Viêm khớp khớp ngón tay
Patients › Hand
Osteoarthritis and inflammatory arthritis of the PIP joint — non-operative and surgical options.
Những gì bạn đang cảm nhận
Bạn có thể cảm thấy đau ở khớp giữa của ngón tay, được gọi là khớp liên đốt gần. Cơn đau này thường xuất phát từ viêm xương khớp do hao mòn hoặc tổn thương từ một chấn thương trước đó. Bác sĩ phẫu thuật của bạn có thể đề xuất phẫu thuật này chỉ khi cơn đau trở nên nghiêm trọng đến mức khiến bạn không thể thực hiện các hoạt động hàng ngày. Bạn có thể nhận thấy cơn đau trở nên tồi tệ hơn sau khi sử dụng tay hoặc khi thức dậy vào buổi sáng.
Những hành động đơn giản có thể trở nên rất khó khăn. Bạn có thể gặp khó khăn khi với tay ra sau lưng để cài áo ngực hoặc nhét áo vào quần. Khớp có thể cảm thấy cứng, khiến bạn khó uốn cong hoặc duỗi thẳng ngón tay hoàn toàn. Trong một số trường hợp, khớp có thể không cử động tốt như trước đây, và tầm vận động này có thể trở nên tồi tệ hơn theo thời gian. Nếu bạn bị viêm khớp dạng thấp, việc điều trị sớm bằng các loại thuốc cụ thể có thể giúp cải thiện tình trạng của bạn.
Mặc dù quá trình bệnh lý rất phức tạp, bạn có thể mong đợi giảm đau và cải thiện chức năng sau phẫu thuật. Nhiều bệnh nhân nhận thấy rằng việc thay thế bề mặt khớp mang lại sự giảm đau đáng kể với ít vấn đề. Tuy nhiên, bạn nên biết rằng tầm vận động của ngón tay có thể giảm nhẹ theo thời gian. Nếu bạn có tình trạng co rút khiến ngón tay bị kẹt ở tư thế cong, việc nắn chỉnh tuần tự có thể giúp sửa chữa tình trạng này trước hoặc sau phẫu thuật. Bác sĩ phẫu thuật của bạn sẽ xem xét xem thủ thuật này có phù hợp với bạn hay không dựa trên các triệu chứng cụ thể và tình trạng khớp của bạn.
Những gì thực sự đang xảy ra
Trong ngón tay của bạn, lớp phủ trơn tru trên đầu xương, được gọi là sụn, bị mòn theo thời gian. Viêm xương khớp do hao mòn này hoạt động như một bộ giảm xóc đã mất đi lớp đệm. Khi sụn mỏng đi, các xương cọ xát vào nhau, gây đau và cứng khớp. Bạn có thể nhận thấy rằng bạn di chuyển trong một phạm vi chuyển động nhỏ hơn khi thực hiện các nhiệm vụ hàng ngày vì khớp không còn trượt mượt mà.
Vấn đề sâu hơn nhiều so với chỉ xương. Các gân, giống như những sợi dây kết nối cơ với xương, thay đổi sớm trong quá trình bệnh. Các gân này bắc cầu qua nhiều khớp, vì vậy một thay đổi ở một khu vực ảnh hưởng đến cách toàn bộ ngón tay của bạn di chuyển. Sự phụ thuộc lẫn nhau này có nghĩa là khi một phần của ngón tay bạn thay đổi, các phần khác sẽ gặp khó khăn trong việc theo kịp. Theo thời gian, những thay đổi trong các gân và các cấu trúc liên quan dẫn đến các biến dạng mà bạn thấy.
Bác sĩ phẫu thuật của bạn thấy rằng quá trình này được thúc đẩy bởi cách các lực truyền qua bàn tay của bạn. Phụ nữ mắc tình trạng này thường có lực bàn tay thấp hơn đáng kể, với mức giảm trung bình là 30% trên hầu hết các loại lực. Lực cắt nén cũng có thể làm hỏng khớp theo thời gian, dẫn đến hao mòn thêm. Khi bao khớp, lớp áo bao quanh khớp, và các dây chằng mất đi sự ổn định, các xương sẽ dịch chuyển. Sự dịch chuyển này tạo ra cơn đau và chức năng hạn chế khiến bạn đến gặp bác sĩ phẫu thuật.
Những gì chúng tôi có thể làm về vấn đề này
Hành trình của bạn thường bắt đầu với việc tự quản lý và vật lý trị liệu. Nếu bạn có ngón tay cứng, nẹp cố định tuần tự là một phương pháp hiệu quả để sửa chữa co cứng gấp ở những bệnh nhân chọn lọc bị viêm khớp. Quá trình này giúp bạn khôi phục khả năng vận động mà không cần phẫu thuật. Bác sĩ phẫu thuật của bạn cũng có thể khuyến nghị các bài tập để giữ cho khớp linh hoạt. Bạn nên dành cơ hội công bằng cho các lựa chọn không phẫu thuật trước khi xem xét các bước xâm lấn hơn.
Nếu chăm sóc đơn giản là không đủ, bác sĩ phẫu thuật của bạn có thể thảo luận về quản lý y tế. Mặc dù bằng chứng không nêu chi tiết tên thuốc cụ thể hoặc loại tiêm cho khớp này, nhưng nó xác nhận rằng giảm đau là mục tiêu chính. Đối với một số người, trọng tâm vẫn là kiểm soát các triệu chứng để duy trì chức năng. Nếu viêm khớp gây ra đau chức năng vô hiệu hóa, bác sĩ phẫu thuật của bạn có thể xem xét các lựa chọn phẫu thuật cụ thể như khớp nhân tạo TACTYS một cách đặc biệt. Tuy nhiên, đối với nhiều người, trọng tâm là duy trì khớp hoạt động tốt trong khi kiểm soát khó chịu.
Khi chăm sóc bảo thủ đạt đến giới hạn, phẫu thuật trở thành một lựa chọn đáng tin cậy. Phẫu thuật thay thế khớp bằng implant khớp liên đốt gần (PIP) là một lựa chọn tốt và đáng tin cậy cho viêm khớp có triệu chứng trong bối cảnh lâm sàng phù hợp. Thủ thuật này có thể cung cấp giảm đau đáng tin cậy, lâu dài và duy trì chức năng. Hầu hết bệnh nhân trở lại làm việc sau thời gian trung vị là 8 tuần kể từ khi phẫu thuật này. Mặc dù khớp có thể cảm thấy tốt hơn, bạn nên được tư vấn rằng phạm vi chuyển động có thể suy giảm theo thời gian với một số loại implant. Bác sĩ phẫu thuật của bạn sẽ giúp bạn quyết định xem đây có phải là bước phù hợp cho ngón tay cụ thể của bạn hay không.
Khi nào cần gặp bác sĩ
Hãy yêu cầu đánh giá bởi chuyên gia nếu bạn có tình trạng đau dai dẳng do viêm xương khớp do thoái hóa hoặc viêm xương khớp sau chấn thương không cải thiện khi nghỉ ngơi. Hãy tìm kiếm sự giúp đỡ nếu bạn gặp phải tình trạng yếu, mất ổn định hoặc khóa khớp ở ngón tay. Hãy liên hệ với bác sĩ của bạn nếu các triệu chứng ảnh hưởng đến giấc ngủ hoặc công việc của bạn. Bạn cũng nên tìm kiếm lời khuyên nếu bạn nhận thấy tình trạng của mình xấu đi đột ngột. Hãy lưu ý rằng tầm vận động có thể suy giảm theo thời gian. Nếu bạn mắc bệnh tiểu đường, hãy thảo luận về nguy cơ biến chứng cao hơn với bác sĩ phẫu thuật của bạn trước khi xem xét phẫu thuật.
Evidence & references
Overview
- Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- There has been an increased use of primary proximal interphalangeal joint arthroplasty utilization for patients with osteoarthritis, whereas revision proximal interphalangeal joint arthroplasty has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Minimizing postoperative complications after metacarpophalangeal and proximal interphalangeal joint arthroplasty is one avenue to decrease health care costs [7].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Minimum two years of follow-up evaluation of the self-locking finger joint implant proximal interphalangeal joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Silicone arthroplasty for osteoarthritis of the proximal interphalangeal joint remains a good option for pain relief [13].
- Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of proximal interphalangeal joint arthritis [16].
Anatomy & Pathophysiology
- Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types [21].
- People with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with controls [32].
- The internal structure and material properties of the phalanges play a significant role in both the magnitude and distribution of stresses in the MCP joint during common tasks [24].
- Interdependency of joints is a primary feature of finger function [39].
- The function of a muscle with respect to a certain joint cannot be inferred from the position of the muscle with respect to that one joint alone due to tendons bridging multiple joints [39].
- Changes occurring in the tendons and related structures are the most important factor in the development of finger deformities, especially in early stages [27].
- Detailed understanding of the functional anatomy and related pathologic features of the trapeziometacarpal joint complex provides the basis for treatment of acquired afflictions at the base of the human thumb [31].
- Compressive shear forces can lead over time to trapeziometacarpal joint osteoarthritis [33].
- In most degrees of freedom of metacarpal movement relative to the trapezium, the dorsoradial ligament (DRL) is relatively more important than the deep anterior oblique ligament (dAOL) in providing stability to the TMC joint [36].
- Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [22].
- Type I and III wrists had radiographic progression and ultimately underwent deformation [20].
- Most of the outcome measures associated with hand OA or RA are related to body structures and body functions or activity limitations and participation restrictions [30].
Classification
- Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- Primary proximal interphalangeal joint arthroplasty utilization has increased for patients with osteoarthritis, whereas revision utilization has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Minimizing postoperative complications after metacarpophalangeal and proximal interphalangeal joint arthroplasty is one avenue to decrease health care costs [7].
- The TACTYS prosthesis should be proposed exceptionally if the proximal interphalangeal joint arthritis causes invalidating functional pain [8].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the distal interphalangeal joint and is accompanied by a decrease in range of motion of the distal interphalangeal joint, which does not clinically affect patient-reported outcome measures [12].
- Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of proximal interphalangeal joint arthritis [16].
- Cortical breaks were commonly visualized in metacarpophalangeal and proximal interphalangeal joints with high-resolution peripheral quantitative CT and microCT [17].
- Expert consensus can be reached to identify putative risk factors for interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [18].
- The revision rate for the LPM prosthesis was higher than in published series for other proximal interphalangeal joint implants, warranting close surveillance of all patients with this prosthesis currently in situ [43].
- Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the proximal interphalangeal joint [45].
Clinical Presentation
- PIP joint arthroplasty may be a relative contraindication for treatment of the long finger [2].
- Patients with PIP joint arthritis causing invalidating functional pain should be considered for arthroplasty [8].
- PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief [13].
- Surface replacement arthroplasty of the PIP joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Surface replacement arthroplasty of the PIP joint using a volar approach has the tendency to deteriorate in range of motion with longer follow-up [15].
- Pyrolytic carbon hemiarthroplasty for PIP joint arthritis results in good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion [19].
- Patients should be advised that PIPJ range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [9].
- Minimum two-year follow-up evaluation of the Self Locking Finger Joint (SLFJ) implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Autologous rib perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [14].
- Serial casting is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis [6].
- Cortical breaks were commonly visualized in MCP and PIP joints with high-resolution peripheral quantitative CT and microCT [17].
- Expert consensus can be reached to identify putative risk factors for IP joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [18].
- Treatment modalities for PIP joint arthritis are currently limited, and the disease process involves a complex interplay of biochemical, metabolic, and genetic factors rather than simple mechanical stress [40].
- Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes [35].
Investigations
- The volar approach to proximal interphalangeal joint surface replacement arthroplasty can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- There has been an increased use of primary proximal interphalangeal joint implant arthroplasty utilization for patients with osteoarthritis, whereas revision utilization has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Proximal interphalangeal joint implant arthroplasty should be proposed exceptionally if the joint arthritis causes invalidating functional pain [8].
- Patients should be advised that proximal interphalangeal joint range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [9].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the distal interphalangeal joint and is accompanied by a decrease in range of motion of the distal interphalangeal joint, which does not clinically affect patient-reported outcome measures [12].
- Silicone arthroplasty for osteoarthritis of the proximal interphalangeal joint remains a good option for pain relief [13].
- Perichondrium transplants restored injured proximal interphalangeal and metacarpophalangeal joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [14].
- Proximal interphalangeal joint range of motion after surface replacement arthroplasty through a volar approach has the tendency to deteriorate with a longer follow-up [15].
- Cortical breaks were commonly visualized in metacarpophalangeal and proximal interphalangeal joints with high-resolution peripheral quantitative CT and microCT [17].
- Expert consensus can be reached to identify putative risk factors for interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [18].
- Pyrolytic carbon prosthesis replacement of the proximal interphalangeal joint reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion [19].
- Type I and III wrists had radiographic progression and ultimately underwent deformation [20].
- All described techniques for proximal interphalangeal joint arthrodesis can achieve the goal of fusing an osteoarthritic joint [47].
- In patients with established hand osteoarthritis, clinical involvement of the thumb base joint is associated with a higher clinical burden, whereas radiological involvement of the thumb base joint is associated with older age and more structural abnormalities [49].
Treatment
- Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- There has been an increased use of primary proximal interphalangeal joint arthroplasty utilization for patients with osteoarthritis, whereas revision proximal interphalangeal joint arthroplasty has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Minimizing postoperative complications after metacarpophalangeal and proximal interphalangeal joint arthroplasty is one avenue to decrease health care costs [7].
- The TACTYS prosthesis should be proposed exceptionally if the proximal interphalangeal joint arthritis causes invalidating functional pain [8].
- Patients should be advised that proximal interphalangeal joint range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [9].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Minimum two years of follow-up evaluation of the Self Locking Finger Joint implant proximal interphalangeal joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Silicone arthroplasty for osteoarthritis of the proximal interphalangeal joint remains a good option for pain relief [13].
- Proximal interphalangeal joint range of motion after surface replacement arthroplasty through a volar approach has the tendency to deteriorate with a longer follow-up [15].
- Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of proximal interphalangeal joint arthritis [16].
- The combination of distal interphalangeal joint arthrodesis and proximal interphalangeal joint Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility [41].
Complications
- Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2].
- Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [7].
- Patients should be advised that PIPJ range of motion deteriorates over time [9].
- Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [44].
Recovery
- Patients returned to work after a median of 8 weeks following PIP arthroplasty [5].
- Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [7].
- Patients should be advised that PIPJ ROM deteriorates over time [9].
- The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [14].
- PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up [15].
- The study reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion [19].
Key Evidence
- [L4] The volar approach to PIP SRA can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis. [1] (10.1016/j.jhsa.2011.03.003)
- [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. [2] (10.1177/1558944718791186)
- [L4] The data demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased. [3] (10.1177/1558944719837009)
- [L4] Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function. [4] (10.1016/j.jhsa.2008.11.005)
- [L3] Patients returned to work after a median of 8 weeks following PIP arthroplasty. [5] (10.1177/15589447221141485)
- [L4] SC is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis. [6] (10.1016/j.jht.2015.11.005)
- [L3] Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. [7] (10.1016/j.jhsa.2019.11.002)
- [L4] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. [8] (10.1177/15589447211030962)
- [L4] Patients should be advised that PIPJ ROM deteriorates over time. [9] (10.1016/j.jhsa.2023.11.007)
- [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. [10] (10.1177/17531934241265837)
- [L4] The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. [11] (10.1177/1558944717726136)
- [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. [12] (10.1016/j.jhsa.2023.03.027)
- [L4] Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. [13] (10.1177/1558944718769427)
- [L4] Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. [14] (10.1186/s12891-020-03310-5)
- [L4] PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up. [15] (10.1177/1558944718787332)
- [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. [16] (10.1016/j.jhsa.2014.12.016)
- [L4] Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and microCT. [17] (10.1186/s12891-016-1148-y)
- [L4] Expert consensus can be reached to identify putative risk factors for IP joint OA, though the number identified was low and often required multiple Delphi rounds. [18] (10.1177/1753193419865872)
- [L4] The study reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion. [19] (10.1177/1753193413479527)
- [L2] Type I and III wrists had radiographic progression and ultimately underwent deformation. [20] (10.1016/j.jhsa.2009.01.016)
- [L3] Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types. [21] (10.1016/j.jht.2024.02.005)
- [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. [22] (10.5435/jaaos-d-17-00374)
- [L5] The internal structure and material properties of the phalanges were found to play a significant role in both the magnitude and distribution of stresses. [24] (10.1007/s11552-012-9430-4)
- [L4] The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages. [27] (10.2106/00004623-195739030-00006)
- [L2] Most of the outcome measures associated with hand OA or RA are related to body structures and body functions or activity limitations and participation restrictions. [30] (10.1016/j.jht.2019.12.015)
- [L5] Detailed understanding of the functional anatomy and related pathologic features of the trapeziometacarpal joint complex provides the basis for treatment of acquired afflictions at the base of the human thumb and a model for the more general study of idiopathic osteoarthritis. [31] (10.1097/01.blo.0000176968.28247.5c)
- [L3] This study demonstrated that people with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with the controls, and that with instruction on joint protection techniques, participants made significant changes in the amount of movement used to perform tasks, which supports a proof of principle of joint protection. [32] (10.1016/j.jht.2020.10.010)
- [L5] The resulting compressive shear forces can lead over time to trapeziometacarpal joint osteoarthritis. [33] (10.1016/j.jhsa.2010.10.029)
- [L5] Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes. [35] (10.1016/j.jhsa.2011.01.036)
- [L5] In most degrees of freedom of metacarpal movement relative to the trapezium, the DRL is relatively more important than the dAOL in providing stability to the TMC joint. [36] (10.1016/j.jhsa.2006.12.002)
- [L5] The paper concludes that interdependency of joints is a primary feature of finger function, and that the function of a muscle with respect to a certain joint cannot be inferred from the position of the muscle with respect to that one joint alone due to tendons bridging multiple joints. [39] (10.2106/00004623-196345080-00007)
- [L5] Treatment modalities for proximal interphalangeal joint arthritis are currently limited, and the disease process involves a complex interplay of biochemical, metabolic, and genetic factors rather than simple mechanical stress. [40] (10.1016/j.jhsa.2010.09.002)
- [L4] The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility. [41] (10.1177/17531934231215790)
- [L4] The revision rate for the LPM prosthesis was higher than in published series for other PIP joint implants, with close surveillance of all patients with this prosthesis currently in situ recommended. [43] (10.1177/1753193407087864)
- [L3] Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in these DIP/thumb IP joint arthrodeses. [44] (10.1186/s12891-024-07361-w)
- [L4] Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint. [45] (10.1016/j.jhsa.2014.11.015)
- [L1] All described techniques can achieve the goal of fusing an osteoarthritic joint. [47] (10.1530/eor-21-0102)
- [L3] In patients with established hand OA clinical involvement of the TBJ is associated with a higher clinical burden whereas radiological involvement of the TBJ is associated with older age and more structural abnormalities. [49] (10.1016/j.jht.2014.01.006)
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