INDEX OF SUSPICION

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 16-year-old right-handed girl comes to you complaining of a "funny bend" in her left ring finger. She first noticed it 2 days ago, after a martial arts practice session during which she was blocking kicks with her bare hands. After practice, she had pain and considerable ecchymosis in the distal portion of her finger and was unable to extend her distal interphalangeal joint (DIP) fully. The finger has not improved after 2 days of rest, ice, and ibuprofen. She denies other medical or orthopedic problems and has been taking no other medications. On physical examination, the DIP joint of her left ring finger assumes a position of 30 degrees of flexion at rest; she can flex the joint fully but is unable to extend it beyond the resting position.

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Irreducible Palmar Dislocation of the Distal Interphalangeal Joint

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.12.016 ◽

2006 ◽

Vol 31 (3) ◽

pp. 296-297 ◽

Cited By ~ 2

Author(s):

Y. MORISAWA ◽

H. IKEGAMI ◽

R. IZUMIDA

Keyword(s):

Open Reduction ◽

Ring Finger ◽

Interphalangeal Joint ◽

Distal Interphalangeal Joint ◽

Distal Interphalangeal

A case of a child with rare palmar dislocation of the ring finger distal interphalangeal joint requiring open reduction is presented and the literature discussed.

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The Effect of Ring Finger Distal Interphalangeal Joint Stiffness on Grip Strength: A Simulated Study in Normal Participants

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835520500319 ◽

2020 ◽

Vol 25 (03) ◽

pp. 296-300

Author(s):

Robert J. Lambert ◽

Thomas FM. Yeoman ◽

Chaoyang Wang ◽

Jaime Grant ◽

Philippa A. Rust

Keyword(s):

Grip Strength ◽

Ring Finger ◽

Significant Loss ◽

Hand Grip Strength ◽

Interphalangeal Joint ◽

Rank Test ◽

Distal Interphalangeal Joint ◽

Hand Grip ◽

Significant Difference ◽

Distal Interphalangeal

Background: Pain of the hand distal interphalangeal joints may result from trauma, osteoarthritis or inflammatory arthritis. When symptoms are not controlled by non-operative means, surgical arthrodesis may be performed, resulting in complete stiffness of the joint and possible weakening of grip strength. This study aims to quantify the effect of a stiff ring finger distal interphalangeal joint on overall grip strength. Methods: One hundred participants were screened to exclude upper limb pathology. A Jamar dynamometer was used to assess overall hand grip strength. A splint was used to prevent distal interphalangeal joint flexion, thus replicating a fused distal interphalangeal joint. Participants were tested with and without the splint and the results compared. The mean of three grip strength tests was taken. Results: The participants included 55 females. Mean age was 31 (18–60 years). 76 participants had a reduction in grip strength with splinting, with a significant difference seen (p < 0.05) on Wilcoxon signed rank test. The median reduction in grip strength with splinting was 1.67 kg. However only 10 participants (10%) had a grip strength loss of greater than 6.5 kg, which is the minimal clinically important difference. Conclusions: This study found a significant loss in overall hand grip strength when the ring finger distal interphalangeal joint was stiffened. However, despite this significant change, only 10 (10%) participants experienced a reduction of greater than 6.5 kg. This is the level of weakness felt to be required to reduce function. Thus our results suggest that 90% of patients with a stiff ring finger distal interphalangeal joint are unlikely to have a clinically identifiable functional reduction in grip strength as a result.

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Ring Finger Distal Interphalangeal Joint Dislocation

Orthopaedic Nursing ◽

10.1097/nor.0b013e3182879c1e ◽

2013 ◽

Vol 32 (2) ◽

pp. 120-121

Author(s):

Erin S. Hart

Keyword(s):

Ring Finger ◽

Interphalangeal Joint ◽

Distal Interphalangeal Joint ◽

Joint Dislocation ◽

Distal Interphalangeal

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Corrective Step-cut Osteotomy at the Affected Bone for Correction of Rotational Deformity Due to Fracture of the Middle Phalanx

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417720157 ◽

2017 ◽

Vol 22 (02) ◽

pp. 240-243 ◽

Cited By ~ 1

Author(s):

Hiroyuki Fujioka ◽

Yohei Takagi ◽

Juichi Tanaka ◽

Shinichi Yoshiya

Keyword(s):

Present Report ◽

Proximal Phalanx ◽

Ring Finger ◽

Distal Portion ◽

Middle Phalanx ◽

Distal Interphalangeal Joint ◽

Metacarpal Bones ◽

Distal Interphalangeal ◽

Displaced Fracture ◽

Functional Problems

Malunion at the shaft of the middle phalanx yields less functional problems compared with malunion at the shaft of the proximal phalanx and metacarpal bones. In the present report, the patient sustained a minimally displaced fracture at the distal portion of the distal middle phalanx of the ring finger spraining the finger during playing flag football. Fracture was treated conservatively and fracture union was completed. However, the patient complained of functional problems in activities of daily living due to the malrotational deformity of the finger. We treated the malrotational deformity close to the distal interphalangeal joint of the middle phalanx with step-cut osteotomy at the affected bone successfully.

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TRANSVERSE AND LONGITUDINAL OSTEOTOMY FOR THE TREATMENT OF MACRODACTYLY SIMPLEX CONGENITA — A CASE REPORT

Hand Surgery ◽

10.1142/s0218810408003888 ◽

2008 ◽

Vol 13 (02) ◽

pp. 121-128 ◽

Cited By ~ 1

Author(s):

R. Kakinoki ◽

R. Ikeguchi ◽

Scott F. M. Duncan

Keyword(s):

Case Report ◽

Soft Tissue ◽

Ring Finger ◽

Interphalangeal Joint ◽

Soft Tissue Coverage ◽

Distal Interphalangeal Joint ◽

Transverse Osteotomy ◽

Distal Interphalangeal

We report on a three-year-old girl with a severely enlarged right ring finger, which was diagnosed as macrodactyly simplex congenita. This was treated by epiphysial resection and osteosynthesis of the distal interphalangeal joint, longitudinal and transverse osteotomy of the phalanges, and soft tissue coverage using palmar proximal and dorsal distal flaps taken from the original oversised finger.

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Evaluation of the diffusion of corticosteroids between the distal interphalangeal joint and navicular bursa in horses

Journal of the American Veterinary Medical Association ◽

10.2460/javma.232.9.1343 ◽

2008 ◽

Vol 232 (9) ◽

pp. 1343-1343

Author(s):

Frederik E. Pauwels ◽

James Schumacher ◽

Fernando A. Castro ◽

Troy E. Holder ◽

Roger C. Carroll ◽

...

Keyword(s):

Interphalangeal Joint ◽

Distal Interphalangeal Joint ◽

Distal Interphalangeal

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Development and evaluation of two different lameness models in meat goats, a pilot study

Translational Animal Science ◽

10.1093/tas/txaa193 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Emily J Reppert ◽

Michael D Kleinhenz ◽

Abbie Viscardi ◽

Shawnee R Montgomery ◽

Alison R Crane ◽

...

Keyword(s):

Pilot Study ◽

Plasma Cortisol ◽

Interphalangeal Joint ◽

Health Concern ◽

Distal Interphalangeal Joint ◽

Livestock Species ◽

Meat Goats ◽

Distal Interphalangeal ◽

Maximum Temperatures

Abstract Lameness is a serious health concern for livestock species. Understanding individual animal response to pain and characterization of lameness are critical when developing appropriate treatments. The objectives of this pilot study was to evaluate two different lameness models and measures for determining response to induced lameness in meat goats. Lameness was induced by intraarticular injection into the left hind lateral claw distal interphalangeal joint with either amphotericin B (Amp-B) or kaolin-carrageenan (K-C). Response to lameness was characterized by behavior scoring, visual lameness scoring (VLS), infrared thermography (IRT) of the affected digit, pressure mat gait analysis (PMT), and plasma cortisol (CORT) analysis. Lame goats had higher VLS compared to controls (P = 0.003). Maximum temperatures measured in hooves from lame vs control goats were significantly higher (P = 0.003). Pressure mat analysis demonstrated, when compared to controls, lame goats had decreased force (P = 0.013), impulse (P = 0.007), contact pressure (P = 0.007), and contact area of the left hind limb (P = 0.009). Mean CORT levels 4 and 6 h after lameness induction were higher in lame goats (P = 0.005, P = 0.01). The two lameness methods reliably induced lameness of varying severity in healthy meat goats.

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