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

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.

scholarly journals ANALYSIS OF CERVICAL SAGITTAL PARAMETERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 20 (2) ◽  
pp. 94-97
Author(s):  
Kaio Rodrigo Barreto Ramiro ◽  
Sylvio Mystro Neto ◽  
Ivan Guidolin Veiga ◽  
André Frazão Rosa ◽  
Mauricio Coelho Lima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Plane ◽  
Epidemiological Data ◽  
Cross Sectional Study ◽  
Control Group ◽  
Chi Square ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Thoracic Inlet ◽  
Sagittal Parameters

ABSTRACT Objective: To analyze the cervical sagittal parameters of patients with rheumatoid arthritis (RA) and compare them with the parameters obtained from healthy patients in a sample of the Brazilian population. Methods: Epidemiological data were collected and 72 radiographs of the cervical spine in the sagittal plane were evaluated by measuring the cervical sagittal parameters COG-C7 (distance measured between the center of gravity of the head and the C7 plumb line -cranial offset), C2-C7 lordosis (vertebrae from C2 to C7), T1S (T1 slope), TIA (thoracic inlet angle) and NT (neck tilt). Statistical analysis was performed using the Student’s t and chi-square tests. Results: The TIA and NT values in the RA group were 88.8° ± 12.6° and 54.5° ± 9.3°, respectively, while for the control group, they were 77.7° ± 7.9° and 50.5° ± 7.7°, respectively, the RA group values being statistically higher than the control group values (p <0.001 and p = 0.050, respectively). The values obtained for COG-C7, C2-C7 lordosis and T1S for the RA group were 9.4 ± 16.4mm, 25° ± 22.4° and 2.6° ± 10.1°, respectively, while for the control group they were 11.8 ± 17.6mm, 26.8° ± 12.5° and 30.9° ± 8.4°, respectively. Conclusions: Patients with RA present changes in the thoracic inlet parameters as compared to the control group, with a statistically significant increase in the TIA and NT values, outlining a characteristic compensatory pattern for maintaining cervical sagittal balance. Level of evidence III; Controlled cross-sectional study.

Ultrasound imaging of the distal radioulnar joint: a new method to assess ulnar radial translation in forearm rotation

2016 ◽  
Vol 42 (4) ◽  
pp. 389-394 ◽  
Author(s):  
C. E. Oldfield ◽  
M. R. Boland ◽  
D. Greybe ◽  
W. Hing
Keyword(s):  
Rheumatoid Arthritis ◽  
Ultrasound Imaging ◽  
Normal Values ◽  
Distal Radioulnar Joint ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Radioulnar Joint ◽  
Translational Movement ◽  
Healthy Participants ◽  
Very High

A cross-sectional reliability study was conducted with 23 normal participants to establish normal values, and the repeatability and validity of distal radioulnar joint translation measurements using ultrasound imaging. Static transverse images of maximal supination, neutral and maximal pronation were examined to assess translation, using a method consistent with the rheumatoid arthritis subluxation ratio. Translation while gripping a 1 kg weight in supinated and pronated positions was then compared with non-gripping translation. There was significantly more ulnar radial translation found with pronation than supination, when compared with neutral. Gripping in pronation did not produce statistically significant changes in translation, whereas the changes produced by gripping in supination were significant. Internal consistency was deemed very high and the rheumatoid arthritis subluxation ratio values measured using ultrasound imaging were consistent with previously documented values measured by computerized tomography. This study demonstrated that translational movement of the distal radioulnar joint can be reliably detected in healthy participants using ultrasound imaging. This may reduce dependency on other imaging modalities to diagnose distal radioulnar joint instability. Level of Evidence: 2.

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.

scholarly journals SUBTALAR JOINT IN NEUTRAL AND RELAXED POSITIONS FOR EVALUATION OF MEDIAL LONGITUDINAL ARCH

2021 ◽  
Vol 29 (4) ◽  
pp. 177-180
Author(s):  
ANDRÉ SETTI PERSIANE ◽  
DAIANE MAGALHÃES GOMES NEGRÃO ◽  
RAONE DALTRO PARAGUASSU ALVES ◽  
DIEGO GALACE DE FREITAS ◽  
CLÁUDIO CAZARINI JÚNIOR ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Cross Sectional Study ◽  
Medial Longitudinal Arch ◽  
Strongly Correlated ◽  
Test Results ◽  
Moderate Correlation ◽  
Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Longitudinal Arch

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson’s test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

scholarly journals Effectiveness of adaptive silverware on range of motion of the hand

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1667 ◽  
Author(s):  
Susan S. McDonald ◽  
David Levine ◽  
Jim Richards ◽  
Lauren Aguilar
Keyword(s):  
Range Of Motion ◽  
Repeated Measures ◽  
Hand Function ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
Main Effects ◽  
Minimal Research

Background.Hand function is essential to a person’s self-efficacy and greatly affects quality of life. Adapted utensils with handles of increased diameters have historically been used to assist individuals with arthritis or other hand disabilities for feeding, and other related activities of daily living. To date, minimal research has examined the biomechanical effects of modified handles, or quantified the differences in ranges of motion (ROM) when using a standard versus a modified handle. The aim of this study was to quantify the ranges of motion (ROM) required for a healthy hand to use different adaptive spoons with electrogoniometry for the purpose of understanding the physiologic advantages that adapted spoons may provide patients with limited ROM.Methods.Hand measurements included the distal interphalangeal joint (DIP), proximal interphalangeal joint (PIP), and metacarpophalangeal joint (MCP) for each finger and the interphalangeal (IP) and MCP joint for the thumb. Participants were 34 females age 18–30 (mean age 20.38 ± 1.67) with no previous hand injuries or abnormalities. Participants grasped spoons with standard handles, and spoons with handle diameters of 3.18 cm (1.25 inch), and 4.45 cm (1.75 inch). ROM measurements were obtained with an electrogoniometer to record the angle at each joint for each of the spoon handle sizes.Results.A 3 × 3 × 4 repeated measures ANOVA (Spoon handle size by Joint by Finger) found main effects on ROM of Joint (F(2, 33) = 318.68, Partialη2= .95,p< .001), Spoon handle size (F(2, 33) = 598.73, Partialη2= .97,p< .001), and Finger (F(3, 32) = 163.83, Partialη2= .94,p< .001). As the spoon handle diameter size increased, the range of motion utilized to grasp the spoon handle decreased in all joints and all fingers (p< 0.01).Discussion.This study confirms the hypothesis that less range of motion is required to grip utensils with larger diameter handles, which in turn may reduce challenges for patients with limited ROM of the hand.

Rheumatology

2019 ◽  
pp. 609-620
Keyword(s):  
Rheumatoid Arthritis ◽  
Soft Tissues ◽  
Clinical Signs ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Autoimmune Conditions ◽  
Osteoporosis Risk Factors ◽  
Drug Treatments ◽  
Distal Interphalangeal

Chapter 31 gives an overview of rheumatology, the study of rheumatic conditions which can involve the joints, soft tissues, and bones and also comprises connective tissue disorders, vasculitides, and a number of autoimmune conditions. The chapter outlines patterns of rheumatological disease (e.g. mono-, oligo-, and polyarthropathies), symmetrical versus asymmetrical presentations of disease, and explains how to try and differentiate between inflammatory and non-inflammatory disorders. The chapter provides information on common drug treatments, including dangerous side effects from improperly prescribed methotrexate. Advice is given on history taking and detailed hand examination, with clinical signs of rheumatoid arthritis: Swan neck deformity, Boutonniere’s deformity, Z deformity of thumb, Bouchard’s nodes (proximal interphalangeal joint), Heberden’s nodes (distal interphalangeal joint, first metacarpophalangeal joint), finger ulnar deviation (metacarpophalangeal joint), and wrist radial deviation and subluxation. The most common rheumatological disorders are discussed, including rheumatoid arthritis, spondyloarthropathy, ankylosing spondylitis, psoriatic arthritis, gout, and osteoporosis (including the ‘MESSAGE’ mnemonic for osteoporosis risk factors). The Chapel Hill classification for vasculitides is also covered.

Hand Function, Biomechanics and Disability

1980 ◽  
Vol 9 (4) ◽  
pp. 215-220
Author(s):  
W K Purves ◽  
N Berme ◽  
J P Paul
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Assessment ◽  
Joint Replacement ◽  
Index Finger ◽  
Hand Function ◽  
Three Dimensional ◽  
Normal Subjects ◽  
Metacarpophalangeal Joint ◽  
Biomechanical Analysis ◽  
Biomechanical Tests

A functional assessment and biomechanical analysis of certain joints of the fingers are presented. The functional assessment has been carried out on rheumatoid arthritis patients who were assessed pre- and post-surgically after metacarpophalangeal joint replacement. Twenty normal subjects have been assessed in the biomechanical tests as they carried out two activities, tap turning and jar closing. The load actions applied by the index finger were measured by a six component transducer and the three-dimensional coordinates of the joint centres were derived from external markers attached to the skin of the index finger. From this information the forces and components of moment to be transmitted at the proximal interphalangeal and metacarpophalangeal joints have been calculated.

scholarly journals Hand's Functional Status of Children with Rheumatoid Arthritis in Everyday Activities: A Cross-Sectional Study

Esculapio ◽  
2021 ◽  
Vol 17 (1) ◽  
pp. 9-14
Author(s):  
Hafiza Ayesha Ikram ◽  
Wajeeha Abdul Ahad ◽  
Fazila Huma
Keyword(s):  
Rheumatoid Arthritis ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Hand Function ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Daily Life Activities ◽  
Everyday Activities

Objective: Rheumatoid Arthritis [RA] is a chronic, systemic, autoimmune disease on an unknown aetiology. It leads to the progressive destruction of joints. It also warrants difficulties in performance of Activities of Daily Living(ADL). This study aimed at determine relationship between activities of daily living [ADL] and functional status of the hand. Methods: This Crossectional Study was conducted at Romatology Department Children Hospital and Sheikh Zayed Hospital Lahore from June 2018 to December 2018. Convenient sampling technique helped in the collection of data. A hand function questionnaire and the Barthel Index were the contributary data collection methods. Rheumatoid Arthritis [RA] patients selected were those experiencing functional impairment in hands, having difficulty in performing ADL. Results: The patients who were able to perform the hand function test were independent in their daily life activities. Whereas, those who were not able to perk the test were dependent on their daily life activities. Conclusion: It was found that children with RA had a significant association between performing the ADL and functional status of hand. Key Words: Activities of Daily Living [ADL], Rheumatoid Arthritis [RA] How to cite: Ikram A.H., Ahad A.W., Huma Fazlia. Hand's functional status of children with rheumatoid arthritis in everyday activities: a cross-sectional study Esculapio. 2021.17(01): 9-14

New insights into the immediate outcome of collagenase injections for Dupuytren’s contracture

2015 ◽  
Vol 41 (6) ◽  
pp. 583-588 ◽  
Author(s):  
D. J. Warwick ◽  
D. Graham ◽  
P. Worsley
Keyword(s):  
Spontaneous Rupture ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Consecutive Series ◽  
High Complication Rate ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
The Mean

Collagenase clostridium histolyticum is now established as an effective and safe option to treat patients with a single joint affected with Dupuytren’s contracture. We have extended its use to natatory and combined cords. In a prospective consecutive series of 298 cords in 237 patients, the mean total extension loss improved in cords crossing the metacarpophalangeal joint from 46° to 1°, in cords crossing the proximal interphalangeal joint from 56° to 7°, in natatory cords from 130° to 25° and in combined cords from 102° to 16°. The immediate correction of combined cords and natatory cords was less reliable than that obtained in cords crossing the metacarpophalangeal joint or proximal interphalangeal joint. Less severe pre-intervention contractures tended to correct better. We found a high complication rate, which may cause alarm. A total of 21% developed skin splits, with the risk of skin splits generally increasing with more severe pre-injection deformity. Blood blisters were only encountered after manipulation of the more severe contractures. A total of 23 patients (8%) had a spontaneous rupture and 57 patients (19%) had a partial spontaneous rupture. Only 4.9% needed a second injection. We noticed a learning curve, with seven of the first 20 cords (35%) needing a second injection to achieve a satisfactory correction and then only seven (2.5%) in the rest. Level of evidence: IV

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