Thumb boutonnière deformity without rheumatoid arthritis or trauma

Hara, Taro; Yoneda, Hidemasa; Kurimoto, Shigeru; Yamamoto, Masayuki; Iwatsuki, Katsuyuki; Hirata, Hitoshi

doi:10.1177/1753193417704610

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…3 In patients with rheumatoid arthritis, the "z-thumb" deformity is caused secondary to synovitis of the MCP joint, weakening of the extensor pollicis brevis tendon insertion and subluxation of the extensor pollicis longus tendon. 14 However, the deformity could by speculation also develop secondary to tightness in the median and ulnar nerve innervated intrinsic two heads of the flexor pollicis brevis muscle.…”

Section: Discussionmentioning

confidence: 99%

“…3 The z-thumb deformity has also been attributed to the SHD and refers to a MCP joint flexion and IP joint hyperextension and is a common finding in patients with rheumatoid arthritis. 14 Based on increasing flexion of the MCP joints and co-occurrence of deformities, subluxations and contractions in other finger joints, SHD severity staging was just recently suggested. 3 Importantly, testing of intrinsic muscles tightness, commonly used in hand surgical assessment of intrinsic-plus hand, 15 is not included in the proposed SHD examination.…”

mentioning

confidence: 99%

“…Swan‐neck deformity in addition to flexed MCP joints is often seen in patients with an intrinsic‐plus hand and has also been described in patients with more severe SHD, although a swan‐neck deformity may develop for other reasons and irrespective of MCP joint flexion 3 . The z‐thumb deformity has also been attributed to the SHD and refers to a MCP joint flexion and IP joint hyperextension and is a common finding in patients with rheumatoid arthritis 14 …”

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confidence: 99%

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Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives

Brogren

Dahlin

Franzén

et al. 2022

Movement Disord Clin Pract

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BackgroundBackground: The knowledge about striatal hand deformities (SHD) in Parkinson's disease (PD), has recently increased but need more attention due to their early impact on dexterity. The focus of clinical studies has been on the staging of SHD severity and neurological features. However, a hand surgical perspective has not been considered. Objectives Objectives: Our purpose was to examine SHD in patients with PD using hand surgical assessment methods and the recommended staging of SHD. Methods Methods: In this observational study, a specialist in neurological physiotherapy examined 100 consecutive PD patients and identified 35 with suspected SHD, who were then examined by two hand surgeons. Their hands were clinically evaluated for severity of SHD, according to a previous proposed staging, focusing on metacarpophalangeal (MCP) joint flexion, presence of intrinsic and extrinsic tightness, as well as other hand deformities. ResultsResults: Three kinds of deformities were identified among 35 included patients: surgical diagnoses unrelated to PD (n = 5), SHD (n = 23), and PD related hand deformities with increased extrinsic tightness (n = 10); three of these 10 patients had also contralateral SHD, thus are included in SHD group. In addition to previously described MCP joint flexion, swan neck deformity and z-thumb deformity, we found in most hands finger "clefting," abduction of the little finger and/or an increased intrinsic tightness, indicating pathology of intrinsic muscles of the hand involved in SHD. Conclusions Conclusions: SHD diagnosed with a modified staging method, including features of intrinsic and extrinsic hand deformities, should be considered in PD to implement early and more accurate treatment.A striatal hand deformity (SHD) is recognized by flexion of the metacarpophalangeal (MCP) joints, sometimes in combination with hyperextension of the proximal interphalangeal (PIP) joints. [1][2][3] The term "striatal deformity" has been used since the 70's to describe various abnormal parkinsonian postures of the hand, foot and spine. 3 Today, we know that lesions in the striatum (caudate and putamen) cause dystonia, but evidence supporting that "striatal deformities" are related to the striatum are in fact scarce. 3 Thus, SHD in Parkinson's disease (PD), occurring in 8-10% of PD patients, 4,5 is still relatively unrecognized and not fully understood. 1,4,5 It seems as SHD is poorly responsive to medication effects, 2 is not action-induced 6 and is still present with the hands relaxed and during sleep, 1,6 indicating that a SHD shares features with rigidity, although dystonia has been discussed in relation to the origin of SHD. 3,4,7 Also, other PD related deformities, such as "clenched fist" 8 or wrist flexion while walking related to motor fluctuations, 9 are closely related to dystonia. Interestingly, mild stages of SHD can be one of the earliest parkinsonian signs in untreated patients and the laterality of SHD is highly specific for the worst affected side of PD. [2][3][4] Patients with SHD are yo...

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Section: Discussionmentioning

confidence: 99%

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Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives

Brogren

Dahlin

Franzén

et al. 2022

Movement Disord Clin Pract

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“…Häufig richtet sich das Endgelenk wieder aus. Ist dies nicht der Falle, so wird auch dieses versteift 10 .…”

Section: Spezifische Pathogenese Der Rheumatischen Handunclassified

Konservative und operative Therapie der rheumatischen Hand

Gaulke¹

2022

Orthopädie und Unfallchirurgie up2date

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“…Um einen Zweiteingriff zu vermeiden, ziehen wir eine 2,3-mm-Schraube mit flachem Kopf, der der Kortikalis gut aufliegt, dem queren K-Draht vor, welcher in der Regel stört und wieder entfernt werden muss. Nach Ausgradung des MCP I richtet sich das IP I bei flexibler Hyperextension spontan orthograd aus und kann wieder aktiv gebeugt werden [13,14]. Besteht auch im IP I eine fixierte Kontraktur oder eine Destruktion, so ist zusätzlich eine IP-I-Arthrodese erforderlich.…”

Section: Orthopädisch-rheumatologische Grundsätze Der Operativen Vers...unclassified

Entzündlich-rheumatische Erkrankungen der Hand jenseits der rheumatoiden Arthritis

Gaulke¹

2022

Handchirurgie Scan

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Thumb boutonnière deformity without rheumatoid arthritis or trauma

Abstract: III.

Cited by 5 publications

References 30 publications

Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives

Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives

Konservative und operative Therapie der rheumatischen Hand

Entzündlich-rheumatische Erkrankungen der Hand jenseits der rheumatoiden Arthritis

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