Fourth Metacarpophalangeal Joints Research Articles

Russel's sign: Unilateral hand callosities in bulimia nervosa.

A dermatology consult was sought for a 34-year-old female who presented with repeated vomiting and loss of weight, quantified to be around 13 kgs over the preceding 4 months. Examination revealed strictly unilateral callosities and few superficial erosions over the right distal hand, third and fourth metacarpophalangeal joints, and interphalangeal joints of the second digit, consistent with Russell's sign in bulimia nervosa. History of binge eating followed by purging by forced vomiting was found on dietary history.

Role of inflammatory burden and treatment on joint space width in psoriatic arthritis—a high-resolution peripheral quantitative computed tomography study

BackgroundTo investigate the relationship between disease-related parameters and joint space width (JSW) on high-resolution peripheral quantitative computed tomography (HR-pQCT) in psoriatic arthritis (PsA) patients.MethodsPsA patients who underwent HR-pQCT examination of the second to fourth metacarpophalangeal joint (MCPJ 2–4) were recruited in this cross-sectional study. The joint space metrics included joint space volume (JSV), mean, minimum, and maximum JSW, JSW asymmetry, and distribution. Correlation analysis and multivariable linear regression models were used to determine the association between disease-related variables and JSW.ResultsSixty-seven patients [37 (55.2%) males; median (IQR) age: 57.0 (53.0, 63.0); median disease duration: 21 (16, 28) years] were included in this analysis. Multivariable linear regression analysis demonstrated that males had larger JSV (MCPJ 2–4), mean (MCPJ 4), and maximum JSW (MCPJ 3). Longer disease duration (MCPJ 2–3) and higher ESR values (MCPJ 3) were negatively associated with mean and maximum JSW, while higher damage joint count was negatively associated with mean and minimum JSW (MCPJ 2). Use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) was negatively associated with minimum JSW (MCPJ 3) while use of biologic DMARDs (bDMARDs) was positively associated with minimum JSW (MCPJ 2).ConclusionHigher inflammatory burden as reflected by longer disease duration, higher ESR levels, and damage joint count was negatively associated with mean, maximum, and minimum JSW, while suppression of inflammation using bDMARDs seems to limit the decline in JSW.

Seronegative Erosive Arthritis Following SARS-CoV-2 Infection.

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affecting mostly the respiratory system, but several other organs and systems can be involved. Extrapulmonary manifestations and autoimmune phenomena following SARS-CoV-2 infection are frequent events occurring during the first 2 weeks or in later stages of the disease course. These can be expressed as an isolated discovery of autoantibodies, mostly antinuclear or antiphospholipid antibodies, through to full-blown autoimmune organ-specific and systemic diseases. Joint pain is a frequent complain in most patients, but to our knowledge, frank arthritis has not been reported so far. A 46-year-old woman developed symmetrical polyarthritis 2 months after SARS-CoV-2 infection. Laboratory tests showed high acute phase reactants, while the immunological profile was negative. Hand and wrists X-rays revealed soft tissue swelling as well as bone erosions at the ulnar base of the third and fourth metacarpophalangeal joint of the right hand and carpal bones. The patient responded well to small doses of prednisone and methotrexate and after 4 months she had a sustained clinical and laboratory improvement. This is the first report making an association between SARS-CoV-2 infection and erosive polyarthritis. Physicians dealing with patients infected from SARS-CoV-2 should be aware for the possible development of musculoskeletal disorders, among them symmetrical polyarthritis. Thus, a close follow-up and monitoring is mandatory.

Radial extracorporeal shock wave therapy for Dupuytren’scontracture: a case report

Dupuytren’s contracture (DC) is a fibro-proliferative disorder of palmar and digital fascia, which leads to contracture deformity of hand and consequent disability. There is not a satisfying method for management of the disease and standard invasive treatments such as collagenase injection and fasciectomy have high rates of failure and recurrence. Recently, focused extracorporeal shock wave therapy (ESWT) has been used successfully for reduction of pain and dysfunction in DC. We hypothesized that radial ESWT would benefit this condition and used it in a chronic case. The patient was a 64-year-old farmer with the history of DC in both hands for eight years. He experienced exacerbation in the flexion contracture of the fourth metacarpophalangeal (MCP) joint of his right hand in the past month. We treated the patient with six weekly sessions of radial shock wave. Extension restriction in the fourth MCP joint reached from 30° to normal at the end of treatment and function of hand was also improved. Thus, radial ESWT should be considered and investigated for management of the DC in future studies.

SUCCESSFUL CORRECTION OF HYPERURICEMIA AND FOLLOWING ARTHROSCOPIC INTERVENTION IN A YOUNG GOUT PATIENT: CASE STUDY

Patient G., male, 32 years old was admitted to Chengdu Rheumatism hospital with the complains of pain and ulceration at the site of big tophaceous stone of fourth finger joint on the right hand as well as the pain and restricted movements in other right hand joints (elbow, wrist, fingers). Patient was first diagnosed with the gout approximately 10 years prior; by his own choice did not receive any urate-lowering treatment, only using oral analgesics during gout attacks. After surgery and following urate lowering therapy patient has noted functional improvement and reduction of pain. Decrease in serum urate levels from 586.7 to 469.3 μmol/L was reported. Wounds healing took from 1 to 1.5 weeks, with the wound on fourth metacarpophalangeal joint of the right hand being the last one to heal due to the wide ulceration defect. The longer follow-up period is needed to fully evaluate functional outcome (6-month follow-up examinations were scheduled).

Use of the First Dorsal Metacarpal Artery-Based Fascial Flap for Reconstruction of Small Defects on the Dorsum of the Hands

To describe the reconstruction of small defects on the dorsum of the hands using a first dorsal metacarpal artery-based fascial flap harvested through the borders of the defect. From January, 2015 to May, 2017, 29 patients (29 hands) with soft tissue defects on the dorsum of the hand were treated using a first dorsal metacarpal artery-based fascial flap. At final follow-up, we measured range of motion of the metacarpophalangeal joints and the first web span. Average size of the defects was 2.7× 2.5 cm. Average size of the flaps was 2.9× 2.7 cm. Average length of the pedicle was 2.9 cm. All flaps survived. Range of motion of the second to fourth metacarpophalangeal joints reached 93% to 98% of the opposite hand. The span of the first web reached 98% of the opposite hand. A first dorsal metacarpal artery-based fascial flap can be an alternative for reconstruction of small defects on the dorsum of the hands. Flap harvesting through the border of the defect avoided an additional scar at the donor site. Therapeutic IV.

Annals for Educators - 5 December 2017

Annals for Educators - 5 December 2017

Distribution of Sesamoid Bones in the Hand—A Study in the Chinese Population: 研究中國人的手部籽骨分佈

ObjectiveTo report the prevalence and distribution of hand sesamoid bones in Chinese ethnic group and its left-right symmetry. MethodsA retrospective study involving hand radiographs taken in patients admitted to United Christian Hospital from January 2011 to June 2014. Exclusion criteria included previous hand fracture, inadequate radiological views and those of non-Chinese ethnic group. ResultsA total of 307 hand radiographs (162 left and 145 right; 181 males and 126 females) in 266 patients were reviewed. Bilateral hand radiographs were available in 41 patients. Their mean age (± standard deviation) was 48.8 ± 11.3 years (range, 25–69 years). The total number of sesamoid bones identified was 1,641. Sesamoid bones were found at the first metacarpophalangeal joint (MCPJ) at a rate of 100%, while the prevalence at the second MCPJ, third MCPJ, fourth MCPJ, fifth MCPJ as well as the first interphalangeal joint (IPJ) was 59.0%, 2.93%, 0%, 47.6% and 28.0%, respectively. Bilateral hand radiographs showed 100% symmetrical distribution of sesamoid bones on right and left sides. ConclusionThis is the first study in Hong Kong to report prevalence of sesamoid bones in the Chinese Population and identify the symmetry of sesamoid bones in bilateral hands. The result revealed that the Chinese ethnic group had a higher prevalence of sesamoid bones at the 2nd and 3rd MCPJ when compared with other ethnic groups. The distribution of sesamoid bones was symmetrical in bilateral hands.

Forgotten but Not Gone! Syphilis Induced Tenosynovitis.

Objective. Tenosynovitis, inflammation of a tendon and its synovial sheath, is a rare manifestation of secondary syphilis and if diagnosed early is reversible. Background. A 52-year-old male with past medical history of untreated syphilis presented with gradual onset of swelling and pain of the right fourth metacarpophalangeal joint (MCP). He reported a history of painless penile lesions after having sexual intercourse with a new partner approximately five months ago which was treated with sulfamethoxazole/trimethoprim. An RPR done at that time came back positive with a high titer; however, patient was lost to follow-up. On examination, patient had an edematous, nonerythematous right fourth proximal interphalangeal (PIP) joint. Urgent irrigation, debridement, and exploration of the right hand into the tendon sheath were performed. With his history of syphillis, an RPR was done, which was reactive with a titer of 1 : 64. A confirmatory FTA-ABS test was completed, rendering a positive result. Based on his history of untreated syphilis, dormancy followed by clinical scenario of swelling of the right fourth finger, and a high RPR titer, he was diagnosed with secondary syphilis manifesting as tenosynovitis.

Segmentation and quantification of bone erosions in high-resolution peripheral quantitative computed tomography datasets of the metacarpophalangeal joints of patients with rheumatoid arthritis

To develop a precise three-dimensional (3D) segmentation technique for bone erosions in high-resolution peripheral quantitative CT (HR-pQCT) datasets to measure their volume, surface area and shape parameters. Assessment of bone erosions in patients with RA is important for diagnosis and evaluation of treatment efficacy. HR-pQCT allows quantifying periarticular bone loss in arthritis. HR-pQCT scans with a spatial resolution of about 120 µm of the second to fourth metacarpophalangeal joints were acquired in patients with RA. Erosions were identified by placing a seed point in each of them. After applying 3D segmentation, the volume, surface area and sphericity of erosions were calculated. Results were compared with an approximation method using manual measurements. Intra- and interoperator precision analysis was performed for both the 3D segmentation and the manual technique. Forty-three erosions were assessed in 18 datasets. Intra- and interoperator precisions (RMSCV/RMSSD) for erosion volume were 5.66%/0.49 mm(3) and 7.76%/0.76 mm(3), respectively. The correlation between manual measurements and their simulation using segmentation volumes was r = 0.87. Precision errors for the manual method were 15.39% and 0.36 mm(3), respectively. We developed a new precise 3D segmentation technique for quantification of bone erosions in HR-pQCT datasets that correlates to the volume, shape and surface area of the erosion. The technique allows fast and effective measurement of the erosion size and could therefore be helpful for rapid and quantitative assessment of erosion size.

THU0419 A novel technique to quantify bone erosions in patients with rheumatoid diseases using high-resolution PQCT images

BackgroundCurrently, radiographs are used to semi-quantitatively assess bone destruction in patients with rheumatoid and psoriatic arthritis. However, an exact quantification of bone erosions may be important for evaluating disease activity...

AB0720 Monitoring of changes of size, shape and bone mineral density of bone erosions in high resolution ct datasets of patients with rheumatoid arthritis under treatment

BackgroundDiagnosis and monitoring of patients with rheumatoid arthritis (RA) is largely based on radiographs, therefore the sensitivity to detect small changes of bone erosions is limited. This is also true...

Tophaceous Gout – Even Today

OPINION article Front. Immunol., 23 September 2013Sec. Inflammation https://doi.org/10.3389/fimmu.2013.00284

Chondrosarcoma of metacarpal - A rare presentation.

Chondrosarcoma, a malignant bone tumour constitutes about 9% of primary bone malignancies. Common in locations like proximal femur, proximal humerus, and pelvis, rarely it can occur in hand.1 We describe a patient with chondrosarcoma of the fourth metacarpal, a rare presentation of this tumour. To the best of our knowledge, only 13 cases (primary & secondary) are reported in literature so far.2–6

Interleukin-6 receptor blockade induces limited repair of bone erosions in rheumatoid arthritis: a micro CT study

IntroductionInterleukin-6 receptor (IL-6R) blockade improves the signs and symptoms of rheumatoid arthritis (RA) and retards bone damage. Whether IL-6R blockade allows repair of existing bone erosions is so far unclear.MethodsThis...

A detailed comparative study of high‐resolution ultrasound and micro–computed tomography for detection of arthritic bone erosions

To test whether bony lesions appearing on ultrasound (US) imaging are cortical breaks detectable by micro-computed tomography (micro-CT). Twenty-six subjects (14 with rheumatoid arthritis, 6 with psoriatic arthritis, and 6 healthy controls) were assessed for bone erosions at the radial, palmar, and dorsal regions of the second metacarpophalangeal (MCP) joint and the palmar and dorsal regions of the third and fourth MCP joints. All patients underwent US and, for validation of the results, micro-CT scanning. The prevalence and severity of bone erosions as determined by US and by micro-CT were recorded and compared. Overall there was a good correlation between the severity of erosions as assessed by US and by micro-CT (r = 0.463, P < 0.0001). False-negative results (US negative/micro-CT positive) were obtained in only 9.9% of the joint regions and were mostly due to small erosive lesions at the dorsal sides of the MCP joints. False-positive results (US positive/micro-CT negative) were more frequent (28.6%) and were primarily based on vascular bone channels at the palmar sides of the MCP joints as well pseudo-erosions created by osteophytes. These data show that the majority of bone lesions appearing on US are indeed bone erosions with a cortical break. The sensitivity of US for detecting bone erosions was high and there was a good correlation between the severity of bone erosions as assessed by US and as assessed by micro-CT. Specificity of US for bone erosions was substantially lower, suggesting that smaller lesions seen on US do not always represent breaks in the cortical bone surface.

Partial Paralysis of the Posterior Interosseous Nerve - A Case Report -

Partial paralysis of the posterior interosseous nerve at the forearm region has been rarely reported. We report our patients. After closed crushing injury at the forearm region, the patients showed Sign of horns which means disability of extension at the third and fourth metacarpo-phalangeal joint because of partial paralysis of the posterior interosseous nerve. We treated the patients as conservative treatment and the patients was completely recovered. So the autors report this case.

Role of metacarpophalangeal joint anatomic factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis.

To investigate the role of metacarpophalangeal (MCP) joint anatomic and biomechanical factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis (RA). Thirty-three patients with early RA with clinically diagnosed MCP joint disease and 28 healthy controls were examined by magnetic resonance imaging of the second to fifth MCP joints of the dominant hand. T1 and T2 fat-suppressed coronal sequences were obtained to assess erosion, and dynamic contrast-enhanced images were acquired to assess synovitis in all of the RA patients and in 8 of the controls. Erosions were defined as bone defects with sharp margins observed using T1-weighted imaging in 2 planes, with a cortical break seen in at least 1 plane. The location of erosions was recorded. The volume of synovitis surrounding each MCP joint (divided into 8 regions) was calculated by summation of voxels derived from the maximal enhancement parameters. The synovial volumes adjacent to MCP joint collateral ligaments were determined by correcting synovial volumes for the positions of asymmetrically placed flexor tendons. In patients with early RA in whom bone erosions were present, there was a propensity for involvement of the radial side of the second (P < 0.0001), third (P = 0.002), and fourth (P = 0.056) MCP joints, but not the fifth. Fifty-two of the 110 erosions (47.3%) occurred adjacent to the radial collateral ligaments of the second, third, and fourth MCP joints. The volume of synovitis was also greater on the radial side of the second (P < 0.0001) and third (P < 0.001) MCP joints. A predilection for synovitis in all of the MCP joints adjacent to the radial collateral ligaments was evident when the positional effects of the flexor tendon were considered. The position of radial collateral ligaments had an effect on erosion formation that was independent of synovitis. A predilection for radial bone damage was also evident in the controls, although lesions were 5-fold less frequent, were generally smaller, and had well-defined margins. This study shows that there is a predilection for both synovitis and bone erosion formation on the radial side of the MCP joints in early RA, and that joint inflammation appears to drive the inherent tendency for bone damage on the radial side of joints. These findings have implications regarding the pathogenesis of joint damage in RA.

Leiomyoma of the hand: A case report and review of the literature

An 18-year-old, right-handed black woman presented with a 1-year history of a mass at the base of her right fourth finger. Physical examination revealed a painless 1 • 1 cm soft, mobile mass at the palmar aspect of the fourth metacarpophalangeal joint (Fig. 1) unassociated with sensory or motor compromise. An x-ray film of the right hand showed a soft tissue mass with two microcalcifications, most compatible with a hemangioma. Excision of the tumor was performed under general anesthesia. At surgery, the tumor dissected easily from surrounding structures and was not adherent to tendons, vessels or deep tissue layers (Fig. 2). Microscopic examination revealed a nodule composed of interlacing bundles of smooth nonstriated muscle (Fig. 3). Throughout the lesion were scattered thin-walled vessels that were on occasion associated with small areas of calcification. The nuclei were bland and rounded to slightly fusiform (Fig. 4). Myofibrils were identified by electron microscopy. The surgical wound was closed with a split-thickness skin graft (Fig. 5). At the patient's most recent postoperative visit the incision had healed, motor and sensory function were intact, and there was full range of motion.

Syndrome of Camptodactyly, Arthropathy and Coxa Vara (Cac Syndrome)

Three Saudi children (two female, one male) are described who presented with familial arthropathy associated with congenital camptodactyly. This rare but recognized clinical entity has a variable clinical presentation and may be associated with pericarditis and coxa vara. Camptodactyly was observed in the neonatal period in all patients, while joint swelling was observed between the third and 11th month. Pericarditis was suspected in the referral hospital in one patient but was not subsequently confirmed at our institution, raising the possibility that pericarditis may be reversible. Radiological examination of the hips showed coxa vara with short femoral neck in all patients. Synovial biopsy in the three patients revealed proliferating synovial epithelium with moderate fibrocollagenous densities and multinucleated giant cells, occasional lymphocytes or neutrophils but no plasma cells were identified. This is the first series of this familial arthropathy with a triad of camptodactyly, arthropathy and coxa vara (CAC syndrome) in Saudi Arabia which is to be considered in patients where more than one family member has juvenile arthritis.