Interphalangeal Joint Research Articles

Dorsal and Volar Approaches for Proximal Interphalangeal Joint Replacement: Comparing Outcomes Through Systematic Review and Meta-Analysis.

The 2 primary surgical approaches for proximal interphalangeal joint (PIPJ) arthroplasty, dorsal or volar, have been extensively described in the literature. However, the ongoing debate regarding which approach offers superior results or is associated with fewer complications persists. This systematic review aims to compare the outcomes of PIPJ arthroplasty between the dorsal and volar approaches. A comprehensive search of multiple databases was conducted, and studies meeting predetermined criteria were included. Data extraction, assessment of bias risk, and statistical analysis were performed to compare treatment modalities. Outcome measures included range of motion (ROM), patient-reported outcome measures (PROMs), revisions, and reported complications. Among 368 screened articles, 5 studies involving 302 patients (310 implants) were eligible for final review. No significant differences were observed between the 2 approaches regarding postoperative ROM (mean difference [MD] 2.24; 95% confidence interval [CI] -3.83, 8.32; P = .47) and PROMs (standardized mean difference [SMD] 0.18; 95% CI -0.12, 0.48; P = .25). Complication rates, including revision/fusion, persistent pain, stiffness, infection, and dislocation, did not significantly differ between the approaches. Notably, dorsal approach was associated with higher risk of swan-neck deformity (9 out of 82 implants), while no such cases were reported in the volar approach (0 out of 101 implants). Despite limitations and heterogeneity in the literature, both dorsal and volar approaches for PIPJ arthroplasty appear to yield equivalent outcomes for patients. II, therapeutic.

Successful Subungual Glomus Tumor Removal: A Case Report and Future Guidance on Diagnosis and Treatment

Background: Glomus tumors are rare benign hamartomas of the glomus body that occur mostly – though not limited to - the distal phalanxes of the digits. This article provides a real-life example of successful rare disease identification and treatment. It also provides a guideline that may help serve as future guidance on diagnosis and treatment. Case: A 41-year-old male came to our hospital presenting with a chief complaint of episodes of throbbing pain, which occurred spontaneously on the left thumb for the past two years. The pain had worsened in the past two weeks. The patient was positive for Hildreth’s, Love’s pin, and cold sensitivity tests. The previous x-ray showed no abnormalities in the left thumb. MRI found a hyperdense subungual lesion in the dorsal interphalangeal joint of the left thumb. We then performed an excision using the transungual approach. Histopathological findings found a relatively well-circumscribed lesion of the glomus apparatus absent of abnormal mitosis and necrosis. Two months after the excision, the patient reported no symptoms of recurrency, nail deformity, or other adverse outcomes. Conclusion: Patients typically present a chief complaint of chronic paroxysmal throbbing nail pain that persists for years, increases following exposure to cold environments, and is disproportionately exacerbated with the slightest touch. Hildreth’s, Love’s Pin, and cold sensitivity tests are special examinations that elicit or suppress pain. As with most benign tumors, complete excision usually yields good results. Adequate knowledge about diagnostic methods will help patients achieve early intervention and cure.

Disability Related to the Upper Extremities in Early Rheumatoid Arthritis-Long-Term Course and Disease Variable Impact: A Cohort Study.

To investigate the course of disability related to the upper extremities (UEs) in early rheumatoid arthritis (RA), and to assess correlations between such disability and clinical variables, including grip force. In an inception cohort of patients with early RA (diagnosed 1995-2005, N = 222, follow-up 10 yrs), disability of the UEs was assessed using a subscore of the Health Assessment Questionnaire-Disability Index (HAQ-DI-UE), and average grip force of the dominant hand was measured. Changes between consecutive follow-up visits in the HAQ-DI-UE subscore, and correlations at each visit with key clinical variables, were assessed. The relation between joint involvement and HAQ-DI-UE was examined using multivariate linear regression analysis. The HAQ-DI-UE decreased significantly from inclusion to the 6-month follow-up (mean change -0.26, 95% CI -0.18 to -0.34), and increased significantly after 2 years. There were fairly strong correlations for HAQ-DI-UE with grip force (r = -0.50 to -0.62), patient global assessment (r = 0.53 to 0.64), and patient-reported pain (r = 0.54 to 0.60) at all timepoints through 5 years, but only moderate to weak correlations with swollen joints, C-reactive protein, and erythrocyte sedimentation rate. At inclusion, wrist synovitis and tender proximal interphalangeal joints both had an independent effect on HAQ-DI-UE, whereas tenderness of the shoulder and the wrist had a greater importance at 6 months. Disability related to the UEs decreased significantly during the first 6 months, and increased again after 2 years. The correlations with clinical variables underline the major effect of pain and impaired hand function in early RA.

Surgical Deroofing and Trichloroacetic Acid Application: A Novel Treatment for Digital Mucous Cysts.

Digital mucous cysts (DMCs) are benign cysts located in digital interphalangeal joints or the proximal nail fold. Despite various treatments, standardized guidelines are lacking, and recurrence rates remain high. This study evaluates the efficacy and safety of a novel treatment combining surgical deroofing with trichloroacetic acid application. This study was conducted on 27 patients with DMCs treated from 2019 to 2022. Clinical features and therapeutic responses were documented with photographic records at the initial presentation and follow-ups. Histopathological examinations confirmed diagnoses and classified histopathological types. Among 27 lesions, 20 were within the proximal nail fold, 7 were beneath the proximal nail fold; 26 were ganglionic, and 1 was myxomatous. Four patients required multiple treatments within 6 months due to recurrences. Long-term follow-up showed clinical improvement in all patients: 17 achieved complete remission, and 8 showed partial improvement. The treatment was effective regardless of cyst type, with minimal complications and mild postoperative pain resolving within days. The combination of surgical deroofing and trichloroacetic acid application minimizes complications and enhances efficacy. It allows for repetitive treatments in case of recurrence, making it a viable option for managing persistent DMCs, with favorable outcomes and minimal complications.

Low field magnetic resonance imaging of palmar osteochondral fragmentation of the distal phalanx

SummaryBackgroundThe presence of palmar osteochondral fragments of the distal phalanx is a newly recognised cause of foot lameness with only a few cases having been reported.ObjectivesTo describe the low field magnetic resonance imaging (MRI) appearance of palmar articular fragmentation of the distal phalanx and concurrent abnormalities of the distal interphalangeal joint (DIPJ); to investigate the prevalence of these fragments in a population of sports and pleasure horses and their potential clinical significance.Study designRetrospective descriptive case series.MethodsThis is a retrospective descriptive case series in which all Sports and Pleasure horses undergoing standing low‐field MRI of the feet between 2015 and 2023 were reviewed. Appearance, location and number of palmar articular fragments were recorded. When a palmar fragment was present, abnormal findings of the DIPJ were graded.ResultsA total of 855 horses underwent MRI examination of one or both front feet. Palmar osteochondral fragmentation of the distal phalanx was identified in four horses (0.4% prevalence), three Lusitanos and one Warmblood. The age range was 4–17 years old. All fragments were located along the palmarolateral margin of the glenoid of the distal phalanx in front feet. Concurrent imaging abnormalities of the joint were present in all four horses.Main limitationsLack of histopathology.ConclusionsThe prevalence of palmar articular fragments of the distal phalanx was low in this population of horses. Palmar osteochondral fragmentation must be considered when evaluating lameness localised to the foot, since it was identified only in lame limbs and associated with other imaging abnormalities of the DIPJ.

Radiographic features and subtypes of congenital thumb duplication type C3 according to Wu et al. and their potential implications for surgical management: new classification and preliminary results

BackgroundWu et al. introduced a modified radiographic system that allows classification of all forms of CTD with excellent interobserver and intraobserver reliability. No study to date has evaluated the radiographic characteristics of Wu et al. type C3 CTD with osseous attachment at the level of the metacarpal.ObjectiveThis study aimed to evaluate the radiographic features of type C3 CTD according to the system of Wu et al., to describe the different anatomical subtypes of the duplication, and to propose a categorization approach to distinguish diverse surgical strategies based on the radiographic anatomy of this specific subtype of duplication.MethodsWe performed a retrospective analysis of 215 patients (221 thumbs) diagnosed with Wu et al. type C3 CTD at our Institution between 2015 and 2021. We evaluated all CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints and by assessing the presence of abnormal hypertrophic epiphysis of the primary thumb on posteroanterior (PA) radiographs. The proposed classification system has four types: Type I with good alignment of both MP and IP joints, Type II with ulnar deviation of the MP joint, Type III with radial deviation in the MP joint and Type IV with abnormal hypertrophic epiphysis of the distal phalanx of the main thumb with ulnar deviation of the IP joint with or without ulnar deviation of the MP joint.ResultsThere were 140 male and 75 female patients with CTD (221 thumbs). There were 65 left, 144 right and 6 bilateral forms. The right-to-left, male-to-female and unilateral-to-bilateral ratios were 2.2:1, 1.9:1 and 35.8:1 respectively. The mean age at surgery was 22.3 ± 11.8 months (range, 8–80). The proposed classification system allowed the classification of all CTDs (n = 221). Specifically, 53 fingers were classified as Type I (24%), 136 as Type II (61.5%), 21 as Type III (9.5%), and 11 as Type IV (5%).ConclusionThe proposed system is based on radiographic pathoanatomy and complements that of Wu et al. by identifying four distinct subtypes of deformity. It has the potential to improve inter-professional communication and guide surgery in patients with Wu et al. type C3 CTD. However, our results are preliminary and further research is needed to validate them.Level of evidenceIII.

Surgical Management for Boutonniere Disease

Boutonniere disease is a hand injury causing extension lag or restriction in the proximal interphalangeal joint and hyperextension in the distal interphalangeal joint. This condition often arises from direct laceration or closure damage to the central tendon, rheumatoid arthritis, osteoarthritis, Dupuytren contracture, pulley injury, burns, and other conditions. Surgical management for Boutonniere deformity relies on the expertise of the attending physician and involves both non-surgical and surgical options. In acute cases, conservative therapy should be pursued, while in chronic cases, conservative management may be advised. Surgical intervention is used to transform excessive extension force of the distal interphalangeal joint into extension force of the proximal interphalangeal joint. This is necessary to heal an open rupture of the central tendon. Surgical techniques for chronic deformity are complex due to variables and hand surgeons' expertise. There is no definitive surgical therapy for persistent buttonhole deformity, but several approaches have been documented in case studies. These include terminal tenotomy, collateral band surgery, central tendon surgery, tendon transfer and grafting, stepwise extension mechanism readjustment surgery, and arthrodesis. Central tendon surgery addresses the central tendon, where injured tissue transforms into scar tissue, resulting in delayed extension of the proximal interphalangeal joint. Tendon transfer or grafting have been documented for rotator cuff mechanism rehabilitation, but no definitive guidance exists for these techniques. Curtis treatment introduced a sequential therapy approach for traumatic buttonhole deformity, which involves splinting, excising the transverse reticular ligament, resecting and lengthening the collateral ligament, and repositioning the core tendon. Arthrodesis may be applicable in cases of advanced arthritis, coronal plane deformity, functional impairment, or elderly patients. There are no definitive indications for surgical interventions for persistent buttonhole deformity, and outcomes may be variable or inferior. Understanding the deformity, its progression, and patient's functional constraints is crucial for effective treatment

Numerical and Experimental Study of a Wearable Exo-Glove for Telerehabilitation Application Using Shape Memory Alloy Actuators

Hand paralysis, caused by conditions such as spinal cord injuries, strokes, and arthritis, significantly hinders daily activities. Wearable exo-gloves and telerehabilitation offer effective hand training solutions to aid the recovery process. This study presents the development of lightweight wearable exo-gloves designed for finger telerehabilitation. The prototype uses NiTi shape memory alloy (SMA) actuators to control five fingers. Specialized end effectors target the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, mimicking human finger tendon actions. A variable structure controller, managed through a web-based Human–Machine Interface (HMI), allows remote adjustments. Thermal behavior, dynamics, and overall performance were modeled in MATLAB Simulink, with experimental validation confirming the model’s efficacy. The phase transformation characteristics of NiTi shape memory wire were studied using the Souza–Auricchio model within COMSOL Multiphysics 6.2 software. Comparing the simulation to trial data showed an average error of 2.76°. The range of motion for the MCP, PIP, and DIP joints was 21°, 65°, and 60.3°, respectively. Additionally, a minimum torque of 0.2 Nm at each finger joint was observed, which is sufficient to overcome resistance and meet the torque requirements. Results demonstrate that integrating SMA actuators with telerehabilitation addresses the need for compact and efficient wearable devices, potentially improving patient outcomes through remote therapy.

Therapy for Dupuytren’s Disease: Collagenase Therapy—A Long-Term Follow-Up Study

Background: Dupuytren’s disease (DD) is a systemic connective tissue disorder of the palm. It particularly affects men of Northern European or Caucasian origin over the age of 55. In addition to the classical surgical therapy via limited fasciectomy, Dupuytren’s contracture can also be treated minimally invasively. A relatively new treatment method is the use of collagenase injections (Xiapex) to reduce the contracture of the fingers. The data regarding the long-term success of this therapy are currently limited. Methods: In this monocentric retrospective study, we examined 35 patients who were treated with collagenase (Xiapex) for Dupuytren’s contracture in the long fingers. Following the manufacturer’s recommendations, the injection was administered intralesionally, and the cord was ruptured through the passive extension of the finger under local anesthesia with Mepivacain the following day. The clinical follow-up examination was conducted after an average of 5.7 years. The stages of Dupuytren’s disease were documented using the Tubiana classification. Additionally, parameters of finger extension ability, differentiated by metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints, as well as patient-specific risk parameters, were evaluated Results: The long-term results of collagenase therapy after an average of 5.7 years showed a significant improvement in the contracture of the affected fingers. In the MCP joints, the flexion contracture decreased from 42° to 17° (p ≤ 0.001), and in the PIP joints, it decreased from 56° to 33° (p ≤ 0.001). The primary recurrence rate was 11% for the MCP joints and 19% for the PIP joints, respectively. The analysis of risk factors showed a significant risk for worse long-term outcomes in patients with diabetes and those with nicotine abuse. Conclusions: Collagenase therapy for Dupuytren’s disease achieved significant long-term improvements in contracture in both MCP and PIP joints. In accordance with general risk factors for DD, patients with diabetes and those with nicotine abuse are at risk of worse long-term outcomes. Overall, it is a time-saving, low-risk, and straightforward technique for treating the disabling contracture component of this disease.

A Percutaneous Triple K-Wire Fixation Technique for Nascent Malunion of Proximal Interphalangeal Joint Fracture-Dislocation: A Case Series With an Assessment of Functional Outcome

Fracture-dislocations of the proximal interphalangeal (PIP) joint are difficult to manage. In the case of a 2- to 4-week delay in definitive treatment, a nascent malunion may result. This study aimed to evaluate the effectiveness of the percutaneous triple K-wire technique for treatment of the PIP joint nascent malunion. We treated 13 patients with nascent malunion of PIP joint fracture-dislocations using the percutaneous triple K-wire fixation technique based on the principle of soft callus manipulation to achieve congruity and reduction in the joint. The study included cases where the percentage of articular involvement exceeded 40% and in whom there was a minimum follow-up of 12 months. At the final follow-up, we measured the range of motion at the PIP joint. The Ishida and Ikuta scores were determined. The mean period between injury and surgery was 17.2 days. The average follow-up time was 14.2 months. The mean active arc of motion before surgery in the PIP joint was 15 degrees and that at the final follow-up was 83 degrees. Seven patients achieved excellent outcomes according to the Ishida and Ikuta scores. The final postoperative range of motion at the PIP joint was comparable with that reported in the literature for patients who underwent different procedures. This procedure can be considered a viable alternative to open reduction and plating, hemihamate arthroplasty, and ligamentotaxis with distraction, particularly in the presence of nascent malunion. Therapeutic IV.

Endoscopic Resection of Horseshoe Ganglion of the Great Toe

Twelve percent of the foot ganglion cysts occur on the toes, and they are often symptomatic and recurrent. When conservative treatment failed, surgical excision is recommended, which is classically an open resection of the ganglion cyst. However, communicating lesions between ganglion cysts and the interphalangeal joint or tendon sheath make it difficult to prevent a recurrence. Techniques of arthroscopic or endoscopic toe ganglionectomy have been reported, which is either arthroscopic/endoscopic internal drainage to the adjacent joint or tendon sheath or endoscopic resection of the ganglion cyst. Difficulty in identifying the communicating valvular lesion and high incidence of multiloculated lesions make endoscopic internal drainage not always feasible for toe ganglion. The purpose of this Technical Note is to describe the details of endoscopic resection of horseshoe ganglion of the great toe. This minimal invasive approach may help to reduce the risk of recurrence.

Extensor Tendon Repair.

Extensor tendon injuries are a common condition that hand surgeons must be prepared to treat. The area of extensor tendon injury can traditionally be broken down into 9 zones. Physical examination is the best way to diagnose extensor tendon injury with a loss of active extension in the injured digit. The tenodesis effect may be utilized to aid in diagnosis: wrist flexion should cause passive extension at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints if the extensor tendon is in continuity. Repair of extensor tendon injuries depends on the zone of injury and the thickness of the tendon, which determines its ability to hold core sutures. For zone-I and II injuries, several "figure of 8" buried sutures can be utilized or a running type of suture may be employed. For zone-III to VII injuries, 1 or 2 core sutures and a supplementary running suture can be utilized. Several alternative techniques have been previously described. These include variations in the number of core strands, repair configuration, and suture caliber, as well as the use of epitendinous repair. Alternative treatments also include nonoperative treatment, which is typically reserved for partial tendon injuries and for patients who are unable to tolerate a surgical procedure. The techniques that we describe are tailored to the thickness of the tendon. Running sutures are applicable to any zone, whereas core sutures are best utilized in zones III through VII. The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish compared with the other techniques, and was found to have good to excellent clinical results in a study of lacerations in zones IV and V1,2. Repair of extensor tendon lacerations has demonstrated good long-term outcomes if performed in a timely manner after injury. A previous study showed good to excellent function in up to 64% of acute extensor tendon repairs, more fingers lost the ability to flex fully than lost the ability to extend3. Systematic reviews have suggested that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting4. The Elson test should be performed under a digital nerve block in order to properly assess the integrity of the central slip.In distal zone I and III injuries, suture anchors or bone tunnels may be utilized when there is no remaining tendon on the distal end of the laceration.When preparing the tendon ends for repair, it is important to handle the tendon delicately-preferably through the cut end of the tendon rather than the tendon itself.In zone-VII injuries, the injured tendon may lie beneath the extensor retinaculum. In such cases, windowing of the extensor retinaculum may decrease adhesion formation and facilitate repair. MCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangealIP = interphalangealROM = range of motionRMS = relative motion splintRIHM = running interlocking horizontal mattress.

Surgical repair of multiple pulley injuries with proximal interphalangeal joint contracture under WALANT

Flexor tendon pulley reconstruction in patients with multiple pulley ruptures and proximal interphalangeal joint contracture after closed injuries is relatively uncommon. The paucity of evidence in the literature supporting one technique can make these surgical decisions and surgeries challenging. This article presents the surgical technique we use for treatment of the proximal interphalangeal joint stiffness and pulley reconstruction at the same time, using wide-awake local anesthesia with no tourniquet (WALANT). The clear advantage of this anesthetic technique for this procedure is the ability to directly verify the contracture release and tendon's gliding through the reconstructed pulley system during the patient's active mobilization, allowing the surgeon to make adjustments during the surgery and educating the patient on the postoperative therapy.

Delayed Correction of Intra-articular Lateral Head Fracture of the Proximal Phalanx of the Great Toe in Children.

Conservative treatment of intra-articular lateral head fracture of the proximal phalanx (LHFPP) of the great toe in young children has a high rate of nonunion, leading to hallux valgus interphalangeus (HVIP). This study presents a case series of surgically managed, late-diagnosed LHFPP, highlighting the difficulties of the surgery and presenting satisfactory results. Nine unilateral cases (8 late-diagnosed and 1 acute) were treated by open reduction and Kirchner wire fixation. The average time from trauma to surgery was 2.9 years (range, 0.5-10.1 years) in our late-diagnosed cases. The average age at the time of operation was 9.2 years (range, 3.4-16.3 years). The causes of injury were various. Intraoperative findings were reviewed through medical records and photographs. Pre- and postoperative HVIP angle, American Orthopedic Foot and Ankle Society (AOFAS) score, and range of motion of the interphalangeal joint were measured and compared statistically. Progressive HVIP was a chief complaint in all 8 late-diagnosed cases. Bony fragment size depended on the time elapsed after trauma (fragments increased in size due to ossification of cartilage) with a mean of 23.5% articular involvement. Four cases required bone graft, and union was achieved in all cases. The mean HVIP angle improved from a mean of 17.8° to 10.5°. The average AOFAS score and range of motion were significantly improved after surgery. Although LHFPP is rare and difficult to diagnose, even cases detected long after the initial trauma can be successfully treated, albeit with difficulty. All 9 of our patients had successful outcomes when treated by open reduction and internal fixation.

Biodegradable, stretchable, and high-performance triboelectric nanogenerators through interfacial polarization in bilayer structure

The increasing demand for wearable electronics has led to the development of triboelectric nanogenerators (TENGs) as a promising energy harvesting and sensing technology. However, conventional TENGs often utilize non-biodegradable materials, contributing to environmental pollution. In this work, we present a stretchable and biodegradable TENG based on hydroxyethyl cellulose (HEC) and gelatin (HG-TENG). The HG-TENG features a bilayered structure, where the large difference in their relative permittivity between HEC and gelatin induces interfacial polarization, effectively mitigating charge recombination and enhancing triboelectric performance. The optimized HG-TENG achieves an open-circuit voltage (Voc) of 93 V, a maximum power density of 57.8 µW/cm2, and can power 38 blue light-emitting diodes. The device exhibits a stretchability of 150 % and biodegrades within 3 hours in phosphate-buffered saline. Furthermore, we demonstrate the application of the HG-TENG as a wearable sensor by modifying it with trichloro(1H, 1H, 2H, 2H-perfluorooctyl)silane (FOTS) (FHG-TENG). The FHG-TENG-based smart glove, integrated with machine learning algorithms, enables real-time monitoring of blood pressure waveforms and finger motions, showcasing its potential for human-machine interfaces. The smart glove, equipped with five FHG-TENGs on the proximal interphalangeal joints of each finger, detects diverse finger gestures and generates voltage signals that control a robotic hand in real-time, demonstrating effective human-machine interaction through synchronized motion. Moreover, the smart glove achieves a high recognition accuracy of 96.15 % for 10 different hand sign languages.

Managing RS3PE: Diagnostic approach, initial steroid response, and long-term management with DMARDs

Background. RS3PE, or Remitting Seronegative Symmetrical Synovitis with Pitting Edema, is a unique and relatively rare form of inflammatory arthritis that predominantly affects older adults. It is distinguished by its hallmark features: symmetrical swelling of the joints, significant pitting edema in the extremities, and a negative serological profile for common markers associated with rheumatoid arthritis, such as rheumatoid factor (RA factor) and anti-citrullinated protein antibodies (anti-CCP). This condition is often characterized by a remitting course, meaning that symptoms may improve or resolve over time, particularly with appropriate treatment. The condition usually affects older adults and can sometimes be associated with other underlying health issues, such as malignancies or infections. The “remitting” aspect of RS3PE refers to the fact that the symptoms often improve or resolve over time, particularly with appropriate treatment, which usually involves corticosteroids or other anti-inflammatory medications. Case report. This case study details the clinical presentation, diagnosis, and management of a 56-year-old female patient with known hypertension who presented with bilateral dorsal hand swelling, pain, and early morning stiffness over a 15-day period. The patient’s initial examination revealed bilateral pitting edema and active arthritis in the proximal interphalangeal joints, with significant warmth and tenderness. Laboratory tests showed elevated ESR and CRP, normocytic normochromic anemia, and negative rheumatoid factor and anti-CCP antibodies. Imaging studies, including X-ray, ultrasound, and mammogram, showed no erosive changes or malignancy, while a Pap smear and serum CA-125 levels were within normal limits. The clinical picture, combined with the exclusion of other conditions, supported the diagnosis of RS3PE. Treatment commenced with intravenous low-dose dexamethasone, which led to significant symptomatic improvement. This was followed by a transition to oral prednisolone, and the patient initially showed complete resolution of symptoms. However, recurrence of symptoms occurred upon discharge, prompting the introduction of steroid-sparing agents: methotrexate and hydroxychloroquine, alongside continued oral steroid treatment. Over a two-month follow-up period, the patient experienced no signs of relapse. This case fits the clinical and investigative criteria for RS3PE. The patient showed symptomatic improvement after treatment with low-dose steroids.

Ultrasound nail assessment in patients with psoriasic arthritis: is there an association of findings with clinical scores?

BackgroundPsoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings.ObjectivesTo describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)).MethodsThis was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student’s t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher’s exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification.ResultsThe Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some correlations between US findings and clinical scores: ultrasound nail involvement and the NAPSI score (p = 0.034), the number of fingers and mean change in the nail plate and the ASDAS-CRP (p = 0.030). DAPSA (remission/low activity versus moderate/high activity) was associated to the mean change in the nail plate (p < 0.013). CONCLUSIONS: Nail ultrasound has the potential to assist in the capturing of the actual disease activity status in patients with psoriatic arthritis.

High-frequency ultrasonography for the detection of subclinical arthritis in chronic plaque psoriasis patients - A cross-sectional study.

Background Psoriatic arthritis (PsA) is seen in almost 30-40% cases of psoriasis. Psoriasis precedes the onset of PsA in 85% of cases. Delay in the diagnosis of PsA may lead to poor functional outcomes and morbidity. Screening psoriasis patients with high-frequency ultrasound helps to diagnose arthritis at an early stage leading to prompt intervention and possible reduction in the morbidity associated with the disease. Objectives To determine the role of high frequency ultrasonography (USG) in the detection of subclinical PsA. Methods A cross-sectional study was conducted in a dermatology and radiology department of Armed Forces Medical College, Pune between July 2021 and December 2022. Patients of chronic plaque psoriasis with no clinical evidence of arthritis were assessed using high-frequency USG. Various parameters such as bony erosions, synovial thickening, tendon thickening, tendon hypo-echogenicity, calcifications and power doppler signals were assessed. Results A total of 117 patients were included in the study. The distal interphalangeal joint (DIP) and Achilles tendon were the most commonly affected sites. Synovial thickening in DIP was observed in 67 (57%) patients and Achilles tendon thickening was observed in 39 (33%) patients. Limitations of the study The cross-sectional nature of the study is the major limitation. A longitudinal study will be required to understand the clinical relevance of ultrasonographic changes in these patients. Another limitation of the study is the lack of age and gender-matched controls. Future research should include such controls to ensure more accurate results. Conclusion Subclinical arthritis is common in patients with chronic plaque psoriasis. High-frequency ultrasound is a useful tool for detecting subclinical synovitis and enthesitis in asymptomatic patients. The DIP joint and Achilles tendon ultrasound can be used for screening for early detection of PsA.

Iatrogenic Irreducible Pediatric Salter-Harris II Middle Phalanx Base Fracture With Dorsal Dislocation of the Proximal Interphalangeal Joint: A Case Report.

Pediatric phalangeal Salter-Harris (SH)-type fracture dislocations are rare injuries that often require open reduction and stabilization. We present a case of a 14-year-old male who sustained an iatrogenic irreducible SH II dorsal fracture dislocation of the small-finger proximal interphalangeal joint (PIPJ) after an attempted closed reduction of a small-finger PIPJ dislocation by a community emergency medicine physician. Following the reduction attempt, the epiphysis was noted on radiographs to be rotated approximately 90° with persistent dorsal dislocation and an associated SH II fracture of the base of the middle phalanx. The patient was sent to our trauma center for further evaluation by our on-call hand surgeon and required open reduction and pinning of the fracture dislocation. To our knowledge, this pattern of iatrogenic PIPJ fracture dislocation has not been previously described in the literature. We outline the case presentation, treatment method, and learning points for both the on-call hand surgeon as well as the community emergency medicine physicians in this report.

Thermal Characteristics of the Small Joints of the Hands Between Patients with Rheumatoid Arthritis and Healthy Controls.

Objectives: This study aimed to investigate the thermal characteristics of the small joints of the hands between patients with Rheumatoid arthritis and healthy controls. Patients and Methods: Fifty-two patients with Rheumatoid arthritis and twenty-six healthy controls were included in the study. Joint tenderness was evaluated using Ritchie Articular index. Joint tenderness was scored from 0 to 3. Thermal data was collected from the hand regions of individuals. A FLIR T450sc microbolometer infrared thermal camera with 320x240 resolution was used for the thermography of individuals. Bilaterally proximal interphalangeal joints (1-5) and metacarpophalangeal joints (1-5) were evaluated. The mean temperature was compared between patients and healthy controls Results: The mean temperature values of the joints in the patients with a Rheumatoid arthritis RAI score of 0, 1, 2,3 were 32.43 ± 1.59°C; 32.71 ± 1.36°C; 33.12 ± 1.23°C; 33.60 ± 0.99 respectively. The mean temperature was 31.14 ± 1.51°C in healthy controls. The mean temperature values of the joints in the Rheumatoid arthritis patients with RAI score of 0 was higher compared to healthy controls (p&lt;0.05). Patients with a Ritchie sensitivity score of 1 had a higher mean temperature compared to patients with score of 0 (p&lt;0.05). In Rheumatoid arthritis patients, the joints with a RAI score of 1 had higher mean temperature values than the joints with RAI score of 0 (p&lt;0.05). The mean temperature values of the joints with RAI score of 2 were also higher than the joints with RAI score of 1 (p&lt;0.05). Conclusion: Thermal imaging may be an objective tool for diagnosis and assessing disease activity in Rheumatoid arthritis.