Movable surface models of hand joints using visible korean / Modelos de superficies móviles de articulaciones de manos utilizando visible Korean

SUMMARY: The human hand can make precise movements utilizing several joints of various articular types. To understand hand movements more accurately, it is essential to view the actual movements of bones and muscles considering the X, Y, and Z axes in the joints. This study aimed to investigate the joint movements in a hand using movable surface models, including these axes. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints. To achieve this aim, 70 surface models were adopted from a Visible Korean model. Using Maya software, 20 virtual joints with X, Y, and Z axes included nine distal and proximal interphalangeal joints, five metacarpophalangeal joints, five carpometacarpal joints, and one wrist joint were created. Bone surface models were elaborately polished to maintain their original shape during movement. Muscle surface models were also processed to display the deformation of the muscle shape during movement. The surface models of the hand joints were moved by virtual control of the joints. We saved 87 movable surface models of the hand, including bones, muscles, and joint axes in stereolithography format, and compiled a Portable Document Format (PDF) file. Using the PDF file, the joint movements in a hand could be observed considering the X, Y, and Z axes alongside the stereoscopic shapes of the bones and muscles. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints.

RESUMEN: La mano humana puede realizar movimientos precisos utilizando varias articulaciones de diferentes tipos articulares. Para comprender los movimientos de las manos con mayor precisión, es esencial ver los movimientos reales de los huesos y los músculos considerando los ejes X, Y y Z de las articulaciones. Este estudio tuvo como objetivo investigar los movimientos articulares en una mano utilizando modelos de superficies móviles, incluidos estos ejes. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina de los movimientos de la mano alrededor de las articulaciones. Para lograr este objetivo, se adoptaron 70 modelos de superficie de un modelo coreano visible. Con el software Maya, se crearon 20 articulaciones virtuales con ejes X, Y y Z que incluyeron nueve articulaciones interfalángicas distales y proximales, cinco articulaciones metacarpofalángicas, cinco articulaciones carpometacarpianas y una articulación de muñeca. Los modelos de superficie ósea se pulieron minuciosamente para mantener su forma original durante el movimiento. También se procesaron modelos de superficie muscular para mostrar la deformación de la forma del músculo durante el movimiento. Los modelos de superficie de las articulaciones de las manos se movieron mediante el control virtual de las articulaciones. Guardamos 87 modelos de superficies móviles de la mano, incluidos huesos, músculos y ejes articulares en formato de estereolitografía, y compilamos un archivo en formato de documento portátil (PDF). Usando el archivo PDF, los movimientos de las articulaciones en una mano se pueden observar considerando los ejes X, Y y Z junto con las formas estereoscópicas de los huesos y músculos. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina sobre los movimientos de la mano alrededor de las articulaciones.

Hallazgos ultrasonográficos en articulaciones de muñecas y manos de pacientes con sospecha clínica de artritis reumatoide en fase temprana / Ultrasonographic findings in wrists and hands of patients with clinical suspicion of early phase rheumatoid arthritis

La Artritis Reumatoide (AR) es una enfermedad crónica y autoinmune cuyo primer año de evolución es considerado por el Colegio Americano de Reumatología como su fase temprana. Con el objetivo de describir los hallazgos ultrasonográficos en las articulaciones de muñecas y manos de pacientes con sospecha clínica de AR en fase temprana referidos de la consulta de Reumatología del Hospital Central Universitario Dr. Antonio María Pineda durante el lapso junio-agosto de 2018, se realizó un estudio descriptivo transversal evaluando 126 articulaciones de 21 pacientes según la escala modificada del OMERACT. Los pacientes se caracterizaron por un promedio de edad de 51,4 ± 11,1 años, siendo el grupo etario más afectado el de 41-50 años y 51-60 años. Hubo un predominio del sexo femenino (85,7%) y una media de inicio de síntomas de 5,2 ± 2,8 meses. Las principales alteraciones encontradas fueron derrame sinovial (54,7%), engrosamiento sinovial (28,5%), tenosinovitis en el grupo extensor (28,5%), erosiones óseas (11,1%) y tenosinovitis en flexores (9,5%). Los hallazgos mostraron mayor afectación de las articulaciones radiocarpianas; 12,7% y 7,9% mostraron hipertrofia sinovial y sinovitis grado I, 15% derrame sinovial grado 1 y 2 y 7,9% erosiones óseas pequeñas. El 8,7% de las II metacarpofalángicas mostraron hipertrofia sinovial grado I, 6,3% sinovitis, 13,4% derrame sinovial y 1,5% erosiones óseas medianas; el 0,79% de las II interfalángicas proximales presentaron derrame sinovial grado 1. Se observó tenosinovitis grado 1 en 25,4% de extensores y 7,9% de flexores. En conclusión, la ultrasonografía es una herramienta complementaria en el diagnóstico y seguimiento de la enfermedad reumatoide en fase temprana por lo que se sugiere fomentar su uso evitando gastos innecesarios y retrasos en el inicio del tratamiento(AU)

Rheumatoid Arthritis (RA) is a chronic and autoimmune disease whose first year of clinical manifestations is considered the early phase of the disease according to the American College of Rheumatology. With the aim of describing the ultrasonographic findings in the wrists and hands of patients with clinical suspicion of early phase RA referred to the Rheumatology Service of the Hospital Central Universitario Dr. Antonio Maria Pineda during the period June-August 2018, a cross-sectional descriptive study was conducted evaluating 126 joints of 21 patients according to the modified scale of the OMERACT. Patients had an average age of 51.4 ± 11.1 years and the most affected age groups was the 41-50 years and 51-60 years. Predominance of female sex (85.71%) as well as an average of 5.2 ± 2.8 months of time of symptoms onset was observed. The main alterations observed were synovial effusion (54.7%), synovial thickening (28.5%), tenosynovitis in extensor tendons (28.5%), bone erosions (11.1%) and tenosynovitis in flexor tendons (9.52%). The radiocarpal joints were the most affected showing grade 1 synovial hypertrophy and synovitis in 12.7% and 7.9% of joints, respectively; grade 1 and 2 synovial effusion was observed in 15% of joints and small bone erosions in 7.9%. For the second metacarpophalangeal joint, grade I synovial hypertrophy was found in 8.7% of joints, synovitis in 6.3%, synovial effusion in 13.4% and medium-sized bone erosions in 1.5%; in 0.79% of the proximal interphalangeal joints grade I synovial effusion was observed. Tenosynovitis grade 1 was observed in 25.4% of extensor tendons and 7.9% flexors. The use of ultrasonography should be encouraged as a complementary tool for the diagnosis of RA, avoiding unnecessary expenses and delay in treatment(AU)

A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients / Novo sistema de escore ultrassonográfico (US10) musculoesquelético das articulações das mãos e punho para avaliação de pacientes com artrite reumatoide em fase inicial

ABSTRACT Objective: To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Methods: Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0–1) and semi-quantitatively (grades 0–3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Results: Mean duration of symptoms was 7.58 ± 3.59 months. Significant correlations (p < 0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p < 0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up. Conclusion: The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.

RESUMO Objetivo: Propor um novo sistema de escore ultrassonográfico das articulações da mão e punho (US10) para a avaliação de pacientes com artrite reumatoide (AR) e correlacionar o US10 com variáveis clínicas, laboratoriais e funcionais. Métodos: Foram submetidos 48 pacientes com AR em fase inicial a avaliações clínicas e laboratoriais, bem como a exames cegos de ultrassom (US) no início do estudo e com 3, 6 e 12 meses. O sistema US10 proposto envolveu a avaliação do punho e das articulações metacarpofalângicas e interfalângicas proximais do segundo e terceiro dígitos. O escore consistiu em parâmetros inflamatórios (proliferação sinovial [PS], Power Doppler [PD] e tenossinovite [TN]) e parâmetros de danos articulares (erosão óssea [EO] e danos na cartilagem [DC]). PS, PD, EO e DC foram pontuados qualitativamente (0 a 1) e semiquantitativamente (graus 0 a 3). A tenossinovite foi pontuada como presença/ausência. A avaliação envolveu também o escore 28-Joint Disease Activity (DAS28), o Health Assessment Questionnaire (HAQ) e o nível de proteína C-reativa (PCR). Resultados: A duração média dos sintomas foi de 7,58 ± 3,59 meses. Foram encontradas correlações estatisticamente significativas (p < 0,05) entre os parâmetros de inflamação e a PCR no início do estudo e entre as mudanças nessas variáveis ao longo do estudo. Foram encontradas também correlações significativas (p < 0,05) entre o escore DAS28 e a PD e TN no início do estudo e entre as mudanças no escore DAS28 e PS e TN em todo o seguimento. Além disso, foram encontradas correlações significativas entre as mudanças no escore dos parâmetros de inflamação e no escore HAQ ao longo do seguimento. Conclusão: O sistema de escore US10 proposto provou ser uma ferramenta útil para monitorar a inflamação e o dano articular em pacientes com AR em fase inicial, demonstra correlações significativas com as alterações longitudinais na atividade da doença e no estado funcional.

Comparative study between hand-wrist method and cervical vertebral maturation method for evaluation of skeletal maturity in Saudi boys

The hand-wrist method and cervical vertebral maturation [CVM] are two common diagnostic approaches to assess skeletal 'maturity in clinical orthodontics. The objective of this study was to evaluate the correlation between CVM method and hand-wrist method in estimating the skeletal maturity level of Saudi male children. Lateral cephalograms and hand-wrist radiographs of 145 Saudi male children ranging from 10 to 15 years of age were utilized. The CVM method of Franchi and Baccetti [Franchi and Baccetti, 2002] was used to analyze the maturational morphologic characteristics of the cervical vertebrae from lateral cephalometric radiographs; whereas Bjork's skeletal maturity standards [Bjork, 1972] were utilized to determine the skeletal maturity stage from hand-wrist radiographs. Skeletal age for each subject was established using Greulich and Pyle's standard hand and wrist radiographic atlas [Greulich and Pyle, 1959]. The mean chronological age of the sample was 12.13 +/- 1.54 years, while the mean skeletal age was found to be 11.51 +/- 1.9 years. High correlation [0.89, P<0.01] was established between CVM stages and hand-wrist skeletal maturity stages. The findings of this study suggest that CVM method is a valid and reliable method to assess skeletal maturity in Saudi male children

Evolución clínica y radiográfica de una artrosis de mano en veinticinco años / Clinical and radiographic hand osteoarthritis in twenty five years

Se presenta la evolución clínica y radiográfica de una artrosis de mano seguida durante 25 años. Se hace énfasis en los buenos resultados obtenidos con un nuevo programa de ejercicios. Se analizan detalladamente losproblemas de alineación e inestabilidad del carpo y su colapso, tanto en las radiografías simples como en la escanografía.