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The wrist and hand
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
These are simple joints, but it must be remembered that the joint space of the metacarpal joint is distal to the knuckle on palpation and is a condylar joint, with one palmar and two collateral ligaments. The interphalangeal joints are simple hinge joints, each with a palmar and two collateral ligaments. It is important to remember the neurovascular bundle at the side of each joint when injecting.
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
As its name indicates, the metacarpophalangeal joint is a joint between the metacarpals and the phalanges of the hand. This joint allows flexion, extension, abduction, and adduction of the proximal phalanges and thus of the digits as a whole. Lastly, between the phalanges are interphalangeal joints (only one in the thumb, but two—proximal and distal—in the other digits). These joints only allow flexion and extension of the middle and distal phalanges.
Rheumatology and Clinical Immunology
Published in John D Firth, Professor Ian Gilmore, MRCP Part 1 Self-Assessment, 2017
John D Firth, Professor Ian Gilmore
Arthritis with predominant involvement of the distal interphalangeal joint occurs most often in generalised osteoarthritis and psoriatic arthritis. The fact that this patient is relatively young and has a raised ESR indicates an underlying inflammatory disease is the most likely cause of her symptoms, hence psoriatic arthritis is the most likely diagnosis in this case. Examination of the skin and nails for psoriasis is very important in confirming the diagnosis. The scalp hairline, the naval and the palms are areas often involved in psoriasis but easily missed.
Association between endometriosis, infertility and autoimmune antiplatelet glycoprotein VI antibodies in two patients
Published in Platelets, 2023
Stéphane Loyau, Anne Bauters, Nathalie Trillot, Cédric Garcia, Pierre Cougoul, Hélène Pol, Camille Paris, Geoffroy Robin, Chrystèle Rubod, Bernard Payrastre, Martine Jandrot-Perrus, Sophie Voisin, Annabelle Dupont
A 31-year-old patient presented to laboratory investigation with an 8 years history of pelvic endometriosis-associated infertility. The history of the patient reveals the presence of ecchymosis since the age of 8, but platelet count was normal (400 G/L). Menorrhagia started at menarche (14 years old). Diagnosis of ITP was established at the age of 23, on the basis of an isolated and asymptomatic thrombocytopenia (platelet count 40 G/L). Initial assessment found positive antinuclear antibodies (1/640, speckled), anti SSA and anti SSB antibodies. Serum protein electrophoresis showed polyclonal hypergammaglobulinemia. Bone marrow smear confirmed the peripheral mechanism of thrombocytopenia. The thrombocytopenia was corticosteroid responsive. Four years later, the patient presented with inflammatory arthralgias, concerning wrists, elbows, then ankles and shoulders. The clinical examination found arthritis of the proximal interphalangeal joints of the second and third fingers of the left hand, as well as of the thumb spine, and a limitation of shoulder’s amplitudes. Symptoms of the Sjögren syndrome (SS) resolved after short oral corticosteroid therapy. Treatment with hydroxychloroquine 200 mg ×2/day was initiated to control arthralgias.
Metacarpal reconstruction with a medial femoral condyle flap based on a 3D-printed model: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Manfred Schmidt, Matthias Holzbauer, Stefan M. Froschauer
One year after surgery, the locking plates were removed. Proximally, a protruding ossification of the bone flap was trimmed and a bone cyst at the capitate was debrided, filled with cancellous bone flap and the proximal MFC flap was fixed to the capitate with a mini-plate (Figure 1(b,c)). There was no histological evidence of tumor recurrence. At two years follow-up, there was no clinical or radiographic sign of tumor recurrence as well as no donor site morbidity. Moreover, the final metacarpal length was improved compared to the preoperative one. However, we unfortunately observed some subsidence of metacarpal length during follow-up and range of motion could only be improved to 30° flexion in the metacarpophalangeal joint. The range of motion of the proximal and distal interphalangeal joint was not impaired. While this restriction did not represent a subjective functional disability of the hand function for our patient, this procedure preserved the aesthetic integrity of the hand (Figure 3).
Radial nerve palsy following humeral shaft fracture: a theoretical PNF rehabilitation approach for tendon and nerve transfers
Published in Physiotherapy Theory and Practice, 2022
Lauren Fader, John Nyland, Hao Li, Brandon Pyle, Kei Yoshida
During Phase II, the individual performs high-frequency (hourly), low-intensity donor muscle group activation “fisting,” and low-intensity PNF isometric “position and hold” exercises. Long-term treatment effectiveness is directly related to the motor learning developed during this phase. Early use of high intensity manually resisted scapular PNF patterns at the ipsilateral and contralateral upper extremity may facilitate involved side proximal-to-distal overflow to the wrist and finger extensors, and thumb extensors-abductors. Manually resisted scapular PNF patterns may be safely applied with high intensity at both upper extremities as no direct load is applied to the healing humerus fracture site. Distally, at the involved upper extremity hand and wrist, a passive rhythmic initiation PNF technique can be used within specific ranges of motion in conjunction with verbal cues to open the hand, and extend the wrist, or close the hand, and flex the wrist following a quick stretch stimulus (Adler, Beckers, and Buck, 2008; Saliba, Johnson, and Wardlaw, 1993). Manually applied wrist, metacarpophalangeal, or interphalangeal joint approximation, or slight traction may improve joint stability or mobility, respectively. These techniques should improve extensor carpi radialis brevis generated wrist extension-abduction, extensor digitorum communis generated proximal and distal interphalangeal joint and wrist extension, extensor digiti minimi generated little finger metacarpophalangeal joint extension, and extensor carpi ulnaris generated wrist extension-adduction.