Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations

Abstract Background: Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. Methods: Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. Results: Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. Conclusions: No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.(AU)

Distal radius and tibia bone microarchitecture impairment in female patients with diffuse systemic sclerosis.

Radius and tibia bone microarchitecture, analyzed through a high-resolution peripheral quantitative computed tomography, were significantly impaired in female patients with diffuse systemic sclerosis compared with healthy controls. Acroosteolysis, quality of life-grip strength, hand disability, and disease duration were significantly associated with this bone deterioration. INTRODUCTION: The effect of diffuse systemic sclerosis (dSSc) on the bone is not completely understood. The objective of this study was to analyze the volumetric bone mineral density (vBMD), microarchitecture, and biomechanical parameters at the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT, XtremeCT) in female patients with dSSc and identify clinical and laboratory variables associated with these parameters. METHODS: Thirty-eight women with dSSc and 76 healthy controls were submitted to HR-pQCT at the distal radius and tibia. Clinical and laboratory findings, bone mineral density(BMD), nailfold capillaroscopy (NC), total passive range of motion(ROM), and quality of life (health assessment questionnaire-HAQ) were associated with HR-pQCT (Scanco Medical AG, Brüttisellen, Switzerland) parameters. Multiple linear regression models adjusted for clinical and laboratory variables, ROM and HAQ, were performed. RESULTS: Density, microarchitecture, and biomechanical parameters at the distal radius and tibia were significantly impaired in dSSc patients compared with healthy controls (p < 0.001). Multiple linear regression models showed that lower trabecular density (Tb.vBMD) (radius R2 = 0.561, p = 0.002; and tibia R2 = 0.533, p = 0.005), and lower trabecular number (Tb.N) (tibia R2 = 0.533, p = 0.005) were significantly associated with acroosteolysis. Higher trabecular separation (Tb.Sp) was associated with disease duration and higher HAQ-grip strength (radius R2 = 0.489, p = 0.013), while cortical density (Ct.vBMD) was associated with ROM (radius R2 = 0.294, p = 0.002). CONCLUSION: Bone microarchitecture in patients with dSSc, analyzed through HR-pQCT, showed impairment of trabecular and cortical bone at distal radius and tibia. Variables associated with hand involvement (acroosteolysis, quality of life-grip strength, and ROM) and disease duration may be considered prognostic factors of this bone impairment.

A novel treatment for idiopathic knuckle pads with cantharidin-podophylotoxin-salicylic acid.

Knuckle pads are benign subcutaneous nodules that appear most frequently on the small joints of the hands. In children, they are often idiopathic, and no universally effective treatment has been reported. We present the case of an adolescent successfully treated with a combination of topical cantharidin -podophylotoxin -salicylic acid.

Motion deficit in nodal interphalangeal joint osteoarthritis by digital goniometer in housewives.

Range of motion (ROM) measured objectively in nodal hand osteoarthritis (NHOA) is missing. Evaluation of collateral ligaments by ultrasound (US) is unknown in NHOA also. To compare ROM in interphalangeal joints in housewives with nodal OA, with a control group by a digital system using angle to voltage (Multielgon). The second objective was to assess correlation between collateral radial and ulnar ligaments thickness and ROM. For this cross-sectional observational study, we assessed 60 hands with symptomatic NHOA and 30 hands of healthy housewives matched for age. We obtained clinical and demographic characteristics (a complete standardized physical examination of hand joints, DASH questionnaire, pain surveys, gross grasp hand goniometer, and ROM measurements by Multielgon. Presence of synovitis, power Doppler signal, osteophytes, and collateral ligaments thickness was evaluated by US. We used descriptive statistics, Spearman correlation, X2 test, t test and odds ratio. Significant less gross grasp and ROM in the right hand were observed in NHOA (p = 0.01 for both). Presence of OA, painful joints, disease duration, and score DASH were significant correlated with reduced ROM (OR 4.12, 4.12, 1.04 and 1.09, respectively). Reduced ROM was statistical significant in thumb MCP and IP joints, second and third DIP in dominant hand. There was no association between collateral radial and ulnar ligaments and reduced ROM. Synovitis and osteophytes were more prevalent in OA group. Multielgon demonstrated the pattern of reduced ROM in nodal OA of housewives particularly in MCP and IP thumb joints, second and third distal interphalangeal joints.

Interphalangeal Joint Sonography of Symptomatic Hand Osteoarthritis: Clinical and Functional Correlation.

OBJECTIVES: To assess the correlation between inflammatory sonographic findings (grayscale synovial hypertrophy and power Doppler) and clinical and functional assessments in hand osteoarthritis (symptomatic interphalangeal joints) and to correlate the intraobserver and interobserver reliability of these findings. METHODS: A prospective double-blind study of 60 interphalangeal joints was conducted. The joints were assessed 6 times per year by clinician and sonographer observers. RESULTS: A total of 720 measurement recesses were included (360 palmar and 360 dorsal). Small correlations and a few associations were found. Proximal interphalangeal joint quantitative measurements of the dorsal recess showed a statistical correlation with joint swelling (P = .043) and pulp-to-pulp pinch strength (P = .043); in the palmar recess, statistical correlations were seen for joint swelling (P = .007), the Australian/Canadian (AUSCAN) Function Index (P = .044), and grip and finger strength (P = .037, .003, .019, and .017). In dorsal semiquantitative assessments, there were associations between sonographic findings and joint swelling (P = .010) and pinch strength (P = .027, .003, and .014); in the palmar recess, we found associations with the AUSCAN Index (P = .048) and grip and finger strength (P = .031, .006, and 0.041). No correlations or associations were found in distal interphalangeal joints. Power Doppler signals were found in only 1.7% of the sample, precluding statistical analysis. Excluding palmar semiquantitative assessments in distal interphalangeal joints (P = .623), sonographic findings were reliable (intraclass correlation coefficients, 0.474-0.857; κ = 0.390-0.673). CONCLUSIONS: Joint swelling, grip and pinch strength, and the AUSCAN Index were weakly correlated and associated with sonographic findings in proximal interphalangeal joints. Intraobserver and interobserver sonographic assessments were reliable.

The effect of finger joint hypomobility on precision grip force.

STUDY DESIGN: Repeated measures experiment. INTRODUCTION: Traumatic injuries and certain other diseases of the hand typically affect mobility of the finger joints. Decreased mobility may alter grip force control while one is grasping and lifting objects. However, the effect of finger joint hypomobility on grip force control has not yet been systematically investigated. PURPOSE OF THE STUDY: The aim of this study was to investigate the effects of limited finger joint mobility, without other associated symptoms like pain, or sensory/proprioceptive deficits, on precision grip force control. METHODS: Fifteen healthy subjects performed a pinching and lifting task of an object equipped with a force sensor and an accelerometer, via opposition of the thumb and index finger, in the following experimental conditions: unrestricted finger joint movement (UJM), restricted finger flexion (RFF), restricted finger extension (RFE), mock restricted flexion (MRF), mock restricted extension (MRE). The following pinch force variables were measured and analyzed: grip force at lift off, grip force peak, load force peak, latency, and static force. RESULTS: A significant increase in latency (F = 4.41, p < 0.01) was noted during RFE relative to UJM and MRF conditions. There were no statistically-significant differences between the conditions among the other variables of precision grip force control. CONCLUSIONS: Limited joint mobility of the thumb and index finger may cause temporal changes in precision grip force control, which can lead to reduced manual dexterity. Restoring range of motion might be an important priority to improve thumb-index pinch force control during manipulative tasks.

Avaliação do tratamento da camptodactilia: análise retrospectiva de 22 pacientes, em um total de 39 dígitos

Camptodactilia é uma deformidade congênita caracterizada por uma postura em flexão na IFP, geralmente encontrada no dedo mínimo. Afeta aproximadamente 1% da população. A causa primária para esta deformidade é ainda motivo de discussão, não havendo consenso na literatura mundial. Se não for tratada haverá uma piora progressiva em cerca de 80% dos casos. Essa patologia, de aparência relativamente simples, não é fácil de ser tratada. O problema reside no fato da existência de várias formas de apresentação clínica, o que faz com que não haja um modelo único de tratamento efetivo. O objetivo deste estudo é avaliar, retrospectivamente, os resultados dos casos tratados no serviço de Cirurgia da Mão do INTO-MS-RJ, a partir de um protocolo pré estabelecido; e realizar uma análise crítica dos resultados alcançados, separando os casos em seus respectivos subgrupos. Foram avaliados 22 pacientes, num total de 39 dígitos, de janeiro de 2004 a dezembro de 2012. Relacionamos as estruturas anatômicas alteradas encontradas nos casos que foram submetidos a procedimento cirúrgico e seus resultados, tanto no tratamento conservador, como para os cirúrgicos, enfatizando suas principais indicações. Os resultados foram analisados pelo método de Sierget e col da clínica Mayo. Observamos que os casos de camptodactilia isolada do dedo mínimo na forma flexível, >60º, que foram submetidos a tratamento cirúrgico, de maneira uniforme apresentaram resultados excelentes. Nas formas rígidas, nossas observações indicam benefícios com ganho de extensão e correção da deformidade, entretanto o arco de movimento com flexão ativa na IFP é sempre parcial. Com o tempo de evolução alguns casos apresentaram alguma perda de ganho previamente alcançado, o que corrobora a permanente vigilância necessária no acompanhamento, com uso sistemático de órteses, até a fase final do crescimento esquelético.

Silicone arthroplasty for chronic proximal interphalangeal joint dislocations.

Chronic dislocations of the proximal interphalangeal (PIP) joint pose a significant treatment challenge. Chronically dislocated PIP joints can experience several changes to the articular cartilage including pressure necrosis, degeneration, and the development of secondary incongruence. Moreover, chronic dislocation allows the edema and hemorrhage from soft tissue trauma to develop into collateral ligament fibrosis and inelastic scar formation. Similarly, chronic dislocations associated with a fracture at the base of the middle phalanx can also experience changes in the form of joint incongruency, bony resorption, or malunion formation. Subsequently, these cumulative joint changes prohibit standard open reduction of the PIP joint and can cause significant loss of motion thereby demanding a different approach to restore motion and minimize pain. We propose the use of silicone arthroplasty in the management of chronic dislocations of the PIP joint.

Brachialis muscle transfer to reconstruct finger flexion or wrist extension in brachial plexus palsy.

PURPOSE: Tendon transfers are a routine procedure used to improve hand function in brachial plexus injuries; however, muscles from forearm donors are not always available for transfer. In this situation a distant muscle may be used. This study describes transfer of the brachialis muscle to the forearm muscles to reconstruct finger flexion or wrist extension in patients with brachial plexus injuries. METHODS: In 6 patients the brachialis muscle was transferred to the flexor digitorum profundus and the flexor pollicis longus to restore finger and thumb flexion with the goal of reconstructing a key pinch and hook grasp. In 3 patients the brachialis muscle was transferred to the extensor carpi radialis brevis to restore wrist extension. The patients were evaluated at regular intervals and had final assessments between 10 and 12 months after surgery. RESULTS: Brachialis transfer to the flexor digitorum profundus and the flexor pollicis longus resulted in active motion with full range of digital flexion in the 2 patients who had partial flexion before surgery, and for the 4 patients who had no finger flexion before surgery it resulted in a pulp-to-palm distance for the middle finger of 1 cm in 3 patients and of 2 cm in 1 patient. A lateral key pinch and hook grasp reconstruction was achieved in all patients. Grasping and lateral pinch strengths averaged 110 and 94 mm Hg, respectively. When the brachialis was transferred to the wrist extensors the patients recovered 20 degrees of active wrist extension against resistance. CONCLUSIONS: Brachialis muscle transfer to the forearm muscle constitutes a valid strategy in the reconstruction of finger and thumb flexion and wrist extension after brachial plexus injury when forearm donor muscles are not available. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

The trapeziometacarpal joint. Tenotomy of the accessory tendons in early osteoarthritis.

The TMC joint is an articulation with special articular surfaces adapted to produce simple (nonrotatory) and complex (rotatory) metacarpal movements. Its articular anatomy and biomechanics are closely related to the pathogenesis of osteoarthritis. The joint works under high transarticular compressive-shearing forces. In osteoarthritic thumbs, the articular forces are increased because of the constant presence of accessory APL tendons, almost exclusively of the digastric type. Other factors should be considered in the pathogenesis of TMC joint osteoarthritis, such as repetitive use of the thumb under unfavorable patterns of function) strong side-to-side pinch grips, thumb with the tendency to maintain in reposition), cartilage aging, hormonal disturbances in women, and general osteoarthritic disease. Osteoarthritic thumbs in stages I and II that have failed to respond to conservative treatment are candidates to unload the joint by tenotomy of the transarticular accessory tendons. Long-term results have been very satisfactory (97%), eliminating or substantially reducing pain and returning patients to their activity. The procedure is contraindicated in severe (stage III) TMC joint osteoarthritis and in primary articular instability.

Camptodactilia congenita del quinto dedo de la mano: fisiopatologia y tratamiento / Congenital camptodactyly of the fifth finger: physiopathology and treatment

Desde 1990 hasta 1993 fueron operados 11 dedos con deformidad congenita en flexion del quinto dedo de la mano, en 5 pacientes. Todos los casos tenian contractura en flexion de la articulacion interfalangica proximal (IFP) con hiperextension de la metacarpofalangica (MF). Con la maniobra de oponerse a la hiperextension de la MF (prueba de Bouviere) se lograba la extension de la IFP en mas de 50 grados. Tambien habia lesiones asociadas con dedos de los pies en garra y pies cavus. La evaluacion neurologica clinica y el electromiograma no revelaron patologia alguna, tanto central como periferica. En los 11 dedos se realizo la transferencia del flexor superficial del quinto dedo a la polea flexora (tecnica del lazo) por abordaje transversal en el pliegue palmar distal. Con la transferencia se corrigio la hiperextension de la MF y la flexion de la IFP, con lo que se restituyo la biomecanica del aparato extensor. El seguimiento fue de mas de 6 meses. Los resultados obtenidos se evaluaron en un periodo de entre 2 y 6 años. En todos lo casos se logro corregir la hiperextension de la MF y se obtuvo una mejoria del 90 por ciento de la deformidad en flexion de la IFP

Camptodactilia congenita del quinto dedo de la mano: fisiopatologia y tratamiento / Congenital camptodactyly of the fifth finger: physiopathology and treatment

Desde 1990 hasta 1993 fueron operados 11 dedos con deformidad congenita en flexion del quinto dedo de la mano, en 5 pacientes. Todos los casos tenian contractura en flexion de la articulacion interfalangica proximal (IFP) con hiperextension de la metacarpofalangica (MF). Con la maniobra de oponerse a la hiperextension de la MF (prueba de Bouviere) se lograba la extension de la IFP en mas de 50 grados. Tambien habia lesiones asociadas con dedos de los pies en garra y pies cavus. La evaluacion neurologica clinica y el electromiograma no revelaron patologia alguna, tanto central como periferica. En los 11 dedos se realizo la transferencia del flexor superficial del quinto dedo a la polea flexora (tecnica del lazo) por abordaje transversal en el pliegue palmar distal. Con la transferencia se corrigio la hiperextension de la MF y la flexion de la IFP, con lo que se restituyo la biomecanica del aparato extensor. El seguimiento fue de mas de 6 meses. Los resultados obtenidos se evaluaron en un periodo de entre 2 y 6 años. En todos lo casos se logro corregir la hiperextension de la MF y se obtuvo una mejoria del 90 por ciento de la deformidad en flexion de la IFP

The syndrome of pericarditis, arthritis, and camptodactyly: an under-recognized cause of pericardial constriction in children?

The syndrome encompassing the combination of pericarditis, arthritis, and camptodactyly is a rarely described cause of pericardial constriction in children. It is likely that this association is being under-recognized. We report a new case in which the skeletal abnormalities were subtle. The syndrome should be included in the differential diagnosis of any child with persistent non-inflammatory pericardial effusion. A careful search at the bedside for the associated skeletal abnormalities should lead to the correct diagnosis. Pericardiectomy is the treatment of choice.

Traçäo dinâmica e movimentaçäo passiva para as fraturas de falanges e suas sequelas / Dynamic traction and passive motion for phalangeal joint fractures and their sequels

Os autores estudaram prospectivamente, no período de 1988 a 1994, 11 pacientes tratados pelo método de traçäo contínua, no serviço de Cirurgia da Santa Casa de Misericórdia do Rio de Janeiro e no Serviço de Ortopedia do Hospital da Lagoa. Cinco pacientes tiveram fraturas de articulaçöes interfalangiana proximal e metacarpofalangiana e seis eram os casos desse tipo de fraturas por sequelas. O objetivo deste trabalho é mostrar um método mais natural para o tratamento dessas fraturas täo difíceis e suas sequelas.