A prospective outcomes study of Swanson Metacarpophalangeal Joint Arthroplasty for the rheumatoid hand

Chung, Kevin C.; Kotsis, Sandra V.; Kim, H.Myra

doi:10.1016/j.jhsa.2004.03.004

Cited by 112 publications

(99 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In summary, patients treated with a silicone metacarpophalangeal arthroplasty are pleased with the results, mainly because the fi nger deformity has been corrected, particularly the ulnar drift [ 65 ]. The arc of joint mobility may not increase much, but it is placed in more extension, which makes it more functional and improves the aesthetic appearance of the hand [ 35 , 43 ] (Figs.…”

Section: Resultsmentioning

confidence: 99%

Treatment of MCP Joints in the Rheumatoid Hand

Lluch

2016

Clinical Management of the Rheumatoid Hand, Wrist, and Elbow

View full text Add to dashboard Cite

The fi nger extensor tendons do not insert at the base of the proximal phalanx , as they need to glide proximally and distally to provide extension of the interphalangeal joints (IPJ). The extensor tendons are stabilized at the dorsum of the metacarpal heads by two aponeurotic expansions, the sagittal bands (SB), which insert at both sides of the volar plate of the metacarpophalangeal joints (MPJ). The SB are responsible for maintaining the extensor tendon at the dorsum of the joint during radial and ulnar inclination of the fi ngers, as well as allowing the tendon to glide proximally and distally during extension and fl exion of the fi nger joints. If the intrinsic muscles are paralyzed, as seen after median and ulnar nerve lesions, the extensor tendon will only extend the MPJ, causing a claw deformity of the fi ngers. In these circumstances, if the MPJ are passively held in fl exion, because the extensor tendon does not insert into the proximal phalanx (PP), it will be capable of extending the IP joints.The fl exion forces at the MPJ, provided by the extrinsic fl exors and the intrinsic musculature, are far greater than the extension force provided by the extensor tendon. The collateral ligaments (CL) originate on the dorsum of the metacarpals and insert at the most anterior part of the base of the proximal phalanx, for the purpose of preventing the PP from displacing anteriorly. Anterior displacement of the PP is also prevented by the ball and socket joint morphology, as well as the constraint of the SB, which insert at both sides of the volar plate and should be considered as a proximal extension of the PP.Synovitis of the MPJ will attenuate the collateral ligaments (CL) and the SB, allowing the PP to displace volarly from the pull of the extrinsic and intrinsic fl exor muscles. The intensity and characteristics of the joint synovitis, as seen in cases of lupus, may rapidly destroy the CL and both SB, causing a complete anterior dislocation of the PP. When the dorsal stabilizers are not completely disrupted, the PP will partially sublux causing a scalloping deformity from wear of the dorsal part at its base.Another common deformity is an ulnar inclination of the fi ngers, known as ulnar drift. There is no single cause for the ulnar drift deformity, but rather a combination of several factors and the relative importance of each of them are diffi cult to determine. The following causes have been described as contributing to ulnar drift of the fi ngers in the rheumatoid hand: gravity, thumb

show abstract

Section: Resultsmentioning

confidence: 99%

Treatment of MCP Joints in the Rheumatoid Hand

Lluch

2016

Clinical Management of the Rheumatoid Hand, Wrist, and Elbow

View full text Add to dashboard Cite

show abstract

“…If not possible, surgeons should be aware that patients who have undergone intensive treatment may have a higher risk for AOs. A multidisciplinary approach including hand surgeons, rheumatologists and occupational therapists is more convenient for patients and more successful in targeted disease management (33)(34)(35). Long-term follow-up of outcomes and complications need to be assessed in RA patients undergoing HSP to facilitate evidence-based decision making.…”

Section: Discussionmentioning

confidence: 99%

Adverse outcomes following hand surgery in patients with rheumatoid arthritis

et al. 2016

View full text Add to dashboard Cite

R heumatoid arthritis (RA) is a systemic inflammatory and autoimmune disease characterized by inflammation in the synovial joints. It typically causes a symmetrical small-joint polyarthropathy that affects the proximal interphalangeal and metacarpophalangeal joints of the hands, wrists and feet (1). The wrist joint is often involved early in the disease course, and is regarded as one of the primary therapeutic targets because appropriate treatment prevents patient disability at work and preserves independent self-care (2). Currently, there is good evidence that early recognition of the disease and intensive treatment using disease-modifying antirheumatic drugs (DMARDs) favours improved outcomes and delays disability in RA patients (3). Nevertheless, when synovial inflammation persists over the follow-up period, joint destruction appears early and leads to rheumatic hand disease, which is characterized by deformity, dysfunction and, frequently, pain (4). Patient responses to DMARDs may be highly variable and it is currently exceedingly difficult to predict which patients will respond to which medication regimen, although current research to identify patient-specific disease signatures via genetic and proteomic approaches is ongoing. Functional and aesthetic compromise, and symptomatic complaints are the most common manifestations of the rheumatoid hand and may affect up to 70% of patients with longstanding disease (5). In such a clinical context, indications for surgery, in order of priority are: impending tendon rupture or severe nerve compression, pain relief, improved function and to correct deformity (5). Although there are clear recommendations from the National Institute for Health and Clinical Excellence (NICE) regarding early surgical referral (6), the systemic, progressive and polyarticular nature of RA elevates the complexity involved in decision-making to higher levels than is found in other areas of hand surgery. The definition of successful surgical intervention according to rheumatologists and hand surgeons varies, and has been a matter of debate for generations of physicians (7-9). Generally, rheumatologists underestimate the benefits of HSPs, while the converse is true for hand surgeons. Moreover, VM Menchaca-Tapia, EM Rodríguez, I Contreras-Yáñez, M Iglesias-Morales, V Pascual-Ramos. Adverse outcomes following hand surgery in patients with rheumatoid arthritis.

show abstract

“…There is good evidence that quantitative measurements of joint contracture, grip strength and others do not necessarily correlate with subjective patient scores of hand and wrist function. 2,3,7 In developing the Brigham and Women's Hospital symptom severity scale (SSS) and functional status scale (FSS), a patient questionnaire for carpal tunnel syndrome, Levine et al noted there was 'no universally accepted measurement of the severity of symptoms or functional status of the hand'. 8 They reported that grip, pinch strength, median nerve sensory conduction, two-point discrimination and Semmes-Weinstein monofilament testing did not correlate well with patient reported symptom (SSS) and functional (FSS) improvements in carpal tunnel syndrome.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional assessment of hand outcome

Pearl

Belcher

2013

annals

View full text Add to dashboard Cite

Introduction Patient reported outcome measures are central to National Health Service quality of care assessments. This study investigated the benefit of elective hand surgery by the simultaneous analysis of pain, function and appearance, using a three-dimensional (3D) graphical model for evaluating and presenting outcome. Methods A total of 188 patients scheduled for surgery completed pre- and postoperative questionnaires grading the severity of their pain, dysfunction and deformity of their hand(s). Scores were plotted on a 3D graph to demonstrate the degree of ‘normalisation’ following surgery. Results Surgical groups included: nerve compression (n=53), Dupuytren’s disease (n=51), trigger finger (n=20), ganglion (n=17) or other lump (n=21), trapeziometacarpal joint osteoarthritis (n=10), rheumatoid disease (n=5) and other pathology (n=13). A significant improvement towards normality was seen after surgery in each group except for patients with rheumatoid disease. Conclusions This study provides a simple, visual representation of hand surgery outcome by plotting patient scores for pain, function and appearance simultaneously on a 3D graph.

show abstract

A prospective outcomes study of Swanson Metacarpophalangeal Joint Arthroplasty for the rheumatoid hand

Cited by 112 publications

References 33 publications

Treatment of MCP Joints in the Rheumatoid Hand

Treatment of MCP Joints in the Rheumatoid Hand

Adverse outcomes following hand surgery in patients with rheumatoid arthritis

Three-dimensional assessment of hand outcome

Contact Info

Product

Resources

About