RESUMEN
This article provides a brief overview of systemic lupus erythematosus and a more detailed outline of its manifestations in the hand. The indications for surgical treatment of these manifestations are discussed.
Asunto(s)
Deformidades Adquiridas de la Mano/etiología , Lupus Eritematoso Sistémico/complicaciones , Adolescente , Adulto , Femenino , Humanos , Masculino , Enfermedad de Raynaud/etiologíaRESUMEN
An appreciation of the salient clinical and radiologic presentations of osteoarthritis, as well as associated tenosynovial problems (stenosing tenosynovitis and carpal tunnel syndrome), is necessary for effective diagnosis. The treatment of osteoarthritis is predicated upon an understanding of the anatomy and pathomechanics of the disease process. Relevant features of the anatomy of the joints of the hand have been reviewed. The correlation of pathologic abnormalities with their radiologic findings has been presented. The degenerative joint disease termed osteoarthritis affects primarily cartilagenous and osseous tissues, while synovial changes are less pronounced. The characteristics of osteoarthritis of the interphalangeal, carpometacarpal joint of the thumb, and metacarpophalangeal joints of the hand have been reviewed.
Asunto(s)
Articulaciones de los Dedos/diagnóstico por imagen , Mano/diagnóstico por imagen , Osteoartritis/diagnóstico , Pulgar/diagnóstico por imagen , Síndrome del Túnel Carpiano/diagnóstico , Humanos , Osteoartritis/diagnóstico por imagen , Radiografía , Tenosinovitis/diagnósticoRESUMEN
Ten patients with systemic lupus erythematosis hand deformities were studied. Wrist involvement included distal ulnar subluxation in 14 wrists (with four requiring excision) and various degrees of carpal instability in 12 wrists (usually asymptomatic). Metacarpophalangeal (MP) joint subluxation treated by soft tissue procedures for passively correctable deformities in 30 joints had a failure rate of 70%. MP joint arthroplasties performed in 33 joints gave fair results in 16 joints with fixed deformities and good results in 17 joints with passively correctable deformities. Thumb deformities always involved all three joints, and maintenance of carpometacarpal (CMC) joint stability was the key to thumb reconstruction. CMC joint stabilization with ligamentous reconstruction gave good results in three of four thumbs. Four CMC joint fusions and two CMC joint implant arthroplasties gave good results. Each was accompanied by appropriate procedures on the MP joint or interphalangeal joint.