Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.

Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.

Development of Korean Academy of Medical Sciences Guideline for Rating Physical Disability of Upper Extremity

While the lower extremities support the weight and move the body, the upper extremities are essential for the activities of daily living, which require many detailed movements. Therefore, a disability of the upper extremity function should include a limitation of all motions of the joints and sensory loss, which affects the activities. In this study, disabilities of the upper extremities were evaluated according to the following conditions: 1) amputation, 2) joint contracture, 3) diseases of upper extremity, 4) weakness, 5) sensory loss of the finger tips, and 6) vascular and lymphatic diseases. The order of 1) to 6) is the order of major disability and there is no need to evaluate a lower order disability when a higher order one exists in the same joint or a part of the upper extremity. However, some disabilities can be either added or substituted when there are special contributions from multiple disabilities. An upper extremity disability should be evaluated after the completion of treatment and full adaptation when further functional changes are not expected. The dominance of the right or left hand before the disability should not be considered when there is a higher rate of disability.

Artropatías seronegativas infantiles / Seronegative artropathies in children

Se analizaron las características clínicas, de laboratorio y radiológicas en 35 niños afectados por oligoartritis crónicas que fueron controlados entre los años 1980 y 1989, con el próposito de identificar en ellos las diferentes formas de artropatías seronegativas infantiles, a lo largo de un seguimiento de 3,3 años (media). 63 por ciento de los pacientes eran varones, en 88,6 por ciento de los casos la enfermedad comenzó después de los 8 años de edad, todos tuvieron síntomas articulares, siendo tobillos y rodillas los sitios más afectados. Se registraron manifestaciones de compromiso del esqueleto axial en 71,44 por ciento y entesitis en igual porcentaje de los pacientes, 45 por ciento de los cuales tenían antecedentes familiares de afección reumatológica, 34,3 por ciento de diarrea precedente y 85,7 por ciento manifestaciones mucocutáneas. La velocidad de sedimentación era mayor a 50 mm en 57 por ciento de estos niños y HLA B27 positivo en 45,7 por ciento de ellos. Entre los 28 pacientes en quienes se efectuó radiológico y cintigráfico, en 32 por ciento se encontraron alteraciones radiológicas y en 50 por ciento cintigráficas. El diagnóstico definitivo se pudo hacer en 43 por ciento de los pacientes, permaneciendo el resto como espondiloartropatías indiferenciadas. Los niños que sufren oligoartritis predominantemente en las extremidades inferiores asociadas a entesopatía deben ser evaluados y controlados en el tiempo para pesquisar las espondiloartropatías

Las enfermedades profesionales en Chile y las perspectivas del kinesiológo en salud ocupacional / The occupational diseases in Chile and perspectives for the physical therapist in occupational health

Se presenta un estudio de distribución de frecuencia de enfermedades profesionales en Chile, según una serie de variables, como clasificación según rubro de actividades económicas, etc. Se pone especial atención a aquellas que por su frecuencia y permanente aumento en un período de 10 años, tienen algún grado de comparación de tasas observadas y esperadas se determina el subregistro que existe en Chile para esos años, en relación a la denuncias de enfermedades profesionales que partícularmente hacen los organismos estatales administradores de la ley 16.744. El método de investigación es descriptivo, la unidad de análisis son los anuarios del Ministerio de Salud referentes al tema, y los años estudiados comprenden la década 1977-1987