Ulnar Drift of the Fingers in Rheumatoid Disease

Ellison, Monty R.; Flatt, Adrian E.; Kelly, K. J.

doi:10.2106/00004623-197153060-00002

Cited by 36 publications

(7 citation statements)

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“…Ulnar deviation of the digits was treated with tendon centralization, securing the extensor tendon to the proximal phalanx, 12 and crossed intrinsic transfers. 20 Arthrodesis was used as a salvage procedure for recalcitrant flexion contractures of the digits.…”

Section: Finger Alignmentmentioning

confidence: 99%

Surgical Management of the Hand in Freeman-Sheldon Syndrome

Kalliainen¹,

Drake²,

Edgerton³

et al. 2003

Annals of Plastic Surgery

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Freeman-Sheldon syndrome is a rare form of distal arthrogryposis characterized by craniofacial anomalies, a rheumatoid-appearing hand, and pedal deformities. The hand deformities include ulnar deviation of the fingers, camptodactyly, first web space contracture, and hypoplasia of the thumb. Because of clinical variability and rarity, there is no standard management protocol. The authors have developed a systematic method of management of the hand in Freeman-Sheldon syndrome using principles commonly applied to other complex hand problems. In 17 years, the authors have evaluated nine patients. Of 18 hands evaluated, the authors have operated on 15. Good results were achieved in five hands and fair results in 10. There were no cases of useless hands. The authors have been most pleased with the results after crossed intrinsic transfers, centralization of extensor tendons, and intrinsic release of the thumb. Although physical deformities remain, functional adaptation is generally good.

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Section: Finger Alignmentmentioning

confidence: 99%

Surgical Management of the Hand in Freeman-Sheldon Syndrome

Kalliainen¹,

Drake²,

Edgerton³

et al. 2003

Annals of Plastic Surgery

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“…In addition, prolonged synovitis of the most commonly involved joint of the thumb, the MCP joint, leads to joint instability and the classic thumb deformities described by Nalebuff (28). Laxity of the MCP thumb joint and the laxity of the MCP joint of the index finger combine to result in a diminished pinch force (3,4,18). Thus the dependent variables chosen for this study did, in the authors' judgment, form a logical though unproven set.…”

Section: Discussi Nmentioning

confidence: 99%

“…It has been suggeste that the structural changes secon ary to RA combine with the forces i volved in the use of the hand t produce deformity 3, 14-19). Ellison, Flatt, and Kelly ive equal weight to the deforming forces of usage and to the laxity of su porting joint structures (18). Flatt ater states, "There must be aberrati ns of structure or function to ini iate the deformity."…”

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confidence: 99%

Handedness and Hand Joint Changes in Rheumatoid Arthritis

Hasselkus

Kshepakaran

Safrit

1981

The American Journal of Occupational Therapy

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This study investigates the relationship of hand use to the deforming hand joint changes of rheumatoid arthritis. Measurements of metacarpophalangeal lateral mobility, loss of metacarpophalangeal hyperextension, thumb metacarpophalangeal range of motion, and lateral pinch strength were statistically compared across dominant and nondominant hands of 51 adult subjects who had definite or classical rheumatoid arthritis. Incidence of boutonniere and swan neck deformities and distal radioulna laxity was also recorded. Results of a multivariate analysis of variance of the difference scores between dominant and nondominant measures were not significant. The authors concluded that the relationship of hand use to joint destruction is not yet clearly defined and further study is needed. Implications for treatment principles of joint protection are presented.

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“…In order to prevent a possible postoperative limitation of PIP joint fl exion or even a swan-neck deformity, it has been proposed to insert the transfer to the radial collateral ligament at the proximal phalanx [ 31 ]. Ellison et al performed some biomechanical studies in freshly amputated fi ngers comparing four insertion sites of the transferred intrinsic tendon: dorsum of middle of proximal phalanx, anterior part of middle of proximal phalanx, extensor hood at mid-shaft of proximal phalanx, and insertion of the radial CL [ 29 ]. They observed that attachment of the intrinsic muscle to the distal end of the CL was less likely to cause an intrinsic contracture or a swan-neck deformity, as occurred in 12 of the 25 patients initially reported.…”

Section: Associated Procedures Cross Intrinsic Transfer ( Cit )mentioning

confidence: 99%

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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Ulnar Drift of the Fingers in Rheumatoid Disease

Cited by 36 publications

References 0 publications

Surgical Management of the Hand in Freeman-Sheldon Syndrome

Surgical Management of the Hand in Freeman-Sheldon Syndrome

Handedness and Hand Joint Changes in Rheumatoid Arthritis

Treatment of MCP Joints in the Rheumatoid Hand

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