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

PIP joints, MCP joints and wrists of 80 patients with rheumatoid arthritis were operated on with late synovectomy. The rate of recurrence of local synovitis was about 5%, which contrasted favourably with a considerably higher rate of progression of bony erosions. The loss of range of movement was small to moderate. Pain was alleviated in most cases. The possibility of forecasting the results by preoperative parameters was limited. It was concluded that the main indication for late synovectomy of the hand was alleviation of pain. The prophylactic effect on joint destruction seemed to be both slight and unpredictable.
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PMID:Late synovectomy of the hand in rheumatoid arthritis. 98 95

One hundred and seven patients presenting 140 localizations of Dupuytren's disease were operated upon by a single surgeon before 1985, according to a modified Mac Cash procedure combining a Bruner approach and open transverse digital and/or palmar incisions. All surgery was performed under axillary block on an out-patient basis. A striking feature is the absence of complications such as haematoma, skin necrosis or infection. In the early post-operative follow-up (mean 105 days), the average angular improvement was 79.5% in all patients. Among the 107 patients, 54 (for a total of 67 localizations) were specifically reviewed with an average follow-up of 5.6 years. Improvement averaged 74% in 83.5% of digits. In the remaining 16.5%, the lack of extension averaged 31 degrees. Some factors had a negative effect on final results: early age of onset, major involvement of the PIP joint, localization at fifth ray level. The recurrence rate (41%, 23% of which severe) is identical to other reports on limited fasciectomy. A good indication is therefore a patient older than 50, and the method provided low postoperative morbidity and pain, associated with acceptable results.
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PMID:Open palm technique for Dupuytren's disease. A five-year follow-up. 128 16

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

A case of dermatomyositis which developed one month after normal delivery and subsided spontaneously was reported. A 29-year-old woman gave birth to a healthy child. One month later, she noticed muscular pain and weakness of the upper extremities. On admission, there were diffuse edema of upper eyelids with heliotrope rash. The reddish skin rashes were observed on the extensor surfaces of the PIP and MP joints of fingers. Erythrocyte sedimentation rate was 29 mm/hr. The lactic dehydrogenase (LDH), SGOT, CK levels were 470 (normal 150 to 320 IU/l), 43 (normal 6 to 25 IU/l) and 317 (normal 21 to 110 IU/l) respectively. Autoantibodies to nuclear and cytoplasmic antigens were negative. Rheumatoid factor and anti-DNA antibody were negative. Thyroid function was normal. An electromyogram (EMG) demonstrated small amplitude short-duration polyphasic motor unit potentials. The muscle biopsy specimen from left upper arm showed degenerating muscle fibers and infiltration of inflammatory cells surrounding blood vessels. The skin biopsy revealed the presence of edema and perivascular infiltration of lymphocytes. Based on these clinical features and results of various diagnostic tests, a diagnosis of dermatomyositis was established. After the admission, muscle strength has improved dramatically and the CK returned to normal level without specific drug therapy. She has since been seen as an out patient, and complete remission lasted for two years up to date. Review of the literature disclosed that 13 cases of PM/DM which developed during pregnancy or postpartum have been reported including the present case. Detailed analysis showed that these patients were characterized by mild muscular diseases, rare occurrence of internal organ involvements and good response to steroid therapy. As our case, a spontaneous remission was also observed. Although the mechanism involved in occurrence of inflammatory myositis associated with pregnancy or delivery are not clarified, these patient indicated a presence of subset of PM/DM which do not require intensive drug therapy.
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PMID:[Spontaneous remission of dermatomyositis which developed one month after normal delivery]. 160 20

The anatomy and topography of the vincula are described. Their role in the blood supply to the flexor tendons is reviewed in the light of current reports. The authors present the case history of a 59-year old patient with blunt trauma to the middle finger of the right hand. This patient suffered from severe pain in the area of the proximal phalanx and the PIP joint of the third finger, as well as from reduced extension with a deficit of 20 degrees in the PIP joint. The differential diagnosis and clinical picture are discussed. The operative findings suggest a rare instance of detachment or rupture of the vinculum of the intact superficial flexor tendon.
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PMID:[Isolated rupture of the vinculum longum superficiale (V1) following blunt trauma]. 233 2

In this study the effect of pressure gradient gloves was compared with that of control gloves by eight patients with rheumatoid arthritis (RA) and diffusely and symmetrically swollen hands. In the morning at fixed times, grip strength, circumference of PIP joints and proximal phalanges, nocturnal pain and morning stiffness in the hands were measured. Significant improvement of circumference of PIP joints (P less than 0.001) and proximal phalanges (P less than 0.01) were found. On wearing the control gloves, some improvement was also found, but only the circumference of PIP joints decreased significantly (P less than 0.05). Nocturnal pain and morning stiffness diminished significantly on wearing both types of glove. Grip strength improved, but not significantly with both. No significant differences were detected between the effects of wearing the two types of glove. No correlation was found between the decreased swelling in the hands as measured by PIP joint circumference or circumference of the proximal phalanges and the decreased nocturnal pain or morning stiffness. This study provided no explanation for the beneficial effect of the gloves. It was shown that for some patients with painful and swollen hands, wearing gloves at night may give relief.
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PMID:The effect of pressure gradient and thermolactyl control gloves in arthritic patients with swollen hands. 235 2

Selection of the reconstructive technique for the traumatized joint requires a careful consideration of the condition of the injured and adjacent joints, the needs and desires of the patient, and an understanding of the advantages and disadvantages of the available options. The MP joint is the key to a useful arc of motion, providing 77 per cent of the total arc of flexion. Every effort should be made to preserve its maximum pain-free movement. PIP joint motion, although important in maintaining grip strength, can more readily be sacrificed to provide stability when MP joint motion is normal. Arthrodesis provides a pain-free stable joint with a sacrifice of motion. It may be indicated in young patients in whom heavy loading is likely; in joints with a fixed, painful deformity, instability, or loss of motor; and in the salvage of failed implant arthroplasty. Arthrodesis is generally contraindicated where physes are open. PIP joint arthrodesis is well tolerated in the index finger with minimal morbidity. Motion of MP joints and PIP joints of the long, ring, and small fingers, however, should be preserved using other techniques when possible. Resection arthroplasty may be useful in selected cases of post-traumatic arthroplasty where other treatment techniques are not available. Soft tissue interposition techniques are useful in specific cases. Eaton volar plate arthroplasty provides good results where 50 per cent of the articular surface is preserved. The technique, however, requires precision to avoid rotational malalignment. Perichondrial resurfacing provides a reasonable alternative in patients younger than 40 years of age who have a relatively well maintained joint contour, preferably involving a single joint surface. Prior infection is a relative contraindication. MP joints generally produce better results than PIP joints. Swanson interposition arthroplasty remains the most widely accepted implant technique, providing improved stability and earlier motion than simple resection arthroplasty. Reported arcs of motion range from a minimum of 29 degrees to a maximum of 85 degrees, with results generally better for MP than for PIP joints. Complications are common and include implant fracture, lateral instability of the PIP joint, and, occasionally, synovitis. Patient satisfaction, however, has been consistently reported as high. The use of Swanson arthroplasty in acute cases remains controversial, although several authors report favorable results. Silicone arthroplasty is contraindicated in joints with open physes. Allograft small joint reconstruction provides replacement bone and articular surface without donor site morbidity. Experience with the technique, however, has been limited. Increasing concern over the transmission of infectious diseases may make this option less desirable.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Management of the traumatized joint of the finger. 267 27

The importance of anatomical reduction of articular fractures and early mobilisation of these severe forms of trauma which frequently damage the extensor apparatus (58% of cases, led us to propose direct miniaturised osteosynthesis as described by the Nancy-Strasbourg team. Of the 1,000 cases of osteosynthesis performed between 1978 and 1985, we selected 12 fractures of the MP joint, 38 fractures of the PIP joint and 10 fractures of the DIP joint, differentiated into 4 stages according to the condition of the skin and tendons and into 9 categories according to the anatomical type and the site of the fracture. Direct osteosynthesis (screw, bolt, pin) was used in every case. The clinical results were evaluated in terms of the Total Active Range of Movements, the local trophic state, the amount of pain and return to work, for each joint. When well conducted and with effective skin cover, this technique allows almost normal reconstruction in simple fractures and is valuable in more complex fractures by preserving sliding of the tendinous apparatus due to early mobilisation.
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PMID:[Miniaturized osteosynthesis of articular fractures of the fingers. Results of a series of 60 cases]. 319 Mar 14

In view of the results of Swanson implants, particularly the long-term course of silicone implants, the authors studied and developed semi-constrained sliding arthroplasty designed for metacarpo-phalangeal and proximal interphalangeal joints. The preliminary study on bones and then on cadaver hands and finally on the knee of the rabbit allowed the design and experimentation of a prototype which led to the creation of a semi-constrained arthroplasty for which the elastic diaphyseal anchoring is ensured without cement and which possesses sliding surfaces composed of a metallic (proximal piece)--polyethylene (distal piece) interface. We therefore describe the principles of functioning of this arthroplasty, its technique of insertion, dorsal trans-tendon incision, its accessory (drill for diaphyseal preparations), its anatomical requirements (preservation of the palmar plate and lateral ligaments, bone section) and the postoperative course. To date, 52 arthroplasties have been inserted and we present the results of the first 36 cases for which the follow-up is equal to or a greater than one year (20 MP-16 PIP), indicating the technical modalities according to the various aetiologies (21 cases of rheumatoid arthritis--15 post-traumatic cases) and the complications. The average gain in mobility is 40 degrees with a mean range of movement of 64 degrees. In terms of pain, none of the arthroplasties were associated with pain apart from pain on cold in certain post-traumatic cases. The global and thumb-finger prehensile forces were evaluated to be an average of 90% in relation to the healthy side. Radiological assessment demonstrated fixation of the pieces in every case. Lastly, we discuss the outcome of this arthroplasty and its current indications in relation to the problems of instability essentially occurring in dislocated MP joints of rheumatoid arthritis.
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PMID:Proposed digital arthroplasty critical study of the preliminary results. 323 39

Implants have been used since 1969 by the authors for the replacement of damaged finger joints following trauma. In several cases reconstruction of other damaged tissues in the same finger was also performed. A method is described for replacement of the central slip of the extensor tendon over the PIP joint. Analysis of twenty-one MP and sixty-eight PIP endoprostheses placed in eighty-three patients until 1979 is given. Significant improvement in the range of movement is seen. Preoperative pain was relieved in all cases. There was a need to change occupation in ten percent of patients. Careful analysis of early and late complications calls attention to the proper selection of patients for surgery.
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PMID:[Reconstruction of metacarpophalangeal and interphalangeal joints with endoprostheses following injuries]. 323 53


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