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The rheumatoid finger : Treatment concepts and indications for surgery

Kopylov, Philippe LU and Tägil, Magnus LU (2016) In Clinical Management of the Rheumatoid Hand, Wrist, and Elbow p.185-194
Abstract

Synovial proliferation in rheumatoid arthritis causes capsular distension, destruction of tendons and ligaments, and erosion of bone. The classic deformities in rheumatoid arthritis, like boutonnière or swan neck, are not consistent, and each patient may have his or her own pattern of deformities. The anatomic arrangement of the tendons enables motion of the proximal interphalangeal (PIP) joint isolated and separated from the distal interphalangeal (DIP) joint. The central band of the extensor mechanism and the flexor digitorum superficialis (FDS) both insert on the middle phalanx and both contribute to the control of the PIP joint. In contrast, the flexor digitorum profundus (FDP) tendon runs along the whole finger and acts on both the... (More)

Synovial proliferation in rheumatoid arthritis causes capsular distension, destruction of tendons and ligaments, and erosion of bone. The classic deformities in rheumatoid arthritis, like boutonnière or swan neck, are not consistent, and each patient may have his or her own pattern of deformities. The anatomic arrangement of the tendons enables motion of the proximal interphalangeal (PIP) joint isolated and separated from the distal interphalangeal (DIP) joint. The central band of the extensor mechanism and the flexor digitorum superficialis (FDS) both insert on the middle phalanx and both contribute to the control of the PIP joint. In contrast, the flexor digitorum profundus (FDP) tendon runs along the whole finger and acts on both the PIP and DIP joints. In a similar fashion, the conjoined lateral bands insert on the distal phalanx but influence the motion of the PIP joint as well. A change in length, by distention, rupture, or inability to glide one or several of these tendons, will provoke an imbalance, which may lead to a boutonnière or swan-neck deformity. A boutonnière deformity is often identified as a substantial problem to the patient, especially when the DIP joint has gone into hyperextension. Also the swan-neck deformity most often is identified by the patient as a source of severe subjective hand and finger functional impairment because of impaired grip. If a moderate lack of extension after treatment is accepted by the patient, surgical treatment offers an acceptable solution. Implants may be used in stiff joints to regain some mobility of the PIP joint but rebalancing of the extensor mechanism is difficult.

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Please use this url to cite or link to this publication:
author
organization
publishing date
type
Chapter in Book/Report/Conference proceeding
publication status
published
subject
keywords
Boutonnière, Central band, DIP, Finger joint arthroplasty, Intrinsic tightness, Lateral band, PIP, Rheumatoid arthritis, Swan neck, Synovitis
in
Clinical Management of the Rheumatoid Hand, Wrist, and Elbow
pages
10 pages
publisher
Springer International Publishing
external identifiers
  • scopus:84978225972
ISBN
9783319266602
9783319266589
DOI
10.1007/978-3-319-26660-2_16
language
English
LU publication?
yes
id
f9f522fb-b6b0-44e8-b120-8b70c36afebc
date added to LUP
2016-08-15 09:31:51
date last changed
2017-04-12 09:30:33
@inbook{f9f522fb-b6b0-44e8-b120-8b70c36afebc,
  abstract     = {<p>Synovial proliferation in rheumatoid arthritis causes capsular distension, destruction of tendons and ligaments, and erosion of bone. The classic deformities in rheumatoid arthritis, like boutonnière or swan neck, are not consistent, and each patient may have his or her own pattern of deformities. The anatomic arrangement of the tendons enables motion of the proximal interphalangeal (PIP) joint isolated and separated from the distal interphalangeal (DIP) joint. The central band of the extensor mechanism and the flexor digitorum superficialis (FDS) both insert on the middle phalanx and both contribute to the control of the PIP joint. In contrast, the flexor digitorum profundus (FDP) tendon runs along the whole finger and acts on both the PIP and DIP joints. In a similar fashion, the conjoined lateral bands insert on the distal phalanx but influence the motion of the PIP joint as well. A change in length, by distention, rupture, or inability to glide one or several of these tendons, will provoke an imbalance, which may lead to a boutonnière or swan-neck deformity. A boutonnière deformity is often identified as a substantial problem to the patient, especially when the DIP joint has gone into hyperextension. Also the swan-neck deformity most often is identified by the patient as a source of severe subjective hand and finger functional impairment because of impaired grip. If a moderate lack of extension after treatment is accepted by the patient, surgical treatment offers an acceptable solution. Implants may be used in stiff joints to regain some mobility of the PIP joint but rebalancing of the extensor mechanism is difficult.</p>},
  author       = {Kopylov, Philippe and Tägil, Magnus},
  isbn         = {9783319266602},
  keyword      = {Boutonnière,Central band,DIP,Finger joint arthroplasty,Intrinsic tightness,Lateral band,PIP,Rheumatoid arthritis,Swan neck,Synovitis},
  language     = {eng},
  month        = {01},
  pages        = {185--194},
  publisher    = {Springer International Publishing},
  series       = {Clinical Management of the Rheumatoid Hand, Wrist, and Elbow},
  title        = {The rheumatoid finger : Treatment concepts and indications for surgery},
  url          = {http://dx.doi.org/10.1007/978-3-319-26660-2_16},
  year         = {2016},
}