Proximal Interphalangeal Joint Of Index Finger Research Articles

Functional evaluation of optimal index finger proximal interphalangeal joint fusion angle using a simulated joint arthrodesis

This study aims at qualitatively and quantitatively evaluating the effects of simulated index finger proximal interphalangeal (PIP) joint fusion angles on hand kinematic function and performance. Although arthrodesis of the index finger PIP joint is an effective medical procedure that produces a durable, pain-free, and stable joint, it permanently immobilizes the joint. Twenty healthy subjects performed basic functional hand activities with the index finger PIP joint unconstrained (UC) and constrained to selected angles under surveillance of a motion capture system. Our results indicate differences in perceived difficulty, time performance, and the functional ROM of the hand joints when the index finger PIP joint is UC and constrained to 0, 20, and 40 degrees of flexion. The mean total perceived difficulty scores for all 6 tasks were higher for the PIP at 0 degrees than for the UC condition (p < 0.001) and for the PIP at 40 degrees (p = 0.048). The functional ROM presented a smaller total number of hand joints affected by the PIP at 20 degrees (25 in total) than the PIP at 0 (31 in total) and 40 (27 in total) degrees during execution of all 6 tasks tested. Therefore, the decision on the appropriate index finger PIP angle for arthrodesis may be between 20 and 40 degrees, as globally for all 6 tasks tested, 0 degrees exhibited the worst results regarding perceived difficulty, performance time, and number of joints with affected ROM. Selecting the appropriate angle for arthrodesis should consider a more complete set of functional activities.

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.

Bizarre parosteal osteochondromatous proliferation on a phalanx with periosteal erosion

Summary Bizarre parosteal osteochondromatous proliferation (BPOP) is an uncommon benign hand tumor with a high rate of local recurrence, marked proliferative activity, and an atypical histological appearance. The aim of this paper is to present a rare and illustrative example of BPOP with periosteal erosion. A 64-year-old male presented with a 10-year history of a mass, measuring approximately 3 cm in diameter, on the dorsal aspect of the right index finger. On physical examination, the mass was hard, indolent, and located at the level of the proximal phalanx. Roentgenograms displayed a soft tissue mass over the right index finger with erosion of the periosteum. Magnetic resonance imaging revealed a few well-defined lobulated tumors over the right index finger proximal interphalangeal joint with periosteal reaction. The soft tissue tumors were excised and found to have soft consistencies. Pathological findings demonstrated that the tumor was compatible with BPOP. BPOP is a benign but locally aggressive fibro-osseous mass yielding radiographic findings that bear striking clinical similarities to those of other diseases, such as osteochondroma, osteosarcoma, and myositis ossificans. As the radiographic findings of BPOP are equivocal, the differential diagnosis must be based on the pathological results. With this case report, we aim to inform physicians that a hand tumor with an aggressive clinical picture may be benign in origin.

Manifestations and Treatment of the Hand in Adult Congenital Erythropoietic Porphyria

Congenital erythropoietic porphyria (CEP) is a rare enzymatic disorder of heme metabolism, leading to the accumulation of porphyrins in the skin and subdermal structures. We present the case of a 34-year-old, right-hand-dominant, male patient with CEP. The patient had developed a chronic open subluxation of the left index finger proximal interphalangeal joint due to skin necrosis. We successfully treated the patient with proximal interphalangeal arthrodesis. This case demonstrates that childhood-onset CEP can also manifest in the adult hand. Considering the patient's age, the destructive nature of the disease, and the poor quality of function in older patients with childhood CEP, surgical intervention was necessary to avoid further digital length loss. Although the treatment described in this case report is not uncommon, we found it essential to present this case because the clinical presentation of CEP is rare.

Influence of Index Finger Proximal Interphalangeal Joint Arthrodesis on Precision Pinch Kinematics

To evaluate the impact of proximal interphalangeal (PIP) joint arthrodesis on the kinematics of precision pinch. Eleven healthy subjects performed index finger-thumb pinch motions under 4 conditions: unrestricted thumb and index finger (CONTROL) and fusion of the PIP joint of the index finger in flexion of 30° (PIP30), 40° (PIP40), and 50° (PIP50). Fusion was simulated with metallic splints. Kinematics of the thumb and index finger were recorded with a motion capture system. Proximal interphalangeal joint fusion at 30°, 40°, and 50° restricted maximal pinch span between the thumb tip and index finger tip by 6%, 10%, and 14%, respectively. At the time of pulp contact, PIP fusion led to an increase in index metacarpophalangeal joint flexion angle for the PIP30 condition and an increase in variability of thumb tip location for the PIP50 condition. Furthermore, the dynamic coordination between joint angles throughout the movement was affected by PIP fusion. This study reports impairment in the kinematics of precision pinch associated with index finger PIP joint fusion. A PIP joint fusion at 40° to 50° leads to a more natural precision pinch posture, but it restricts the aperture and reduces pinch precision.

REPRODUCIBILITY OF MEASUREMENTS OF THUMB ABDUCTION

The reproducibilities of various measurements of thumb abduction were compared. Two independent observers measured the thumb abduction in 30 volunteers by the following four methods: distance between the thumb tip and the flexion crease of the index finger proximal interphalangeal joint; distance between the flexion crease of the thumb interphalangeal joint and the proximal palmar crease; angle between the thumb and index metacarpals; and angle between the thumb and index proximal phalanx. Measurements were repeated in three weeks and their reproducibility was assessed by the intraclass correlation coefficient (ICC). Intra-observer reproducibilities by distances were high with ICCs between 0.74 and 0.89, compared with those by angles with ICCs between 0.28 and 0.71. Inter-observer reproducibilities by distances were also high (ICCs = 0.79 and 0.81) compared with those by angles (ICCs = 0.28 and 0.42). Assessment of thumb abduction based on distance in the first web is recommended in terms of reproducibility.

Immediate free vascularized joint transfer from second toe to index finger proximal interphalangeal joint: A case report

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.