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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Rheumatoid hand deformities: pathophysiology and treatment. 71 88

A series of 16 cases of chronic mallet finger deformity repaired with tendon flap from palmaris longus tendon or lateral band of extensor tendons is reported. Follow-up ranged from 1 to 4 years, the deformity has been corrected and pain disappeared in all cases. The active extention of DIP joints are 0 degrees in 12 cases and 5 degrees-15 degrees hyperextention in 4 cases. The active flexion of DIP joints are normal (65 degrees-80 degrees) in 11 cases, has 5 degrees-15 degrees flexion lag in 5 cases. The PIP and MP are normal in all cases. The anatomic basis of this procedure is narrated. The restoration of the anatomic continuity of the terminal extensor tendon reestablishes the coordinative effect between the long extensor tendon, intrinsic lateral band and oblique retinacular ligament and thus brings good long term result.
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PMID:[Treatment of chronic mallet finger with tendon flap graft. Report of 16 cases]. 130 23

Forty-four patients with 47 mallet fingers were reviewed to compare the results of operative (24 fingers) and nonoperative (23 fingers) treatment. Distal interphalangeal (DIP) joint extension, DIP flexion, total active motion of the DIP joint, proximal interphalangeal (PIP) extension, PIP flexion, total active motion of the PIP joint, cold intolerance, and persistent pain after treatment were not significantly different in patients treated by surgery or splinting. Secondarily, we compared fingers with and without a fracture of the distal phalanx, and the variables mentioned above were also unaffected by the presence or absence of fractures of the distal phalanx. About one-third of all patients had decreased PIP joint motion following treatment. In about 16% of all patients this loss of PIP motion was more important in determining finger function than DIP motion or symptoms related to the DIP joint. We recommend careful examination of the PIP joint and repeated monitoring of the joint motion. If the PIP joint becomes stiff, therapy and splinting should be used to minimize permanent stiffness. We believe a prospective randomized comparison of operative and nonoperative treatment of mallet finger should be conducted. Such a study would help determine the ideal treatment for mallet finger.
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PMID:Operative and nonoperative treatment of mallet finger. 327 22

One hundred patients with mallet finger injuries were reviewed and examined three to five years after injury. Twenty nine patients still had symptoms consisting mainly of pain and cold intolerance. The degree of residual deformity, presence of a fracture, or delay in treatment were not related to symptoms.
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PMID:The long term results of mallet finger injury. A retrospective study of one hundred cases. 688 44

A retrospective review was performed of 19 patients with irreducible mallet finger fractures after failed splinting. The patients were treated with open reduction and a tension band technique. Follow-up results were available for 18 patients (95%) at an average 8.2 years postoperatively. Eighty-nine percent of patients had no clinical mallet deformity, troublesome pain, or major functional disability. Distal interphalangeal range of motion averaged 1 degree hyperextension to 69 degrees flexion. All fractures healed with a congruent articular surface. Minor nonmechanical complications were encountered in 11% of cases in which a suture was used as the tension band material. Successful treatment may thus be achieved surgically in this select subset of mallet finger fractures when this technique is employed.
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PMID:Surgical treatment of mallet finger fractures by tension band technique. 813 25

A case involving an isolated bony avulsion fracture of the extensor insertion on the distal phalanx of the great toe is described. The fracture was displaced 2 mm with 30 degrees dorsal angulation; the joint was congruent and not subluxed. The patient was treated nonsurgically with a rigid-soled sandal. Bony healing at the fracture site was clearly evident at 16 weeks postinjury. The patient began using a normal shoe at 10 weeks and resumed his running activities without pain at 16 weeks. The nonsurgical treatment of this injury, similar to that of a mallet finger, was successful.
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PMID:Avulsion fracture of the great toe: a case report. 1035 75

An internal suture technique has been used for mallet finger fractures involving at least 30% of the articular surface. It provides fixation without a button or transfixion of the fragment. An independent retrospective review was conducted of ten patients at a mean follow-up of 17 months. Mean visual analogue score (0 to 10) for pain was 2.4 and satisfaction 7.9. Mean active range of motion was 13 to 49 degrees, passive motion was 2 to 56 degrees, pinch strength of effected finger to thumb was 3.8 kgf (81% of the opposite finger), grip strength 37.9 kgf (95% of the opposite hand). All fractures united and there were no neuromas. Complications included two nail deformities, a superficial infection and a pin track infection. One patient with a crush injury continued to have pain despite an arthrodesis.
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PMID:Internal suture for mallet finger fracture. 1067 5

Closed tendon injuries of the hand are frequently seen in the emergency department. Unlike open tendon injuries, however, these injuries are often missed on initial presentation. Early recognition and treatment can decrease the pain, dysfunction, and long-term sequelae associated with these injuries. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner. Injuries discussed include rupture of the flexor digitorum profundus, mallet finger, central slip rupture, extensor hood rupture, and ulnar collateral ligament injury.
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PMID:Orthopedic pitfalls in the emergency department: closed tendon injuries of the hand. 1114 26

The aim of this study were to assess what type of foot deformities are found in rheumatoid arthritis (RA) patients, to detect frequency of deformities, and to evaluate deformities affecting Foot Function Index (FFI) and patient functional capacity. Anteroposterior and lateral weight-bearing radiographs of 156 feet of 78 patients who had RA for > or =2 years and of 76 feet of 38 healthy controls were studied. We measured hallux valgus angle, intermetatarsal angle between first and second (M1/2) and intermetatarsal angle between first and fifth (M1/5) on anteroposterior radiographs, and calcaneal pitch on the lateral radiographs. We examined the feet of all RA patients and healthy controls for hallux rigidus, cock-up deformity, clawing toe, and mallet finger, and measured calcaneal valgus angle. FFI, comprised of pain, disability, and activity limitation subscales, was administered to all RA patients. Their Steinbrocker Functional Class (SFC) and Health Assessment Questionnaire (HAQ) scores were determined. We determined frequency of deformities as 96.2% in RA patients and 97.4% in controls by radiological and physical examination (p>0.05). The frequency of each deformity was markedly increased in RA patients, with the exception of calcaneal valgus deformity. There was significant correlation between SFC and HAQ with FFI and subscales (respectively, r=0.46, p=0.001; r=0.67, p=0.001). For FFI and subscales, HAQ was the most important predictor factor, followed by gender and hallux rigidus. Foot deformities are seen very frequently in RA. These deformities may affect patient functional foot, especially hallux rigidus and calcaneal valgus.
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PMID:Foot deformities in rheumatoid arthritis and relevance of foot function index. 1634 14

Interphalangeal arthrodesis is a reliable method of pain relief for arthritic proximal and distal interphalangeal joints in the fingers. Indications include osteoarthritis, acute trauma, chronic reconstruction for trauma, rheumatoid and other inflammatory arthritides, and at the distal interphalangeal joint, chronic mallet finger deformity and unreconstructible flexor tendon defects. Solid arthrodesis imparts stability to the digital skeleton. Headless compression screws can be reproducibly inserted and are a good method to provide fixation adequate to accomplish interphalangeal arthrodesis. Surgical technique involves a dorsal incision and preparing the skeleton for good bony apposition. Exact technique for screw insertion depends on the specific screw used. Union rates range from 85% to 100% in published studies, with time to union of 7 to 10 weeks.
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PMID:Instructional Course Lecture. Arthrodesis of the interphalangeal joints with headless compression screws. 1782 68


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