X-ray Guided Steroid Injections for Proximal Interphalangeal Joint Osteoarthritis of the Fingers

2017 ◽  
Vol 22 (02) ◽  
pp. 214-218 ◽  
Author(s):  
Clare A. Miller ◽  
Stephen Dalgleish ◽  
Quentin Cox
Keyword(s):  
Simple Procedure ◽  
Hand Function ◽  
Image Intensifier ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Prospective Audit ◽  
Range Of Movement ◽  
Steroid Injections ◽  
X Ray ◽  
Pain Scores

Background: Osteoarthritis of the finger proximal interphalangeal joints (PIPJ's) is common and severely limits hand function. Intra-articular steroid injections are frequently used, but there is little research assessing this treatment option. Methods: This was a prospective audit of patients undergoing intra-articular steroid injections into the PIPJ under image intensifier guidance. The aims were to assess the duration of pain relief, hand function and range of movement following this procedure. Fifty injected joints were followed up at six weeks, three and six months. Results: There were significant improvements in both pain scores and the range of movement for up to three months. Analgesia requirements decreased and hand function improved up to three months. By six months, patients were approaching their preinjection scores. Conclusions: X-ray guided injections are a simple procedure which can be effectively performed in the out- patient setting, resulting in satisfied patients with improved hand function and pain scores.

A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis: a cross-sectional analysis

2019 ◽  
Vol 45 (2) ◽  
pp. 187-192
Author(s):  
Shogo Toyama ◽  
Ryo Oda ◽  
Maki Asada ◽  
Satoru Nakamura ◽  
Masato Ohara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Hand Function ◽  
Metacarpophalangeal Joint ◽  
Interphalangeal Joint ◽  
Strongly Correlated ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Joint Preserving Surgery

The most common thumb deformity in rheumatoid arthritis is Nalebuff Type 1 deformity (boutonniere deformity). Type 1 deformity severely impairs hand function, and this impairment is evaluated by the Terrono classification. In some cases, the Terrono classification incorrectly categorizes advanced thumb deformity into earlier stages. We modified the Terrono classification by assessing the active range of motion of the interphalangeal joint prior to assessing the passive range of movement of the metacarpophalangeal joint. An active range of movement of the interphalangeal joint was strongly correlated with hand function. In 55 hands that we treated between 2004 and 2015, we compared the modified classification with the original Terrono classification. Our modified classification could detect advanced deformity earlier, and was more strongly correlated with hand function. Additionally, correlation analysis showed that advanced Type 1 deformity should be treated first, even in cases with severe ulnar drift. Our results suggest that the modified classification may benefit the treatment of Type 1 deformity, including joint-preserving surgery. Level of evidence: III

EXTERNAL FIXATION OF THE HAND: A SIMPLE APPROACH TO COMMINUTED PROXIMAL INTERPHALANGEAL JOINT FRACTURES

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 85-89 ◽  
Author(s):  
Alexander Kubitskiy ◽  
Bishoy A. B. Soliman ◽  
Michael B. Dowd ◽  
Paul Curtin
Keyword(s):  
External Fixation ◽  
Treatment Options ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Range Of Movement ◽  
Active Motion ◽  
Non Union ◽  
Poor Treatment ◽  
Total Active Motion

Proximal interphalangeal joint (PIPJ) fractures are a treatment challenge for hand surgeons. Poor treatment options may lead to stiffness, non-union and markedly reduced range of movement (ROM). We describe our experience using the Hoffman-2 micro static external fixation device (Stryker) in a case series of ten patients with closed comminuted intra-articular PIPJ fractures. The use of this device in the management of these fractures has not previously been described. The mean total active motion (TAM) of the injured joint had recovered to 80% of normal at the six-month follow up.

Destructive Arthropathy of the Interphalangeal Joint Following Revascularization After Degloving Hand Injury: A Case Report

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Akihiro Hirakawa ◽  
Shingo Komura ◽  
Tomihiro Masuda ◽  
Kazu Matsumoto ◽  
Haruhiko Akiyama
Keyword(s):  
Hand Surgery ◽  
Tendon Graft ◽  
Hand Injury ◽  
Proximal Interphalangeal Joint ◽  
Functional Restoration ◽  
Interphalangeal Joint ◽  
Functional Improvement ◽  
X Ray ◽  
Degloving Injury ◽  
Destructive Arthropathy

It is difficult to achieve satisfactory results in the treatment of advanced degloving injury, which is one of the most challenging injuries in hand surgery. In this report, we present a case of marked destructive arthropathy of the interphalangeal joint that developed following revascularization after degloving hand injury. A 37-year-old, right-handed female manual worker sustained a degloving injury of her fingers, including the dorsal hand. We performed revascularization and secondary surgery, which included tenolysis and a tendon graft, to obtain functional improvement. These 2 procedures provided significant improvement in the active range of motion of the respective fingers. However, the patient complained of postoperative pain in the proximal interphalangeal joint. X-ray revealed destructive changes in the interphalangeal joint, which advanced progressively. Destructive changes in the interphalangeal joint following advanced degloving injury should be recognized as a potential complication that could be a limitation of functional restoration. Follow-up X-ray examination is necessary, even in cases with no fracture of the phalanges at the time of injury. In the management of degloving injury, patients should be informed of the potential risk of destructive arthropathy, which could result in restricted motion with pain.

A Search Satisfied Skateboarder

2020 ◽  
pp. 181-186
Author(s):  
Pat Croskerry
Keyword(s):  
Young Male ◽  
Middle Finger ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plate ◽  
Common Error ◽  
X Ray ◽  
Clinical Clerk ◽  
Complete Search ◽  
Attending Physician

In this case, a clinical clerk sees a young male who has sustained an injury to his hand while skateboarding. She focuses on his middle finger and orders an X-ray. It shows a fracture at the proximal interphalangeal joint, often associated with injuries to the volar plate. In the course of reviewing the case with the attending physician, further injuries come to light. The case is a good example of search satisficing bias, the tendency to call off a search before it is complete. Search satisficing is probably one of the older “evolutionary” biases and is the second most common error in radiology.

Nonoperative Treatment of Fixed Flexion Deformity of the Proximal Interphalangeal Joint

1999 ◽  
Vol 24 (3) ◽  
pp. 281-283 ◽  
Author(s):  
E. HUNTER ◽  
J. LAVERTY ◽  
R. POLLOCK ◽  
R. BIRCH
Keyword(s):  
Nonoperative Treatment ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexion Deformity ◽  
Range Of Movement ◽  
The Average Range ◽  
Fixed Flexion Deformity

Sixty-one stiff, stable proximal interphalangeal joints were treated by exercise and splinting. The average range of movement was 24° to 67° before treatment; this increased to 8° to 98° after treatment. The indications and technique are described.

Acute Calcification in the Fingers

1985 ◽  
Vol 10 (2) ◽  
pp. 263-266
Author(s):  
IAN A. TRAIL
Keyword(s):  
Differential Diagnosis ◽  
Local Anaesthetic ◽  
Acute Infection ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
X Ray

A patient with acute calcification of the proximal interphalangeal joint is presented to emphasize its importance in the differential diagnosis of acute infection in the finger. The diagnosis is made both clinically and by x-ray. The calcification may not be seen on standard views and oblique views may be necessary. Treatment is conservative by immobilisation and the injection of local anaesthetic.

Medium-term outcomes of pyrocarbon arthroplasty of the proximal interphalangeal joint

2012 ◽  
Vol 37 (6) ◽  
pp. 497-500 ◽  
Author(s):  
J. R. B. Hutt ◽  
O. Gilleard ◽  
A. Hacker ◽  
N. Citron
Keyword(s):  
Range Of Motion ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Implant Removal ◽  
Medium Term ◽  
Pain Scores ◽  
Potential Failure

We evaluated the outcome of pyrocarbon arthroplasty for proximal interphalangeal joint osteoarthritis in 18 arthroplasties carried out by a single surgeon using the Ascension prosthesis (Ascension Orthopedics Inc., Austin, Texas) in 15 patients after a mean of 6.2 years. Significant and maintained improvements in pain scores at rest and on active movements were achieved for surviving implants, and the range of motion was comparable with preoperative measurements. The radiographs, which were evaluated for evidence of ongoing migration and potential failure, were of concern in 10 out of 18 joints. Two patients required implant removal.

Pins and Rubber Traction System for Intra-Articular Proximal Interphalangeal Joint Fractures Revisited

2010 ◽  
Vol 35 (5) ◽  
pp. 396-401 ◽  
Author(s):  
G. Debus ◽  
A. Courvoisier ◽  
S. Wimsey ◽  
P. Pradel ◽  
F. Moutet
Keyword(s):  
Learning Curve ◽  
Simple Procedure ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
System A ◽  
Articular Fractures ◽  
Joint Fractures ◽  
Joint Flexion ◽  
Traction System

The Pins and Rubber Traction System (PRTS) can be used to treat proximal interphalangeal intra-articular fractures. Our experience is that outcomes are not always excellent and that many patients have reduced joint function or residual deformities. The aim of this study was to evaluate the reasons behind the poorer outcomes of some of the patients treated with this system. A retrospective clinical and radiological evaluation was performed on 15 patients after a minimum of 2 years’ follow-up. The mean interphalangeal joint flexion range was 66° (range 0—100) in our series. The review of the literature shows an average active interphalangeal joint flexion of 78° (range 64—95). Reasons for this difference include preoperative delay, technical deficiencies, the learning curve, a lack in postoperative physiotherapy and degenerative changes due to the longer follow-up. Although the Pins and Rubber Traction System seems a simple procedure, a learning curve is necessary to avoid pitfalls.

scholarly journals Design of a Reconfigurable Robotic System for Flexoextension Fitted to Hand Fingers Size

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
J. Felipe Aguilar-Pereyra ◽  
Eduardo Castillo-Castaneda
Keyword(s):  
Adult Population ◽  
Full Range ◽  
Tracking Error ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Robotic System ◽  
Interphalangeal Joint ◽  
Range Of Movement ◽  
Population Maximum ◽  
Displacement Speed

Due to the growing demand for assistance in rehabilitation therapies for hand movements, a robotic system is proposed to mobilize the hand fingers in flexion and extension exercises. The robotic system is composed by four, type slider-crank, mechanisms that have the ability to fit the user fingers length from the index to the little finger, through the adjustment of only one link for each mechanism. The trajectory developed by each mechanism corresponds to the natural flexoextension path of each finger. The amplitude of the rotations for metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) varies from 0 to 90° and the distal interphalangeal joint (DIP) varies from 0 to 60°; the joint rotations are coordinated naturally. The four R-RRT mechanisms orientation allows a 15° abduction movement for index, ring, and little fingers. The kinematic analysis of this mechanism was developed in order to assure that the displacement speed and smooth acceleration into the desired range of motion and the simulation results are presented. The reconfiguration of mechanisms covers about 95% of hand sizes of a group of Mexican adult population. Maximum trajectory tracking error is less than 3% in full range of movement and it can be compensated by the additional rotation of finger joints without injury to the user.

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