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• W2767915878 abstract "Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems. Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems. CME Information and DisclosuresThe Journal of Hand Surgery will contain at least 2 clinically relevant articles selected by the editor to be offered for CME in each issue. For CME credit, the participant must read the articles in print or online and correctly answer all related questions through an online examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details.The JHS CME Activity fee of $15.00 includes the exam questions/answers only and does not include access to the JHS articles referenced.Statement of Need: This CME activity was developed by the JHS editors as a convenient education tool to help increase or affirm reader’s knowledge. The overall goal of the activity is for participants to evaluate the appropriateness of clinical data and apply it to their practice and the provision of patient care.Accreditation: The ASSH is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.AMA PRA Credit Designation: The American Society for Surgery of the Hand designates this Journal-Based CME activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.ASSH Disclaimer: The material presented in this CME activity is made available by the ASSH for educational purposes only. This material is not intended to represent the only methods or the best procedures appropriate for the medical situation(s) discussed, but rather it is intended to present an approach, view, statement, or opinion of the authors that may be helpful, or of interest, to other practitioners. Examinees agree to participate in this medical education activity, sponsored by the ASSH, with full knowledge and awareness that they waive any claim they may have against the ASSH for reliance on any information presented. The approval of the US Food and Drug Administration is required for procedures and drugs that are considered experimental. Instrumentation systems discussed or reviewed during this educational activity may not yet have received FDA approval.Provider Information can be found at http://www.assh.org/Pages/ContactUs.aspx.Technical Requirements for the Online Examination can be found at http://jhandsurg.org/cme/home.Privacy Policy can be found at http://www.assh.org/pages/ASSHPrivacyPolicy.aspx.ASSH Disclosure Policy: As a provider accredited by the ACCME, the ASSH must ensure balance, independence, objectivity, and scientific rigor in all its activities.Disclosures for this ArticleEditorsDavid T. Netscher, MD, has no relevant conflicts of interest to disclose.AuthorsAll authors of this journal-based CME activity have no relevant conflicts of interest to disclose. In the printed or PDF version of this article, author affiliations can be found at the bottom of the first page.PlannersDavid T. Netscher, MD, has no relevant conflicts of interest to disclose. The editorial and education staff involved with this journal-based CME activity has no relevant conflicts of interest to disclose.Learning ObjectivesUpon completion of this CME activity, the learner should achieve an understanding of:•Types of crystal-like arthropathies (exclusive of arthropathies caused by collagen vascular disorders)•Clinical presentations of these conditions in hand and wrist•Specific diagnostic tests for these conditions•Surgical treatment optionsDeadline: Each examination purchased in 2018 must be completed by January 31, 2019, to be eligible for CME. A certificate will be issued upon completion of the activity. Estimated time to complete each JHS CME activity is up to one hour.Copyright © 2018 by the American Society for Surgery of the Hand. All rights reserved. The Journal of Hand Surgery will contain at least 2 clinically relevant articles selected by the editor to be offered for CME in each issue. For CME credit, the participant must read the articles in print or online and correctly answer all related questions through an online examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details. The JHS CME Activity fee of $15.00 includes the exam questions/answers only and does not include access to the JHS articles referenced. Statement of Need: This CME activity was developed by the JHS editors as a convenient education tool to help increase or affirm reader’s knowledge. The overall goal of the activity is for participants to evaluate the appropriateness of clinical data and apply it to their practice and the provision of patient care. Accreditation: The ASSH is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA PRA Credit Designation: The American Society for Surgery of the Hand designates this Journal-Based CME activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. ASSH Disclaimer: The material presented in this CME activity is made available by the ASSH for educational purposes only. This material is not intended to represent the only methods or the best procedures appropriate for the medical situation(s) discussed, but rather it is intended to present an approach, view, statement, or opinion of the authors that may be helpful, or of interest, to other practitioners. Examinees agree to participate in this medical education activity, sponsored by the ASSH, with full knowledge and awareness that they waive any claim they may have against the ASSH for reliance on any information presented. The approval of the US Food and Drug Administration is required for procedures and drugs that are considered experimental. Instrumentation systems discussed or reviewed during this educational activity may not yet have received FDA approval. Provider Information can be found at http://www.assh.org/Pages/ContactUs.aspx. Technical Requirements for the Online Examination can be found at http://jhandsurg.org/cme/home. Privacy Policy can be found at http://www.assh.org/pages/ASSHPrivacyPolicy.aspx. ASSH Disclosure Policy: As a provider accredited by the ACCME, the ASSH must ensure balance, independence, objectivity, and scientific rigor in all its activities. David T. Netscher, MD, has no relevant conflicts of interest to disclose. All authors of this journal-based CME activity have no relevant conflicts of interest to disclose. In the printed or PDF version of this article, author affiliations can be found at the bottom of the first page. David T. Netscher, MD, has no relevant conflicts of interest to disclose. The editorial and education staff involved with this journal-based CME activity has no relevant conflicts of interest to disclose. Upon completion of this CME activity, the learner should achieve an understanding of:•Types of crystal-like arthropathies (exclusive of arthropathies caused by collagen vascular disorders)•Clinical presentations of these conditions in hand and wrist•Specific diagnostic tests for these conditions•Surgical treatment options Deadline: Each examination purchased in 2018 must be completed by January 31, 2019, to be eligible for CME. A certificate will be issued upon completion of the activity. Estimated time to complete each JHS CME activity is up to one hour. Copyright © 2018 by the American Society for Surgery of the Hand. All rights reserved. Population-based studies report a prevalence of radiographic degenerative arthropathy in the hand of up to 76%.1Niu J. Zhang Y. LaValley M. Chaisson C.E. Aliabadi P. Felson D.T. Symmetry and clustering of symptomatic hand osteoarthritis in elderly men and women: the Framingham Study.Rheumatology. 2003; 42: 343-348Crossref PubMed Scopus (67) Google Scholar, 2van Saase J.L. van Romunde L.K. Cats A. Vandenbroucke J.P. Valkenburg H.A. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations.Ann Rheum Dis. 1989; 48: 271-280Crossref PubMed Scopus (680) Google Scholar However, the prevalence of symptomatic arthropathy is lower (8% to 17%).1Niu J. Zhang Y. LaValley M. Chaisson C.E. Aliabadi P. Felson D.T. Symmetry and clustering of symptomatic hand osteoarthritis in elderly men and women: the Framingham Study.Rheumatology. 2003; 42: 343-348Crossref PubMed Scopus (67) Google Scholar Degenerative arthropathy involves other joints in the hand in about 80% of patients.3Dahaghin S. Bierma-Zeinstra S.M.A. Ginai A.Z. Pols H.A.P. Hazes J.M.W. Koes B.W. Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study).Ann Rheum Dis. 2005; 64: 682-687Crossref PubMed Scopus (374) Google Scholar Some arthropathies can indicate an underlying systemic process. We provide a review of the more common nonrheumatoid arthropathies and their surgical treatment.aChoo A.D. Middleton G. Wilson R.L. Nonrheumatoid inflammatory arthroses of the hand and wrist.J Hand Surg Am. 2015; 40: 2477-2487Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Topics of discussion include hereditary hemochromatosis (HH), calcium pyrophosphate deposition disease (CPPD), gout, diabetic cheiroarthropathy (DCA) and hepatitis C virus (HCV)-associated arthropathy. Hereditary hemochromatosis is an inherited disease characterized by progressive iron overload to specific organ systems; it affects one in every 200 to 400 Caucasians. Males seem to be more affected than females.4Powell L.W. Seckington R.C. Deugnier Y. Haemochromatosis.Lancet. 2016; 388: 706-716Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar Symptoms of fatigue and arthralgia usually develop in males aged under 30 years and in women after menopause.4Powell L.W. Seckington R.C. Deugnier Y. Haemochromatosis.Lancet. 2016; 388: 706-716Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar Patients may develop a progressive brown hue of the skin from iron overload. Involvement of the pancreas may result in insulin-dependent diabetes. Over time, patients can develop cirrhosis and or cardiomyopathy. There are 4 types of HH based on their gene mutations. Type 1, also known as classic or high iron–related HH, is the most common form with a genetic dysregulation of intestinal cellular iron uptake, which usually presents during the fourth to fifth decade. In type 2 HH or juvenile HH, patients present with severe iron overload before age 30. This form typically involves the cardiovascular system and may cause life-threatening arrhythmias. Type 3 HH leads to iron overload only in homozygous states owing to transferrin receptor deficiency. Finally, in type 4 HH iron overload occurs because of mutations in the transmembrane protein ferroportin. Diagnostic workup includes serum ferritin levels and transferrin saturation tests. Further testing is needed if ferritin levels are above 200 ng/mL (449 pmol/L) in women or above 300 ng/mL (674 pmol/L) in men or if a transferrin saturation above 45% in women or 50% in men is found. Acute or chronic inflammatory processes, autoimmune diseases, neoplasms, chronic renal insufficiency, hepatopathies, and the metabolic syndrome may lead to elevated ferritin levels without pathologic iron overload. In these cases, transferrin saturation is generally normal. Serum ferritin levels may not be elevated in early stages of the disease. In addition, hemochromatosis gene testing is readily available that identifies the most common gene mutation. Schumacher5Schumacher R.H.J. Hemochromatosis and arthritis.Arthritis Rheum. 1964; 7: 348-356Crossref Scopus (157) Google Scholar was the first to recognize the association of hemochromatosis with arthritis in 1964. Arthralgia of the metacarpophalangeal (MCP) joints affects 42% of HH patients and is the presenting problem in 28% of patients.6Huaux J.P. Geubel A. Koch M.C. et al.The arthritis of hemochromatosis: a review of 25 cases with special reference to chondrocalcinosis, and a comparison with patients with primary hyperparathyroidism and controls.Clin Rheumatol. 1986; 5: 317-324Crossref PubMed Scopus (43) Google Scholar Patients with HH may present with a severe arthropathy mimicking osteoarthritis involving the index and/or middle finger MCP joints or larger joints.7Elmberg M. Hultcrantz R. Simard J.F. Carlsson Å. Askling J. Increased risk of arthropathies and joint replacement surgery in patients with genetic hemochromatosis: a study of 3,531 patients and their 11,794 first-degree relatives.Arthritis Care Res. 2013; 65: 678-685Crossref Scopus (24) Google Scholar, 8Askari A.D. Muir W.A. Rosner I.A. Moskowitz R.W. McLaren G.D. Braun W.E. Arthritis of hemochromatosis: clinical spectrum, relation to histocompatibility antigens, and effectiveness of early phlebotomy.Am J Med. 1983; 75: 957-965Abstract Full Text PDF PubMed Scopus (50) Google Scholar, 9De Jonge-Bok J.M. Macfarlane J.D. The articular diversity of early haemochromatosis.J Bone Joint Surg. 1987; 69: 41-44Google Scholar This pattern occurs in 20% to 55% of HH patients with articular problems.8Askari A.D. Muir W.A. Rosner I.A. Moskowitz R.W. McLaren G.D. Braun W.E. Arthritis of hemochromatosis: clinical spectrum, relation to histocompatibility antigens, and effectiveness of early phlebotomy.Am J Med. 1983; 75: 957-965Abstract Full Text PDF PubMed Scopus (50) Google Scholar Metacarpophalangeal arthropathy associated with HH demonstrates bony enlargement, tenderness to palpation, and limited flexion on physical examination. The limited flexion of the MCP joints may lead to the presence of the “iron salute” (Fig. 1). Up to one-fifth of patients may present with coexisting CPPD.8Askari A.D. Muir W.A. Rosner I.A. Moskowitz R.W. McLaren G.D. Braun W.E. Arthritis of hemochromatosis: clinical spectrum, relation to histocompatibility antigens, and effectiveness of early phlebotomy.Am J Med. 1983; 75: 957-965Abstract Full Text PDF PubMed Scopus (50) Google Scholar Hemochromatosis exhibits radiographic findings of MCP eburnation, subchondral cyst formation, chondrocalcinosis, and joint space narrowing. A notable feature of HH arthritis is the development of hook-like osteophytes on the radial side of the metacarpal head (Fig. 2). A magnetic resonance imaging study by Frenzen et al10Frenzen K. Schaefer C. Keysser G. Erosive and inflammatory joint changes in hereditary hemochromatosis arthropathy detected by low-field magnetic resonance imaging.Rheumatol Int. 2013; 33: 2061-2067Crossref PubMed Scopus (13) Google Scholar found hooked MCP osteophytes in 32% of patients. Joint erosions, synovitis, and scapholunate dissociation are also common findings in HH.10Frenzen K. Schaefer C. Keysser G. Erosive and inflammatory joint changes in hereditary hemochromatosis arthropathy detected by low-field magnetic resonance imaging.Rheumatol Int. 2013; 33: 2061-2067Crossref PubMed Scopus (13) Google Scholar Treatment for HH consists of systemic iron depletion by phlebotomy or the use of iron chelation therapy. However, improvement of arthropathic changes is reported in only 13.6% to 30% of patients after iron removal therapies.11Sahinbegovic E. Dallos T. Aigner E. et al.Musculoskeletal disease burden of hereditary hemochromatosis.Arthritis Rheum. 2010; 62: 3792-3798Crossref PubMed Scopus (67) Google Scholar Arthralgia is treated by placement of an orthosis, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroid injections. If nonoperative treatments are ineffective, arthroscopy, arthroplasty, and arthrodesis are options for treatment.12Rizzo M. Metacarpophalangeal joint arthritis.J Hand Surg Am. 2011; 36: 345-353Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In the case of unexplained isolated MCP arthritis involving the index or middle finger, hemochromatosis should be considered. Early recognition in hemochromatosis is valuable because treatment can prevent systemic complications. Gout commonly manifests as a monoarthritis. Onset of pain is usually at night, combined with multiple signs of inflammation such as fever or chills. The erythrocyte sedimentation rate, C-reactive protein, and white blood cell count may be elevated (Table 1).bUmberhandt R. Isaacs J. Diagnostic considerations for monoarticular arthritis at the hand and wrist.J Hand Surg Am. 2012; 37: 1480-1485Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Coincidence with rheumatoid arthritis (RA) has been described.13Kuo C.F. Tsai W.P. Liou L.B. Rare copresent rheumatoid arthritis and gout: comparison with pure rheumatoid arthritis and a literature review.Clin Rheumatol. 2008; 27: 231-235Crossref PubMed Scopus (22) Google Scholar Monosodium urate monohydrate crystals are negatively birefringent and may form tophi in severe cases. Around 12% to 35% of patients with gout have tophi.14Larmon W.A. Surgical management of tophaceous gout.Clin Orthop Relat Res. 1970; 71: 56-69Crossref PubMed Google Scholar These lesions may cause carpal tunnel syndrome, joint damage, or ulcerations leading to superficial infections. The inflammatory reaction leads to damage of the articular surfaces and surrounding soft tissues. In chronic stages, plain radiographs of the hand often demonstrate the arthritis and irreversible changes of the joint. New depositions of crystals resulting in synovial thickening and inflammation may be detected using high-resolution ultrasonic investigations.Table 1Diagnostic Findings in ArthritisAdapted from Tagoe et al,42Tagoe C.E. Raza Y. Differences in acute phase reactants between gout and pseudogout.Int J Clin Med. 2013; 4: 13-19Crossref Google Scholar Carpenter et al,43Carpenter C.R. Schuur J.D. Everett W.W. Pines J.M. Evidence-based diagnostics: adult septic arthritis.Emerg Med. 2011; 18: 781-796Google Scholar and Brannan et al.44Brannan S.R. Jerrard D.A. Synovial fluid analysis.J Emerg Med. 2006; 30: 331-339Abstract Full Text Full Text PDF PubMed Scopus (77) Google ScholarJointSerum LevelsSynovial FluidWBCsErythrocyte Sedimentation RateC-Reactive ProteinUric AcidSynovial Fluid CrystalsSynovial Fluid Cell CountNormalNNNN-<200 WBC/mm3Septic arthritis↑↑↑↑↑↑N->50,000 WBC/mm3Gout↑↑↑N/↑↑Negative bifringement crystals>2,000 WBC/mm3CPPD↑↑↑N/↑Positive bifringement crystals>2,000 WBC/mm3WBCs, white blood cells. Open table in a new tab WBCs, white blood cells. Primary gout attacks are self-limiting and are likely to resolve with oral or intra-articular glucocorticoids, urate clearing, microtubule inhibiting, or NSAID medications. Surgery is indicated if tophi cause mechanical impairment, skin lesions, nerve compression, or joint destruction or if tophi become infected.15Lee J.H. Park J.Y. Seo J.W. Oh D.Y. Ahn S.T. Rhie J.W. Surgical treatment of subcutaneous tophaceous gout.J Plast Reconstr Aesthetic Surg. 2010; 63: 1933-1935Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Surgical options are tophus aspiration, sharp debridement or curettage (tophectomy), tenosynovectomy, arthroscopy, and articular resection with arthroplasty or arthrodesis. These patients have a high incidence of delayed wound healing. Arthroscopy may be used to remove tophaceous material as has been described in metatarsophalangeal joints.16Wang C.C. Lien S.B. Huang G.S. et al.Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout.Arthroscopy. 2009; 25: 153-158Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Arthrodesis or arthroplasty should be reserved for patients with severe joint destruction and functional impairment. Calcium pyrophosphate dehydrate crystal deposition disease is a pathology typically found in older patients.cResnik C.S. Miller B.W. Gelberman R.H. Resnik D. Hand and wrist involvement in calcium pyrophosphate dihydrate crystal deposition disease.J Hand Surg Am. 1983; 8: 856-863Abstract Full Text PDF PubMed Scopus (28) Google Scholar Depositions of CPPD crystals in the joint cartilage form and manifest as intra-articular calcifications (chondrocalcinosis) on plain radiographs.17Genant H.K. Roentgenographic aspects of calcium pyrophosphate dihydrate crystal deposition disease (pseudogout).Arthritis Rheum. 1976; 19: 307-328Crossref PubMed Scopus (69) Google Scholar The erythrocyte sedimentation rate, C-reactive protein, and white blood cell count may be elevated (Table 1). Synovial fluid analysis demonstrates positive birefringent crystals. The most commonly involved joints are the knee followed by the wrist,dDoherty W. Lovallo J.L. Scapholunate advanced collapse pattern of arthritis in calcium pyrophosphate deposition disease of the wrist.J Hand Surg Am. 1993; 18: 1095-1098Abstract Full Text PDF PubMed Scopus (23) Google Scholar, eBeck J.D. Deegan J.H. Riehl J.T. Lena J.C. Incidence of scapholunate ligament dissociation in patients with aspiration-confirmed gout.J Hand Surg Am. 2010; 35: 1938-1942Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar the MCP joints, and finally the hip and shoulder. The disease may present with acute pain and is generally self-limiting. Treatment includes NSAIDs, physiotherapy, and systemic or intra-articular steroids. Surgical treatment is reserved for chronic cases with severe arthritis and consists of debridement of the periarticular calcifications, arthroplasty, or arthrodesis. Diabetic cheiroarthropathy, also referred to as the syndrome of limited joint mobility, diabetic sclerosis, pseudosclerodermatous hand of the diabetic, and diabetic stiff hand syndrome, presents as a mostly painless limitation of extension and flexion in the MCP and/or interphalangeal joint.18Fitzcharles M.A. Duby S. Waddell R.W. Banks E. Karsh J. Limitation of joint mobility (cheiroarthropathy) in adult noninsulin-dependent diabetic patients.Ann Rheum Dis. 1984; 43: 251-254Crossref PubMed Scopus (74) Google Scholar It occurs in diabetes mellitus types 1 and 2. Prevalence is reported at 8% to 50%.19Gerrits E.G. Landman G.W. Nijenhuis-Rosien L. Bilo H.J. Limited joint mobility syndrome in diabetes mellitus: a minireview.World J Diabetes. 2015; 6: 1108-1112Crossref PubMed Google Scholar The pathogenesis lies in microvascular damage resulting from hyperglycemia. It is a clinical diagnosis of exclusion because imaging findings are often nonspecific. Two typical clinical signs are the prayer sign, in which the patient is unable to press both palms flat together, and the tabletop sign, in which the patient is unable to place the palm flat on the table (Fig. 3). Diabetes is associated with stenosing flexor tenosynovitis. Some authors have suggested that Dupuytren contracture is more common in patients with DCA, and that it may contribute to a stiff hand. Therapies focus on glycemic control, NSAIDs, and hand therapy. There is a lack of literature investigating the etiology of arthritis in patients with HCV infection. This manifestation may result from immune activation and direct viral particle deposition within the synovia.20Sayiner Z.A. Haque U. Malik M.U. Gurakar A. Hepatitis C virus infection and its rheumatologic implications.Gastroenterol Hepatol (N Y). 2014; 10: 287-293PubMed Google Scholar Mixed cryoglobulinemia is a common extrahepatic complication of a chronic HCV. Although the prevalence is almost 50% in patients with HCV, few are symptomatic. The most common problems of this sequelae are symmetric and nondestructive monoarticular or polyarticular arthritis affecting hands and knees. It is important to differentiate between HCV-related arthritis and RA because both diseases can present similar arthropathies. Anti-cyclic citrullinated peptide antibodies are very specific (96% to 98%) for RA although they are present only in rare cases (4.5% to 7%) of HCV arthritis.21Palazzi C. Buskila D. D’Angelo S. D’Amico E. Olivieri I. Autoantibodies in patients with chronic hepatitis C virus infection: pitfalls for the diagnosis of rheumatic diseases.Autoimmun Rev. 2012; 11: 659-663Crossref PubMed Scopus (48) Google Scholar In patients with isolated HCV, pain in the finger joints is common and patients report joint pain more often than do coinfected patients with human immunodeficiency virus. Aside from treating the underling viral infection, the first line of treatment of HCV-related arthritis consists of pharmaceutical management, including cyclooxygenase-2 inhibitors, NSAIDs, corticosteroids, hydroxychloroquine, methotrexate, and penicillamine. Chen22Chen Y.C. Arthroscopy of the wrist and finger joints.Orthop Clin North Am. 1979; 10: 723-733PubMed Google Scholar first described arthroscopy of the small joints of the hand in 1979. Metacarpophalangeal joint arthroscopy is performed by placing the digits in finger traps in a traction tower with 10 to 15 lb of traction.23Rozmaryn L.M. Wei N. Metacarpophalangeal arthroscopy.Arthroscopy. 1999; 15: 333-337Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar The joint is injected with saline until the capsule is maximally distended. Small joint arthroscopes, usually around 2 mm in size, are placed ulnarly and radially to the extensor tendon. A synovectomy is generally performed to gain adequate visualization. Calcific deposits are debrided using a small joint shaver. In some cases, a curette is useful. The cartilage on the metacarpal head is relatively soft and caution should be taken when placing instruments into the joint. Declerq et al24Declerq G. Schmitgen G. Verstreken J. Arthroscopic treatment of metacarpophalangeal arthropathy in haemochromatosis.J Hand Surg Br. 1994; 19: 212-214Crossref PubMed Scopus (17) Google Scholar, fWilczynski M.C. Gelberman R.H. Adams A. Goldfarb C.A. Arthroscopic findings in gout of the wrist.J Hand Surg Am. 2009; 34: 244-250Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar described arthroscopic treatment of HH arthritis in a case report. The aim of an arthroplasty is to provide pain relief while preserving some range of motion.25Bain G.I. Polites N. Higgs B.G. Heptinstall R.J. McGrath A.M. The functional range of motion of the finger joints.J Hand Surg Eur Vol. 2015; 40: 406-411Crossref PubMed Scopus (75) Google Scholar, 26Hayashi H. Shimizu H. Essential motion of metacarpophalangeal joints during activities of daily living.J Hand Ther. 2013; 26: 69-74Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Joint replacement can be performed with pyrolytic carbon, silicone, or metal-polyethylene implants. Silicone implants are commonly used for RA and may be used for other conditions. These are generally effective for pain relief, but patients may have limited grip strength. Implant fracture is common in silicone arthroplasty at long-term follow-up.27Trail I.A. Martin J.A. Nuttall D. Stanley J.K. Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement.J Bone Joint Surg Br. 2004; 86: 1002-1006Crossref PubMed Scopus (80) Google Scholar Pyrolytic carbon implants require ligamentous stability and can be used for patients with well-controlled RA or with nonrheumatoid arthritis.27Trail I.A. Martin J.A. Nuttall D. Stanley J.K. Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement.J Bone Joint Surg Br. 2004; 86: 1002-1006Crossref PubMed Scopus (80) Google Scholar, 28Haase S.C. Chung K.C. Clinical and radiographic outcomes of metacarpophalangeal joint pyrolytic carbon arthroplasty for osteoarthritis.J Hand Surg Am. 2013; 38: 544Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 29Neral M.K. Pittner D.E. Spiess A.M. Imbriglia J.E. Silicone arthroplasty for nonrheumatic metacarpophalangeal joint arthritis.J Hand Surg Am. 2013; 38: 2412-2418Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, 30Chung K.C. Burns P.B. Wilgis E.F.S. et al.A multicenter clinical trial in rheumatoid arthritis comparing silicone metacarpophalangeal joint arthroplasty with medical treatment.J Hand Surg Am. 2009; 34: 815-823Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 31Escott B.G. Ronald K. Judd M.G.P. Bogoch E.R. NeuFlex and Swanson metacarpophalangeal implants for rheumatoid arthritis: prospective randomized, controlled clinical trial.J Hand Surg Am. 2010; 35: 44-51Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 32Dickson D.R. Badge R. Nuttall D. et al.Pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthritis: minimum 5-year follow-Up.J Hand Surg Am. 2015; 40: 1956-1962Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 33Feldon P. Terrono A.L. Nalebuff E. Millender L.H. Flexible implant arthroplasty.in: Green’s Operative Hand Surgery. 7th ed. Elsevier, Philadelphia2017: 1832-1903Google Scholar, 34Cook S.D. Beckenbaugh R.D. Redondo J. Popich L.S. Klawitter J.J. Linscheid R.L. Long-term follow-up of pyrolytic carbon metacarpophalangeal implants.J Bone Joint Surg Am. 1999; 81: 635-648Crossref PubMed Scopus (205)" @default.
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• W2767915878 title "Nonrheumatoid Arthritis of the Hand" @default.
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