Arthritis Of Metacarpophalangeal Joint Research Articles

Patient-Reported and Clinical Outcomes After Tendon Autograft Reconstruction of the Thumb Ulnar Collateral Ligament

This study aimed to report clinical and patient-reported outcomes collected in a registry after thumb ulnar collateral ligament (UCL) reconstruction with a free tendon autograft. Furthermore, the patient-reported outcomes of patients with persistent instability after reconstruction and patients with concomitant metacarpophalangeal joint arthritis diagnosed during surgery were analyzed. Patients undergoing reconstruction with a tendon autograft between December 2011 and February 2021 were included. Michigan Hand Outcomes Questionnaire (MHQ) scores at baseline were compared with those at 3 and 12 months after surgery. Stability was tested at 3 months after surgery. Tip and key pinch strength and metacarpophalangeal joint range of motion were measured at baseline and 12 months after surgery. We included 31 patients with thumb UCL insufficiency or failed UCL surgery who underwent reconstruction. The MHQ total score improved significantly from 62 at baseline to 75 at 3 months and continued to increase to 84 at 12 months after surgery. The MHQ function and pain scores improved significantly from intake to 3 and 12 months after surgery. Twenty-six of 31 patients (84%) regained postoperative metacarpophalangeal stability. Key pinch strength improved significantly 12 months after surgery from 5.2 kg at baseline to 6.4 kg at 12 months. The MHQ total, pain, and function scores of patients with persistent instability remained similar from baseline to 12 months after surgery. In four patients with metacarpophalangeal arthritis, the MHQ total and pain score improved significantly from baseline to 3 and 12 months after surgery. Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. Although the sample size of patients with thumb metacarpophalangeal arthritis diagnosed during surgery was small, they reached adequate patient-reported outcomes at 12 months after surgery. Therapeutic IV.

Arthrodesis for Primary Osteoarthritis of Trapeziometacarpal Joint Using Multiple Kirschner Wires and Tension Band Wire in Female Patients Older than 40.

Background: The purpose of this study was to evaluate the results of arthrodesis with multiple Kirschner (K)-wires and tension band wire for primary osteoarthritis of trapeziometacarpal (TM) joint in female patients aged 40 years or older. Methods: We retrospectively obtained data regarding all female patients 40 years or older who underwent TM joint arthrodesis for TM joint osteoarthritis with K-wires and tension band wire over a 10-year period from 2009 till 2019. Thumb length, active range of motion (ROM) at the metacarpophalangeal (MCP) joint, active ROM of radial and volar adduction and abduction and key pinch strength was measured. Patient-reported outcomes were assessed using a pain and satisfaction questionnaire and the DASH score. We also recorded postoperative complications. Results: The study included 60 thumbs in 49 patients with an average age 60 years and a mean follow-up of 40 ± 21 months. All but one thumb had radiographic evidence of fusion within 6 months and the union rate was 98%. Key pinch strength increased from 2.3 to 4.9 kg after surgery. Total arc of motion in radial adduction-abduction decreased from 16° to 10°. Total arc of motion in volar adduction-abduction decreased from 25° to 9°. One patient experienced attritional rupture of the flexor pollicis longus tendon attributed to a K-wire penetration into the carpal tunnel. Although 46 thumbs (77%) had no or mild hardware-related symptoms, they underwent hardware removal after solid bone union. In 23 thumbs with follow-up period longer than 48 months, two thumbs developed scaphotrapeziotrapezoid joint arthritis and two thumbs developed metacarpophalangeal joint arthritis. Conclusions: We found that arthrodesis with multiple K-wires and tension band wire is a valuable option in the management of trapeziometacarpal joint osteoarthritis in female patients aged 40 years or older. Level of Evidence: Level IV (Therapeutic).

A case with Beh\xe7et\u2019s disease involving erosive Metacarpophalangeal joint arthritis: the value of ultrasonography in the diagnosis of an Erosion

BackgroundBehçet’s disease (BD) is a chronic multisystemic vasculitis that may emerge with musculoskeletal system involvements, oral-genital recurrent aphthae, mucocutaneous lesions, and ocular symptoms. Arthritis in BD is usually non-erosive and not related to crippling disease. Erosive arthropathy is a very rare manifestation of BD.Case presentationHerein, we present a 60-year-old male patient suffering from BD for 33 years with erosive arthritis in his second metacarpophalangeal joint. After we assessed his finger by X-ray, we diagnosed erosive arthropathy quickly by musculoskeletal ultrasonography. In addition, a systematic literature search was performed via the PubMed and Scopus databases using the keywords, ‘Behçet’s disease [AND] erosive/destructive arthritis’.ConclusionsErosive arthritis due to BD can be evaluated by ultrasonography in an easy, fast and cost-effective manner. The literature search between 1985 and December 2019 revealed a total of 19 patients with peripheral erosive arthropathy related to BD and the characteristics of the results are summarized in the paper.

Clinical efficacy of arthroscope-assisted treatment of traumatic metacarpophalangeal arthritis

Objective To explore the clinical efficacy of arthroscopic minimally invasive technique in the treatment of traumatic pain and dysfunction of metacarpophalangeal joint in the early and middle stages. Methods From March 2016 to December 2018, nine patients with traumatic metacarpophalangeal arthritis were treated with arthroscopic minimally invasive assistance to understand the lesions of metacarpophalangeal joint, and to clean up the osteophytes, intra-articular free bodies and synovitis. After the operation, the patients were instructed to take progressive functional exercise. The joint motion degree of the affected fingers was followed up. Whether there were swelling, deformity and pain in the fingers was observed. Results The postoperative follow-up time ranged from 6 to 24 months, with an average of 15 months. All the patients did not have any symptoms such as surgical complications and pain discomfort in a short period of time. The joint flexion and extension function were improved in varying degrees. According to the measurement standard of total active motion (TAM) of finger flexion and extension function, before operation the results were good in 1 case, fair in 5 cases and poor in 3 cases; after operation the results were excellent in 6 cases, good in 2 cases and fair in 1 case. Conclusion In the early and middle stage of traumatic arthritis of metacarpophalangeal joint, the minimally invasive treatment under arthroscope has the advantages of small trauma, high accuracy and pertinence, quick postoperative recovery, which is an effective treatment method to improve hand function and reduce joint pain, and is worthy of clinical promotion. Key words: Metacarpophalangeal joint; Treatment outcome; Traumatic arthritis; Arthroscopes

A Rare Association of Rheumatoid Arthritis with Crohn’s Disease

Crohn’s disease (CD) is an chronic autoimmune inflammatory bowel disease (IBD) which may involve any part of the gastrointestinal system (GIS) (1). Although the rellationships among autoimmune diseases are known, association of rheumatoid arthritis (RA) and CD is an extremely rare condition (2,3). A 50-year-old male patient who had the diagnosis of seropositive RA for 5 years, presented with the complaints of bloody diarrhea and abdominal pain. The RA treatment had been regulated as a combination of methotrexate, sulfasalazine and hydroxychloroquine, and the patient reported that he was regularly taking the medical therapy. In joint examination, metacarpophalangeal joint arthritis were found bilateral. No hand deformity was observed. In physical examination, there were no findings except tenderness in the lower abdominal quadrants. There was not any bacterial growth in the stool culture. The results of the colonoscopy, found inflammation in the ileum (Figure 1a, 1b). Histopathologic examination was compatible with CD. Anteroposterior hand radiography revealed narrowing in 3rd and 4th proximal interphalengeal joints (Figure 1c). Genu varum deformity was found in the knee and magnetic resonance imaging (MRI) revealed synovial hypertrophy. Biochemical analysis yielded sedimentation rate as 22 mm/h (Reference range: 0-20 mm/h), C-reactive protein 1.21 mg/dL (reference range: 0-0.5 mg/dL), rheumatoid factor (+) and anti cyclic citrullinated peptide (CCP) (+). Mesalazine and azathioprine were added to his treatment protocol. At follow-up, complaints of the patiens gradually regressed within 4 months. Articular system involvement is commonly seen in IBD such as ulcerative colitis (UC) and CD. Axial and peripheral articular findings may commence before, concurrently or after the diagnosis of IBD. Peripheral arthritis is generally in form the oligoarticular involvement of the large joints. However, in a small portion of IBDs, an arthritis form may be seen, resembling rheumatoid arthritis and often affecting the small joints of the hand symmetrically and polyarticularly (4). Peripheral arthritis is reported in CD by 10-20% which is more frequent compared to UC (5). Our patient was diagnosed with CD, suggesting us the joint findings may be occured due to this condition. However, IBD arthritis is seronegative and never or rarely causes joint destruction compared to RA (5). In our patient, arthritis had begun about 5 years before GIS symptoms. According to 2010 American College of Rheumatology/European League Against Rheumatism criteria, positivity of anti CCP, RF antibodies, marked synovial hypertrophy in the knees on MRI and narrowing of the joint spacing found in our patient confirmed the diagnosis of RA. Our patient who could not describe an association between the exacerbation of CD and arthritis gave positive response to RA treatment. Hatice Resorlu, Erdem Akbal*, Ferhat Gokmen, Yilmaz Savas

Disseminated Mycobacterium chelonae infection in a patient with T-cell lymphoma

Infections with rapidly growing mycobacteria are rare and most often seen in immunocompromised patients. We herein present the case of a 69-year-old man with a T-cell lymphoma treated by chemotherapy and mogamulizumab with a 6-month history of febrile episodes and subcutaneous nodules in both arms and arthritis of metacarpophalangeal joints. Blood cultures and DNA sequencing results demonstrated the growth of Mycobacterium chelonae. The patient was successfully treated with clarithromycin, moxifloxacin, and tobramycin, but died shortly after due to lymphoma progression.

Delayed Anatomical Repair of Ruptured Ulnar Collateral Ligament Injuries of the Thumb Using a Dissolvable Polylactic Acid Bone Anchor

We describe late anatomic repair of complete distal ulnar collateral ligament (UCL) avulsions of the thumb in the absence of metacarpophalangeal joint arthritis using a dissolvable polylactic acid (PLA) bone anchor in two cases, one of which had a Stener lesion. Patients presented for surgery respectively at 5 months and 2 years after injury. Preoperative X-ray films showed subtle volar subluxation of the proximal phalanx. Volar plate release corrected this in both cases and a transarticular k-wire was not used. Satisfactory repair was achieved in both cases using a dissolvable PLA bone anchor. Flexion-extension mobilization was supervised by a hand therapist from day 1 after surgery. A low profile radial-sided thermoplastic splint to prevent reinjury of the UCL repair was used allowing interphalangeal joint and base of thumb movement, and was worn between therapy sessions for 4 weeks. In both patients, satisfactory UCL stability was maintained at 3-year follow-up after surgery. Dissolvable PLA bone anchors may be used to satisfactorily restore stability and function in late presenting complete distal UCL avulsions of the thumb with or without accompanying Stener lesions.

Technical Section: Technical Tutorial, Notes and Tips

Hyperextension of the thumb metacarpophalangeal joint affects a diverse population of patients. This includes those with cerebral palsy, degenerative or inflammatory arthritides, or following hand trauma. The abnormal movement may result in decreased pinch-grip strength, sesamoid-metacarpal or metacarpophalangeal joint arthritis, or an adduction deformity of the thumb. Sesamoid arthrodesis is indicated to improve function and relieve pain, and is considered superior to metacarpophalangeal joint arthrodesis. Capsuloplasty and capsulodesis have also been described as surgical techniques capable of correcting metacarpophalangeal joint hyperextension.1,2 Sesamoid fusion by interosseous wire suture, as first described by Zancolli, has gained widespread favour and was previously the technique of choice for the senior author (HPG).3 However, this technique can be both cumbersome and time consuming, and there is the inherent risk of potential damage to the extensor mechanism. We describe a new technique involving a modified Mitek® anchor. The device is re-threaded with an interosseous wire, which allows controlled compression between the sesamoid bone and metacarpal.