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Questionnaires about subjective symptoms were sent by post to 120 patients referred to the clinic for mandibular dysfunction. A group of 20 patients with crepitation of the temporomandibular joint (TMJ) and a group of 19 patients with palpatory tenderness of the TMJ were compared with a reference group of 29 patients for any difference in local subjective symptoms, frequency of headache and symptoms in other joints. The patients with TMJ crepitation, which were considered to have TMJ osteoarthrosis, were older and reported a higher frequency of grating sound from the TMJ than the patients in the reference group. The patients with palpatory tenderness of the TMJ reported a higher frequency of toothgrinding, more severe symptoms of mandibular dysfunction and a higher frequency of symptoms in the hand joints. No correlation was found between subjective symptoms of mandibular dysfunction and those of other joints. The results of the study indicate that patients with TMJ osteoarthrosis do not differ from other patients with mandibular dysfunction with respect to subjective symptoms and that subjective symptoms of mandibular dysfunction in general develop independently of those in other joints.

Investigation of the intra-observer and interobserver variation in interpretation of findings in radiographs of the temporomandibular and hand joints showed that the interpretation varied substantially, not only between two observers but also when made on two occasions by one single observer. Inter-observer variation was greater in the interpretation of radiographs of the temporomandibular joints than of the hand joints.

SummaryThe commonest cause of disability in rheumatoid arthritis in Sweden is today inferior hand function with incapacity to grip and pinch. The rehabilitation is complicated, as the pathological process most often continues, so the treatment of the basic disease must go on parallel with the function treatment. Besides, the process can sometimes change its character so that operative transplantations of tendons and changes of joint surfaces may be less convenient owing to later altered positions.Therefore in rheumatoid arthritis more than in other deformities of the hand, surgical rehabilitation must be limited and training and conservative movement treatment is preferable, possibly combined with small arthrodesis-operations and tendon-sheath cleaving. An outline of such training and preventive treatment of malpositions and contractures in finger and hand joints is given. The balance between rest and training must continuously be modified because the activity of the process most often appears at interval...

Objectives: To evaluate the natural history of radiographic hand osteoarthritis (OA) over 10 years. Design: We assessed 118 subjects (30 women) twice (X-ray A and B) with mean (SD) follow-up time of 9.6 (0.4) years. Subjects were of mean (SD) age 52 (10) years at X-ray A and had undergone prior knee meniscectomy. Radiographs of the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, and the first interphalangeal (IP1) and first carpometacarpal (CMC1) joints of both hands were read for joint space narrowing (JSN) and osteophytes according to the OARSI atlas. Radiographic progression was evaluated both at joint and subject level. Results: At the time of X-ray A. we found radiographic OA (approximating Kellgren and Lawrence grade 2 or worse) in at least one hand joint in 42 (36%) subjects, and in 62 (53%) at X-ray B (P < 0.001). At X-ray A. 21 subjects (18%) were classified as having primary hand OA vs 35(30%) at X-ray B (P < 0.001). Increase in JSN and osteophyte grade occurred most frequently in the DIP joints. OA at X-ray B was most frequently found in subjects' CMC1 (29%), DIP (14-27%), and IP1 joints (19%). Fifty-nine percent of subjects progressed radiographically (increase in total radiographic score by at least 2). However, the progression of the radiographic changes was mostly minor. Conclusions: In subjects with prior meniscectomy, CMC1, DIP, and IP1 joint OA is common. However, further hand OA progression over 10 years, as detected by plain radiography, is relatively modest. More sensitive imaging techniques may be preferable for clinical trials to evaluate structural hand OA progression. 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved. (Less)

Summary Objective: Using high definition macroradiography the pattern of advancement in the zone of calcified cartilage (termed a ZCC step) was detected in osteoarthritic hand joints of patients and compared to the joint space width (JSW) measurement. Design: X5 macroradiographs were obtained of the osteoarthritic hands of 44 patients at baseline and at 18 months. The incidence of ZCC steps, identified as an advancement in the mineralized cartilage front into articular cartilage, was assessed at each articular surface. JSW was measured and was used to determine the difference in JSW between hands and groups of joints with and without ZCC steps at both X-ray visits. Results: ZCC steps were found at the convex articular surfaces in only 42 (48%) hand joints in 28 (64%) patients. Here, ZCC steps were present in 36 joints in the non-dominant hand, compared with 30 joints in the dominant hand. In the former, they were present in 22 DIP, six PIP and eight MCP joints and in 12 DIP, eight PIP and 10 MCP joints in the dominant hand. By 18 months, new ZCC steps had formed in 15 hands with and 17 hands without previous ZCC steps. At both X-ray visits no statistically significant difference in JSW was found between the hands and joint groups with and without ZCC steps. Conclusion: In patients with ZCC steps, the pattern of distribution in the hand appeared to be related to that due to vascular changes, such as hyperlipidaemia, rather than to that associated with mechanical forces.

The patient was a 57-year-old female peasant. Ten years ago she fell and was struck in the left hand, which was lightly swollen. But there was no fracture in the skeleton of the wrist.She was little symptomatic five years ago when she noted swelling and pain in movement of the left hand. Then she had been treated conservatively, the response was not satisfactory.Roentogenograms of the left hand joint revealed many findings as follows, such as atrophic flattering of the Scaphoid bone, narrowing of radionavicular joint and destruction of the articular cartilage, the subchondral bone tissue of the radius end.Therefore both bone drilling and bone peg transplantation were performed to the Scaphoid bone.In histological examination after the operation necrotic figure was observed.Over the last three months after the surgical treatment there has been subjective and objective improvement in her condition.

Summary A proportion of patients with osteoarthritis (OA) have polyarticular involvement and are categorized as having generalized OA (GOA). However, a widely accepted definition of GOA does not exist. The topography of affected joints as well as the threshold number of affected joints used in defining GOA remain unidentified. According to number, site and clustering of affected joints, various subtypes of GOA, possibly related to different genetic factors, may exist. Such subtypes have still to be clearly identified. Among them, the association of hand and knee OA emerges as a probable subtype. Polyarticular involvement of hand joints is common, but may include various subtypes of differing significance. Further studies are needed to clarify the definition of GOA.

Plain radiograph is the most accepted imaging technique to assess structural changes of osteoarthritis and it is proposed as ‘surrogate’ of outcome of the disease process. The existing radiographic methodology is well standardized with respect to its technique for investigation of hip, knee and hand joints, including advice on the most appropriate views, patient positioning, X-ray beam alignment, quality control. Quantitation of joint space narrowing is currently proposed as the primary variable in studies of disease progression for hip and knee, while semi-quantitation of this same parameter or of bone changes by published atlases have to be intended as secondary variables, or outcomes in hand studies. Unfortunately, the review of studies that evaluated the longitudinal rate of joint space narrowing indicates that the yearly change may be very small (

The temporomandibular joints of 64 patients and the hand joints of 62 patients with mandibular pain and/or dysfunction were exposed in oblique lateral transcranial, transmaxillary, and dorso-volar projections. The relationship between radiographic signs generally ascribed to osteoarthrosis was investigated. Indices were constructed to quantify the radiographic findings in the two joints. In the temporomandibular joint statistically significant age-independent correlations were found between flattening of the lateral part of the condyle, subcortical sclerosis of the condyle and reduced joint space. In the hand joints statistically significant age-independent correlations were found between osteophytes, subcortical sclerosis, eroded/absent cortical outlining, reduced/obliterated joint space and dislocations. No statistically significant correlation could be found between radiographic findings in the temporomandibular and hand joints. It is concluded that the radiographic signs in the temporomandibular joint of reduced joint space, subcortical sclerosis of the condyle and flattening of the lateral part of the condyle are interrelated and probably characteristic of osteoarthrosis, and that these relationships are similar to those that occur in the hand joints.

Two groups of 25 patients, one with pseudospondylolisthesis (PSL) and the other without, have been compared in order to verify the impression that arthrosis of the hands occurs more frequently in those with PSL. The observed differences were significant, being especially marked in women in whom five or more hand joints were involved and increasing in frequency with age. No relation was found between PSL and either discarthrosis or being overweight. The presence of PSL can probably be included in the pattern of generalized osteoarthrosis described by Kellgren and Lawrence (1958).

The effect of long-term oestrogen treatment of at least 5 yr on the development of osteoarthrosis was studied in 48 postmenopausal women. Osteoarthrosis at the hand joints was graded according to Kellgren's criteria, using hand X-rays. Data obtained in a normal population of 155 women served as controls as well as data obtained in 24 postmenopausal women who did not receive oestrogen replacement therapy. No significant difference in osteoarthrosis between the treated and non-treated groups was found. The development of osteoarthrosis at the hand joints seems to be independent of the hormonal status in postmenopausal women.

In an effort to conserve time during replacement arthroplasty in the hand, the author, in collaboration with Mr. George Gibson, designed a cone-shaped reamer to prepare the medullary canals for the stems of Swansondesign silicone joint implants. A single taper was considered satisfactory, as this factor was nearly constant for all sizes of this implant design. Since the fluting of a conventional drill bit draws the drill into the material, the fluting on the original reamer was reversed to obviate the risk of splitting the phalanx or metacarpal (Fig. I). However, this design reduces the cutting power. The flutes now are machined so that they are straight rather than spiral. The straight flute design en

The diagnosis of organic disease of the temporomandibular joint is often based on radiographic findings. The relationship between the radiographic findings in this joint and in hand joints, and clinical findings in the masticatory system, was analysed. The results showed that patients with crepitation of the temporomandibular joint frequently have radiographic abnormalities in this joint and in hand joints. Subcortical sclerosis and reduced joint space were significantly correlated with the number of occluding pairs of molar teeth.

Increased mortality and morbidity was seen in association with lower formal educational levels in 75 rheumatoid arthritis (RA) patients over 9 years. Nine of the 20 patients with 8 or fewer years of eduction had died, compared to 10 of 34 with 9–12 years of education, and only one of 21 with more than 12 years of education. Among survivors with functional capacity data available from baseline and 9 year review, declines greater than 20% were seen in 8 of 10, 13 of 21, and 9 of 19 patients in the three education categories. Overall, 79% of grade-school educated, 43% of high-school educated, and 20% of college-educated patients had either died or declined more than 50% in functional capacity. Patients of different formal educational levels were similar at baseline in age, duration of disease, measures of functional capacity, number of involved hand joints, number of severe radiographic changes, use of gold, oral corticosteroids or other therapies, and associations between formal educational level and disease course are not explained by these variables. Formal educational level appears a simple quantitative marker which identifies a surrogate or composite variable associated with increased mortality and morbidity in RA.

We selected 500 patients randomly from a total of 1300 patients seen in our Hand Rehabilitation Center between 1971 and 1975; 212 of the 500 presented with a chief complaint of stiff hand joints. Of the 212 patients treated non-operatively, 173 responded sufficiently to this treatment alone. Of the 789 stiff joints, 686 responded sufficiently to this treatment alone. The results of this regime of non-operative treatment of stiff joints provide excellent functional improvement in most patients, with a large saving of money through the reduction in disability payments required.

In the rheumatology literature, most of the available evidence on three-dimensional ultrasound (3D US) is related to the acquisition process and highlights the virtual operator independence and shortening of the US examination time. The main aim of this study was to compare 3D US using a high-frequency volumetric probe and conventional 2D US at the wrist and hand in patients with rheumatoid arthritis (RA). The 3D US examinations were performed using a Logiq 9 (General Electrics Medical Systems, Milwaukee, WI) with a high-frequency (8-15 MHz) volumetric probe. Overall, there is good-to-excellent agreement between the two modalities relating to both joint inflammation and bone erosion. This study is an initial step towards establishing a methodology necessary for developing multi-centre US studies which are aimed at assessing hand involvement in patients with RA.

Purpose: Erosive hand osteoarthritis (HOA) is considered a subset of HOA. The difference between erosive and non-erosive HOA with respect to pain and functioning is largely unknown and therefore subject of this study. Methods: Patients with familial OA participating in the GARP (Genetics ARthrosis and Progression) study, were eligible for the present analysis if they had HOA defined by the ACR criteria for clinical HOA or the presence of structural abnormalities (multiple bony swellings/radiological OA) in the hands. Erosive HOA was defined as the presence of erosive radiographic features according to the Verbruggen-Veys anatomical phase score in at least 2 interphalangeal joints. Self-reported hand pain and function were assessed with the Australian/Canadian Osteoarthritis Hand Index (AUSCAN LK 3.0). A standard diagram of the hand joints was used to identify the number painful joints. During physical examination pain intensity upon lateral pressure in all hand joints was graded 0-3 and the number of bony swellings was recorded. Performance was evaluated with grip strength, pinch grip, fingerpalm distance during finger flexion and the HAMIS (Hand Mobility in Scleroderma), which assesses all movements included in the range of motion of the hand. Higher scores on the HAMIS reflect worse hand mobility. Measures of pain and functioning were compared between patients with erosive and non-erosive HOA using t-test and Mann-Whitney U test for normally and not-normally distributed variables, respectively. Performance measures were related to AUSCAN using linear regression with adjustment for age, sex, and body mass index. Results: Erosive HOA was present in 42 (18%) of 236 HOA patients (83% women, mean age 65 yrs). Demographics characteristics did not differ between the groups. Clinical measures are shown in the table. Patients with erosive HOA experienced more pain and reported more functional limitations than patients with non-erosive HOA. Grip strength and pinch grip did not differ between the groups. The HAMIS was significantly worse in patients with erosive HOA, which was found for finger mobility, but not for thumb mobility. Finger-palm distance was higher in patients with erosive HOA. HAMIS and finger-palm distance were related to AUSCAN pain and function in both groups, whereas grip strength and pinch grip were related to the AUSCAN only in non-erosive HOA.