An alternative splinting and rehabilitation protocol for metacarpophalangeal joint arthroplasty in patients with rheumatoid arthritis

Burr, Nicholas; Pratt, AL; Smith, Paul J.

doi:10.1053/hanthe.2002.v15.01541

Cited by 14 publications

(6 citation statements)

References 28 publications

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“…However, the improvement in the extension ROM of the MCP joints was not as significant as that reported by Burr et al (2002). This may be due to insufficient exercising of the affected hand.…”

Section: Discussioncontrasting

confidence: 60%

“…Alternating static splinting exercise and splinting were conducted according to the rehabilitation plan reported by Burr et al (2002). Rehabilitation began on the third postoperative day.…”

Section: Discussionmentioning

confidence: 99%

“…MCP joints are commonly known to be the most important joints for hand function; they contribute to 77% of the total arc of finger flexion (Moran & Berger, 2003) and are important for MCP joint flexion. However, flexing the MCP joint against the resistant forces of a dynamic splint can be very difficult for some patients (Burr et al, 2002). On the other hand, a static splint placed at MCP joint maintains the MCP joints at 70 degrees in a flexion position.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, Burr, Pratt & Smith (2002) suggested the usefulness of alternating daily the application of static extension and flexion splints. Their study reported improved extension and flexion ROM.…”

Section: Introductionmentioning

confidence: 99%

“…

Burr et al (2002) reported the results of a 19-month follow-up study on a static splinting regimen as an alternative to dynamic extension splinting after metacarpophalangeal (MCP) joint arthroplasty. However, the long-term results of static splinting therapy have not been reported.

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mentioning

confidence: 99%

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A 3-year Follow-up Study on the Alternating Use of Static Splints after Metacarpophalangeal Joint Arthroplasty in a Patient with Rheumatoid Arthritis

Hayashi

Uchiya

2011

Asian J OT

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A 72-year-old male with high-demand activities of daily living presented with rheumatoid arthritis mostly affected finger joints of his right hand. Radiographically, there was severe destruction with luxation of metacarpophalangeal joints (MCPJs) II-V. The constrained RM prostheses were inserted into the MCPJs II-V typically in the uncemented manner, and the course was primarily complicated due to periprosthetic fracture of the metacarpal IV intraoperatively, that was treated with immobilization in a plaster splint for 6 weeks. After that, the course was uncomplicated. Eight years after primary surgery, the patient reported increasing pain with loss of function isolated in his MCPJ IV since 6 months; all other finger joints did not reveal any clinically relevant symptoms. Radiographically, distinctive osteolyses with cortical thinning around all components of the 4 RM prostheses were seen, and the hinge joint of implant in MCPJ IV was broken. A total exchange arthroplasty of the MCPJ IV using the unconstrained MCPJ resurfacing SR TM MCP implant with cementation of both components was performed. At the 10-year follow-up, that includes a 2-year follow-up after MCPJ IV exchange arthroplasty, there was unchanged correct positioning of all MCPJ implants; and despite distinctive radiographic loosening and subsidence of the 3 other RM prostheses, the patient is able to perform his high-demand activities of daily living.

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Section: Discussioncontrasting

confidence: 60%

“…Alternating static splinting exercise and splinting were conducted according to the rehabilitation plan reported by Burr et al (2002). Rehabilitation began on the third postoperative day.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

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A 3-year Follow-up Study on the Alternating Use of Static Splints after Metacarpophalangeal Joint Arthroplasty in a Patient with Rheumatoid Arthritis

Hayashi

Uchiya

2011

Asian J OT

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Post-operative therapy for metacarpophalangeal arthroplasty

Massy‐Westropp

Johnston

Hill

2008

Cochrane Database of Systematic Reviews

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Treatment of MCP Joints in the Rheumatoid Hand

Lluch

2016

Clinical Management of the Rheumatoid Hand, Wrist, and Elbow

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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

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An alternative splinting and rehabilitation protocol for metacarpophalangeal joint arthroplasty in patients with rheumatoid arthritis

Cited by 14 publications

References 28 publications

A 3-year Follow-up Study on the Alternating Use of Static Splints after Metacarpophalangeal Joint Arthroplasty in a Patient with Rheumatoid Arthritis

A 3-year Follow-up Study on the Alternating Use of Static Splints after Metacarpophalangeal Joint Arthroplasty in a Patient with Rheumatoid Arthritis

Post-operative therapy for metacarpophalangeal arthroplasty

Treatment of MCP Joints in the Rheumatoid Hand

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