Common Hand and FingerDeformities
Swan-Neck Deformity.:- This deformity usually involves only the fingers. There is flexion of the metacarpophalangeal and distal interphalangeal joints, but the real deformity is extension of the proximal interphalangeal joint. The condition is a result of contracture of the intrinsic muscles or tearing of the volar plate and is often seen in patients with rheumatoid arthritis or following trauma .
Boutonniere Deformity.:- Extension of the metacarpophalangeal
and distal interphalangeal joints and flexion of the proximal interphalangeal joint (primary deformity) are seen with this deformity. The deformity the result of a rupture of the central tendinous slip of the extensor hood and is most common after trauma
or in rheumatoid arthritis.
Ulnar Drift:-. This deformity, which is commonly seen in patients with rheumatoid arthritis but can occur with other conditions, results in ulnar deviation of the digits due to weakening of the capsuloligamentou structures of the metacarpophalangeal joints and the accompanying "bowstring" effect of the extensor communis tendons .
Extensor Plus Deformity. This deformity is caused :' adhesions or shortening of the extensor communis -tendon proximal to the metacarpophalangeal joint. It results in the inability of the patient to simultaneously 'ex the metacarpophalangeal and proximal interphalan;real joints, although they may be flexed individually.
Claw Fingers. This deformity results from the loss of intrinsic muscle action and the overaction of the extrinsic (long) extensor muscles on the proximal phaanx of the fingers. The metacarpophalangeal joints are hyperextended, and the proximal and distal interphalangeal joints are flexed (Fig. 7 -12). If intrinsic funcon is lost, the hand is called an intrinsic minus
hand. The normal cupping of the hand is lost, both the longitudinal and the transverse arches of the hand
disappear, and there is intrinsic muscle ·wasting. The deformity is most often caused by a comined
median and ulnar nerve palsy.
Trigger Finger :-Also known as digital tenovaginitis stenosans, this deformity is the result of a thickening of the flexor tendon sheath, which causes stickmg of the tendon when the patient attempts to flex the finger. A low-grade inflammation of the proximal rold of the flexor tendon leads to swelling and con- triction (stenosis) in the digital flexor tendon. When the patient attempts to flex the finger, the tendon ticks, and the finger "lets go," often with a snap. As the condition worsens, eventually the finger will flex but not let go, and it will have to be passively extended. The condition is more likely to occur in middle- aged women, whereas "trigger thumb" is more common in young children. The condition usually occurs in the third or fourth finger. It is most often
associated with rheumatoid arthritis and tends to be worse in the morning.
Ape Hand Deformity.:- Wasting of the thenar eminence of the hand occurs as a result of a median nerve palsy, and the thumb falls back in line with the fingers as a result of the pull of the extensor muscles.
Bishop's Hand or Benediction Hand Deformity.
Wasting of the hypothenar muscles of the hand, the interossei muscles, and the two medial lumbrical muscles occurs because of ulnar nerve palsy .Flexion of the fourth and fifth fingers is the most obvious resulting change shows an inability to extend and adduct the ring and little finger and sometimes the middle finger, especially rapidly, despite good function of the wrist, thumb, and
index finger. In addition, the patient shows an exaggerated triceps reflex and positive pathological reflexes
"Z" Deformity of the Thumb:-. The thumb is flexed at the metacarpophalangeal joint and hyperextended at the interphalangeal joint . Thedeformity may be caused by heredity, or it may be associated with rheumatoid arthritis.
Dupuytren's Contracture:-. This condition is the result of contracture of the palmar fascia. There is a fixed flexion deformity of the metacarpophalangeal and proximal interphalangeal joints (Fig. 7-18). Dupuytren's contracture is usually seen in the ring or little finger, and the skin is often adherent to the fascia. It affects men more often than women and is usually seen in the 50- to 70-year old age group.
Mallet Finger.:- A mallet finger deformity is the result of a rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger. The distal phalanx rests in a flexed position .
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