Early Orthotic Treatment and Occupational Therapy Improved Boutonnière Deformity in Rheumatoid Arthritis：A Case Report / The Japanese Journal of Rehabilitation Medicine

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.

Early Orthotic Treatment and Occupational Therapy Improved Boutonnière Deformity in Rheumatoid Arthritis：A Case Report / The Japanese Journal of Rehabilitation Medicine

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.

The Experience of Introduction Team-Based Learning（TBL） / 医学教育

Introduction: Our school adopted team-based learning （TBL） in symptomatology classes for fourth-year students in 2010.<br>Method: This study examined the effects and problems of using a questionnaire survey involving students.<br>Results: The final scores of the students were distributed widely between approximately 65 to 90 points, indicating that TBL increased the spread of scores. The results of the survey showed that many students considered TBL to be a more effective approach than class-based learning, but most students showed an unfavorable attitude toward peer assessment. However, the results of multiple linear regression analysis showed no correlation between the survey results and final scores. The students who did not work together had better scores than students who did （p＝0.048）.<br>Discussion: The findings suggest that students’ scores after TBL are correlated with those after class-based teaching and that TBL helps improve students’ scores, especially those for case-study questions.

A Study on the Dermatitis among the Perilla Workers / 日本農村医学会雑誌

Finger dermatitis among perilla workers have been reported since 1970 in Japan. The agricultural chemicals used for perilla culture and the allergic effects of the perilla itself are discussed as for the causative factors of the dermatitis.<BR>In this report, epidemiological survey and dermatological examination were carried out, with special concern for the prevalence of hazards of each fingers of the workers in relation to their work process, especially picking perilla leaves. Subjects were all of 152 workers who engaged in perilla culture in 2 area in Nankoku, Kochi Prefecture. And the skin patch testing for 32 workers (17 ones with dermatitis and 15 ones without dermatitis) and 20 controls was done using samples of the leaves cultivated without agricultural chemicals for more than 3 weeks and perilla oil extracted from them.<BR>Results were as follows.<BR>1. Skin hazards of the fingers, such as erosion, fissure, desquamation, thickening or bleeding were observed among about half of the workers.<BR>2. The hazards were more frequently observed among the workers whose working hours for perilla culture and picking perilla leaves were longer.<BR>3. The hazards were more frequently observed in the fingers touching the reverse sides of the leaves which had the secreting glands than in those touching the surface sides, on which might be contaminated by agricultural chemicals.<BR>4. The perilla oil acted as the irritating substance for almost all of the examinee, and the skin patch testing demonstrated that both the perilla leaves and their oil caused allergic reactions to the workers with dermatitis.<BR>5. It was considered that the perilla leaves and their oil had played an important role of a cause of the dermatitis among the perilla workers.