ABSTRACT
Since hand deformities in rheumatoid arthritis (RA) are relatively not very painful, the worsening of the deformities often goes unnoticed and the functional impairment progresses irreversibly. Herein, we report a case of boutonnière deformity of the left middle and ring fingers treated with rehabilitation since an early stage. The patient was a 58-year-old woman who was referred to our hospital due to joint pain in the fingers and feet, following which a diagnosis of RA as made；however, she could not be administered methotrexate due to complications. PIP joint deformity of the left middle and ring fingers developed later. The middle finger was in -50-degree extension and difficult to correct passively, while the ring finger was in -35-degree extension and correctable. Surgery for the left middle finger was proposed based on the diagnosis of boutonnière deformity；however, consent was not obtained. After a steroid injection in the painful middle finger, she was managed using a Capener splint and ROM exercises with finger stretching. The symptoms improved five months following the rehabilitation intervention. Nalebuff et al. classified the severity of the boutonnière deformity based on the limited PIP joint extension and recommended treatment accordingly. In this case, surgical treatment was believed to be required；however, since the patient refused surgery, conservative treatment was chosen. Although the extension was severe, there was little joint destruction, due to which the symptoms improved with early and active intervention. Orthotic treatment and occupational therapy were effective in improving ADL.
ABSTRACT
Since hand deformities in rheumatoid arthritis (RA) are relatively not very painful, the worsening of the deformities often goes unnoticed and the functional impairment progresses irreversibly. Herein, we report a case of boutonnière deformity of the left middle and ring fingers treated with rehabilitation since an early stage. The patient was a 58-year-old woman who was referred to our hospital due to joint pain in the fingers and feet, following which a diagnosis of RA as made；however, she could not be administered methotrexate due to complications. PIP joint deformity of the left middle and ring fingers developed later. The middle finger was in -50-degree extension and difficult to correct passively, while the ring finger was in -35-degree extension and correctable. Surgery for the left middle finger was proposed based on the diagnosis of boutonnière deformity；however, consent was not obtained. After a steroid injection in the painful middle finger, she was managed using a Capener splint and ROM exercises with finger stretching. The symptoms improved five months following the rehabilitation intervention. Nalebuff et al. classified the severity of the boutonnière deformity based on the limited PIP joint extension and recommended treatment accordingly. In this case, surgical treatment was believed to be required；however, since the patient refused surgery, conservative treatment was chosen. Although the extension was severe, there was little joint destruction, due to which the symptoms improved with early and active intervention. Orthotic treatment and occupational therapy were effective in improving ADL.
ABSTRACT
This study evaluated the exercise profile (heart rate, cycling speed and pedal cadence) during 25-30 km cycling and fitness and health level for adults (11 males: 69.6 ± 4.7 yrs; 6 females: 66.3 ± 4.9 yrs) with a recreational cycling habit (27.6 ± 14.8 km/week). Exercise intensity at a constant speed on a flat road during male and female cycling was 71.2 ± 11.5 and 66.8 ± 11.4% heart rate reserved (HRR), respectively. Exercise intensity over 60% HRR occupied 72% of cycling time. Peak intensity during male and female cycling was 89.2 ± 8.9 and 93.1 ± 6.1% HRR, respectively. VO2max and CS (chair stand)-30 test for male and female were 40.3 ± 4.3 and 37.7 ± 2.4 ml/kg/min, and 30.8 ± 3.1 and 30.1 ± 3.2 times, respectively. The muscle cross-sectional area of thigh extensor and flexor measured by MRI were 55.4 ± 6.5 and 58.3 ± 13.3 cm<sup>2</sup> for male, and 45.5 ± 6.4 and 50.2 ± 5.7 cm<sup>2</sup> for female, respectively. Blood profile for HDL-C (cholesterol), LDL-C and HbA1c (JDS) for male and female were 65.9 ± 8.2 and 67.9 ± 10.6 mg/dl, 112.3 ± 32.0 and 130.6 ± 12.3 mg/dl, and 4.8 ± 0.4 and 4.7 ± 0.1%, respectively. Fitness level and blood profile results were superior to those of the same aged adults. We concluded that the exercise intensity of cycling by middle and older adults with a recreational cycling habit is high and their fitness and health level are higher than average adults.