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Annals of Plastic Surgery Nov 2018The purposes of this article were to present an exemplary case of bilateral locked metacarpophalangeal (MCP) joint of the second metacarpal and to review the literature...
BACKGROUND
The purposes of this article were to present an exemplary case of bilateral locked metacarpophalangeal (MCP) joint of the second metacarpal and to review the literature for a more comprehensive understanding of this condition.
METHODS
For the literature review, PubMed and Google Scholar research were performed using the term "metacarpophalangeal joint (MCP joint) locking or locked metacarpophalangeal joint (MCP Joint)" with a set of inclusion and exclusion criteria.
RESULTS
We recently treated a patient with bilateral locked MCP, which presented to our office on 2 separate occasions in the space of 3 years. The left hand was affected in 2015 and the right hand in 2018. After clinical and imaging investigations, the patient was operated on. The patient had a locking of the accessory collateral ligament behind a radial sided prominence of the second metacarpal head. After surgery, the patient regained full function of her index finger. On the basis of our literature review, we found 47 cases described in the literature, plus our case, the index finger (22), and the long finger (11) were most commonly involved.
CONCLUSION
Left untreated, the locked MCP joint may lead to a flexion contracture and disabilities in performing daily life activities. The diagnosis is mainly clinical. The radiographs can show degenerative changes or a particular shape of the metacarpal head/neck as a first clue to the possible cause. Gentle closed reduction can be attempted, but surgery is most often required. The surgical approach depends on the presumed localization of the pathology.
Topics: Adult; Collateral Ligaments; Female; Humans; Metacarpophalangeal Joint; Osteophyte
PubMed: 30161044
DOI: 10.1097/SAP.0000000000001593 -
Seminars in Arthritis and Rheumatism Aug 2014To analyse clinical, laboratory, and imaging characteristics of all patients with palmar fasciitis and polyarthritis syndrome (PFPAS) described in the literature. (Review)
Review
OBJECTIVE
To analyse clinical, laboratory, and imaging characteristics of all patients with palmar fasciitis and polyarthritis syndrome (PFPAS) described in the literature.
METHOD
Comparison of the clinical presentation of one patient with acute onset of PFAPS with 99 other published cases identified through a PubMed literature research.
RESULTS
Since the original description in 1982 by Medsger et al., there have been numerous case reports and small case series in the literature. In total, 73 articles in English, French and Spanish language were included in the analysis. PFPAS is a rare but characteristic paraneoplastic syndrome in rheumatology. Its distinct clinical feature is a painful swelling of both the hands caused by an inflammation of the palmar fascia, tendon sheaths and small joints of fingers and wrist, and flexion contractures develop rapidly. Since the subcutaneous tissues become indurated and hard, the illustrative term "woody hands" was coined. The most frequent underlying malignancy is ovarian cancer but adenocarcinomas of the breast, gastrointestinal tract and other organs can also cause this syndrome. A helpful diagnostic procedure in order to identify the nature of the underlying malignancy in many cases has been the determination of various serum tumour markers. In cases when a complete removal of the malignancy is possible, PFPAS can also undergo complete remission.
CONCLUSIONS
Knowledge of the distinct features of this rare paraneoplastic syndrome facilitates early diagnosis and potentially life-saving therapeutic interventions.
Topics: Adenocarcinoma; Arthritis; Fasciitis; Female; Humans; Ovarian Neoplasms; Paraneoplastic Syndromes
PubMed: 24684975
DOI: 10.1016/j.semarthrit.2014.03.005 -
Hand (New York, N.Y.) Nov 2020Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors' aim was to improve patient care through clarifying the definition...
Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors' aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a "Weak" global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.
Topics: Child; Conservative Treatment; Contracture; Humans; Limb Deformities, Congenital; Retrospective Studies
PubMed: 30897950
DOI: 10.1177/1558944719834654 -
Burns : Journal of the International... Feb 2017Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing... (Review)
Review
OBJECTIVE
Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the prevalence, course, and determinants is essential.
METHODS
A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar contracture assessment, point prevalence, and possible determinants.
RESULTS
Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38-54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity.
CONCLUSIONS
The prevalence of burn scar contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar contractures, their evolvement over time, and risk factors.
Topics: Adult; Age Factors; Arm Injuries; Body Surface Area; Burns; Child; Cicatrix; Contracture; Female; Fires; Humans; Male; Neck Injuries; Odds Ratio; Prevalence; Range of Motion, Articular; Risk Factors; Sex Factors
PubMed: 27639820
DOI: 10.1016/j.burns.2016.08.002 -
Child's Nervous System : ChNS :... Jun 2021Selective dorsal rhizotomy (SDR) has been used to improve mobility and reduce lower extremity spasticity in patients with a various CNS conditions. Incidentally,... (Review)
Review
PURPOSE
Selective dorsal rhizotomy (SDR) has been used to improve mobility and reduce lower extremity spasticity in patients with a various CNS conditions. Incidentally, literature on SDR has been performed in the pediatric population as such there is a paucity of research on the use in adult patients.
METHODS
Studies describing SDR in adults were identified from Medline and Embase databases. Combinations of search terms "Selective Dorsal Rhizotomy," "Selective Posterior Rhizotomy," and "Adult" were used. Only literature in English language on patients over the age of 18 years and that included measures for lower extremity outcome (i.e., spasticity, mobility) were included. Case reports, reviews without primary data, or inaccessible publications were excluded.
RESULTS
One hundred twenty-nine publications between 1970 and 2019 were identified. Twelve of these publications fit the inclusion criteria (n = 141 patients). In series where it was reported, SDR resulted in ambulatory improvement (54%, n = 44 out of 81), reduced spasticity (75.2%, n = 106 out of 141), and minimized muscle and joint pain (74.5%, n = 64 out of 86). SDR also showed improvement in parameters of the activities of daily life. 92.3% (n = 48 out of 52) of patients post-SDR developed new lower limb paresthesia.
CONCLUSION
The success and efficacy appear durable in the short-term, but further follow-up is necessary to validate these findings. The goal of the intervention dictates the ideal adult patient for SDR. Patients seeking ambulatory improvement, any etiology of spasticity besides MS, seem favorable. Positive locomotive predictors include the ability to isolate lower extremity function, lack of contractures, lower limb strength, and post-SDR physiotherapy.
Topics: Adult; Causality; Cerebral Palsy; Child; Databases, Factual; Humans; Middle Aged; Muscle Spasticity; Rhizotomy; Treatment Outcome
PubMed: 33928427
DOI: 10.1007/s00381-021-05167-y -
Zeitschrift Fur Gerontologie Und... Jun 2010Free movement of the limbs is a prerequisite of mobility and autonomy in old age. The prevalence of contractures in international studies has been reported to range... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Free movement of the limbs is a prerequisite of mobility and autonomy in old age. The prevalence of contractures in international studies has been reported to range between 15% and 70%. The wide variation might be explained by different definitions and diagnostic criteria, settings, and participants' characteristics. Contractures lead to additional nursing demands. In Germany, contracture risk assessment and prevention have been recently defined as a quality indicator of nursing home care that should be regularly monitored by expert raters of the statutory health insurance system. Therefore, it is necessary to have a clear definition of contracture. The goal of this literature review was to identify definitions of contractures used in controlled trials.
METHODS
A systematic literature search of controlled trials investigating contracture as primary, secondary, or adverse outcome was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. The search was limited to articles published after 1985 and written in English or German language. Publications were excluded, if animals, children, or congenital contracture were investigated. Two reviewers independently screened the abstracts and extracted data from full publications. Disagreement was solved by consensus involving a third reviewer.
RESULTS
Initially, 544 publications were identified; 37 controlled studies fulfilled the inclusion criteria and were included. A total of 33 studies investigated contracture as primary outcome, three as secondary outcome, and one as adverse outcome. Five studies clearly defined the term contracture. However, all these definitions are different. In 31 studies, only the diagnostic criteria were mentioned and one study mentioned neither a definition nor specific diagnostic criteria.
CONCLUSION
The majority of clinical trials investigating contracture as outcome parameter do not provide a clear definition. However, the success of contracture prevention and treatment in clinical trials and practice can only be judged in the presence of a clear definition. Thus, it appears especially difficult to use contracture as a quality indicator for nursing homes.
Topics: Aged; Aged, 80 and over; Clinical Trials as Topic; Contracture; Female; Geriatric Assessment; Germany; Homes for the Aged; Humans; Joint Diseases; Male; Nursing Homes; Prevalence; Quality Indicators, Health Care; Risk Assessment
PubMed: 20069303
DOI: 10.1007/s00391-009-0089-6 -
The Cochrane Database of Systematic... Jan 2017Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used... (Review)
Review
BACKGROUND
Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review.
OBJECTIVES
The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events.
SEARCH METHODS
In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries.
SELECTION CRITERIA
We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE.
MAIN RESULTS
Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants).In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data.In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD -0.2, 95% CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds' phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data.
AUTHORS' CONCLUSIONS
There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than seven months have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.
PubMed: 28146605
DOI: 10.1002/14651858.CD007455.pub3 -
EFORT Open Reviews May 2021Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon... (Review)
Review
Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood.A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age.Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms: gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction.All approaches reported success in at least one of our selected outcome domains: plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat.Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group.This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article: 2021;6:354-363. DOI: 10.1302/2058-5241.6.200110.
PubMed: 34150329
DOI: 10.1302/2058-5241.6.200110 -
Pediatric Physical Therapy : the... 2016To determine whether casting, orthoses, stretching, or supported standing programs are effective in improving or maintaining body functions and structures, activity, or... (Review)
Review
PURPOSE
To determine whether casting, orthoses, stretching, or supported standing programs are effective in improving or maintaining body functions and structures, activity, or participation in children with neuromuscular disabilities.
METHODS
A systematic review was conducted using 6 electronic databases to identify Level 1 and 2 studies investigating stretch interventions for children aged 0 to 19 years with neuromuscular disabilities. Interventions were coded using the International Classification of Function and rated with Grading of Recommendation Assessment, Development and Evaluation, the Oxford Levels of Evidence, and the Evidence Alert Traffic Light System.
RESULTS
Sixteen studies evaluated the effectiveness of stretch interventions. Low-grade evidence supports casting temporarily increasing ankle range of motion, orthoses improving gait parameters while they are worn, and supported standing programs improving bone mineral density.
CONCLUSION
There is limited evidence suggesting stretch interventions benefit body functions and structures. There is inconclusive evidence to support or refute stretching interventions for preventing contractures or impacting a child's activity or participation.
TRIAL REGISTRATION
Prospero CRD42014013807.
Topics: Adolescent; Ankle Joint; Bone Density; Casts, Surgical; Child; Child, Preschool; Disabled Children; Exercise Therapy; Female; Gait; Humans; Infant; Infant, Newborn; Male; Muscle Stretching Exercises; Neuromuscular Diseases; Orthotic Devices; Posture; Quality of Life; Range of Motion, Articular; Young Adult
PubMed: 27341572
DOI: 10.1097/PEP.0000000000000269 -
Journal of Plastic, Reconstructive &... Mar 2022Different elbow flap reconstructions have been described in the literature. We aim to define the optimal flap technique based on defect size and etiology. (Review)
Review
INTRODUCTION
Different elbow flap reconstructions have been described in the literature. We aim to define the optimal flap technique based on defect size and etiology.
METHODS
A systematic review was undertaken using the terms "(Elbow reconstruction) AND ((Soft tissue) OR (flap))". Flaps were grouped under fasciocutaneous (FCF), muscular (MF), distant pedicled (DPF), and free flaps (FF). The primary outcome was flap survival. The secondary outcomes were postoperative complications and range of motion (pROM).
RESULTS
Twenty articles with 224 patients were included. Defect sizes were small (<10 cm) (18%), medium (10-30 cm) (23%), large (30-100 cm) (43%), and massive (>100 cm) (16%). Etiologies included trauma (26%), burn contractures (26%), infection (26%), hardware coverage (16%), and others (6%). FCF (54%) was the preferred flap followed by MF (28%), DPF (13%), and FF (5%). The rate of flap necrosis was 4% and that of other complications was 10%. The postoperative range of motion (pROM) (reported in 154 patients) was >100°, 50-100°, and <50° in 82%, 17%, and 1% of the cases, respectively. Small defects were most commonly reconstructed with MFs (83%), medium defects were reconstructed with MFs (52%) or FCFs (46%), and large defects were reconstructed with FCFs (91%). Massive defects predominantly required DPFs (60%) and FFs (26%). FCFs were the most common reconstruction method for burn contractures (84%), infections (55%), and traumatic defects (51%). Hardware coverage was predominantly performed using MFs (86%). No difference in complications and pROM was found between flap techniques.
CONCLUSION
Elbow flap reconstruction can be performed using different techniques. FCFs are the most commonly used reconstruction method. MFs are useful for smaller defects and hardware coverage. DPFs and FFs are needed for massive injuries.
Topics: Elbow; Elbow Joint; Free Tissue Flaps; Humans; Plastic Surgery Procedures; Soft Tissue Injuries
PubMed: 34961697
DOI: 10.1016/j.bjps.2021.11.091