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

This study examined 76 consecutive patients (100 feet) treated by a single surgeon for both flexible and rigid hammertoes with a PIP arthrodesis using custom-machined drills, a peg cutter, and hole cutter, combined with an extensor tenotomy and dorsal capsulotomy. Forty-eight percent of patients were defined as satisfied without reservation, 37% were defined as satisfied with reservations, and 15% were defined as dissatisfied. The incidence of radiographic fusion was 95% (130/137 toes). The most common reasons for either reservation or dissatisfaction included incomplete pain relief, residual toe angulation, and prolonged shoe wear restriction in the postoperative period. Based upon the results of this study, the authors suggest that when using a peg and socket arthrodesis for hammertoe correction (1) there is a 95% rate of radiographic fusion, (2) patients over 65 years old be alerted to a diminished rate of satisfaction, and (3) a distal flexor tenotomy be considered in patients with a preoperative DIP flexion contracture.
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PMID:Treatment of symptomatic hammertoe with a proximal interphalangeal joint arthrodesis. 856 20

Well known complications of proximal interphalangeal joint fractures and fracture dislocations are stiffness, chronic instability, and degenerative arthritis. The Compass PIP Hinge is a dynamic external fixator that allows protected proximal interphalangeal mobilization after closed reduction, open reduction and internal fixation, volar plate arthroplasty, or other salvage procedures. To help avoid these problems, 20 patients, 12 treated within 2 weeks of injury (Group I) and 8 treated more than 4 weeks after injury (Group II), are reported. Articular surface involvement among Group I cases averaged 66% (range, 50%-90%), and postoperative proximal interphalangeal motion for this group averaged 9 degrees to 82 degrees. Mild pain with heavy use was present in 3 patients, and 9 patients were pain free. Postoperative proximal interphalangeal motion for Group II averaged 21 degrees to 77 degrees. Pain was moderate to severe in 2 patients, mild with heavy use in 1 patient, and none in 5 patients. One patient from Group II underwent surgery to convert to a silicone proximal interphalangeal arthroplasty because of painful degenerative arthritis. It is concluded that there is a role for hinged external fixation in treating unstable proximal interphalangeal fracture dislocations. Outcomes in acute injuries are superior to those in chronic or salvage cases.
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PMID:Hinged device for fractures involving the proximal interphalangeal joint. 864 Oct 76

The authors report 27 Digital Joint Arthroplasties (DJOA), implanted exclusively in cases of osteoarthritis, between 1985 and 1994. The metacarpophalangeal joint was involved in 8 cases and the proximal interphalangeal joint was involved in 19 cases in a series of 20 patients with a mean age of 58 years (49-84). The mean interval between the first clinical signs and the surgical operation was 34 months (12-72). An anterolateral incision was used in 5 cases for the PIP joint, and an anterior incision was used in one case for the MP joint. All other cases were operated via a dorsal incision. Two early complications were observed: septic ulceration of the skin and dislocation of the PIP prosthesis on the 8th day. Good results were obtained in terms of pain. Range of movement was only slightly improved by arthroplasty and exclusively in the extension sector. The range of movement of the MP joint increased from 35 degrees to 50 degrees, while the range of movement of PIP joint remained unchanged at 50 degrees with a slight displacement of 5 degrees towards the extension sector. This can be explained by the radiological follow-up of our implants which showed impaction of the prosthetic shaft during the first two postoperative years with appearance of signs of periarticular ossification. The results concerning range of movement and pain were analogous to those of other series in the literature, particularly with the use of Swanson implants. On the other hand, DJOA arthroplasty presents a low incidence of axial deviation problem (1 case out of 27). The authors are currently trying to improve the results of DJOA arthroplasty by creating a size 0 to suit anatomical requirements and by adopting the anterolateral incision to preserve the extensor apparatus in order to decrease postoperative flexion deformity.
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PMID:[Primary metacarpophalangeal and proximal interphalangeal arthrosis of the hand. Indications and results of 27 DJOA arthroplasty]. 913 42

The aim of this prospective study was to evaluate the efficiency of radiation synovectomy with rhenium-186 or erbium-169 in rheumatoid arthritis. In the control groups articulosynovitis was treated by injection of triamcinolonhexacetonid. Follow-up time was 3 years. Patients of the study had to fulfill the following criteria: rheumatoid arthritis (ARA criteria 1988), patient age above 40 years, standardized medical treatment with methotrexate, (started at least 6 month prior to injection therapy, given for the entiry study time), prednisolon < or = 7.5 mg/d and diclofenac < or = 150 mg/ d, and no previous surgery or injection therapy on this/these joint/s. Shoulder, elbow, wrist, and ankle joints were treated in group 1 by injection of rhenium-186 combined with triamcinolonhexacetonid, in group 2 by injection of triamcinolonhexacetonid alone. Each treatment group included 50 joints. Digital joints underwent injection of erbium-169 combined with triamcinolonhexacetonid (group 3 = 131 joints) or triamcinolonhexacetonid (group 4 = 86) alone. During the follow up period, the joints were assessed for pain, synovial swelling, joint motion, and stage of radiological destruction (Larsen-Dale-Eek). After 3 years follow-up, 228 joints met the above named criteria: group 1 = 41 joints, group 2 = 21 joints, group 3 = 131 joints, group 4 = 53 joints. Significantly better clinical results were achieved with the combined injection of rhenium-186 or erbium-169 and triamcinolonhexacetonid. Results for PIP joints were worse than for other joints, which is explained by better immobilization of the latter ones after injection. The progression in radiological joint destruction according to the stages of Larsen-Dale-Eek during the follow-up time of 3 years (= stage at 3 years minus stage prior to treatment) corresponded to the clinical results and was significantly slower in groups 1 and 3: group 1 = 0.62; group 2 = 1.7; group 3 = 0.75; group 4 = 1.43 Therefore, we recommend radiosynovectomy with erbium-169 or rhenium-168 in combination with triamcinolonhexacetonid and consequent immobilization after injection.
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PMID:[Chronic polyarthritis and radiosynoviorthesis: a prospective, controlled study of injection therapy with erbium 169 and rhenium 186]. 941 61

Skin retraction is a commonly observed complication of severe joint stiffness in the hand. After freeing the joint, this raises the problem of closing the skin without tension to avoid necrosis, disunion or pain during early rehabilitation and splinting. We have used a simple rotation flap for PIP extension (and hyperextension) stiffness and a "castle" flap for PIP flexion retraction and for both extension and flexion stiffness of the MPJ. It consists in withdrawing the skin (dorsal or palmar) of the phalanx distal to the freed joint. We have used this flap in 13 clinical cases of severe stiffness and it allowed wide access to all structures involved and facilitated early post-operative mobilization.
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PMID:[Skin problems in severe retraction stiffness of the hand and fingers. Role of the so called "castle" flap]. 976 92

Sixty-three patients (118 toes) were evaluated at an average 61 month follow-up following PIP resection arthroplasty for a fixed hammertoe deformity. The deformity involved the second toe in 35%, the third toe in 21%, the fourth toe in 24%, and the fifth toe in 20%. The involved toe averaged 2 mm. greater length than the adjacent toes and was longer in 49/94 (52%). Seventy-eight percent of patients complained of pain preoperatively due to the hammertoe deformity and 49% complained of callus formation. Following a resection arthroplasty technique with intramedullary Kirschner wire fixation, fusion of the PIP joint occurred in 81% of toes. A fibrous union resulted in the remaining 19% of cases. Patients rated subjective alignment as acceptable in 86% of cases and radiographic alignment was rated as good in 79%. Malalignment and numbness were the major factors associated with an unsuccessful result. Pain was relieved in 92%of patients and subjective satisfaction was noted by 84% of patients. Minor complications occurred in 5%. The average postoperative AOFAS score was 83 points. Resection arthroplasty of the proximal interphalangeal joint with intramedullary Kirschner wire fixation as a technique for correction of a fixed hammertoe deformity is a reliable technique that consistently gives a high level of satisfactory results.
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PMID:Operative repair of the fixed hammertoe deformity. 1069 20

A 10 mm wide ring graft from the second extensor compartment with periosteum from the floor of the sheath was used to correct bowstringing in six patients who sustained an isolated rupture of the A2 pulley. It was attached to the lateral rims of the sheath. Periosteum was used for additional graft fixation. Bowstringing was assessed by magnetic resonance imaging and ultrasound preoperatively and 19.5 months after surgery. It was corrected in five patients and improved in one. Pain was reduced from 35 to 7 points on a visual analogue scale. Digital circumference decreased from 76 to 71 mm. Flexion at the PIP joint increased from 88 degrees to 116 degrees. Pinch grip improved from 28 to 56 N.
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PMID:The use of a graft from the second extensor compartment to reconstruct the A2 flexor pulley in the long finger. 1076 35

Pain, weakness, malalignment and limited range of motion (ROM) at the PIP joint following arthrosis (degenerative or post-traumatic) or rheumatoid arthritis frequently require surgical treatment. PIP joint fusion or implantation of a prosthetic device are options. The purpose of this study was to report our long-term results with a surface replacement PIP arthroplasty (SR PIP arthroplasty) and the description of our operative technique. 82 prostheses were done in 60 patients between 1980 and 1999. All patients were reexamined, the average follow up was 64 months (12 to 260 months); average age was 57 years. 48 patients were operated on the right hand, 12 on the left hand. 44 patients were female, 16 were male. All patients complained of pain preoperatively. Patients were divided into three groups: A degenerative arthrosis, B posttraumatic arthrosis and C inflammatory arthritis. Active range of motion of all fingers of the operated hand, grip-strength, pain relief, joint stability or deformity and comprehensive radiographic assessment were studied. The subjective impressions of the patients were measured in four grades: very satisfied--satisfied--dissatisfied--very dissatisfied. Finally the investigators divided the overall results in: good--fair--poor. The average flexion arc was 31 degrees (maximum 15 degrees hyperextension to 95 degrees flexion) preoperatively and 47 degrees (maximum 14 degrees hyperextension to 90 degrees flexion) postoperatively. Over 70% of the patients had complete pain relief. In 12 fingers secondary procedures were necessary, usually related to soft tissue deformity and extensor tendon function. No arthrodesis was performed as a following operation. In 40 fingers a good result was achieved (49%), 25 had a fair (30%) and 17 (21%) a poor result. Our results of resurfacing PIP arthroplasty are encouraging and provide equal and usually improved motion in comparison with other joints. With experience and refinements of the operative technique our confidence in surface replacement arthroplasty has increased. For this reason we prefer this procedure for posttraumatic or degenerative arthrosis as against PIP joint fusion or silastic implants.
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PMID:[Complete superficial replacement of the middle finger joint--long-term outcome and surgical technique]. 1118 95

Local anesthetics, commonly used for treating cardiac arrhythmias, pain, and seizures, are best known for their inhibitory effects on voltage-gated Na(+) channels. Cardiovascular and central nervous system toxicity are unwanted side-effects from local anesthetics that cannot be attributed to the inhibition of only Na(+) channels. Here, we report that extracellular application of the membrane-permeant local anesthetic bupivacaine selectively inhibited G protein-gated inwardly rectifying K(+) channels (GIRK:Kir3) but not other families of inwardly rectifying K(+) channels (ROMK:Kir1 and IRK:Kir2). Bupivacaine inhibited GIRK channels within seconds of application, regardless of whether channels were activated through the muscarinic receptor or directly via coexpressed G protein G(beta)gamma subunits. Bupivacaine also inhibited alcohol-induced GIRK currents in the absence of functional pertussis toxin-sensitive G proteins. The mutated GIRK1 and GIRK2 (GIRK1/2) channels containing the high-affinity phosphatidylinositol 4,5-bisphosphate (PIP(2)) domain from IRK1, on the other hand, showed dramatically less inhibition with bupivacaine. Surprisingly, GIRK1/2 channels with high affinity for PIP(2) were inhibited by ethanol, like IRK1 channels. We propose that membrane-permeant local anesthetics inhibit GIRK channels by antagonizing the interaction of PIP(2) with the channel, which is essential for G(beta)gamma and ethanol activation of GIRK channels.
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PMID:Mechanism underlying bupivacaine inhibition of G protein-gated inwardly rectifying K+ channels. 1135 68

In a follow-up examination of 30 patients who had sustained dorsal dislocations of the PIP joint, the results of two conservative therapy regimens, either immobilisation or early motion were investigated. In Group A, 15 patients were treated by closed reduction and immobilisation with a forearm cast for four weeks. Nine patients showed normal range of motion, whereas a limitation of extension of ten degrees and more was seen in six cases. All PIP joints were stable. Nine patients were satisfied. Three patients complained of a limitation of extension, two of a limitation of extension and pain and one of swelling. In Group B, 15 patients were treated by dorsal block splinting of the PIP joint following reposition. The finger was released in extension with daily active exercise of the PIP joint. Only two of 15 patients showed limitation of extension, whereas 13 cases showed normal range of motion. Instability of one collateral ligament was seen in two cases. Palmar instability did not occur. Eleven patients were satisfied. One patient complained of instability, pain and lack of extension, one of pain in combination with instability, one of pain and one of swelling of the joint.
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PMID:[Dorsal dislocation of the proximal interphalangeal joints of the finger. Results after static and functional treatment]. 1146 99


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