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

Treatment of the MP joint in the patient with rheumatoid arthritis can lead to very satisfying results. Decision making is based on the degree of compromise in the hand and the knowledge of anticipated outcomes with surgery. In patients in whom pain is an overriding feature, implant surgery is highly successful. The timing for implant surgery in regard to deformity is less clear. Soft tissue correction procedures without implants appear to have value in the treatment of moderate to late disease and further documentation of the long-term outcomes will prove helpful in determining the roles of such procedures. If silicone rubber MCP arthroplasty is performed, one can anticipate an arc of motion in the 50-degree range, with improvement of extensor lag. There also is improvement of ulnar deviation, although recurrence into the 10 to 15 degree range is not unexpected. Complications such as deep infection, recurrent deformity, and implant breakage all play a role in making the decision to undertake surgery. Younger patients obviously have more risk for future prosthetic problems. The development of silicone implant arthroplasty of the MP joint has given the hand surgeon a valuable way of improving hand function in patients with severe rheumatoid involvement. It is a procedure the outcome of which may be anticipated and patients may be reassured with some degree of confidence that the hand surgeon can provide them with improved hand function.
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PMID:Metacarpophalangeal joints in rheumatoid arthritis of the hand. 884 16

20 patients were operated on consecutively with osseointegrated MCP joint prostheses in 64 joints at our department between September 1993 and February 1995. The one-stage procedure included joint resection and cancellous bone grafting from the iliac crest before insertion of screw-shaped titanium fixtures, connected with a flexible silicone spacer. 18 patients (57 joints) were clinically and radiographically examined at median 28 (18-37) months postoperatively. Indications for surgery were joint destruction due to chronic arthritis in 17 patients (56 joints), and posttraumatic arthrosis in 1 patient (1 joint). Postoperative median range of motion was 40 (15-85) degrees, with an extension deficit of 30 (-20-70) degrees. 16 patients were satisfied, and had good pain relief and substantially improved postoperative hand function, evaluated with the standardized Sollerman hand function test. Radiographic osseointegration was obtained in 112 of 114 titanium fixtures (98%), but fracture of the silicone spacer was observed in 14 implants (25%). We conclude that osseointegration of longitudinal titanium fixtures in the bone marrow canal is possible in a one-stage procedure, but our findings show the need for a new, more durable joint spacer.
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PMID:Osseointegrated silicone implants. 18 patients with 57 MCP joints followed for 2 years. 1036 6

Successful surgical reconstruction of the basilar thumb joint requires a thorough knowledge of the longitudinal intercalated collapse that may occur with this condition. Evaluation of the hyperextended thumb MCP joint and appropriate treatment are instrumental to successful basal joint reconstruction. Stabilization of the MCP joint helps maximize return of a pain-free, efficient pinch mechanism. A useful guide to specific reconstructive methods for the MCP joint is presented in Table 1.
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PMID:The role and implementation of metacarpophalangeal joint fusion and capsulodesis: indications and treatment alternatives. 1147 47

An elite collegiate boxer developed extensor tendon subluxation in the small finger of his dominant right hand. He was thought to have a radial sagittal band disruption and was allowed to complete his season with custom padding. Surgical exploration revealed intact sagittal bands with divergent dislocation of the two extensor tendons to the small finger with underlying capsular rupture. These lesions were repaired and he successfully returned to boxing. Soft tissue injuries to the dorsal MCP joint may involve the collateral ligaments, the sagittal bands, the extensor tendons, or the joint capsule. Symptoms usually involve persistent pain, swelling, and tendon subluxation or dislocation. Accurate recognition and treatment is crucial as nonoperative treatment is generally unsuccessful and surgical reconstruction is required for optimal return to function.
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PMID:Traumatic extensor tendon dislocation in a boxer: a case study. 1452 99

Chemokines are a family of peptides originally identified as the factors regulating the migration of leukocytes in inflammatory and immune responses. Recently, they have been shown to be produced in the central and peripheral nervous systems under various pathological conditions and act on neuronal and glial cells. In this study, we examined the production of monocyte chemoattractant protein-1 (MCP-1), a well-characterized chemokine, in dorsal root ganglia (DRG) in a rat model of neuropathic pain. Partial ligation of the sciatic nerve induced mechanical allodynia in the ipsilateral hindpaw with weaker allodynia in the contralateral one. Immunohistochemical analyses revealed that the number of MCP-1 immunoreactivity (ir)-positive cells was increased in the ipsilateral DRG. The increase started by 4h after the ligation, peaked at 24h and continued to at least 48 h. The weaker but significant increase was observed in the contralateral DRG. Double immunofluorescent staining demonstrated that almost all of the MCP-1ir-positive cells were neuronal cells. In situ hybridization histochemistry showed that MCP-1 mRNA expression was markedly upregulated in the ipsilateral DRG with weaker increase in the contralateral one at 24 h after the ligation, indicating that the elevation in MCP-1ir detected by immunohistochemistry was due to an upregulation of MCP-1 production by the DRG neurons themselves. Furthermore, intrathecal administration of MCP-1 induced mechanical allodynia. These results suggest that MCP-1 produced in the DRG neurons is involved in the development of mechanical allodynia induced by nerve injury.
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PMID:Enhanced production of monocyte chemoattractant protein-1 in the dorsal root ganglia in a rat model of neuropathic pain: possible involvement in the development of neuropathic pain. 1504 Dec

Rheumatoid diseases are generalized chronic inflammatory diseases of the musculoskeletal system. Although the different structures and different joints are affected, all cause a very uniform type of pathology and joint destruction. The main indication for implantation of the endoprosthesis are severe pain and walking disability with poor quality of life. On the X-ray involvement includes periarticular osteopenia, cystic changes, and destruction's affected joints. Endoprosthetic replacement has been successful in the treatment of severe rheumatoid disease of almost all joints of all ages, but predominantly replacement of the hip, knee, shoulder, elbow and MCP joints. Arthroplasty has proved to be an excellent addition to the therapeutic armamentarium for the rehabilitation of handicapped patients with rheumatoid disease. Advancements in endoprosthetic technology and surgical techniques, allow us to perform alloarthroplasty in most of the patients with severe rheumatoid disease of all different joints.
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PMID:[Endoprosthetic procedures in rheumatoid patients]. 1509 66

The metacarpophalangeal arthroplasty in rheumatoid arthritis reported is a modification of the Vainio-Arthroplasty. The main difference of the technique is the fixation of the proximal extensor tendon to the palmar plate, better to the ligamentum metacarpeum transversum profundum. The more flexion of the metacarpophalangeal joint the more reposition of the joint is achieved. The long-term results of 30 arthroplasties of the metacarpophalangeal joint are presented in a prospective study. The cases were followed for 10.5 to 14.5 years (average 11.6 years). Marked release of pain was found in all patients. 75 per cent of the patients reported functional improvement of their hand at a score of "good" or "very good". The postoperative movement was 70 degrees on an average. In summary, the resection arthroplasty of the metacarpophalangeal joints produces very good function and correction of the ulnar deviation and palmar luxation of the MCP-joints. The arthroplasty is a real alternative to the total endoprosthetic replacement of metacarpophalangeal joints in rheumatoid arthritis.
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PMID:[Long-term results of resection arthroplasty of the metacarpophalangeal joint in rheumatoid arthritis]. 1574 50

Adult rheumatoid arthritis (RA) is the most common of rheumatoid diseases, that may cause hand dysfunction in some patients. Its equivalent in children is juvenile chronic arthritis (JCA). The aim of our study was to evaluate differences in hand deformity between children with JCA and adults with RA. The prospective study was performed on two groups of patients: 15 with JCA (average age 13.1 years, range from 9 to 18 years) and 15 with RA (average age 53.6 years, range from 42 to 60 years). Both groups were similar in terms of Seyfried classification system and duration of the disease--7.9 years for children and 8.6 for adults. Clinical assessment was performed according to Swanson and Seyfrieda classification system. Patients with RA had only radial wrist "deviation" and those with JCA had both radial and ulnar wrist deviation. In MCP joints in adult's group fingers were always in ulnar position and in children's group finder position was opposite to wrist position. "Swan neck" deformity of fingers from II to V was found in both groups. "Buttonhole deformity" was more often seen in older group. Pain of wrist and in IP joints was more often found and was more severe in RA group. Hypertrophy of synovium and subluxation of IP and wrist joust were found with similar frequency in both groups. In other joints subluxation was rare. Concluding, radial wrist deviation is typical for RA patients. Children with JCA had both radial and ulnar wrist deviation. In MCP joints deformity is always opposite to wrist deviation.
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PMID:[Hand deformity in adult rheumatoid arthritis and juvenile chronic arthritis]. 2016 74

This paper presents outcomes after 13, 4, and 3½ years in three digital amputees treated with osseointegrated prostheses. One had prosthetic replacement of the index and middle fingers at the PIP level. The second had four fingers replaced at the PIP level, but only three prostheses were retained. The third had a thumb replacement at the MCP level. All patients scored their reconstructed hand highly in terms of appearance and frequency of use. The first and third patients rated the function of the reconstructed hand as similar to the normal hand, and this was confirmed by the Jebsen Test, but the second patient had poor function. All patients could detect pressure and vibration through their prostheses, although grip and pinch strengths were weaker in all three. All three also experienced some pain in the implanted fingers. This study identifies osseointegration as a stable long-term reconstructive option.
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PMID:Long-term outcomes of osseointegrated digital prostheses for proximal amputations. 2080 21

In this retrospective study, we evaluated the effect of radiosynovectomy of patients with rheumatoid arthritis. Radiosynovectomy was performed in 577 joints of 137 rheumatoid patients. We applied 185 MBq yttrium-90 in knees (n = 58), 74-111 MBq rhenium-186 colloids in ankle (n = 50), wrists (n = 43) and shoulders (n = 35), and 15 to 37 MBq in finger (n = 298) and toe joints (n = 46). The effect of radiosynovectomy was scored in 4 subjective categories: excellent response (no symptoms); good response (significant reduction of symptoms); moderate response (slight decrease); and bad response (no change or worsening), of pain and/or swelling in treated joint 3 months after the procedure. Excellent or good response was observed in 57% of treated knees, 63% of shoulders, 60% of wrists, 64% of ankles, 54% of thumb bases, 55% of MCP's, 54% of PIP's, 53% of DIP's, and 54% of MTP's. Side effects associated to the RSO, i.e., swelling or transient increase of pain, were recorded in 7% of the patients that resolved within 1 month. No patient had any non-reversible skin alteration after treatment, only slight erythema was observed in 5 patients. Radiosynovectomy is effective and safe in the treatment of rheumatoid arthritis.
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PMID:Efficacy of radiosynovectomy in rheumatoid arthritis. 2196 82


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