Metacarpophalangeal Joint Deformity Research Articles

Understanding prescribed dose in hand strengthening exercise for rheumatoid arthritis: A secondary analysis of the SARAH trial.

1) To identify therapist or participant characteristics associated with prescribed dose of hand strengthening exercise in adults with rheumatoid arthritis and 2) To determine the impact of dose prescribed on outcome (hand function and grip strength). Overall dose was calculated using area under the curve (AUC). Analysis 1 assessed the association between therapist professional background, therapist grade, baseline participant physical and psychological characteristics and prescribed dose. Analyses 2 and 3 estimated the relationship between prescribed dose and overall hand function and grip strength. Generalised estimating equation linear regression analysis was used. Analysis 1: Being treated by an occupational therapist (β=-297.0, 95% CI -398.6, -195.4), metacarpophalangeal joint deformity (β=-24.1, 95% CI -42.3, -5.9), a higher number of swollen wrist/hand joints (β=-11.4, 95% CI -21.6, -1.2) and the participant feeling downhearted and low all of the time (β=-293.6, 95% CI -436.1, -151.1) were associated with being prescribed a lower dose. Being treated by a grade 6 therapist (β=159.1, 95% CI 65.7, 252.5), higher baseline grip strength (β=0.15, 95% CI 0.02, 0.28) and greater participant confidence to exercise without fear of making symptoms worse (β=18.9, 95% CI 1.5, 36.3) were associated with being prescribed a higher dose. Analyses 2 and 3: Higher dose was associated with greater overall hand function (β=0.005, 95% CI 0.001, 0.010) and full-hand grip strength (β=0.014, 95% CI 0.000, 0.025) at 4-month. Higher dose was associated with better clinical outcomes. Prescription of hand strengthening exercise is associated with both therapist and participant characteristics.

Opening wedge phalangeal osteotomy for correction of Wassel type IV-D thumb duplication.

Thumb duplication is one of common anomalies of the hand. Among of Wassel type IV subtypes, type IV-D duplication with a zigzag deformity is most challenging for reconstructing. Several factors may affect the surgical outcomes. This study aimed to present an opening wedge osteotomy at proximal phalangeal neck for treating type IV-D duplication. Data from 14 patients are presented in this study. Eight patients had duplication of the right thumb, and six left thumb. After removal of radial supernumerary thumb, a snug collateral ligament was repaired to correct angular deformity of metacarpophalangeal joint (MCP). Angular deformity of the interphalangeal (IP) joint was corrected by an opening wedge osteotomy at the proximal phalangeal neck. A wedge bone from ablated thumb was grafted to correct the malalignment. IP joint was further stabilized by plication of the ulnar capsule. The relocation of radial part of FPL to the center of distal phalangeal base by use of pull-out suture technique RESULTS: After surgery, the angulations of the IP joints and the MCP joints were improved. Bone union was observed in all patients. According to the Japanese Society for Surgery of the Hand evaluation form, twelve cases were rated good, 2 cases fair. Stability of IP and MCP joints was good in all cases. The active ROM of IP was less in residual thumb than in normal thumb. Small nails were observed in some patients. Although the reconstructed thumbs were smaller than normal counterparts, they were aligned and with stable joints. The opening wedge osteotomy at proximal phalangeal neck could improve realignment of IP joint and prevent reoccurrence of deformity over time.

A 16-Year Journey in the Study of Rheumatoid Hand Disease.

Evidence-based medicine is a relatively new concept in hand surgery. A lack of high-level evidence often leads to uncertainty in the effectiveness of various procedures and regional variation in their use. Rheumatoid hand surgery has been plagued by a lack of quality data that has caused controversy between rheumatologists and hand surgeons. Research over the past 16 years has strived to provide data that can be used to provide evidence-based care for rheumatoid arthritis patients. The Silicone Arthroplasty in Rheumatoid Arthritis study is a prospective, long-term cohort study of rheumatoid arthritis patients with severe metacarpophalangeal joint deformity who have elected to undergo or not to undergo metacarpophalangeal joint arthroplasty; the study was funded for 10 years by the National Institutes of Health and has provided invaluable results on the effectiveness of this procedure in terms of outcomes and cost, improving knowledge for both physicians and patients.

Modified metacarpal shortening osteotomy of the midcarpal bone for preserving metacarpophalangeal joints in patients with rheumatoid arthritis

Recent advances in medication choices have strikingly improved the management of rheumatoid arthritis. However, medication alone cannot place back already deformed joints. Thus, to prevent metacarpophalangeal (MP) joint destruction, joint deformity correction should be considered since mechanical stress induced by finger motions will eventually destruct the undestructed joint, with a possibility of recurrence and future implant arthroplasty in mind since RA still remains as a progressive disease. We report a modified metacarpal shortening osteotomy for correcting MP joint deformity. The advantage of our technique over previous osteotomies is that it easily allows for subsequent implant arthroplasty even after the recurrence of joint deformity/destruction. Major modifications include that the metacarpal is shortened at its mid-shaft and the osteotomy is performed vertical to the shaft and fixed with surgical wiring. We believe that combination therapy consisting of medication and surgery is preferable to prevent joint destruction, even in this age of biological agents.

Correction of claw hand deformity after burns by elastic traction

To investigate a new method for correction of claw hand deformity after burns. From May 2006 to Jul. 2010, 12 patients with claw hands deformities after burns were treated with skin grafts (11 hands) and skin flap (1 hand) with unsatisfactory results. Then elastic traction (skin traction or skeletal traction) were performed with individual functional brace. All patients were followed up for 0.5 to 2 years. Elastic traction was effective in the correction of metacarpophalangeal joint deformity, buttonhole deformity, thumb-in-palm deformity, scar contracture, and palmar arch deformity. Elastic traction is a simple and effective way for the correction of claw hand deformity after burns with less morbidity and stable results.

Shortening Osteotomy for Treatment of Metacarpophalangeal Joint Deformity

The results of a new subcapital shortening osteotomy for correction of metacarpophalangeal joint deformity in patients with rheumatoid arthritis of the hands are presented. Seven patients (16 joints) were followed up for a mean of 33.5 months. The mean shortening of the metacarpal bone was 4.6 mm (range, 4-8 mm), and seven joints had additional intrinsic release. Only four (25%) joints held the correction of the deformity; all other joints had recurrence of palmar subluxation with or without additional ulnar drift. The range of motion of the joints with preserved correction after surgery was 80 degrees compared with 28 degrees of the joints with recurrent deformity. The possible mechanism of failure was analyzed. The results of the current series suggest that subcapital shortening osteotomy may not be indicated for treatment of severe metacarpophalangeal joint deformity in patients with rheumatoid arthritis.