Finger Proximal Interphalangeal Joint Research Articles

Treatment of Chronic Severe Flexion Contractures of Fingers with Bilateral Side-Finger Flaps (Wing Flaps) and Full-Thickness Skin Graft.

Background: Severe flexion contractures of proximal interphalangeal joint of fingers can significantly impair hand function, typically after burn injury recovery. Extensive surgical release exposes deep vital structures, which subsequently requires significant skin coverage. The author presents the results of using bilateral side-finger flaps (wing flaps) and full-thickness skin graft for coverage of the defects. Methods: Seven patients (8 fingers) with chronic severe flexion contractures of fingers resulting from burn injury were included. Results: Mean flexion contracture and full flexion angles of the joints were improved from 84.4°/93.7° to 4.7°/92.5° at the last follow-up visit. No major complications were observed during the postoperative follow-up period (range, 6-16 months). Conclusions: This alternative surgical technique can be successfully applied for the treatment of chronic severe flexion contractures of fingers. The advantages of this approach are the use of local flaps from injured digit, and that it can be performed as a one-session procedure.

Interpositional Arthroplasty Using Mammary Capsule for Finger Joints: A Novel Technique.

Degenerative osteoarthritis frequently affects the hands, altering the movements; surgical therapy includes arthrodesis and arthroplasty. We report the case of a female patient who presented arthrosis in the hands, severe on the proximal interphalangeal (PIP) joints, initially in her right index finger, and subsequently in the index and middle left fingers. At first, she received treatment in the PIP joint of the right index finger with a silicone implant; later on, she presented fracture of it and required replacement 8 years later. In the PIP joints of index and middle left fingers, treatment was made with interposition arthroplasty by mammary implant capsule. We present the postoperative progression of the silicone versus mammary capsule interposition arthroplasty. It is remarkable that, over time, articular function of the intervened joints with capsular arthroplasty remained stable with good motion, while range of motion in other fingers was reduced as a consequence of osteoarthritis. The frequency of patients presenting simultaneously with mammary capsule contracture and osteoarthritis is low, but this novel technique is nonetheless worthwhile to take into consideration.

Novel orthotic design for lateral band attenuation of finger proximal interphalangeal joint

Patients with lateral band attenuation present with a snapping finger which may be misdiagnosed for a trigger finger. Lateral bands work as a flexor after 30° flexion of the proximal interphalangeal (PIP) joint, assisting with flexion of the PIP joint. It assists central slip and works as an extensor from 30° onward, extending the PIP and distal interphalangeal joints. Loss of coordination between the multiple, specialized components of the extensor mechanism results in tendon imbalances, leading to altered interphalangeal joint flexion and extension forces. This case report is to introduce the fabrication of an orthotic to tackle finger injury for quick and effective conservative treatment. The indications and functions of the orthosis are discussed. The fabrication process is illustrated, including materials needed and steps of molding the splint. Wearing regimen and precautions are highlighted to ensure effective patient compliance to the orthosis program for finger injury. Objective data collected include pre- and post-pain level and outcome measures indicative of improved functional performance.

Non-vascularized partial joint transfer for Finger Proximal Interphalangeal joint reconstruction: a series of 9 patients

Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction. Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25-50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor. Mean follow-up period was 4.0years (range 1.2-7.9years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18kg and 8 ± 5kg, close to the healthy side values (45 ± 15kg and 9 ± 4kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor. In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.

Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands

Background and purpose — Few prospective studies have reported the long-term effect durability of collagenase injections for Dupuytren disease. We assessed the 3-year treatment outcome of collagenase injections and predictors of recurrence.Patients and methods — We conducted a single-center prospective cohort study. Indication for collagenase injection was palpable Dupuytren’s cord and active extension deficit (AED) ≥ 20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. From November 2012 through June 2013, we treated 86 consecutive patients (92 hands, 126 fingers). A hand therapist measured joint contracture before, 5 weeks, and 3 years after injection. The patients rated their treatment satisfaction. Primary outcome was proportion of treated joints with ≥ 20° AED worsening between the 5-week and 3-year measurements. We analyzed predictors of recurrence.Results — 3-year outcomes were available for 83 of the 86 patients (89 hands, 120 treated fingers). Between the 5-week and 3-year measurements, AED worsened by ≥ 20° in 17 MCP (14%) and 28 PIP (23%) joints. At 3 years, complete correction (passive extension deficit 0–5°) was present in 73% of MCP and 35% of PIP joints. Treatment of small finger PIP joint contracture, greater pretreatment contracture severity, and previous fasciectomy on the treated finger were statistically significant predictors of recurrence. Treatment satisfaction was rated as very satisfied or satisfied in 59 of 87 hands. No long-term treatment-related adverse events were observed.Interpretation — 3 years after collagenase injections for Dupuytren disease, improvement was maintained and treatment satisfaction reported in two-thirds of the treated hands, with no adverse events. Complete contracture correction was achieved in 3 of 4 MCP joints, but in only a third of the PIP joints.

Classification and Assessment of Hand Arthritis Stage using Support Vector Machine.

Arthritis is one of the most common health problems affecting people around the world. The goal of the work presented work is to classify and categorizing hand arthritis stages for patients, who may be developing or have developed hand arthritis, using machine learning. Stage classification was done using finger border detection, developed curvature analysis, principal components analysis, support vector machine and K-nearest neighbor algorithms. The outcome of this work showed that the proposed method can classify subject finger proximal interphalangeal joints (PIP) and distal interphalangeal joints (DIP) into stage classes with promising accuracy, especially for binary classification.

Technical keys in maximizing finger proximal interphalangeal joint motion after vascularized toe joint transfers.

Vascularized toe joint transfers to the fingers have been performed for more than four decades, but their outcomes are not comparable with implant arthroplasty. Limited range of motion and extensor deficits of about 30° remain major problems with the constructed joints. We observed that the central extensor tendon of the toe is often attenuated proximally in its course on the dorsum of the proximal interphalangeal joint. A tight repair of the toe extensors to finger extensors limits joint motion. We reviewed our surgical techniques with this consideration. Thirty-eight fingers that we followed for 6 to 123 months had active range of motion of the reconstructed proximal interphalangeal joint in the finger of 58° (range 17°-76°) with an extensor deficit of 18° (range 0°-30°). We consider that the extensor mechanism and central slip insertion to the middle phalanx must be reconstructed meticulously to improve joint motion and decrease extension lag, and design of a lateral skin flap paddle to better cover vessels and allow extensor repairs.

Outcomes of Endoscopic Carpal Tunnel Release With Ring Finger Flexor Digitorum Superficialis Opponensplasty in Severe Carpal Tunnel Syndrome

To evaluate the outcomes of endoscopic CTR with ring finger flexor digitorum superficialis (FDS) opponensplasty for the treatment of patients with severe carpal tunnel syndrome (CTS). We prospectively studied 52 patients who were graded as having severe CTS by physical examination and electrodiagnostic studies and who underwent endoscopic CTR-ring finger FDS opponensplasty. Preoperative and postoperative data were collected for active perpendicular thumb abduction; Kapandji score for thumb opposition; grip, key, and tip pinch strength; Medical Research Council score on sensory and motor recovery; Semmes-Weinstein monofilament testing; thenar muscle bulk recovery; and work status. Follow-up was 17.5 months on average (range, 7-34 months). Thumb abduction improved significantly from 13.2° (±4.6°) before surgery to 61.7° (±6.4°) afterward. Mean thumb opposition (as measured by Kapandji score) improved significantly from grade 1.5 to 8.7. Tip pinch strength significantly improved from 38.9% to 72.9% of the contralateral side. Medical Research Council scores improved to S3+ and S4 in 85% of patients and to M4 and M5 in 96% of patients. Sensory threshold recovery to 3.61 and 4.31 monofilament occurred in 85% of patients. We observed thenar muscle bulk recovery in 51.9% of patients. Time to return to work was 5 weeks after surgery, on average. Two patients reported scar pain, 2 reported pillar pain, and we found ring finger proximal interphalangeal joint contracture in3. Endoscopic CTR with FDS opponensplasty provides satisfactory outcomes of improved thumb abduction and opposition, sensory and motor recovery, and early return to work in patients with severe CTS. Therapeutic IV.

A Flexor Digitorum Superficialis Tenodesis Technique for Surgical Treatment of Finger PIP Joint Volar Plate Chronic Avulsion.

Background: Chronic, post-traumatic, avulsion of the proximal interphalangeal (PIP) joint volar plate represents a disabling lesion. The purpose of this report is to describe a flexor digitorum superficialis (FDS) tenodesis using a mini-bone anchor inserted into the proximal phalanx, and its clinical outcome. Methods: 15 patients with chronic post-traumatic hyperextension instability of the PIP joint were treated surgically. From the first post-operative day patients were invited to start an early gradual joint active motion, wearing an extension block splint. Forty days after surgery, clinical evaluations were carried out, including: joint stability, pain and range of motion (ROM). The use of a circumferential splint was recommended for two further months, avoiding strenuous manual activities. The range of motion, time lost at work and the functional results were recorded six months after surgery. Results: At last follow up, 7 of the 13 reviewed patients presented an excellent functional recovery, with complete resolution of pain and stability with attainment of ROM comparable to the contralateral finger. The others 6 patients obtained good results, with remission of the functional impairment and pain, with either residual hyperextension or flexion contracture. There was one case of recurrence consecutively to a premature traumatic work-related activity. Conclusions: The FDS tenodesis via a bone anchor, combined with early active PIP joint protected motion, was shown in this study to be effective and reliable.

Research on finger movement sensing performance of conductive gloves

Knitted flexible sensors are sensors based on the loop structure of knitted fabric, which are soft and close-fitting. Monitoring finger motion can obtain useful information for some applications such as rehabilitation medicine, sports bionics, or human–computer interaction. In this paper, a conductive glove was knitted by SHIMA Seiki SWG 061N-15G computerized flat knitting machine. One experimenter wore it to measure motions data of index finger. The glove has a conductive intarsia area knitted by silver-nylon filaments. The experimenter performed static and dynamic test of hand posture, respectively, then observed the effect of figure bending characteristics on the glove resistance data. The result showed that human finger motion can be monitored successfully by the conductive glove without hard transducers, and both of the bending rate ( Br) and bending angle of the finger proximal interphalangeal joint ( Pba) affect the resistance change of the conductive area of the glove. In other words, the conductive glove has potentials to monitor and reflect human finger motions in detail.

Impact of multi- versus single finger proximal interphalangeal joint arthroplasty: analysis of 249 fingers treated in 15 years.

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Pilot testing of the spring operated wearable enhancer for arm rehabilitation (SpringWear)

BackgroundRobotic devices for neurorehabilitation of movement impairments in persons with stroke have been studied extensively. However, the vast majority of these devices only allow practice of stereotyped components of simulated functional tasks in the clinic. Previously we developed SpringWear, a wearable, spring operated, upper extremity exoskeleton capable of assisting movements during real-life functional activities, potentially in the home. SpringWear assists shoulder flexion, elbow extension and forearm supination/pronation. The assistance profiles were designed to approximate the torque required to move the joint passively through its range. These three assisted DOF are combined with two passive shoulder DOF, allowing complex multi-joint movement patterns.MethodsWe performed a cross-sectional study to assess changes in movement patterns when assisted by SpringWear. Thirteen persons with chronic stroke performed range of motion (ROM) and functional tasks, including pick and place tasks with various objects. Sensors on the device measured rotation at all 5 DOF and a kinematic model calculated position of the wrist relative to the shoulder. Within subject t-tests were used to determine changes with assistance from SpringWear.ResultsMaximum shoulder flexion, elbow extension and forearm pronation/supination angles increased significantly during both ROM and functional tasks (p < 0.002). Elbow flexion/extension ROM also increased significantly (p < 0.001). When the subjects volitionally held up the arm against gravity, extension at the index finger proximal interphalangeal joint increased significantly (p = 0.033) when assisted by SpringWear. The forward reach workspace increased 19% (p = 0.002). Nine subjects could not complete the functional tasks unassisted and only one showed improvement on task completion with SpringWear.ConclusionsSpringWear increased the usable workspace during reaching movements, but there was no consistent improvement in the ability to complete functional tasks. Assistance levels at the shoulder were increased only until the shoulder could be voluntarily held at 90 degrees of flexion. A higher level of assistance may have yielded better results. Also combining SpringWear with HandSOME, an exoskeleton for assisting hand opening, may yield the most dramatic improvements in functional task performance. These low-cost devices can potentially reduce effort and improve performance during task practice, increasing adherence to home training programs for rehabilitation.

Ténodèse du flexor digitorum superficialis pour les déformations en hyperextension de l’articulation IPP dans l’arrachement chronique de la plaque palmaire

Purpose Injuries of finger proximal interphalangeal (PIP) joint are among the most common trauma of the upper limb. As a result of a severe PIP sprain, the avulsion of the volar plate from the phalanx can lead to instability of the joint. This lesion causes a finger hyperextension disabling deformity, which leads to pain and functional restriction. A late diagnosis is not infrequent and the volar plate is usually retracted or thinned, thus a functional repair has to be researched. With this goal Littler, conceived a flexor digitorum superficialis tenodesis (FDS) in 1959. The purpose of this report is to describe a modified Littler FDS tenodesis technique for the correction of chronic, traumatic joint hyperextension of PIP joint and to present the follow-up. Nine patients presenting a chronic, post-traumatic PIP joint hyperextension were evaluated by one of the consultant in hand surgery. They were treated with a modified Littler FDS tenodesis using a mini bone-anchor placed on the volar aspect of the P1, to insert and stretch directly the tendon slip. Patients were reviewed and evaluated at a follow up of 12 months. Results were classified as excellent in 2 cases, good in 6 cases, fair in one case. To make the tenodesis, the flexor sheath was incised between the A1 and A2 pulleys. The ulnar slip of the FDS was cut as proximally as possible. A mini bone anchor was then placed at the centre of the P1 in a slight sidelong proximal-to-distal direction. The FDS slip was sutured to the anchor, carefully tensioning it so that the PIP joint was approximately 5°-10° short of full physiological extension. The wound was covered with a slight dressing and a temporary small orthoses was applied dorsally, leaving the flexion motion free. Patients were invited to start an immediate gradual active motion. We believe that the results of this PIP tenodesis are strongly related with the fixation technique of the tendon slip. The goal is to avoid a wide opening of the flexor sheath, a long postoperative immobilization, rehabilitation and splinting. The results of FDS tenodesis using a mini-invasive technique and starting an immediate postoperative assisted mobilization, seem to be good and reliable over time.

Swan neck deformity due to chronic radial collateral ligament injury of the little finger proximal interphalangeal joint.

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The impact of transferred vascularized toe joint length on motion arc of reconstructed finger proximal interphalangeal joints: a cadaveric study.

Vascularized toe joint transfer for finger proximal interphalangeal joint reconstruction can result in sub-optimal arc of motion and extension lag due to inappropriate intercalated bony segment length. We investigated the impact of intercalated segment length on passive arc of motion and extension lag of the reconstructed proximal interphalangeal joint. Cadaveric intercalated joint grafts were harvested from lesser toes and transferred to cadaveric fingers. The pre-determined finger proximal interphalangeal joint defect size was 2 cm. Three different intercalated segment lengths were inserted and resulting proximal interphalangeal joint arc of motion and extension lag were measured. The average arc of motion of finger proximal interphalangeal joints was 81° and 54° for toe proximal interphalangeal joints. Long intercalated segments had an average arc of motion of 30° with 32° extension lag. Equal-length intercalated segments had an average 49° arc of motion with 15° extension lag. Short intercalated segments had an average arc of motion of 71° with 8° extension lag. Shorter intercalated segments provide the greatest reduction in extension lag.

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

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. 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. 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. 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.

Customizing Extensor Reconstruction in Vascularized Toe Joint Transfers to Finger Proximal Interphalangeal Joints: A Strategic Approach for Correcting Extensor Lag.

Vascularized toe proximal interphalangeal joint transfer allows the restoration of damaged joints. However, extensor lag and poor arc of motion have been reported. The authors present their outcomes of treatment according to a novel reconstructive algorithm that addresses extensor lag and allows for consistent results postoperatively. Vascularized toe joint transfers were performed in a consecutive series of 26 digits in 25 patients. The average age was 30.5 years, with 14 right and 12 left hands. Reconstructed digits included eight index, 10 middle, and eight ring fingers. Simultaneous extensor reconstructions were performed and eight were centralization of lateral bands, five were direct extensor digitorum longus-to-extensor digitorum communis repairs, and 13 were central slip reconstructions. The average length of follow-up was 16.7 months. The average extension lag was 17.9 degrees. The arc of motion was 57.7 degrees (81.7 percent functional use of pretransfer toe proximal interphalangeal joint arc of motion). There was no significant difference in the reconstructed proximal interphalangeal joint arc of motion for the handedness (p = 0.23), recipient digits (p = 0.37), or surgical experience in vascularized toe joint transfer (p = 0.25). The outcomes of different techniques of extensor mechanism reconstruction were similar in terms of extensor lag, arc of motion, and reconstructed finger arc of motion compared with the pretransfer toe proximal interphalangeal joint arc of motion. With this treatment algorithm, consistent outcomes can be produced with minimal extensor lag and maximum use of potential toe proximal interphalangeal joint arc of motion. Therapeutic, IV.

Establishing a Calculation Method for Estimating the Normal Circumference of the Proximal Interphalangeal Finger Joints

Objective: To estimate the normal circumference of the interphalangeal (IP) thumb joint and the proximal IP (PIP) joints from the index finger to the little finger using individual physical parameters such as body height and body weight. Methods: The maximum size on the ring gauge was recorded which caused resistance when the IP joint of the thumb or PIP joints of the index to small fingers were passed through the gauge. RG was defined as the ring gauge number with the same diameter as the circumference of the IP thumb joint and PIP finger joints from the index finger to the little finger. There were 300 healthy subjects and 600 hands. Univariate and multivariate analyses were used to analyze the relationships between RG and the parameters of age, sex, height, weight, and dominant hand, and regression equations were derived. Results: Age, sex and body weight were all statistically significant predictive factors of RG in all fingers. R2, the coefficient of determination in the regression equation, was almost 0.7 for all fingers, indicating that a moderate or strong correlation was observed between RG and the regression equation. Conclusions: The circumference of the IP thumb joint and PIP finger joints from the index finger to the little finger can be estimated in healthy individuals using a calculation formula that takes age, sex, body height and body weight into account.

Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial.

BackgroundIn the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted.This multicentre randomized controlled trial aims to address the following questions:Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA?What are patients’ motivation and reasons for wanting CMC1-surgery?Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery?Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA?Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function?Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery?Is OT more cost-effective than surgery in the management of CMC1-OA?Methods/DesignAll persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years.DiscussionThe findings will improve the evidence-based management of HOA.Trial registration identifier NCT01794754. First registrated February 15th 2013.

Experimental study of the optimal angle for arthrodesis of fingers based on kinematic analysis with tip-pinch manipulation

To evaluate the appropriate angle for arthrodesis of the index finger proximal interphalangeal (PIP) joint, the functional range of motion (ROM) of the joints and manipulabilities at three selected tip-pinch manipulation postures of the finger were studied experimentally under imposed PIP joint arthrodesis angles. A kinematic model of the index finger was used in experiments which involved three postures. Experiments were conducted using seven healthy subjects in tip-pinch manipulation tasks to obtain the measurements of finger motions under imposed angles of joint constraint, including the functional ROM of the joints and the three criteria of kinematic manipulability. Data show that the functional ROM and the shape of the kinematic manipulability ellipses at the fingertip were influenced significantly by the imposed PIP joint constraint in the tip-pinch manipulation tests. Results suggest that a PIP arthrodesis angle between 40° and 60° led to the optimal performance of fingers in grasping and manipulation of fine objects. This theoretical and experimental study can help surgeons and clinicians to make more informed decisions on the appropriate constraint angles before the arthrodesis operation, and to customize this angle for individual patients in order to enhance not only the capability of manipulation of the finger but also the quality of life after such intervention.