Finger Joint

The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.

To describe early radiographic findings in patients from the Swedish psoriatic arthritis (SwePsA) registry, progression of destruction, correlations with clinical disease variables, and predictors of destruction. Hand and foot radiographs were available for 72 of 197 SwePsA patients followed for 5 years. Clinical data were collected according to the SwePsA protocol. Disease characteristics and clinical improvement were similar in men and women. Radiographic abnormalities were more pronounced in men. Total Wassenberg radiographic score at baseline was 0 in 45% of men and 51% of women. One man and one woman had a score > 10. At 5 years, total score was 0 in 14% of men and 40% of women (p = 0.018); 17% of men and 7% of women had scores > 10. Mean total scores for men and women had increased. Baseline erythrocyte sedimentation rate was associated with baseline total radiographic score. In men, swollen joint count was positively, and in women tender joint count negatively, correlat...

PURPOSE To define the order and frequency of elongation in tendon junctions in extensor carpi radialis longus (ECRL) to flexor digitorum profundus tendon transfer and its correlation to grip strength and lack of finger flexion. METHODS Forty-seven tetraplegic patients had surgery involving the reconstruction of finger flexion with the transfer of the ECRL in a total of 62 arms. During surgery metal markers were placed on both sides of the tendon-to-tendon attachment site. After surgery the distance between the markers was measured on radiographs. Any increase in the distance between the markers was judged as elongation. The grip strength and mean pulp-to-palm distance were evaluated a minimum of 6 months after surgery. Three arms had a second surgery because of insufficient functional results. RESULTS The average final elongation was 9 +/- 10 mm (mean +/- SD). The mean grip strength was 16 +/- 12 kPa (range, 0-50). The lack of flexion (mean value of pulp-to-distal palmar crease of 3...

Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex surgery. In this review, the current concepts surrounding the management of these injuries are reviewed. A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, perc...

This report describes the formation of small phalanges and whole joints from three types of bovine-cell sources transplanted onto biodegradable polymer matrices. The resulting structures had the shape and composition of human phalanges with joints. Fresh bovine periosteum was wrapped around a copolymer of polyglycolic and poly-L-lactic acid. Separate sheets of polyglycolic acid polymer were then seeded with chondrocytes and tenocytes isolated from the shoulders of freshly killed calves. The gross form of a composite tissue structure was constituted in vitro by assembling the parts and suturing them to create models of a distal phalanx, a middle phalanx, and a distal interphalangeal joint. Subcutaneous implantation of the sutured composite tissues into athymic mice resulted in the formation, after twenty weeks, of new tissue with the shape and dimensions of human phalanges with joints. Histological examination revealed mature articular cartilage and subchondral bone with a tenocapsul...

The number of Rheumatoid Arthritis (RA) patients increases recently in Japan. Early treatment improves patient’s prognosis and Quality of Life. The appropriate treatment in accordance with RA progression is required for the better prognosis. The hand X-ray image based modified Total Sharp Score (mTSS) is widely used for the diagnosis of RA progression. The mTSS measurement is essential to achieve the appropriate treatment, but its assessment is time consumed. There are some finger joint detection and mTSS estimation methods for the fully automated mTSS measurement, which focus on the mild RA patients. This paper proposes the automatic joint detection method and discusses about the mTSS estimation for the mild-to-severe RA patients. Experimental results on 90 RA patients’ hand X-ray images showed that the proposed method detected finger joints with accuracy of 91.8%, and estimated the erosion and JSN score with accuracy of 53.3% and 60.8%, respectively.

Tenotomy of the central slip, described by Fowler, can clinically improve chronic distal interphalangeal joint (DIP) extensor lag secondary to mallet finger (terminal tendon disruption). The goal of this study is to evaluate the potential of central slip tenotomy to restore DIP joint extension.A mallet deformity was reproduced in 15 fresh-frozen cadaver fingers after the extensor tendon insertion was sectioned over the DIP joint. A suture anchor inserted at the terminal insertion was then secured to the extensor tendon over the middle phalanx to reconstruct the extensor mechanism. A 500-g weight attached to the proximal extensor tendon applied extensor tension. Central slip tenotomy was then performed. DIP extensor lags before and after tenotomy were recorded.After sectioning of the terminal tendon over the DIP joint the average amount of extensor tendon lag produced was 45°. After central slip tenotomy was performed the average amount of extensor lag correction was 36° (range, 30°–46°).Several clinical studies have shown that central slip tenotomy is an effective treatment for chronic mallet finger but may not fully restore DIP joint extension. Our data suggest that patients with a pre-existing extensor lag of greater than 36° may not achieve full extension from central slip tenotomy, although extensor lags of up to 46° may be corrected.