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Representations of disease in Renaissance paintings have been discussed in medical literature, in the context of historical epidemiology, as potential sources of information about the incidence and appearance of particular conditions in earlier times. The present study seeks to show how Renaissance art can also contribute to historical nosology by casting light on the question of whether particular conditions recognized as abnormal today were understood as pathological in the past. The hands of two Renaissance Madonna figures are examined in sculptures produced by Francesco di Simone Ferrucci (1437–1493). Because the Virgin Mary was considered physically perfect by believers, and because Francesco was a successful producer of devotional sculptures for a wide audience, it is highly probable that any abnormal conditions found in the hands of Madonnas sculpted by him would not have been regarded as pathological at the time. The sculptures examined appear to depict camptodactyly and boutonniere deformity in the hands of Madonna figures. These uncommon conditions are also found in Renaissance artworks that show other individuals of high social status, but their presence in the hands of the Madonna gives the strongest indication that they were not considered pathological, due to religious belief in the Virgin's physical perfection. Examination of Madonna figures in late fifteenth century Renaissance art can contribute to historical nosology by identifying abnormal conditions that were not regarded as pathological at the time. The examples of such conditions identified in the present study are camptodactyly and boutonniere deformity. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To evaluate the effect of a clinical management program involving education on hand function in patients with rhizarthritis. Methods: One hundred and eight patients with rhizarthritis and multiple arthritis (191 hands with clinical and radiographic rhizarthritis) followed for two years as part of an educational program on osteoarthritis were administered the SF-36, DASH, and HAQ questionnaires and measured for the strength of their palmar grip, pulp to pulp pinch, key (lateral) pinch, and tripod pinch at the time of inclusion and after 24 months. Age, race, level and frequency of physical activity, sex, body mass index, percentage of body fat, and degree of osteoarthritis were correlated to the test outcomes. Results: Women improved less than men on the HAQ (p=0.037). Each 1% reduction in fat percentage increased the chance of HAQ score improvement by 9.2% (p=0.038). Physical activity did not influence improvement in the parameters evaluated (p>0.05). Palmar grip improvement was affected by age and presence of rhizarthritis (p

Introduction: Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers., Materials and Methods: In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included., Results: 98.7% (n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0-10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome., Conclusion: We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area., (© 2023. The Author(s).)

Mallet finger is a commonly encountered condition in daily practice. However, there is currently no consensus on whether surgical intervention or conservative treatment with orthosis splint is superior. In this systematic review and meta-analysis, we compare the treatment outcomes between surgery and orthosis for bony and tendinous mallet finger. We searched PubMed, Embase, and the Cochrane Library according to the PRISMA guidelines from inception to January 15, 2021. The primary outcome was distal interphalangeal (DIP) joint extension lag angle, and secondary outcomes were DIP joint flexion and range of motion (ROM) angle. A total of 297 studies were initially identified, of which 13 (ten retrospective non-randomized controlled studies (non-RCTs) and three RCTs) were included in the final analysis. The results of this systematic review and meta-analysis showed that there was no high level of evidence supporting the superiority of surgery over orthosis in the treatment of mallet finger. Based on the available evidence, surgical intervention and conservative treatment with splint may offer similar clinical outcomes in both bony and tendinous mallet finger.

Angioleiomyoma is a rare benign tumour of smooth muscle cells derived from the tunica media of vascular walls, classically described as originating from veins. There are sporadic case reports documenting the occurrence of angioleiomyoma in the digits. We review the existing literature and report an angioleiomyoma occurring in the radial digital artery of a 42-year-old man and add to evidence of arterial origin with demonstrable intra-operative anatomy. Angioleiomyoma should form part of the differential diagnosis for subcutaneous masses occurring in the digit. Level of Evidence: Level V, diagnostic study. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare percutaneous pinning versus splinting of soft tissue mallet finger injury to determine if there are differences in residual extensor lag and complication rates. Methods: Patients ≥18 years of age undergoing mallet finger injury treatment from 2011 to 2020 were retrospectively reviewed. Exclusion criteria included bony or open mallet finger injury and incomplete documentation of residual extensor lag at final follow-up. Complications, including infection, hardware fixation failure and wound complications, were collected from follow-up clinic notes. Those treated with percutaneous pinning were compared to those treated non-surgically with splinting. Results: Of the 150 soft tissue mallet finger injuries that met the inclusion criteria, 126 were treated with splinting, and 24 were treated with percutaneous pinning. There were no differences in residual extensor lag between groups (Splinting: 5.4°, Pinning: 5.8°, p = 0.874). However, the pinning group had a higher overall complication rate than the splinting group (20.8% vs. 1.6%, p = 0.001). Conclusions: Surgery may be an effective treatment method for soft tissue mallet finger, but due to the higher rate of complication and the increased expense of a surgical procedure, splinting should be the preferred treatment method for most of these injuries. Level of Evidence: Level III (Therapeutic).

In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Academy, 18 patients, 12 male and 6 female, with hereditary dystrophic epidermolysis bullosa (HDEB) and hand deformities were surgically treated, to achieve the complete separation of fingers, correction of the thumb adduction contracture and flexion or extension contracture of finger joints. The period of wound healing on flat surfaces after surgery, and the period between two operations was estimated. The most common deformity was the flexion contractures of metacarpophalangeal (MP) joints (45%) and one or both interphalangeal (IP) joints (types A1, A2). In 20% of the hands MP joint was streched with the flexion contracture in distal interphalangeal (DIP) or both IP joints (types B1, B2). In 35% of hands MP joint was in hyperextension with folded proximal interphalangeal (PIP) or both IP joints (C1 i C2). The adduction deformity of the thumb type 1, without the possibility of abduction, was present in 15%. type 2, when the thumb was placed above the palm in 60% and type 3, when the thumb was fused in the palm in 25%. Pseudosyndactyly of the first degree (till PIP joint) was found in 30% of hands, the second degree (till DIP joint) in 25%, and the third degree (the whole finger length) in 45% of hands. Fingers were completely separated and stretched surgically. The period of spontaneous healing was 15 days on the average, EBDC represents great medical and social problem that requires multidisciplinary approach of physicians of various specialties (surgeons, dermatologists, pediatrists, geneticists, nutritionists, physiatrists, ophtalmologists, dentists, ENT, as well as specially trained persons and families). The efficient specific systemic therapy aiming to increase the skin resistance to mechanical trauma does not exist yet, and should be developed in the field of gene therapy. The surgical correction of hand deformities, acrylate glove use in the longer post... [ABSTRACT FROM AUTHOR]

The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger. Level of Evidence: Level V (Therapeutic).

Purpose: The spiral oblique retinacular ligament (SORL) procedure acts as a dynamic tenodesis to restore distal interphalangeal joint (DIP) extension and restrain proximal interphalangeal hyperextension. Despite the ingenious technique based on the oblique retinacular ligament anatomy, obtaining strong internal fixation remains an issue during the SORL procedure. We present a modified technique using the flexor digitorum profundus (FDP) hemi-tendon transfer., Methods: We dissected 5 fresh cadaveric specimens to evaluate morphometric parameters of the SORL procedure using the hemi-FDP. The volar groove of the FDP tendon was identified in zone I of the flexor sheath and the tendon was divided into radial and ulnar bundles. The selected hemi-tendon was divided at the proximal edge of the A1 pulley and a SORL procedure was performed through a transosseous tunnel in the distal phalanx. This technique was used in 3 patients with swan neck deformity., Results: The optimal distance between the DIP joint and the anterior drill hole of the transosseous tunnel was 7.6 mm (range, 6.8-8.5 mm). The relative loss of length of the tendon owing to the SORL path was 25.8 mm (range, 19.6-29.9 mm). In the clinical cases, the procedure improved DIP joint extension lag and prevented proximal interphalangeal joint hyperextension. Preserving one-half of the FDP allowed complete flexion of the DIP joint., Conclusions: The procedure is technically feasible. Its main advantages are that a distal suture is not required and that the substantial length of the tendon allows sturdy proximal internal fixation., Type of Study/level of Evidence: Therapeutic V., (Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to compare the clinical, radiological, aesthetic and economic outcomes of extension pin block technique and extension orthosis in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation (Wehbe and Schneider classification type IB and IC)., Materials and Methods: Thirty-nine patients (11 women and 28 men; mean age: 40.9±11.5 years) who had mallet fractures were retrospectively reviewed. Twenty-one patients were treated with the extension pin block technique, and the remaining 18 were treated with the extension orthosis. Fracture classification, measurement of articular surface involvement, presence of subluxation, and the fragment displacement were performed according to the Wehbe and Schneider classification. Crawford's criteria, extension lag, distal interphalangeal joint (DIPJ) range of motion, dorsal bump, and visual analog scale were evaluated. Fracture union, articular incongruity, and all other complications were followed and analyzed. The Michigan Hand Questionnaire (MHQ) was used to evaluate the aesthetic perception of the patient's finger. Direct and indirect costs were calculated for each treatment method., Results: At the final follow-up (mean: 18.4±6.2 months), there was no significant difference with respect to clinical outcomes between groups (p=0.335) and pain (p=0.131). Fracture union was achieved in all cases. Both extension lag (p=0.150) and DIPJ flexion (p=0.261) were not different between groups. Dorsal bump was more frequent in the conservative treatment group (p=0.048). Aesthetic scores were similar between groups (p=0.477), but female patients rated significantly lower aesthetic scores than males (p=0.003) regardless of the treatment method. The direct medical (p=0.001), indirect (p=0.009) and cumulative costs (p=0.001) were significantly higher in surgical treatment group. One pin tract infection, one nail dystrophy, and one joint space narrowing were seen in the surgical treatment group versus none in the conservative treatment group (p=0.698)., Conclusions: Conservative treatment does not result in inferior clinical, radiographic and aesthetic outcomes compared to surgical fixation in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation. Extension orthosis which is non-invasive, and cheap, maybe the treatment of choice in closed mallet fractures., Level of Evidence: IV; Retrospective cohort., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: The purpose of this study was to test the hypothesis that Jaccoud arthropathy (JA) in patients with systemic lupus erythematosus (SLE) is associated with instability of the extensor digitorum (ED) tendons during flexion of the metacarpophalangeal (MCP) joints by comparing the position of the ED tendons between SLE patients with JA and control subjects on hand MRI obtained with flexed and extended MCP joints., Materials and Methods: Thirty-two hands of SLE patients with JA (13 women and 3 men; mean age, 50.0±12.2 [SD] years; age range: 26-68years) and 24 hands of sex- and age-matched control subjects (20 women and 4 men; mean age, 50.1±13.0 [SD] years; age range: 24-68years) were included in the study. Axial spin echo T1-weighted MRI images of the second to fifth MCP joints in flexion and in extension were obtained. Two radiologists (R1 and R2) separately measured the amplitude and assessed the direction of the displacement of the ED tendons with respect to the midline at the level of each MCP joint. Statistical analysis included two-way ANOVA with random effects to assess differences in amplitude and Fisher-Freeman-Halton exact test to assess differences in direction with P-values<0.0083 and<0.0063 considered as statistically significant respectively., Results: Amplitude of the displacement of the ED tendons was statistically significantly greater in SLE patients with JA than in control subjects in flexion for both readers (median 58°, 95% confidence interval [CI]: 50°-65° vs. 20°, 95% CI: 16°-24°; P<0.0001 for R1 and 54°, 95% CI: 47°-61° vs. 25°, 95% CI: 22°-28°; P<0.0001 for R2) and in extension for one reader (17°, 95% CI: 15°-20° vs. 14°, 95% CI: 11°-16°; P=0.0048 for R1 and 20°, 95% CI: 15°-25° vs. 16°, 95% CI: 12°-18°; P=0.0292 for R2). Ulnar deviation of the ED tendons was statistically significantly more frequent in SLE patients with JA than in control subjects in flexion and in extension for both readers (P<0.0001)., Conclusion: JA is associated with instability of the ED tendons in patients with SLE best depicted when MCP joints are flexed., (Copyright © 2021 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

In a 5-year retrospective review of 319 tendinous mallet fingers, we focused on the result after splint treatment. The splint we used was a 'no pressure' thermoformed customized Stack splint. The patients wore it strictly for 8 weeks. Based on the Patel criteria, we obtained 91% good or excellent results and 9% fair or poor results. The rate of excellent results increased significantly (p < 0.001) when treatment started 20 days after the trauma. Patients were 13 times more likely to have good or excellent results with a delayed treatment. We noticed that inflammation in the distal interphalangeal joint seemed to be detrimental to the healing process. We suggest assessing if there is inflammation to anticipate the failure of treatment, which will lead to a longer treatment. Further studies on the subject should confirm this., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Closed and open injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint can involve the central slip, the lateral slips or both. They are classified as zone III injuries. All open injuries on the dorsal side of the PIP joint should raise suspicion of an extensor tendon injury that is frequently overlooked. The operative strategy consists of wound revision with extensor tendon suture or refixation of the central slip. Acute closed central slip injuries are clinically diagnosed (Elson test) after ruling out bony injuries to the joint. Nondisplaced avulsions of the central slip insertion or lacerations can be treated nonoperatively by splinting. For displaced avulsions and complex injuries the treatment is surgical. In overlooked injuries a typical deformity (buttonhole/Boutonnière deformity) develops within 1-2 weeks that is characterized by an extension lag of the PIP joint and hyperextension at the distal interphalangeal joint. In early cases, when passive extension is still complete (mobile buttonhole deformity) the central slip can be immediately reconstructed. In fixed deformities complete passive extension of the PIP joint has to be restored before surgery by hand therapeutic measures or PIP joint release. Depending on the pattern of the injury and the resulting defects, a number of reconstructive techniques have been established that are summarized in this article. The functional results can be limited by tendon adhesions, imbalance within the reconstructed extensor apparatus and stiff joints that can all restrict the range of motion. Therefore, active rehabilitation protocols are mandatory for optimal results.

Objectives: In this study, we aimed to describe a new hook plate technique (HPT) and to compare our results with the conventional extension block technique (EBT) with a Kirschner wire (K-wire) for bony mallet finger treatment., Patients and Methods: Between April 2015 and January 2018, a total of 19 patients including 10 who were treated with EBT (7 males, 3 females; mean age: 30.1±7.3 years; range, 17 to 48 years) and nine who were treated with HPT (6 males, 3 females; mean age: 31.7±11.3 years; range, 19 to 42 years) for bony mallet finger with distal interphalangeal (DIP) joint subluxation and/or fracture fragment larger than one-third of distal phalanx (Wehbe-Schneider type 1/b, 2/a, 2/b, 3/a) joint were retrospectively analyzed. The DIP range of motion (ROM), Warren and Crawford scores, time to return to work/daily activity, operation time, the number of fluoroscopy shots, cost and complications were compared., Results: No significant difference was found in the DIP ROM (p=0.708) and the Warren/Norris and Crawford scores (p=0.217 and p=0.175, respectively) between the two groups. Operation time and material cost were higher with HPT (p=0.006, p=0.001). There was no significant difference in the number of fluoroscopy shots (p=0.344). Although DIP joint motion was started at two weeks in the HPT group and at eight weeks in the EBT group, no significant difference was observed in the time of return to work and normal daily life in both groups (p=0.859). Complications were observed in two patients in the EBT group and in three patients in the HPT group. No significant difference in total complications was observed between the two groups (p=0.666)., Conclusion: Bony mallet finger treatment with a custom-made hook plate prepared from 1.3-mm AO plates appeared to be clinically and radiologically similar to EBT. Additionally, HPT had the advantages of allowing early ROM to DIP joint and eliminating the need for a secondary surgery such as K-wire removal. On the other hand, hardware cost with HPT was higher than EBT.

Objectives: The aim of this study was to evaluate the functional results of delayed open reduction and Kirschner wire (K-wire) fixation procedures in patients with delayed presentation of bony mallet finger., Patients and Methods: Between February 2009 and November 2019, a total of 19 patients (15 males, 4 females; median age: 24.8 years; range, 14 to 47 years) who were diagnosed with a delayed bony mallet finger and treated with dorsal block pin, direct pinning, or the umbrella handle technique were retrospectively analyzed. The Crawford criteria were used to evaluate the outcomes. The degrees of range of motion (ROM) were measured by a goniometer., Results: The median time from injury to surgery was 41 (range, 28 to 90) days. The median DIP joint extension limitation was 7.63 (range, 0 to 40) degrees and the median ROM of the DIP joint was 66.3 (range, 20 to 90) degrees. There was no statistically significant difference in the postoperative ROM, compared to the uninjured side (p>0.05). The Crawford score was excellent in 11, good in four, fair in three, and poor in one patient. Bone union was achieved in all patients., Conclusion: Delayed open reduction and K-wire fixation of chronic bony mallet finger injuries yield successful functional outcomes with low complication rates. Extension lag can be eliminated in most patients by making the joint surface anatomical. The most optimal method should be selected depending on the size of the fracture fragment.

Background: The goal of this study is to biomechanically compare Fowler central slip tenotomy with spiral oblique retinacular ligament (SORL) reconstruction in correcting a chronic mallet deformity as part of a swan-neck deformity. Methods: We used 24 human cadaver fingers from 6 hands. Mallet finger and swan-neck deformities were created; then, Fowler tenotomy was done on one group including 3 hands with 12 fingers, and SORL reconstruction was done on the others. Results: During simulated finger extension, there was no significant difference between the 2 techniques in correcting the distal interphalangeal joint droop; however, Fowler tenotomy resulted in hyperflexion of the proximal interphalangeal (PIP) joint, whereas it remained straight after SORL reconstruction. Conclusions: This study supports the SORL reconstruction in correcting a chronic mallet deformity, especially when there is a concomitant PIP hyperextension deformity, which lowers the risk of reversing the deformity after a Fowler procedure.

Objective: To investigate the efficacy of percutaneous extensor tendon reconstruction in treating spastic hammery deformity. Methods: From February 2009 to July 2018, the clinicaldata of 36 patients with fresh sputum hammer fingers treated in Jinan People's Hospital were analyzed retrospectively. The tendon was percutaneously sutured with PDS Ⅱmonofilament suture and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole. Removal of the K-wire 6 weeks after the operation, the brace was used to fix the affected finger in the dorsal extension. For 8-10 weeks, only the brace was worn at night and the flexion and extension of the affected finger was gradually strengthened.The extension and flexion function of the interphalangeal joint of the finger was compared pre and post the operation with t test. Results: A total of 36 patients were enrolled but only 33 patientswere followed up for 6 to 15 months. The hammer-shaped deformity was corrected and there was no pain when moving fingers after the operation.The straightening angle of the interphalangeal joint of the finger improved from 46.2°±6.3° before surgery to 7.5°±0.6° after ( t= 35.12, P< 0.05). The passive straightening angle decreased from 3.2°±0.3° before surgery to 0.9°±0.2° after ( t= 37.11, P< 0.05). According to the Crawford functional assessment: excellent in 19 fingers, good in 10 fingers, can be in 4 fingers. The excellent rate was 87.9%. There was no knot exposure, skin necrosis and other complications. Conclusions: Percutaneous resection of the extensor tendon is fixed in the basal phalanx. It is a simple and feasible minimally invasive surgery for hammer-shaped deformity. It can obviously correct the hammer-shaped deformity and has fewer complications.

In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.

Background: Closed tendinous mallet finger can be treated non-operatively by extension splinting of the distal interphalangeal joint (DIPJ) for 6 to 8 weeks. However, method of conservative treatment in detail differs among various reports, especially in type of orthosis, duration of full-time immobilization and additional night orthotic wear after full-time immobilization. In our institution, full-time Stack splint is applied with distal interphalangeal joint (DIPJ) in extension for 12 weeks and night orthosis is worn for 4 weeks., Purpose: The purpose of this study was to evaluate clinical and functional outcomes of tendinous mallet finger using our treatment protocol., Patients and Methods: Between March 2007 and December 2017, patients with tendinous mallet finger who were managed conservatively according to our treatment protocol were retrospectively reviewed. A total of 100 patients (101 cases) were enrolled, including 77 males and 23 females. Extension lag was measured before, soon after treatment, and at the final follow-up. Flexion angle of DIP joint was measured at the final follow-up. Patients were clinically evaluated based on the Crawford classification scale and Abouna & Brown criteria., Results: The mean age of patients was 40 years and the mean follow-up was 48 months. The mean extension lag was 28.3 degrees initially and 2.6 degrees at the final follow-up. (p-value < 0.001) Flexion angle at the final follow-up was 68.3 degrees. Based on the Crawford classification scale, 56 % of patients had excellent results, and 25 % of patients had good results. According to Abouna & Brown criteria, 78 % of patients had success results and 7.5 % of patients had improved results., Conclusions: Wearing orthosis for up to 16 weeks (12 weeks full time and 4 weeks night orthosis) in the treatment of tendinous mallet finger injuries can achieve satisfying result., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

ZIEL: Diese Studie vergleicht die klinischen Ergebnisse nach Delta-Draht-Technik (Gruppe 1 = 7 Patienten) mit den Ergebnissen nach Extensions-Block-Pinning (Gruppe 2 = 11 Patienten) in der Behandlung des knöchernen Mallet-Fingers., Patienten Und Methoden: Sechs Monate postoperativ wurde bei allen Patienten das klinische Ergebnis nach den Crawford-Kriterien, die Schmerzen anhand einer visuellen Analogskale (VAS) und der DASH-Score ermittelt. Zusätzlich wurden die aktive Beweglichkeit und das Extensionsdefizit im Endgelenk sowie aufgetretene Komplikationen festgehalten., Ergebnisse: Patienten der Gruppe 1 hatten eine signifikant bessere Beugung im Fingerendgelenk, aber auch ein signifikant größeres Extensionsdefizit, obwohl sie signifikant früher ihre Arbeit wiederaufnahmen. Nach den Crawford-Kriterien erzielten 71 % der Patienten der Gruppe 1 und 100 % der Gruppe 2 ein exzellentes und gutes Ergebnis. Keine Unterschiede konnten bzgl. der OP-Dauer, der Schmerzen, dem DASH-Score und der Zeit bis zur knöchernen Heilung festgestellt werden., Schlussfolgerung: In der Kurzzeitbeobachtung werden mit Extension-Block-Pinning bessere Ergebnisse in der Behandlung des knöchernen Strecksehnenausriss am Fingerendglied erzielt als mit der Delta-Draht-Technik., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To evaluate the effect of a clinical management program involving education on hand function in patients with rhizarthritis., Methods: One hundred and eight patients with rhizarthritis and multiple arthritis (191 hands with clinical and radiographic rhizarthritis) followed for two years as part of an educational program on osteoarthritis were administered the SF-36, DASH, and HAQ questionnaires and measured for the strength of their palmar grip, pulp to pulp pinch, key (lateral) pinch, and tripod pinch at the time of inclusion and after 24 months. Age, race, level and frequency of physical activity, sex, body mass index, percentage of body fat, and degree of osteoarthritis were correlated to the test outcomes., Results: Women improved less than men on the HAQ (p=0.037). Each 1% reduction in fat percentage increased the chance of HAQ score improvement by 9.2% (p=0.038). Physical activity did not influence improvement in the parameters evaluated (p>0.05). Palmar grip improvement was affected by age and presence of rhizarthritis (p<0.05); patients with unilateral rhizarthritis improved 5.3 times more than patients without the disease (p=0.015), while improvement in palmar grip strength decreased 6.8% per year (p=0.004). Pulp pinch grip strength improved more in women than in men (p=0.018)., Conclusion: Patients with rhizarthritis and multiple arthritis improved quality of life and grip strength through clinical treatment, an educational program, and fat loss. Level of Evidence II; Retrospective study., Competing Interests: All authors declare no potential conflict of interest related to this article.

Objective: The occurrence of iridocyclitis (IC) in early psoriatic arthritis (PsA) has been rarely assessed. The primary end-point of this study was to evaluate the frequency of IC at onset in patients with early PsA., Methods: We evaluated the frequency of IC in a clinical series of consecutive, new outpatients with early PsA observed between January 2000 and December 2009. All patients met the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria for PsA and had a disease duration ≤12 months. The following clinical patterns were considered: peripheral PsA (oligoarthritis ≤4 and polyarthritis ≥5 involved joints), axial PsA and mixed. IC diagnosis was made by the ophthalmologist. Follow-up visits were scheduled at baseline and every 4 months with interval shortening in the case of urgent clinical problems., Results: Two hundred and forty-two patients, 137 (57%) women and 105 (43%) men (mean age 50.33 ± 11.7 years; mean symptom duration 9.38 ± 3.1 months) were studied. One hundred and thirty-two (51%) patients had peripheral PsA, 41 (17%) axial and 69 (28%) mixed. Twenty-six episodes of IC were recorded at diagnosis in 22 (9%) patients, 17 (77.3%) female and five (22.7%) male; 11 (50%) patients had peripheral PsA, two (9.1%) axial, and nine (40.9%) mixed; 5/22 (22.7%) patients were B27-positive. IC recurred in 2/22 (9%) patients over the follow-up period. Mean follow-up duration was 51 ± 23.2 months. Dactylitis was significantly more frequent in patients with IC compared to those without this feature (P = 0.032)., Conclusion: IC occurred in 9% of 242 patients with early PsA with no association with the clinical pattern and B27 positivity. This frequency is higher than previously reported., (© 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

Objective: To investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities., Methods: From February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers were treated by buried purse-string suture. The rupture tendons were sutured by purse-string suture with an atraumatic needle, and the knots were buried under subcutaneous tissue. External fixator was used at the extension position of the finger every night within three weeks after operation., Results: All patients were followed up for 6-12 months, mean 7 months. According to the Patel's evaluation criteria, 2 cases (17%) obtained excellent results, 7 good (58%), 2 fair (17%) and 1 poor (8%). The overall rate of the cases with excellent and good outcomes was 75%., Conclusion: Buried purse-string suture is an easy and effective way to treat mallet finger deformities, with no serious postoperative complications or no need for reoperation.

Objective: Hand and upper limb involvement is common in patients with rheumatoid arthritis (RA). However, its impact on manual activities of daily life has not been fully evaluated. A measure of manual ability was developed, through the Rasch measurement model, by adapting and validating the ABILHAND questionnaire, which measures the patient's perceived difficulty in performing everyday manual activities., Methods: 112 patients with RA were evaluated. The following tests were performed: the ABILHAND questionnaire, the Health Assessment Questionnaire (HAQ), the Jamar grip and key pinch strength tests, the Box and Block dexterity test and the Purdue pegboard dexterity test. In total, 35 patients were reassessed to determine the test-retest reliability of the ABILHAND, and 6 patients were studied before and after therapy with tumour necrosis factor (TNF) blockers to address sensitivity to change., Results: The Rasch refinement of the ABILHAND led to a selection of 27 items rated on a 3-point scale. The resulting ability scale was targeted to the ability of the patients. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Grip and key pinch strength and manual and digital dexterity on both hands were significantly, though moderately, correlated with the ABILHAND measures. Manual ability was also significantly related to the number of affected hands, disease duration, tender and swollen joint counts on upper limbs, disease activity and the HAQ. Sensitivity to change was demonstrated in patients treated with TNF blockers, commensurate with their clinical improvement., Conclusion: The ABILHAND questionnaire is a clinically valid person-centred measure of manual ability that could be useful in longitudinal RA studies.

Thumb deformities are common manifestations of rheumatoid arthritis and represent a significant source of disability. A clear understanding of the pathophysiology of the disease is essential in directing treatment. Differential diagnosis for flexible deformities includes soft-tissue imbalances as well as tendon ruptures. In its early stages, thumb involvement can be treated nonsurgically or with soft-tissue reconstruction. With more advanced disease, arthrodesis and arthroplasty often are required. Isolated interphalangeal involvement is best addressed with arthrodesis. Metacarpophalangeal involvement can be treated with arthroplasty in low-demand patients or with arthrodesis in more active patients. Trapezium resection arthroplasty provides excellent relief for patients with carpometacarpal joint destruction.

Patients suffering from rheumatoid arthritis in many cases develop typical swan-neck and buttonhole deformities. In the further course of the disease we observe several stages. In the beginning active and later passive correction are still possible, while ultimately a fixed contracture is present. The activities of daily life may be severely reduced. The pathology of the swan-neck deformity is initiated at the level of the metacarpophalangeal joint, while at the origin of the buttonhole deformity the synovitis of the proximal interphalangeal joint is obvious. In the early stages, synovectomy and balancing of the soft tissues are surgically indicated. In advanced stages, complicated soft tissue reconstruction in combination with alloarthroplasty or arthrodeses may become necessary to allow for sufficient finger function.

Objective: The aim of this case-control study was to know possible correlates between distinctive pattern of hand arthrosis and length manual milking., Patients and Methods: Between January 1990 and January 1996, we retrospectively reviewed the patients with symptomatic arthrosis in whose hands was identified this pattern: degenerative disease of distal interphalangeal joints with radial deviation and flexion of distal phalanges in association to arthrosis involving metacarpophalangeal and interphalangeal joints of the thumb. The first 88 cases of hand arthrosis without this clinical and radiographic pattern make the control group. Patients suffering inflammatory rheumatic diseases were excluded., Results: 35 patients with this special pattern of hand arthrosis were recruited. The majority of patients were women (94.3%) and coming from rural environment (94.3%). 32 patients had performed daily manual milking over a period of 20 years, but in three patients the pattern was not related to this activity (odds ratio = 928: p < 0.001). Symptoms were more frequent in the control-group (57% versus 26%; p < 0.04), in which no characteristic pattern of alignment abnormality was found., Conclusion: A typical pattern of hand arthrosis was associated with prolonged manual milking: degenerative disease of metacarpophalangeal and interphalangeal joints of thumb, radial deviation associated with flexion of distal phalanges of second at fourth fingers and arthrosis involving their distal interphalangeal joints, often linked to sight ulnar deviation of middle phalanges.

A number of solutions are presented for the problem of over-tight rings particularly in patients with deforming arthropathies of the hand. Rings can be adapted by various methods to allow them to be worn on deformed fingers. An illustrative case is reported.

The emphasis of this review is on anatomy as related to function of the hand. We have described all aspects of functional anatomy from the skin to the skeletal framework. This article provides a concise overview of the hand and intricacies.

The spacer device minimizes oropharyngeal deposition of metered dose inhaler (MDI) medication and helps ensure consistent delivery of the medications to the bronchial tree. Patients with hand limitations and artificial airways may be unable to use an MDI. We describe several modifications to two currently available spacer devices for use in these populations.

The hands of 299 diabetic patients with and 161 without retinopathy were examined for abnormalities. Almost all abnormalities were finger joint contractures resulting in limited joint mobility (LJM) and/or Dupuytren's contractures (DC). Both LJM and DC occurred not only in insulin-dependent diabetes (IDDM) but also in non-insulin-dependent diabetes (NIDDM). In retinopathy patients LJM and DC occurred in 48% and 36% of patients, respectively, compared with 24% and 16% in those without retinopathy. These differences were statistically significant (P less than 0.001). The higher prevalence of LJM in the retinopathy group affected mainly those with severe retinopathy, there being no difference between background and nonretinopathy patients. DC was less clearly related to severe retinopathy. LJM was more severe in those with than without retinopathy. LJM and DC were also related to age and duration of known diabetes. Subgroups matched for age and duration of known diabetes showed that the main relationship of hand abnormalities was to retinopathy in IDDM, but more to age and duration of known diabetes in NIDDM.

Bullous pemphigoid and rheumatoid arthritis are rarely found co-existent in one patient. We report a patient with severe rheumatoid arthritis who four years later showed bullous pemphigoid. This association is rare but may be more than coincidental.

Jaccoud polyarthritis is thought to be a rare complication of rheumatic fever. It is characterized by severe rheumatic fever, with repetitive or prolonged attacks, associated with a painless, but deforming arthritis affecting the small joints of hand and feet. Radiologically, erosion of the metacarpal heads may be present. All described cases have shown obvious rheumatic heart disease. Two patients had the clinical and radiographic features of Jaccoud arthropathy who had no antecedent history of rheumatic fever. Jaccoud arthropathy may have diverse causes.

The ability of 50 rheumatoid arthritis patients with hand involvement and 50 normal control subjects to open a range of reclosable tablet containers and unit dose packs was tested. Child-resistant containers, particularly the clic-loc type, proved the most difficult for patients and control subjects to open. Smaller containers were less easy to open than comparable ones of a larger size. Only 54% patients were able to remove a suppository from its wrapping. Blister packs and conventional screw-capped tablet bottles were easiest to open. Dispensing of drugs for rheumatic patients in child-resistant containers should be limited to those without hand involvement.

In a group of 120 mental patients, the authors found obvious camptodactyly in 65 patients (46%), especially in psychopaths, neurotics and related conditions. Clinical, psychological, radiological and laboratory investigations were carried out in 25 of these cases. The disease was accompanied by disorders of glucose metabolism, endocrine abnormalities, EEG and bone abnormalities together with arthrosis. The mental disorder, causing an inability to return to work, attracted our attention to the series of abnormalities found in these subjects investigated.

Despite intense clinical and cytogenetic research for more than 15 years we are far from knowing any definite relations between karyotype and phenotype. Both cytogeneticists and clinicians are working on the methodological improvements which are still necessary. In the methods of clinical recording there is still very great weakness of exact documentation of findings. Above all there is a lack of reproducible qualitative, and especially quantitative standards which constitute the basis of any practicable nosography. Some procedures for quantifying dysplastic facial features which have hardly been described so far (graphic statistics) are reported briefly. Also the summation of symptoms, a method currently used in the field of chromosomopathy syndromes, is subject to critical consideration. In this group of diseases a total list of symptoms of about 250 items can be obtained which includes multilocular minor stigmata, dysplasias, errors of differentiation and gross malformations of organs. An extraordinarily high degree of overlapping of symptoms is characteristic of these syndromes and makes accurate diagnosis difficult. However, for the trisomy-syndromes we succeeded in working out a diagnostic guideline by differentiating between an unspecified basic symptomatology concerning all trisomias and a pattern-forming additional symptomatology of each single syndrome. Thereby the diverse total symptomatology is reduced to the crucial and the recognition of patterns in daily practice is facilitated considerably. The comparatively specific additional symptomatologies of trisomy 13 -- 14 (Patau), trisomy 17 -- 18 (EDWARDS), and trisomy 21 (DOWN) are demonstrated in graphic views.