scholarly journals The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis--a high-resolution MRI and histological study

Rheumatology ◽  
2006 ◽  
Vol 46 (2) ◽  
pp. 253-256 ◽  
Author(s):  
A. L. Tan ◽  
M. Benjamin ◽  
H. Toumi ◽  
A. J. Grainger ◽  
S. F. Tanner ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
High Resolution ◽  
Histological Study ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Joint Disease ◽  
Distal Interphalangeal Joint ◽  
High Resolution Mri ◽  
Distal Interphalangeal ◽  
The Relationship

scholarly journals Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis

2018 ◽  
Vol 7 (12) ◽  
pp. 546 ◽  
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Agnieszka Owczarczyk-Saczonek ◽  
Waldemar Placek ◽  
Maja Wojtkiewicz ◽  
Joanna Wojtkiewicz
Keyword(s):  
Nail Plate ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Response To Treatment ◽  
Distal Interphalangeal Joint ◽  
Nail Psoriasis ◽  
The Matrix ◽  
Tendon Thickness ◽  
Distal Interphalangeal ◽  
Methotrexate Treatment

To assess the effect of methotrexate on the development of distal interphalangeal joint extensor tendon enthesopathy in psoriasis, thirty-two people aged 34 to 57 years with nail psoriasis and distal interphalangeal joint extensor tendon enthesopathy (19 patients with Ps (psoriasis) and 13 with PsA (psoriatic arthritis) were started on methotrexate at 15 to 25 mg/week and the treatment was continued for 6 months). A total of 319 nails were examined. After six months of treatment, the thicknesses of the nail plate, nail bed and nail matrix were found to decrease in both groups of patients. Methotrexate treatment resulted in a decrease in the joint extensor tendon thickness only in patients with Ps (0.94 ± 0.05 vs. 0.96 ± 0.04, p < 0.001), where the tendon thickness after treatment correlated with the matrix thickness (r = 0.337, p = 0.018) and with the bed thickness (r = 0.299, p = 0.039). Methotrexate treatment resulted in a decrease in the extensor tendon thickness only in patients with Ps but not in PsA. The findings of this study may suggest the effectiveness of systemic treatment of nail psoriasis in patients without arthritis and the use of US nail examinations in Ps and PsA patients in morphological change assessment and response to treatment.

The Surface Anatomy of the Germinal Matrix of the Nail Bed in the Finger

1999 ◽  
Vol 24 (5) ◽  
pp. 531-533 ◽  
Author(s):  
C. M. REARDON ◽  
P. A. McARTHUR ◽  
S. K. SURVANA ◽  
T. M. BROTHERSTON
Keyword(s):  
Histological Study ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Germinal Matrix ◽  
Nail Matrix ◽  
Surface Anatomy ◽  
Angular Extent ◽  
Distal Interphalangeal ◽  
Lateral Extent ◽  
The Mean

Nail spicules result from incomplete excision of the nail matrix of the finger. We report a histological study to delineate the surface anatomy of the nail matrix. Sections were cut longitudinally and transversely in 19 fingertips. The proximal midline extent of the nail matrix was measured and expressed as a ratio of the distance from the nail fold to the distal interphalangeal joint. In the lateral sections, the angle subtended between the midline vertical and the lateral extent of the nail matrix was measured. The mean ratio of the proximal extent was 0.55 in the midline and the lateral angular extent was 66°. The authors recommend that excision of the nail matrix should be rectangular, extending to the midlateral lines and proximally to a point three-quarters of the distance from the nail fold to the distal interphalangeal joint crease.

scholarly journals High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis

2014 ◽  
Vol 74 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Ai Lyn Tan ◽  
Eiji Fukuba ◽  
Nicola Ann Halliday ◽  
Steven F Tanner ◽  
Paul Emery ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
High Resolution ◽  
Flexor Tendon ◽  
Extensor Tendon ◽  
Proof Of Concept ◽  
Collateral Ligament ◽  
High Resolution Mri ◽  
Signal Changes ◽  
Flexor Tenosynovitis ◽  
Normal Controls

ObjectiveDactylitis is a hallmark of psoriatic arthritis (PsA) where flexor tenosynovitis is common. This study explored the microanatomical basis of dactylitis using high-resolution MRI (hrMRI) to visualise the small entheses around the digits.MethodsTwelve patients with psoriatic dactylitis (4 fingers, 8 toes), and 10 healthy volunteers (6 fingers, 4 toes) had hrMRI of the digits using a ‘microscopy’ coil and contrast enhancement. All structures were evaluated including the tendons and ligaments, related enthesis organs, pulleys, volar/plantar plates and tendon sheaths.ResultsIn dactylitis, collateral ligament enthesitis was seen in nine digits (75%), extensor tendon enthesitis in six digits (50%), functional enthesitis (5 digits, 42%), abnormal enhancement at the volar plates (2/5 joints, 40%) and the plantar plate (1/5 joints, 20%). Nine cases (75%) demonstrated flexor tenosynovitis, with flexor tendon pulley/flexor sheath microenthesopathy observed in 50% of all cases. Less abnormalities which were milder was observed in the normal controls, none of whom had any signal changes in the tendon pulleys or fibrous sheaths.ConclusionsThis study provides proof of concept for a link between dactylitis and ‘digital polyenthesitis’ including disease of the miniature enthesis pulleys of the flexor tendons, further affirming the concept of enthesitis in PsA.

scholarly journals Broken Kirschner Wire in Distal Interphalangeal Joint Fixation: A Case Report

2021 ◽  
Vol 26 (3) ◽  
pp. 171-173
Author(s):  
Kyung Jin Lee ◽  
Jung Hyun Park ◽  
Sung Hoon Koh ◽  
Dong Chul Lee ◽  
Si Young Roh ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Distal Interphalangeal Joint ◽  
Protective Measures ◽  
X Ray ◽  
Distal Interphalangeal ◽  
Continued Use

Kirschner wire (K-wire) has been widely used for treatment of fracture for its cost-effectiveness and reliability. This case presents the K-wire breakage in distal interphalangeal joint (DIPJ) fixation. A 55-year-old male patient was injured by a knife and showed rupture of extensor tendon at 1/2 of middle phalanx. A 0.9-mm K-wire was implemented for DIPJ extension, and tenorrhaphy was done. After 6 weeks, we detected breakage of K-wire in the follow-up X-ray. The broken K-wire in the distal phalanx was removed. We removed the remaining K-wire through an incision on volar side of middle phalanx under C-arm after 2 weeks for the patient’s personal reasons. Breakage during postoperative K-wire maintenance is exceedingly rare. This patient is presumed to have ruptured because he continued using his finger. Therefore, while K-wire is present, continued use of finger without protection may cause breakage, so protective measures such as splint are required.

Nail Enthesis Ultrasound in Psoriasis and Psoriatic Arthritis: A Report from the 2016 GRAPPA Annual Meeting

2017 ◽  
Vol 44 (5) ◽  
pp. 688-690 ◽  
Author(s):  
Joanne Szczygiel Cunha ◽  
Abrar A. Qureshi ◽  
Anthony M. Reginato
Keyword(s):  
Psoriatic Arthritis ◽  
Ultrasound Examination ◽  
Power Doppler ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Structure And Morphology ◽  
Nail Changes ◽  
Close Relationship ◽  
Distal Interphalangeal ◽  
Musculoskeletal Ultrasonography

Musculoskeletal ultrasonography is gaining favor in the evaluation of enthesitis in patients with psoriasis and psoriatic arthritis (PsA). Imaging modalities have shown that the enthesis of the distal interphalangeal joint has a close relationship to the nail itself. Studies have focused on the structure and morphology of nails to determine an association between psoriasis nail changes and the presence or severity of PsA. With the use of higher frequency probes, power Doppler (PD) can determine subclinical inflammation of the area under ultrasound examination. At the 2016 meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we proposed an ultrasonographic index for the assessment of the nail enthesis to identify the morphologic and PD findings of the nail, with the potential that both rheumatologists and dermatologists can use it to evaluate their patients.

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