS: Most measurements strongly correlate with each other, with emphasis on objective dexterity measurement.

OBJETIVO: Na maioria das vezes, a avaliação da artroplastia da articulação metacarpofalangeana com implante de silicone é feita apenas por meio de escores funcionais. Este estudo teve como objetivo compreender a correlação entre função, força e alinhamento percebidos e observados. MÉTODOS: Este estudo transversal incluiu todas as 11 mulheres (15 mãos) que foram submetidas a artroplastia metacarpofalangeana no segundo ao quinto dedo devido a artrite reumatoide em um período de sete anos. As medições basearam-se no Michigan Hand Outcomes Questionnaire, no Lafayette Purdue Pegboard e nas forças de pinça e preensão, além da análise de radiografia da mão em leque. O coeficiente de Spearman foi usado para avaliar a correlação; valores de p < 0,05 foram considerados estatisticamente significantes. RESULTADOS: A função objetiva foi fortemente correlacionada a todas as outras variáveis (p < 0,05). Por outro lado, a função percebida não foi correlacionada ao alinhamento articular em ambas as medições (p = 0,240 e p = 0,354). A força e o alinhamento também estiveram fortemente correlacionados (p < 0,05). CONCLUSÕES: A maioria das medições se correlacionou fortemente entre si, com ênfase na medição objetiva da destreza.

Rheumatic hand's clinical, functional and imagiological correlations following metacarpophalangeal joint silicone arthroplasty / Correlações clínicas, funcionais e imagiológicas após artroplastia da articulação metacarpofalangiana com implante de silicone na mão reumatoide

ABSTRACT Objective: Evaluation of rheumatoid hand-associated metacarpophalangeal joint silicone arthroplasty most often relies on functional scores alone. This study aimed to understand the correlation between perceived and observed function, strength, and alignment. Methods: Cross-sectional study including all 11 women (15 hands) submitted to second to fifth metacarpophalangeal joint arthroplasty due to rheumatoid arthritis involvement for a time period of seven years. Measurements relied on the Michigan Hand Outcomes Questionnaire, Lafayette Purdue Pegboard, pinch and grip strength, and analysis of a lateral "OK-sign" X-ray view. Correlation analysis used Spearman's coefficient, assuming statistical significance for p-values < 0.05. Results: Objective function was strongly correlated with all other variables (p < 0.05), while perceived function failed to correlate with articular alignment in both measurements (p = 0.240 and p = 0.354). Strength and alignment were also strongly correlated (p < 0.05). Conclusions: Most measurements strongly correlate with each other, with emphasis on objective dexterity measurement.

RESUMO Objetivo: Na maioria das vezes, a avaliação da artroplastia da articulação metacarpofalangeana com implante de silicone é feita apenas por meio de escores funcionais. Este estudo teve como objetivo compreender a correlação entre função, força e alinhamento percebidos e observados. Métodos: Este estudo transversal incluiu todas as 11 mulheres (15 mãos) submetidas à artroplastia metacarpofalangeana no segundo ao quinto dedo devido a artrite reumatoide em um período de sete anos. As medições basearam-se no Michigan Hand Outcomes Questionnaire, no Lafayette Purdue Pegboard e nas forças de pinça e preensão, além da análise de radiografia da mão em leque. O coeficiente de Spearman foi usado para avaliar a correlação; valores de p < 0,05 foram considerados estatisticamente significantes. Resultados: A função objetiva foi fortemente correlacionada a todas as outras variáveis (p < 0,05). Por outro lado, a função percebida não foi correlacionada ao alinhamento articular em ambas as medições (p = 0,240 e p = 0,354). A força e o alinhamento também estiveram fortemente correlacionados (p < 0,05). Conclusões: A maioria das medições se correlacionou fortemente entre si, com ênfase na medição objetiva da destreza.

Ultrasonographic characterization of the ulnar collateral ligament of normal thumbs in different age groups

OBJECTIVES: The aim of this study was to perform ultrasonographic characterization of the normal ulnar collateral ligament in different age groups and compare it in men and women and in dominant and nondominant hands. METHODS: Forty right-handed volunteers in the age groups 20-30, 31-40, 41-50, and 51-60 years without a history of trauma or surgical procedure in the studied joint were evaluated. The studied parameters were ligament length, greatest ligament thickness, ligament longitudinal section area in the longitudinal plane, distance from the aponeurosis of the adductor muscle to the metacarpal head surface and joint opening at rest and under abduction stress. RESULTS: The results indicated that the mean values of all parameters had minor variations with age, hand dominance, and gender and were slightly higher in men than in women and in the dominant hand than the nondominant hand. However, a statistically significant difference was observed between the joint opening at rest and under stress. In terms of age, there was a small but nonsignificant decrease in the values, likely because of the natural aging process. CONCLUSION: The low variability in the evaluated parameters indicates that large differences between sides or genders are not to be expected. A greater change is likely to indicate a pathological situation.

Aspectos ultrassonográficos, anatômicos e histológicos normais da articulação metacarpofalangeana equina / Normal ultrasonographic, anatomical and histological aspects of the equine metacarpophalangeal joint

O objetivo deste estudo foi descrever e caracterizar as estruturas que compõem a articulação metacarpofalangena equina por meio de análise ultrassonográfica, anatômica e histológica. Membros torácicos equinos (=70), obtidos em instalações frigoríficas, foram submetidos a exame ultrassonográfico post mortem. Destes, 30 membros apresentaram imagens ultrassonográficas consideradas sem alterações. Posteriormente foi realizada a dissecação dos mesmos e o estudo anátomo-histológico. Critérios como tamanho, forma, arquitetura e ecogenicidade foram observados a fim de caracterizar as imagens ultrassonográficas, anatômicas e histológicas normais das estruturas ligamentares, tendíneas, capsulares e cartilaginosas da articulação metacarpofalangeana equina.(AU)

The purpose of this study was to describe and characterize the equine metacarpophalangeal joint structures through ultrasonographic, anatomical and histological analysis. Seventy forelimb specimens were obtained from a slaughterhouse and submitted to ultrasonographic evaluation. Thirty specimens without ultrasonographic detectable lesions were selected for dissection and subsequent anatomical and histological evaluation. Criteria such as size, shape, architecture and echogenicity were observed in order to characterize normal ligaments, tendons, joint capsule and articular cartilage of the metacarpophalangeal joint.(AU)

Aspectos ultrassonográficos, anatômicos e histológicos normais da articulação metacarpofalangeana equina / Normal ultrasonographic, anatomical and histological aspects of the equine metacarpophalangeal joint

O objetivo deste estudo foi descrever e caracterizar as estruturas que compõem a articulação metacarpofalangena equina por meio de análise ultrassonográfica, anatômica e histológica. Membros torácicos equinos (=70), obtidos em instalações frigoríficas, foram submetidos a exame ultrassonográfico post mortem. Destes, 30 membros apresentaram imagens ultrassonográficas consideradas sem alterações. Posteriormente foi realizada a dissecação dos mesmos e o estudo anátomo-histológico. Critérios como tamanho, forma, arquitetura e ecogenicidade foram observados a fim de caracterizar as imagens ultrassonográficas, anatômicas e histológicas normais das estruturas ligamentares, tendíneas, capsulares e cartilaginosas da articulação metacarpofalangeana equina.(AU)

The purpose of this study was to describe and characterize the equine metacarpophalangeal joint structures through ultrasonographic, anatomical and histological analysis. Seventy forelimb specimens were obtained from a slaughterhouse and submitted to ultrasonographic evaluation. Thirty specimens without ultrasonographic detectable lesions were selected for dissection and subsequent anatomical and histological evaluation. Criteria such as size, shape, architecture and echogenicity were observed in order to characterize normal ligaments, tendons, joint capsule and articular cartilage of the metacarpophalangeal joint.(AU)

Diagnostic value of computed tomography, radiography and ultrasonography in metacarpophalangeal joint disorders in horses / Importância diagnóstica da tomografia computadorizada, radiografia e ultrassonografia nas afecções da articulação metacarpofalangeana em equinos

In modern society the work and athletic performance of horses has led to a very important animal production sector in which Brazil possesses the third largest horse stock. Among all equine lesions described, metacarpophalangeal (fetlock) joint lesions are considered one of the main causes of lameness. Consequently, there is a need to improve the understanding and diagnosis of these injuries. The most efficient imaging diagnostic methods for the fetlock region are computed tomography, radiography and ultrasound. Imaging studies of the anatomical structures involving this joint are extremely important to obtain a more precise diagnose. The present study was performed in order to evaluate the capacity of different imaging diagnostic modalities to detect a variety of lesions in different fetlock structures. Twenty horses (Equus caballus) used for horsemanship activities were referred to the Department of Animal Reproduction and Veterinary Radiology of São Paulo State University, Botucatu campus, with clinical signs of metacarpophalangeal joint injuries. Horses were submitted to radiographic and ultrasonographic exam and computed tomography scan. Image analysis revealed a significant capacity of these methods to characterize lesions in this region. However, computed tomography provided broader and better evaluation of lesions in bones and adjacent structures, because it allows the analysis to be performed on three-dimensional projections, with attenuation coefficients (window selections) and tissue density measurement through Hounsfield Units (HU).

As atividades desempenhadas pelo cavalo na sociedade contemporânea são diversas, e o Brasil é portador do terceiro maior plantel mundial de equinos. Entre as várias afecções descritas em cavalos atletas, as lesões na articulação metacarpofalangeana (boleto) são consideradas as principais causas de claudicação. Por isso, continuamente se aprofunda o conhecimento no diagnóstico das enfermidades que acometem essa região. Dentre as modalidades de diagnóstico por imagem, os exames de tomografia computadorizada, radiografia e ultrassonografia constituem os mais eficazes para avaliação da região do boleto. Com o presente trabalho, teve-se como objetivo avaliar o desempenho da tomografia computadorizada, da radiografia e da ultrassonografia nas mais variadas injúrias das estruturas da articulação metacarpofalangeana. Vinte cavalos (Equus caballus), destinados às atividades de horsemanship, foram encaminhados ao Departamento de Reprodução Animal e Radiologia Veterinária da Universidade Estadual Paulista, campus de Botucatu, com sinais clínicos de afecções na articulação metacarpofalangeana. Os animais foram submetidos aos exames de radiografia, ultrassonografia e tomografia computadorizada. As imagens revelaram grande capacidade dos métodos em caracterizar lesões nessa articulação. Entretanto, a tomografia computadorizada possibilitou avaliar de modo mais amplo e aprimorado as lesões em estruturas ósseas e adjacentes dessa articulação, pois permite a análise das imagens por meio de projeções tridimensionais, a seleção de coeficiente de atenuação e a mensuração da densidade dos tecidos em unidade Hounsfield (HU).

Diagnostic value of computed tomography, radiography and ultrasonography in metacarpophalangeal joint disorders in horses / Importância diagnóstica da tomografia computadorizada, radiografia e ultrassonografia nas afecções da articulação metacarpofalangeana em equinos

In modern society the work and athletic performance of horses has led to a very important animal production sector in which Brazil possesses the third largest horse stock. Among all equine lesions described, metacarpophalangeal (fetlock) joint lesions are considered one of the main causes of lameness. Consequently, there is a need to improve the understanding and diagnosis of these injuries. The most efficient imaging diagnostic methods for the fetlock region are computed tomography, radiography and ultrasound. Imaging studies of the anatomical structures involving this joint are extremely important to obtain a more precise diagnose. The present study was performed in order to evaluate the capacity of different imaging diagnostic modalities to detect a variety of lesions in different fetlock structures. Twenty horses (Equus caballus) used for horsemanship activities were referred to the Department of Animal Reproduction and Veterinary Radiology of São Paulo State University, Botucatu campus, with clinical signs of metacarpophalangeal joint injuries. Horses were submitted to radiographic and ultrasonographic exam and computed tomography scan. Image analysis revealed a significant capacity of these methods to characterize lesions in this region. However, computed tomography provided broader and better evaluation of lesions in bones and adjacent structures, because it allows the analysis to be performed on three-dimensional projections, with attenuation coefficients (window selections) and tissue density measurement through Hounsfield Units (HU).(AU)

As atividades desempenhadas pelo cavalo na sociedade contemporânea são diversas, e o Brasil é portador do terceiro maior plantel mundial de equinos. Entre as várias afecções descritas em cavalos atletas, as lesões na articulação metacarpofalangeana (boleto) são consideradas as principais causas de claudicação. Por isso, continuamente se aprofunda o conhecimento no diagnóstico das enfermidades que acometem essa região. Dentre as modalidades de diagnóstico por imagem, os exames de tomografia computadorizada, radiografia e ultrassonografia constituem os mais eficazes para avaliação da região do boleto. Com o presente trabalho, teve-se como objetivo avaliar o desempenho da tomografia computadorizada, da radiografia e da ultrassonografia nas mais variadas injúrias das estruturas da articulação metacarpofalangeana. Vinte cavalos (Equus caballus), destinados às atividades de horsemanship, foram encaminhados ao Departamento de Reprodução Animal e Radiologia Veterinária da Universidade Estadual Paulista, campus de Botucatu, com sinais clínicos de afecções na articulação metacarpofalangeana. Os animais foram submetidos aos exames de radiografia, ultrassonografia e tomografia computadorizada. As imagens revelaram grande capacidade dos métodos em caracterizar lesões nessa articulação. Entretanto, a tomografia computadorizada possibilitou avaliar de modo mais amplo e aprimorado as lesões em estruturas ósseas e adjacentes dessa articulação, pois permite a análise das imagens por meio de projeções tridimensionais, a seleção de coeficiente de atenuação e a mensuração da densidade dos tecidos em unidade Hounsfield (HU).(AU)

Estudio comparativo de artrodesis de dedos: banda de tensión vs tornillo compresivo / Finger atrhodesis: a comparative study with tension band a fusion technique

Objective: There are many different techniques for finger arthrodesis our purpose is to compare the results of metarcophalangeal (MP) and proximal interphalangeal (PIP) joint arthrodesis, with tension band wire technique vs compression screw. Methods: Retrospective cohort study of patients with arthrodesis of the MP and PIP joint between 2006 and 2009, with a tension band wire technique (N = 28) and Mini-Acutrak screw (N = 29). We compared rates and times of union and the incidence of complications. Results: The union rate of the tension band group was 92.9 percent and 85.7 percent for the screw group, at 9.4 and 9.8 weeks respectively. The complications rate was 28.6 percent for tension band wire technique and 27.6 for the screw technique. The reoperation rate was 32.1 percent for the tension band wire technique and 3.6 percent for the screw group, with remove of 25 percent of the tension band. Discussion: Both surgical techniques had a similar rate of union and complications, but with significantly more re-operation to remove implants in the tension band group, which is an important factor to consider when choosing the surgical technique.

Objetivo: Existen múltiples técnicas de atrodesis de dedos, por lo que nuestro objetivo es compara resultados de artrodesis de metacarpofalángicas e interfalángicas proximales de los dedos mediante banda de tensión vs tornillo compresivo. Material y Método: Se realizó un estudio de cohorte retrospectivo, comparativo, de pacientes operados de artrodesis interfalángica proximal o metacarpofalángica de lo dedos primarias entre los años 2006 y 2009. Se analizaron 28 pacientes con banda de tensión y 29 con técnica de tornillo compresivo sin cabeza Mini-Acutrak, comparando tasas y tiempos de consolidación e incidencia de complicaciones. Resultados: Se obtuvo una tasa de consolidación de 92,9 por ciento para el grupo banda de tensión y 85,7 por ciento para el grupo de tornillos, a las 9,4 y 9,8 semanas respectivamente (sin diferencia significativa para ambas variables). La tasa de complicaciones fue de 28,6 por ciento para la bandea de tensión y de 27,6 por ciento para la técnica con tornillo. La tasa de reoperaciones fue de 32,1 por ciento para la técnica con banda de tensión y de 3,6 por ciento con tornillo, determinado por el 25 por ciento de las bandas de tensión, sin haber retiro de tornillos. Discusión; Ambas técnicas quirúrgicas muestran una similar tasa de consolidación y complicaciones, pero existe unna significativa mayor tasa de reoperaciones para el retiro de material de osteosíntesis en el grupo de banda de tensión, lo cual es un factor importante a considerar en la elección de la técnica quirúrgica, siendo en este sentido, el tornillo una mejor opción.

Morfometria das principais estruturas que compõem a articulação metacarpofalangeana em equinos sem raça definida / Morphometry of the main structures that compose the metacarpophalangeal joint in horses

A articulação metacarpofalangeana é um gínglimo formado pela junção da extremidade distal do III metacarpiano, a extremidade proximal da falange proximal e os ossos sesamóides proximais. Dentre as articulações do equino é a mais susceptível a lesões. Visando gerar uma forma de qualidade preditiva se estudou as características morfométricas através de corte transversal, das principais estruturas da articulação metacarpofalangeana de 16 membros torácicos direitos e 14 membros torácicos esquerdos de equinos adultos, sem raça definida. Foram efetuadas mensurações visando obter a largura e espessura do tendão do músculo flexor digital superficial e profundo, ligamento intersesamoideo interdigital, tendão do músculo extensor digital comum e lateral e face dorsal e palmar da cápsula articular, não sendo observadas diferenças entre os tendões do músculo flexor digital superficial, tendões do músculo extensor digital comum e lateral, ligamento intersesamoideo interdigital, tanto em largura quanto em espessura, tendão do músculo flexor digital profundo, somente na espessura e porção dorsal da cápsula articular (P<0,05) independente do antímero, porém, houve diferença significativa entre os tendões do músculo flexor digital profundo quanto à largura (P>0,01), bem como na porção palmar das cápsulas articulares (P>0,05). Dentro das estruturas analisadas a que mais apresentou variações foi a cápsula articular, sugere-se que esta variação possa ter ocorrido porque o grupo experimental (peças anatômicas) não era homogêneo quanto às características dos animais de origem (idade, peso, função, histórico clínico). No correlação não foi possível encontrar valores significantes, uma vez que a correlação foi baixa para a maioria das estruturas.

The metacarpophalangeal joint is a ginglim formed by the conjunction of the distal extremity of the III Metacarpal bone, the proximal extremity of the Proximal phalanx and the proximal sesamoid bones. Amongst the horses' joints this is the most susceptible to lesions. The morfometric characteristics were studied through a transversal incision of the main structures of the metacapophalangeal joints of 16 right side thoracic members and 14 left side thoracic members of adult horses of no defined breeding, seeking to generate a form of predictable quality. Measurements were taken so as to obtain the width and thickness of the superficial and deep tendons of the digital flexor muscle, interdigital intersesamoid ligament, tendon of the common digital extensor muscle and palmar, back and side of the articular capsule. No differences were found between the superficial digital flexor muscle tendons, common and lateral digital extensor muscle tendons, interdigital intersesamoid ligament, neither in width or thickness, deep digital flexor muscle tendon, only in thickness and back portion of the articular capsule (P>0.05) independing of the antimere, however significant differences were found amongst the widths of the deep digital flexor muscle tendons (P>0.01), as well as in the palmar portion of the articular capsules (P>0.05). The articular capsule was the structure that shows the highest variation, maybe because there was not a pattern at the moment of collecting (age, function, clinical historical). In the correlation it was not possible to find significant values, once the correlation was low to the majority of structures.

Efeito analgésico do laser de baixa intensidade (LILT) na artrite reumatóide aguda / Effect analgesic of low intensity laser (LILT) in rheumatoid arthritis acute

Introdução - Avaliar a efetividade da laserterapia de baixa intensidade (LILT) na promoção da analgesia em portadores de artrite reumatóide. Material e Métodos - Dez sujeitos, portadores de artrite reumatóide (05 pertencentes ao grupo irradiado e 05 pertencentes ao grupo placebo) foram submetidos à 10 sessões de LILT, divididas em 5 semanas (2 sessões/semana). O Questionário de Dor Br-MPQ foi aplicado no início e ao final do protocolo. Resultados - Obteve-se um resultado significativo de menor algia no grupo controle (80%) e um resultado de maior algia no grupo irradiado(40%), o que não se implica em um resultado efetivo ao estudo. Conclusão - A LILT (904 nm) não foi efetiva na analgesia em portadores com artrite reumatóide.

Introduction - Evaluating the effectiveness of low power laser therapy in order to promote analgesic effect in rheumatoid arthritis bearers. Material and Methods - Ten subjects bearer of rheumatoid arthritis (05 belonging to radiated group and 05 belonging to placebo group) were evaluated in ten session of LILT, divided in five weeks (two session/week). The Brazilian version of Dor Br - MPQ questionnaire from McGill Pain Questionnaire was used and applied at the beginning and at the end of the protocol. Results - We got a pretty smaller result from the control group (80%) and a bigger result from the radiated group (40%), what does not mean an effective result to this study. Conclusion - The LILT (904 nm) was not effective in the analgesic effect in rheumatoid arthritis bearers.