Triggering, clicking, locking and crepitus of the finger: A comprehensive overview.

Triggering, locking, clicking, and crepitus of the fingers are common symptoms patients present with. Even though crepitus and triggering can occur as part of the same underlying diagnosis, it is important to differentiate between them, as they usually indicate different possible diagnoses. The differential diagnoses that should be considered include trigger finger, metacarpophalangeal joint (MCPJ) arthritis, fractures or dislocations, extensor digitorum communis subluxation or dislocation, locked MCPJ, avascular necrosis of the metacarpal head, and Dupuytren's disease. A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis. Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.

Traumatic hand injury management and outcomes: A case report.

Acute hand injuries are routinely managed by family medicine and primary care physicians. An appropriate initial assessment and treatment, early referral to a hand surgeon when indicated, and timeous referral to a hand therapist are imperative. A patient case report is presented reporting on the initial and subsequent assessment, treatment and outcomes at 3, 6, 7 and 9 months for a patient who sustained an acute finger injury. Finger range of motion (ROM), sensation, pain, time of wound closure, hand function measured with the standardised disability of the shoulder, arm and hand (DASH) questionnaire were the outcomes used. Pain, crepitus, decreased sensation, decreased ROM right index finger proximal interphalangeal joint (PIPJ) and dense scarring was measured at 9 months. Missed injuries or lack of recognition of injury severity leads to delayed referral to specialist hand surgeons and therapists, which lengthens recovery time and leads to sub-optimal outcomes. This article aims to provide the primary care practitioner with the initial management of a patient who sustained a traumatic hand injury whilst using a power tool.

Surface Replacement Proximal Interphalangeal Joint Arthroplasty: A Case Series.

Background: In 2012, our unit published our experience with a pyrocarbon proximal interphalangeal joint (PIPJ) implant. Due to high subsidence rates, a decision was made to change to a cemented surface replacement proximal interphalangeal joint (SR-PIPJ) implant. The purpose of this study was to assess whether the change to a cemented implant would improve the subsidence rates. Methods: Retrospective review of all patients who had a cemented SR-PIPJ arthroplasty performed from 2011 to 2013 with at least 12 months follow-up. Results: A total of 43 joints were included with an average follow-up of 26.5 months. There was a significant (P = .02) improvement in arc of motion with an average satisfaction score of 3.3 (satisfied patient). Subsidence was noted in 26% of joints with a significant difference in range of motion (P = .003) and patient satisfaction (P = .001) between the group with and without subsidence. Conclusions: The change to a cemented implant resulted in satisfied patients with an improvement in range of motion. The rate of subsidence improved but remains unacceptably high.