5th Metacarpophalangeal Joints Research Articles

Prevalence and Variations of Sesamoid Bones in the Hands of Patients Visiting Teaching Hospital of Kaski District: A Retrospective Study

Introduction: Sesamoids are small, well-corticated, ovoid or nodular, may be bipartite ormultipartite bones/ossifications found close to a bone or a joint that are subject to significant morphological variations. Although it is difficult to determine the symptomatic nature of these bones, imaging provides important diagnostic information. The objective of this study is to assess the prevalence and variations of sesamoid bone in hands of patients visiting a teaching hospital of Kaski district.
 Methods: A hospital based retrospective cross-sectional study was conducted by analyzing X-rays of hand with Anteroposterior (AP) view, a total of 150 both male and female patients between the age group of 18 to 85 wereimaged between August 1, 2022 to December 30, 2022 at Department of Radiology & Imaging(X-Ray Unit). Presence of sesamoid bone of hand was noted on 1st, 2nd, 3rd, 4th and 5th metacarpophalangeal joints (MCPj), and the 1st interphalangeal joint (IPj), separately. The data were analyzed for correlation using Pearson’s correlation test. Ethical approval was taken from the Institutional Review Committee of Gandaki Medical College (Reference No.159/079/080).
 Results: The prevalence of sesamoid bone at 1st, 2nd, 3rd, 4th and 5th MCPj, and 1st IPj were 100 (100%), 60 (46%), 24(16%), 20(13.3%), 100(66.7%), and 114(76%) respectively. Variation was more prominent among females at 2nd, 3rdand 5th MCPj and 1st IPj, Also, SB variation was more prominent on left hand compared to right hand in 2nd, 4thand 5th MCPj and 1st IPj.
 Conclusions:No significant correlation between the gender and laterality with presence or absence of SB in the hands were noted.

Anatomical observation and CT three-dimensional reconstruction of Five-shu acupoints of Shaoyin Heart Meridian in rabbit's forelimb

To investigate the location and anatomical structure of "Shaochong"(HT9), "Shaofu"(HT8), "Shenmen"(HT7), "Lingdao"(HT4) and "Shaohai"(HT3) in the rabbit's forelimb. Sixteen rabbits (half male and half female) were used in the present study. By referring to the national standards on the location of acupoints in the human body and the literature about the location of acupoints in the rabbit, and by using the method of comparative anatomy, the location and needling operation of the Five-shu acupoints of Shaoyin Heart Meridian on the rabbit's forelimb were defined, and these acupoints were needled and CT three-dimensional reconstruction were conducted. Then, the rabbits were killed, and intravascular perfusion was performed, followed by inserting acupuncture needles into these five acupoints for observing the anatomical relationship between the inserted acupuncture needle and the structure of surrounding tissues. HT9 is located at the medial side of the little finger of forelimb, about 1 mm beside the nail root, and is adjacent to the superficial flexor tendon of the finger, the dorsal branches of the proper palmar digital artery and vein, and the endings of dorsal branch of palmar digital proper nerve of the ulnar nerve on the fifth finger side. HT8 is located at the palm side of the forelimb, horizontally parallel to the proximal end of the 5th metacarpophalangeal joint and between the 4th and 5th metacarpal bones, and is adjacent to the lumbricalis, the 4th and 5th interossei, and common palmar digital artery and vein and the palmar digital proper nerve of the ulnar nerve. HT7 is located at the medial margin of the extensor carpal tendon on the ulnar side, between the distal end of the ulna and the ulnar carpal bone, and is adjacent to the tendons of flexor carpi ulnaris and extensor carpi ulnaris, ulnar artery, ulnar vein and ulnar nerve. HT4 is located at the medial border of the ulnar flexor tendon, about 1.5 cun superior to HT7, and is adjacent to extensor carpi ulnaris, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, ulnar artery, vein and ulnar nerve. HT3 is located at the depression, medial to the condyle of humerus when the elbow is bent at 90°, its neighbor structure is composed of pronator teres, biceps brachii, brachial artery and vein, radial collateral artery, radial collateral vein, medial antebrachial cutaneous nerve and median nerve. In the rabbit, there is a close relationship between HT9, HT8, HT7, HT4 and HT3 regions and brachial vascular and its branches, cephalic vein and its branches, medial antebrachial cutaneous nerve, median nerve and ulnar nerve, which is the morphological basis of the Five-shu acupoints of Shaoyin Heart Meridian for treating some related clinical disorders.

Floating elbow, an uncommon clinical entity: A case report

Floating elbow is an uncommon complex injury pattern with varied functional outcomes. The term is used to describe combined fractures of humerus and forearm bones in the same extremity. It could occur in children and adults. We describe a 49 years old right – handed male farmer who fell off a moving motorbike into a ditch, sustaining a closed injury to the right upper extremity. Radiographs showed right humeral shaft fracture, comminuted fracture of radial head, fracture of proximal 3rd of Ulna and dislocation of the 5th Metacarpo-phalangeal joint. He had plate and screw fixation of both humerus and ulna fractures, K wire fixation of 5th MP joint and excision of radial head. All fractures united but he has residual stiffness of the fingers and limited forearm rotation 6 months postoperatively. No Neurological sequel.

Ossa Sesamoidea - prevalence of sesamoid bones in human hands.

This study describes the morphology of sesamoid bones in the human hand. Ultrasound imaging was used to record the presence and measurements of sesamoids in 120 hands of 60 healthy, young adults of Caucasian ethnicity. The mean number of sesamoid bones was 4.16 in the left hand and 4.03 in the right hand. 21.6% of cases showed asymmetry between the right hand and the left. There was a significant difference in the prevalence of sesamoid bones between right and left hand in males in this study. Females show a higher incidence of sesamoid bones overall, but do not demonstrate a significant difference between the sides. Prevalence findings: Two in the 1st Metacarpophalangeal joint (MCPJ) in 99.2% of cases, with one case of a single bone. One in the 2nd MCPJ in 43.3% of cases. One in the 5th MCPJ in 84.2% of cases. One in the 1st Interphalangeal joint (IPJ) in 83.4%of cases. Aside from that there was one case of sesamoid in the 3rd MCPJ and separate case of sesamoid in the 3rd proximal IPJ. Moreover, this study discusses discrepancies of opinion regarding sesamoid bones in morphological research.

Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet

We sought to report on the use of wide-awake local anesthesia and no tourniquet (WALANT) for internal fixation of metacarpal fractures. We retrospectively examined 10 patients with metacarpal fractures that required either closed reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). WALANT was administered 20minutes before the surgery outside the operating room. Once the area was numb, an open or closed reduction was made followed by internal fixation of the fracture using plating, intramedullary screws or Kirshner wires (K-wires). We used intraoperative X-ray to confirm anatomic reduction and correct internal fixation. After proper reduction and fixation, the active range of motion (AROM) was assessed while the patient was awake. Patients were discharged the next day after evaluating their neurovascular status and establishing pain control. Follow-up evaluations were carried out at 2, 6 and 12 weeks postoperatively. All individuals underwent uneventful operations. No significant pain or bleeding was recorded during the operation. Nine out of ten patients regained full AROM at the 12-week follow-up visit in the outpatient clinic. One patient still had slight reduction of range of motion (ROM) of the 5th metacarpophalangeal joint. No neurovascular damage or surgical site morbidity was recorded. CRIF and ORIF of simple metacarpal fractures can be executed successfully using WALANT with good functional results without increased morbidity compared to monitored anesthesia care.

Sesamoid disease in two dogs

Two young dogs, a Rottweiler and an Épagneul Breton, presented with chronic forelimb lameness. Orthopaedic examination confirmed the mild lameness and revealed pain on deep palpation at the palmar aspect of the 5th metacarpal. Radiographic evaluation revealed fracture of the 7th metacarpophalangeal sesamoid at the 5th metacarpophalangeal joint. Based on these findings, diagnosis of sesamoid disease was achieved. Both cases had been treated conservatively with restricted activity and anti-inflammatory drugs without any success. Then, resection of the affected sesamoid was performed. The outcome was good and the dogs were free of lameness 1 year post-operatively.

RELATIVE JOINT CONTRIBUTION TO JOINT HYPERMOBILITY IN RUGBY PLAYERS, NETBALLERS AND DANCERS: THE NEED FOR CAREFUL CONSIDERATION OF LUMBAR FLEXION

Generalized joint hypermobility is commonly measured using the Beighton and Horan Joint Mobility Index which provides a Beighton score of 0-9. Generally, scores of > 4 are classified as hypermobile however joint hypermobility classification lacks consistency across the literature. The aim of the study was to compare the relative contribution of five joints to joint hypermobility scores in female and male rugby players, female netball players, female dancers and male and female age matched controls. Individual cohort study. Joint hypermobility was assessed in 286 subjects using the Beighton and Horan Joint Mobility Index. Subjects were assigned a Beighton score of 0-9. These scores were then categorized using three different joint hypermobility classification systems and results were analyzed using a Pearsons Chi Square (x2) to report the relative contributions of each joint to hypermobility scores. Significant differences existed for group and gender analysis at the left and right 5th metacarpophalangeal joints, left and right thumb, left and right elbow and lumbar spine (p < 0.001). Lumbar flexion demonstrated significant x2 values and large effect sizes for all groups. This effect size was reduced to a moderate effect size when male against female analysis was performed and joint hypermobility was greater in females in comparison to males. The knee joint demonstrated the lowest hypermobility across all populations and ranged from 3% in male rugby players to 24% in female dancers. Seven hypermobile knees existed in males and 53 in females. Female dancers had the highest prevalence (93%) of hypermobile lumbar flexion and all female groups had a higher prevalence of hypermobile lumbar flexion than males. The removal of lumbar flexion from the total Beighton score had no effect on joint hypermobility prevalence in males in contrast to females where changes were demonstrated. Joint hypermobility classification of female dancers should consider the high prevalence of hypermobility of lumbar flexion in interpretation. The consideration of separate classification systems for males and females, and between athletes of different sports and dancers may aid future understanding. 2b.

Assessment of malalignment at the metacarpophalangeal joint of the rheumatoid hand using three-dimensional computed tomogram

Objective. For the assessment of rheumatoid hand, three-dimensional (3D) malalignment including flexed or rotational deformities and dislocation at the finger joint is one of the important findings. The objective of this study is to prove usefulness of 3D computed tomography (3DCT) for the accurate measurement of palmoulnar flexion deformity at the metacarpophalangeal (MP) joint of the rheumatoid hand.Methods. Swanson implant arthroplasty at the 2nd through the 5th MP joints was performed at 179 joints in 46 hands of 40 patients with rheumatoid arthritis. Pre-and postoperatively, evaluations included Larsen grade and ulnar flexion angle by an x-ray; and ulnar flexion angle, palmar flexion angle, and resected bone length by a 3DCT.Results. With progression of Larsen grade and the joint dislocation, ulnar flexion angle increased. Average ulnar flexion angle was 18.7 ± 16.0° (mean ± SD) in grade III, 38.4 ± 21.2° in grade IV, and 40.1 ± 21.1° in grade V, 29.6 ± 16.0°in “subluxation,” 24.8 ± 21.2° in “dislocation,” and 41.1 ± 22.2° in “severe dislocation.” There was no significant difference between grade of the MP joint dislocation and palmar flexion angle. With progression of the MP joint dislocation, resected bone length increased.Conclusion. A 3DCT gives accurate information about deformity of the rheumatoid hand. Also, an appropriate length of bone resection can be determined in the preoperative planning.

SAT0186 Bone Mineral Density as A Predictor of Early Erosive Lesions in Rheumatoid Arthritis

BackgroundThe issues of early visualizing of the changes in the joints and bone which can be used as predictors of future joints structural damage are being discussed.ObjectivesTo assess changes in...

SAT0179 Mri Pattern of Arthritis in Sle: A Comparative Study with Rheumatoid Arthritis and Healthy Subjects

BackgroundArthritis in systemic lupus erythematosus (SLE) is traditionally considered mild and non erosive, however chronic pain, hand disability and deformities are frequently reported by patients with longstanding disease. Magnetic resonance...

Early MRI measures independently predict 1-year and 2-year radiographic progression in rheumatoid arthritis: secondary analysis from a large clinical trial

ObjectiveTo determine if early MRI measures predict X-ray progression at 1 and 2 years in a large RA trial cohort.DesignThis study included 256 methotrexate (MTX)-naïve RA patients from a randomised...

FRI0505 Assessment of malalignment at the metacarpophalangeal joint of the rheumatoid hand using three-dimensional computed tomogram

BackgroundIn clinical trial of medical treatment, bone erosion and joint space narrowing in serial x-rays of the hand are important to assess structural damage of the joint affected by rheumatoid...

Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT

ObjectivesTo determine the accuracy of ultrasonography (US) for bone erosion detection in different areas of rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints with multislice CT as the reference method. Second, to...

Patterns of Magnetic Resonance Imaging Bone Erosion in Rheumatoid Arthritis — Which Bones Are Most Frequently Involved and Show the Most Change?: Figure 1.

To investigate by magnetic resonance imaging (MRI) which bones in wrists and metacarpophalangeal (MCP) joints most frequently show bone erosions, and which most frequently demonstrate erosive progression, in early and established rheumatoid arthritis (RA). MRI datasets from 258 RA patients [126 with early RA (disease duration < 6 months)] were analyzed, of whom 223, including 126 with early RA, had 1-year followup MRI. All patients had MRI of one wrist, whereas 86 patients had additional images of 2nd-5th MCP joints, and 46 patients additional images of the contralateral wrist. MRI were evaluated blinded by one reader, according to the OMERACT RA MRI scoring system (RAMRIS) for erosions, and presence/absence of erosions was noted in each bone, as was presence/absence of erosive progression. The capitate, ulna, lunate, triquetrum, and scaphoid were the 5 bones with both most frequent baseline erosions and most frequently demonstrated erosive progression. No bones were without erosions. Patterns of erosions and progression were similar in early and established RA. No major difference between dominant and nondominant wrists was detected. In the fingers, the 2nd-3rd MCP joint most frequently displayed erosions and erosive progression. The distribution and frequency of bone erosion and erosive progression as detected by MRI in RA wrists and MCP joints were identified. No pattern differences between early versus established disease and dominant versus nondominant sides were detected. No bones showed erosive progression. Thus, no self-evident simplification of the RAMRIS erosion score was identified. Bone involvement patterns may be considered, when joints are selected for MRI protocols for clinical trials and practice.

Effects of Modified Dynamic Metacarpophalangeal Joint Flexion Orthoses after Hand Burn

ObjectiveTo assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures.MethodWe enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks.ResultsThe 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05).ConclusionThe modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.

Sesamoid and accessory bones of the hand—An epidemiologic survey in a Mediterranean population

The prevalence and distribution of sesamoid and accessory bones in the hands is quite variable between different populations and ethnic groups. However, there are no published data on their distribution in Mediterranean populations. Studies on the validity of radiographic assessment for the presence of these bones are also lacking. A retrospective review of 442 radiographs of adult patients was performed in order to assess the incidence of sesamoid and accessory bones in the hands of a Mediterranean population. Additionally, two independent observers reviewed 174 radiographs and used the Kappa parameter in order to assess the validity of radiographic interpretation of radiographs for the presence of those bones. There was an incidence of 99.5% sesamoid bones (n = 440) in the 1st metacarpophalangeal (MCP) joint, 42.3% in the 2nd MCP joint (n = 187), and 41.1% (n = 182) in the 5th MCP joint. The incidence in the 1st interphalangeal joints was 26.2% (n = 116). The incidence of sesamoid bones in the 1st, 2nd, and 5th metacarpophalangeal joints in a Mediterranean population was found to be similar to that of Arab and Caucasian populations, whereas their prevalence in the 1st interphalageal joint coincided more with Arab populations. Interobserver reliability of the interpretation of radiographs for the presence of sesamoid bones in the hand was good (Kappa > 0.68) in all locations, except for the 1st MCP joint. Further research is warranted to further elucidate the genetic and/or environmental reasons for the differences between those populations.

Cryptococcal immune reconstitution inflammatory syndrome presenting with erosive bone lesions, arthritis and subcutaneous abscesses

Cryptococcal immune reconstitution inflammatory syndrome presenting with erosive bone lesions, arthritis and subcutaneous abscesses

Conventional radiography requires a MRI-estimated bone volume loss of 20% to 30% to allow certain detection of bone erosions in rheumatoid arthritis metacarpophalangeal joints

The aim of this study was to demonstrate the ability of conventional radiography to detect bone erosions of different sizes in metacarpophalangeal (MCP) joints of rheumatoid arthritis (RA) patients using magnetic resonance imaging (MRI) as the standard reference. A 0.2 T Esaote dedicated extremity MRI unit was used to obtain axial and coronal T1-weighted gradient echo images of the dominant 2nd to 5th MCP joints of 69 RA patients. MR images were obtained and evaluated for bone erosions according to the OMERACT recommendations. Conventional radiographs of the 2nd to 5th MCP joints were obtained in posterior-anterior projection and evaluated for bone erosions. The MRI and radiography readers were blinded to each other's assessments. Grade 1 MRI erosions (1% to 10% of bone volume eroded) were detected by radiography in 20%, 4%, 7% and 13% in the 2nd, 3rd, 4th and 5th MCP joint, respectively. Corresponding results for grade 2 erosions (11% to 20% of bone volume eroded) were 42%, 10%, 60% and 24%, and for grade 3 erosions (21% to 30% of bone volume eroded) 75%, 67%, 75% and 100%. All grade 4 (and above) erosions were detected on radiographs. Conventional radiography required a MRI-estimated bone erosion volume of 20% to 30% to allow a certain detection, indicating that MRI is a better method for detection and grading of minor erosive changes in RA MCP joints.

Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints

The objective of the study was, with multidetector computed tomography (CT) as the reference method, to determine whether bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints detected with magnetic resonance imaging (MRI) and ultrasonography (US), but not with radiography, represent true erosive changes. We included 17 RA patients with at least one, previously detected, radiographically invisible MCP joint MRI erosion, and four healthy control individuals. They all underwent CT, MRI, US and radiography of the 2nd to 5th MCP joints of one hand on the same day. Each imaging modality was evaluated for the presence of bone erosions in each MCP joint quadrant. In total, 336 quadrants were examined. The sensitivity, specificity and accuracy, respectively, for detecting bone erosions (with CT as the reference method) were 19%, 100% and 81% for radiography; 68%, 96% and 89% for MRI; and 42%, 91% and 80% for US. When the 16 quadrants with radiographic erosions were excluded from the analysis, similar values for MRI (65%, 96% and 90%) and US (30%, 92% and 80%) were obtained. CT and MRI detected at least one erosion in all patients but none in control individuals. US detected at least one erosion in 15 patients, however, erosion-like changes were seen on US in all control individuals. Nine patients had no erosions on radiography. In conclusion, with CT as the reference method, MRI and US exhibited high specificities (96% and 91%, respectively) in detecting bone erosions in RA MCP joints, even in the radiographically non-erosive joints (96% and 92%). The moderate sensitivities indicate that even more erosions than are seen on MRI and, particularly, US are present. Radiography exhibited high specificity (100%) but low sensitivity (19%). The present study strongly indicates that bone erosions, detected with MRI and US in RA patients, represent a loss of calcified tissue with cortical destruction, and therefore can be considered true bone erosions.

Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls

Objective. To introduce dynamic magnetic resonance imaging (MRI) as an indicator of inflammatory activity in the metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) or early unclassified polyarthritis, and to compare the results with a healthy control group. Materials and Methods. We examined 42 RA and 23 early unclassified polyarthritis patients, and 12 healthy controls in a cross-sectional study. Dynamic MRI (repeated FLASH-MR images after injection of a contrast agent) was performed through the 2nd to the 5th MCP joint. Two methods for identification of the enhancing synovial membrane were compared: 1) outlining of enhancing synovial membrane on subtraction images and 2) automated recognition by principal component analysis (PCA). The early enhancement (EE) rate was calculated on the basis of the first method. Results. Method 1) and 2) were closely associated (P<0.00001). From the healthy control group, an upper limit (mean+2SD) of normal enhancement was established for the 2nd to 5th MCP joints, which served to identify abnormal EE rates in the corresponding joints of patients. The patients had higher EE rates in the 2nd to 5th MCP joints than had the healthy controls (P<0.01). There were no significant differences between the two patient groups (P>0.09). Conclusion. PCA seems to be a promising method for automated identification of enhancing tissue. EE rates of the finger joints may be useful in the assessment of the inflammatory activity in the joints of patients with RA and early unclassified polyarthritis and may reflect other aspects of disease activity than clinical evaluation.