Relationship between finger and wrist deformities in rheumatoid arthritis.
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The present study was undertaken to test the hypothesis that there is a significant correlation between the position of the wrist and metacarpophalangeal angulation in the common rheumatoid hand deformities. Measurements were carried out on radiographs of the hand from 2 comparative groups: 67 patients (134 hands) with classical or definite rheumatoid arthritis (RA), and a control series of 50 adults (100 hands) attending the routine fracture clinic. Rheumatoid patients were unselected and included those with a variety of hand deformities. The results showed a statistically significant relationship between finger and wrist deformities in patients with RA but not in the normal controls. (+info)
A case of Dupuytren's contracture is described, in which, both clinically and histologically, knuckle pad lesions involved the extensor tendons. Surgical excision of the Dupuytren's tissue from the dorsal aspect of the proximal interphalangeal joints, freeing of the lateral extensor slips and posterior capsulotomy resulted in marked functional improvement. (+info)
Surgical reconstruction of the hand with triple nerve palsy.
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Simultaneous paralysis of the ulnar, median and radial nerves is seen in about 1% of hands with nerve involvement in Hansen's disease. Forty such cases were treated between 1955 and 1976; 35 of these have been followed up. In two hands there was a high radial, median and ulnar palsy and these left no scope for reconstruction. The other 33 cases which underwent two-stage reconstructive surgery are presented here. The first stage consisted of restoring active extension of the wrist, fingers and thumb: for this purpose the ideal muscles for transfer are pronator teres, flexor carpi radialis and palmaris longus respectively, and muscle power exceeding Grade 3 (on the MRC classification) was achieved in 89%, 96%, and 100% of these individual transfers. Arthrodesis of the wrist is not recommended when suitable muscles are available for transfer. The second stage of reconstruction attempts to restore intrinsic function of the fingers and opposition of the thumb; the sublimis is ideal for both purposes and satisfactory restoration of function was achieved in 89% and 85% of cases respectively. Ten of the 18 hands in which all five tendons were transferred had good or excellent results. (+info)
Anglo-French contributions to the recognition of rheumatoid arthritis.
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Early descriptions of rheumatoid arthritis in the English and French literature are reviewed. Charcot pointed out that the disease was recognised as distinct from gout in eighteenth century England, and pictorial evidence for this is presented. His own work on arthritis led to a series of noteworthy interactions with Alfred Baring Garrod, which are discussed. (+info)
Rheumatoid hand deformities: pathophysiology and treatment.
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Rheumatoid disease, as it affects the hand, is a disease of the synovium lining the joints and sheaths of the tendon. The proliferating synovium destroys the articular surfaces of the joint, interferes with the gliding mechanism of the tendons and weakens the supporting ligaments of the joints. The degree and variety of deformities is multifold. Treatment of the rheumatoid hand is aimed at conservation and restoration of hand function, as well as prevention of future deformities. Rheumatologists, physical therapists and hand surgeons carry out important functions in the well-planned, integrated regimen. Surgical treatment of the rheumatoid hand deformity may alleviate pain, lessen deformity and improve function in selected cases. It should be integrated in the general medical management of a patient. Treatment of tendon ruptures includes tenorrhaphy, tendon grafting and arthrodesis in the case of mallet finger deformity. The wrist joint is improved by synovectomy and carpal tunnel release is accomplished by median nerve decompression. Metacarpal phalangeal joint deformities may be treated by synovectomy or silastic joint replacement when there is destruction of the articular joint surface, severe subluxation, or persistent painful motion. (+info)
Hyperplasia of palmar plates and macrodactyly in a young child.
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A case is reported of a young girl who presented with macrodactyly of the right middle finger and tumour masses on the palmar side of both interphalangeal joints. The lesions were fibrocartilaginous and appeared to be hyperplastic palmar plates. The macrodactyly and the hyperplasia of the palmar plates were attributed to trauma. (+info)
Deforming arthritis in systemic lupus erythematosus.
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Of 45 patients in the McGill Lupus Registry 6 were found to have Jaccoud's deformities. One of these 6 and 4 others had fixed flexion contractures of the elbows. Those with Jaccoud's deformities were similar to the other patients with systemic lupus erythematosus in all respects except that those with Jaccoud's syndrome had had their disease and their arthritis significantly longer. It is concluded that Jaccoud's deformities are the result of longstanding arthritis and that elbow contractures occur via a different mechanism. (+info)
Translumbar inferior vena cava catheter for long-term hemodialysis.
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Vascular access failure is a major cause of morbidity and even mortality in patients on chronic hemodialysis. The failure of conventional vascular access and thrombosis of the superior vena cava in a patient with ESRD was successfully treated by the percutaneous insertion of a hemodialysis catheter directly into the inferior vena cava. The translumbar access to the inferior vena cava has been used successfully in bone marrow transplant recipients and may also be used as a last choice for long-term hemodialysis when conventional access is difficult. (+info)