Narrow Results

Background: Partial wrist arthrodesis (PWA) is a salvage procedure used in advanced wrist arthritis and has traditionally been performed via an open dorsal approach. In recent years, surgeons have moved towards arthroscopic fusions to minimise soft tissue damage and preserve vascular supply, increase union rates and hasten recovery. The purpose of this study is to synthesise the current literature on the outcomes of arthroscopic PWA.

Methods: A systematic review was performed to survey the literature regarding outcomes of PWA. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. Data collected included patient demographics, operation time and technique, complications and postoperative patient outcomes in the form of patient-rated surveys, grip strength, range of motion and the pain visual analogue scale (VAS).

Results: Twelve studies were eligible for inclusion, with a total of 191 patients. 94% of patients achieved union, with a mean time to fusion of 12.5 weeks. VAS, Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist scores were significantly improved after the procedure, and complication rates were comparable to open procedures. Range of motion varied greatly across studies, due to heterogeneity in carpal intervals fused.

Conclusions: Arthroscopic PWA is a safe and effective procedure in the treatment of advanced arthritis of the wrist. Further comparative studies would be useful in assessing benefits of arthroscopic arthrodesis over an open approach.

Level of Evidence: Level III (Therapeutic)

Background: Native joint septic arthritis (NJSA) of the hand is poorly studied. Management guidelines are extrapolated from large joint infections despite differences in epidemiology, anatomy and aetiology. Limited evidence suggests shorter courses of antibiotics can achieve outcomes comparable to longer courses. The aim of our study is to characterise the presentation, management and outcomes of NJSA of the hand in an adult cohort from Southeast Queensland (SEQ) and determine if the route or duration of antibiotics affected the outcome. Our cohort was compared to those in the literature to determine if already published data could be applicable to our population.

Methods: A coding based retrospective cohort of adult patients between 2016 and 2022 were assessed. The cohort was divided into short/long course antibiotics and primarily intravenous/oral route for outcome comparison.

Results: Seventy-four patients were included with a joint culture positive rate of 75%. The most common aetiology of infection was direct trauma and the most common pathogen was Staphylococcus aureus. Resolution was achieved in 86% of patients after 1-year follow-up, with a median antibiotic duration of 14 days, and 48% had non-infectious sequelae. Failure to achieve resolution was associated with females and taking immunosuppressants. No significant difference was detected when analysed for primary route or duration of antibiotics.

Conclusions: There was no difference in the rate of resolution attributable to the route or duration of antibiotics. We demonstrated comparability between our cohorts’ demographics, management and outcomes with those in the literature. Based on the findings in our study, noting the retrospective nature and small cohort, the authors conclude for uncomplicated NJSA of the hand, a total antibiotic duration of 14 days in addition to early surgical intervention is likely to be successful in most patients.

Level of Evidence: Level III (Therapeutic)

This study was performed to assess the clincotherapeutic effect of whole venom of honeybee (Apis mellifera) in adjuvant-induced arthritic rat. Ninety Sprague-Dawley male rats were injected with complete Freund's adjuvant (CFA). Adjuvant arthritis was produced by a single subcutaneous injection of 1 mg Mycobacterium butyricum suspended in 0.1 ml paraffin oil into the right hind paw. Righting reflex was uniformly lost and considered to be the point of arthritis development on day 14 after CFA injection. The experiments were divided into three groups. When arthritis was developed in the rat, tested groups were administered with prednisolone (10 mg/kg, p.o.) or honeybee venom (one bee, s.c.) every other day for another 14 days. Control group was injected with 0.1 ml of physiological saline solution subcutaneously. Clinical and hematological values with histopathological findings were observed during the drug administration. In treatment groups, the development of inflammatory edema and polyarthritis was suppressed. No significant differences of hind paw edema volume and lameness score between prednisolone and honeybee venom groups were observed during treatment. White blood cell counts of control group showed leucocytosis that was significantly different from the two treatment groups (p < 0.01). Erosions of articular cartilage and inflammatory cell infiltrations into interphalangeal joint were effectively suppressed in treated groups. In conclusion, whole honeybee venom was found to suppress arthritic inflammation in the rat. This may be an alternative treatment of arthritic agony in humans.

This study was performed to assess the efficacy of α-viniferin (Carex humilis Leyss) on adjuvant-induced arthritis in rats. Adjuvant arthritis was induced by a single subcutaneous injection of 0.1 ml complete Freund's adjuvant (CFA) containing 7.5 mg Mycobacterium butyricum suspended in 1 ml sterile paraffin oil into the right hind paw. Forty female Sprague-Dawley rats were injected. Righting reflex was uniformly lost and considered to be the initial point of arthritis development on day 7 after CFA injection. Rats were divided into four groups, and upon development of arthritis, tested groups were orally administered 3 or 10 mg/kg α-viniferin or 10 mg/kg ketoprofen every day for 14 days. The control group was orally administered 2 ml of physiological saline solution. Bone mineral density (BMD), radiological changes and edematous volumes were measured for 35 days. α-viniferin suppressed the development of inflammatory edema, and inhibited the bone destruction, noted with a decrease in BMD (p<0.05). Hind paw edema volume, BMD and radiological changes did not differ significantly in the ketoprofen and α-viniferin groups during the entire study period. In conclusion, α-viniferin suppressed arthritic inflammation and bony change in rats.

CML-1 is a purified extract from a mixture of 13 Oriental herbs (Achyranthis Radix, Angelicae Gigantis Radix, Cinnamomi Cortex Spissus, Eucommiae Cortex, Glycyrrhizae Radix, Hoelen, Lycii Fructus, Paeoniae Radix, Rehmanniae Radix Preparata and Atractylodis Rhizoma, Zingiberis Rhizoma, Zizyphi Semen, Acori Graminei Rhizoma) that have been widely used for the treatment of inflammatory diseases in Asia. The aim of this study was to investigate the anti-inflammatory and analgesic potential of CML-1. The animals used in this study were administered either vehicle or CML-1 (30, 100, 300 and 600 mg/kg) orally. The vascular permeability induced by acetic acid was significantly reduced by CML-1 in all doses. The swelling of the rat's hind paw induced by carrageenan was significantly inhibited by CML-1 in doses of 100, 300 and 600 mg/kg. In the case of rheumatoid arthritis induced by complete Freund's adjuvant in rats, the treatment with CML-1 at a dose level of 300 mg/kg inhibited edema. CML-1 at a dose level of 600 mg/kg inhibited acetic acid-induced writhing syndrome, however it did not have any anti-nociceptive action in the Randall-Selitto assay or the hot plate test. Our findings suggest that CML-1 has a potent anti-inflammatory activity.

The aim of this study was to investigate the effects of electroacupuncture (EA) on the glycoconjugate (GC) changes in articular cartilage in the ankle of an arthritic model. Arthritis was induced by an intraplantar injection of complete Freund's adjuvant (CFA) into the hindpaw of male Sprague-Dawley rats. Bilateral EA stimulation at 2 Hz, 15 Hz and 120 Hz was applied at those acupoints corresponding to Zusanli and Sanyinjiao in man, using needles for 3-day intervals for 30 days. To determine the presence of arthritis, paw edema was measured by a water displacement plethysmometer. Edema of the hindpaw induced by CFA-injection was strongly inhibited by EA stimulation throughout the experimental period. At 30 days after CFA-injection, GC changes of articular cartilage of the ankle joint were observed using conventional and lectin histochemistry. The CFA-injected rat revealed general reduction of staining abilities and lectin affinities for GC in comparison with normal rats. Significant reductions of neutral and acidic GC were observed in interterritorial matrix and chondrocyte capsules, respectively. All lectin affinities examined except DBA were also decreased in CFA-injected rats compared to normal ones. However, EA-treated rats, showed similar staining patterns and lectin affinities for GC as to normal ones, especially neutral GC in interterritorial matrix and sWGA and RCA-1 affinities in chondrocytes. It is concluded that EA in all frequencies examined, especially 2 Hz, can attenuate inflammatory edema in CFA-injected rats through alleviation of alterations of GC components in articular cartilage.

Litsea coreana Levl., a traditional Chinese medicine, has long been used for its diverse benefits such as detoxification and detumescence. Total flavonoids from Litsea coreana Levl. (TFLC) are the effective fraction of L. coreana. This study was designed to investigate the anti-inflammatory effects and mechanisms of TFLC against Feund's complete adjuvant (FCA)-induced arthritis in rats. Arthritis was evaluated by secondary paw swelling, polyarthritis index, body weight and histopathologic analysis. Con A- or LPS-stimulated splenocyte proliferation and cytokine (IL-1 and IL-2) production were assessed by MTT assay and activated mouse cell proliferation assay, respectively. The results indicate that therapeutic administration of TFLC (50, 100, 200 mg/kg, ig × 12 days) could significantly suppress secondary arthritis in rats with adjuvant-induced arthritis (AA). In vivo, TFLC (50, 100, 200 mg/kg, ig × 12 days) augmented splenocyte proliferation and increased IL-2 production in splenocytes, while reduced IL-1 activity in peritoneal macrophages (PM_Φ) of AA rats. In vitro, TFLC at concentrations from 0.005 to 50 μg/ml exerted the same immunoregulatory effects on AA rats as those in vivo. In addition, an attractive feature of TFLC lies in its apparent lack of toxicity. These results suggest that TFLC without toxicity has a significant anti-arthritic effect on AA rats which could be associated with its anti-inflammatory and immunomodulatory properties.

Macrophages play a crucial role in rheumatoid arthritis (RA). Their activation is the initial step of RA. This study was designed to detect the effects of total flavonoids from Litsea coreana Levl. (TFLC) on the complete Freund's adjuvant-induced (CFA-induced) arthritis (AA) in rats and to explore whether inflammatory cytokines were induced by the IRE1/mTORC1/TNF-α-dependant mechanism in peritoneal macrophages. In vivo, our data indicated that TFLC (100, 200 mg/kg, i.g. × 10 days) could significantly suppress secondary paw swelling and serum levels of TNF-α and IL-1β. Histopathological figures showed that TFLC treatment improved the morphologic changes of articular cartilages and synovium. Results of RT-PCR and western blotting demonstrated that TFLC suppressed expression of 78-KD glucose regulated protein (GRP78), X-box binding protein 1 (XBP1), mTOR complex 1 (mTORC1) and TNF-α in peritoneal macrophages of AA rats. Collectively, these results indicate that TFLC is able to ameliorate adjuvant-induced arthritis in a dose-dependent manner by suppressing the IRE1/mTORC1/TNF-α-regulated inflammatory response initiated in peritoneal macrophages.

Korean Red Ginseng (KRG) is an herbal medicine prescribed worldwide that is prepared from Panax ginseng C.A. Meyer (Araliaceae). Out of ginseng’s various components, ginsenosides are regarded as the major ingredients, exhibiting anticancer and anti-inflammatory activities. Although recent studies have focused on understanding the anti-inflammatory activities of KRG, compounds that are major anti-inflammatory components, precisely how these can suppress various inflammatory processes has not been fully elucidated yet. In this study, we aimed to identify inhibitory saponins, to evaluate the in vivo efficacy of the saponins, and to understand the inhibitory mechanisms. To do this, we employed in vitro lipopolysaccharide-treated macrophages and in vivo inflammatory mouse conditions, such as collagen (type II)-induced arthritis (CIA), EtOH/HCl-induced gastritis, and lipopolysaccharide (LPS)/D-galactosamine (D-GalN)-triggered hepatitis. Molecular mechanisms were also verified by real-time PCR, immunoblotting analysis, and reporter gene assays. Out of all the ginsenosides, ginsenoside Rc (G-Rc) showed the highest inhibitory activity against the expression of tumor necrosis factor (TNF)-$\alpha$, interleukin (IL)-1$\beta$, and interferons (IFNs). Similarly, this compound attenuated inflammatory symptoms in CIA, EtOH/HCl-mediated gastritis, and LPS/D-galactosamine (D-GalN)-triggered hepatitis without altering toxicological parameters, and without inducing gastric irritation. These anti-inflammatory effects were accompanied by the suppression of TNF-$\alpha$ and IL-6 production and the induction of anti-inflammatory cytokine IL-10 in mice with CIA. G-Rc also attenuated the increased levels of luciferase activity by IRF-3 and AP-1 but not NF-$\kappa$B. In support of this phenomenon, G-Rc reduced TBK1, IRF-3, and ATF2 phosphorylation in the joint and liver tissues of mice with hepatitis. Therefore, our results strongly suggest that G-Rc may be a major component of KRG with useful anti-inflammatory properties due to its suppression of IRF-3 and AP-1 pathways.

This prospective study compared the outcome — subjective, objective and radiographic — of two surgical techniques for treating basal joint arthritis of the thumb: a "simple" trapeziectomy (group I) and a ligament reconstruction/tendon (group II) interposition technique. There were respectively 22 patients in group I and 34 in group II, all women with primary osteoarthritis.

Both techniques gave favourable results and there were no significant differences for pain relief, patient satisfaction, mobility, DASH-score, key pinch force and gripping force. However in group II, the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited. There was also a significant correlation between the remaining trapezial space and key pinch force.

Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification.

The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58–76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3–35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126° and radioulnar deviation was 43°. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.

Trapezio-metacarpal joint arthritis is common, affecting 7% of men and 15% of women. Numerous surgical techniques are described for this condition but it is not clear which is best. Eighty-six silicone trapezium replacements were assessed at an average of 46 months (six to 156 months) postoperatively for patient satisfaction, pain, key and power grip strength, range of motion, complications and disability with DASH score. Patient satisfaction was 92%. There was excellent pain reduction from 4.2 to 0.6 on a scale of 0 to 5. Strength was 72% and 84% of age-sex-matched normal data for key and power grips, respectively. The complication rate was low, with two cases of persistent pain. One resolved spontaneously, the other resolved following revision of the silicone implant. The average DASH score was 30. Silicone trapezium replacement is an effective operation that offers the patient good pain relief, strength and good function with few complications.

Osteoid osteoma in the wrist and hand region is an uncommon but severely symptomatic primary bone tumour. We report the case of a professional athlete with a radial styloid osteoid osteoma who presented with significant wrist pain and stiffness resembling arthritis for which she was treated initially. The symptoms started after a fall on the outstretched hand and significant delay in the diagnosis occurred. Following detailed imaging evaluation of the tumour site excision biopsy was curative.

Penetrating sea urchin spine injuries, can lead to devastating, irreversible consequences. Persistent inflammation, cutaneous granuloma, neuroma, tenosynovitis, arthritis and destructive arthritis, leading to permanent loss of function and digit amputation, can occur. We present a case of a patient who developed sea urchin spine arthritis of the proximal interphalangeal joint. Only 17 cases of sea urchin spine arthritis of the hand have been documented in the medical literature. However, in this case, the article also includes sequential radiographs, histopathological slides, and intra-operative photographs.

Background: Finger injuries are common in the sport of hurling. Injury to the little finger distal interphalangeal joint (DIPJ) often occurs when a high dropping ball impacts on the outstretched finger. The little finger contributes to approximately 15% of grip strength. Injury therefore results in reduced grip strength and may impair the ability of players to grip or catch a ball.

Methods: Six elite hurlers with post-traumatic arthritis of their non-dominant little finger DIPJ underwent arthrodesis in 30 degrees of flexion. Kirchner wires were inserted for up to 8 weeks to achieve fusion of the joint. Patients were evaluated after recovery using a dynamometer to assess grip strength, the DASH questionnaire and a sport specific questionnaire.

Results: All arthrodeses achieved bony union without complication. All patients reported a resolution of their pain and recovery in their ability to catch & retain a ball. Measurements of grip strengths were comparable between hands. DASH scores improved by up to 47 points. All scores were less than 5 at final follow-up.

Conclusions: Grip strength decreases when fingers are immobilized in full extension. In sports that require catching or gripping a ball or a bat, arthrodesis of the DIP joint in flexion can improve grip strength and hand function. Fusion in 30 degrees of flexion for hurlers results in restoration of function and resolution of pain. Little finger DIPJ arthrodesis is a valid method of treating posttraumatic arthritis in ball and bat sports.

Rheumatic manifestations are the most common extraintestinal features in the inflammatory bowel disease. The aim of this study was to determine the effectiveness of ^99mtechnetium-labelled polyclonal human immunoglobulin G (^99mTc-IgG) scintigraphy, to detect peripheral joint inflammation in patients with enteropathic arthropathy. Nineteen patients (Crohn disease: 4, colitis ulcerosa: 15) with either pain and/or swelling of peripheral joints, underwent ^99mTc-IgG scintigraphy. The results were correlated with clinical, and laboratory activity parameters, as well as with radiological findings. The mean duration of bowel disease was 7.55 ± 6.11 years. In 19 patients 17 peripheral joints were swollen and 58 were tender. Taking tenderness as a potential indicator of joint involvement; 31 (53%) of the joints revealed abnormality on ^99mTc-IgG scintigraphy. The most frequently affected sites were the knees, ankles and tarsals. The total scintigraphic scores were significantly correlated with tenderness and swelling scores. No correlation was observed between the scores of ^99mTc-IgG scintigraphy and radiological findings. In conclusion ^99mTc-IgG scintigraphy can be appropriate for detecting inflammation of peripheral joints and can be used to establish the extent of arthritis in patients with inflammatory bowel disease.

Until recently, limited evidence existed to support the efficacy of exercise programs for patients scheduled for total hip arthroplasty (THA), and no evidence-based guidelines were available regarding the length or intensity of exercise programs and their effect on patient recovery. The purpose of this randomized controlled trial was to determine the impact of an eight-week pre-surgery and 20 week post-surgery customized exercise program on the strength and function of subjects scheduled for THA. A series of physical tests and quality of life questionnaires were completed by patients (n = 57) pre-surgery and on three occasions post-surgery. In the week prior to surgery, the exercise group exhibited significant improvements (p < 0.05) in composite hip strength score and WOMAC total score in comparison to control subjects. By week 24, post-surgery scores for WOMAC total score, Harris Hip score, composite strength score, hip flexion range of motion of the operated hip and the distance walked in 6 minutes were significantly (p < 0.05) better in exercise group patients. A detailed description of the exercise intervention is presented in this paper.

Purpose: To epidemiologically assess the gender-specific relationship between height and radiographic osteoarthritis (OA) of the knee, hand, foot, and cervical spine. Methods: Data collected from men (N = 1090) and women (N = 2441) aged 40 years and older participating in the Clearwater Osteoarthritis Study (1988–current) were used (N = 3531). Physical exams including radiographs were conducted. The Kellgren and Lawrence ordinal scale was used to determine evidence of radiographic OA. Results: There is a modest, albeit consistent, increase in OA prevalence among shorter-stature study subjects at all four sites in women and at two sites in men (hands and cervical spine). Our adjusted findings suggest that shorter stature is a risk factor for OA for the hands, feet, and cervical spine, with odds ratios varying between 1.25 and 1.82. After adjusting for body mass index and age, this relationship maintained statistical significance among women for hand OA. (OR = 1.57; p = 0.0001) and feet OA (OR = 1.41; p - value = 0.009). Curiously, no significant association was indicated between height and knee OA for either gender. Conclusions: Shorter stature appears to be associated with an elevated risk of OA, but particularly so for women. Future epidemiologic studies examining this relationship can offer insight into skeletal growth and development knowledge, thus further elucidating the etiology of OA.

Osteoarthritis (OA) is a degenerative joint disease that may cause joint inflammation, stiffness, and pain. Current therapy for OA involves symptomatic treatment, mainly pain management. Therefore, it does not repair degenerated cartilage or attenuate joint inflammation. Because articular cartilage cannot heal or regenerate these tissues, tissue regeneration remains one of the most important objectives of new and potential OA therapeutics. The main features of adult mesenchymal stem cells (MSCs) are simple acquisition from adult tissues, rapid proliferation in vitro, immunomodulation in vivo, and lasting existence in the host, which are beneficial for OA treatment. In the past 15 years, adult MSCs, including bone marrow-, adipose-, and synovial membrane-derived MSCs, and their secretome have been successfully used in different animal (preclinical) models or in genetic manipulation for regenerating degenerated cartilage, reducing inflammation, or relieving pain. Furthermore, the implantation of adult MSCs showed pain reduction, anti-inflammation, and cartilage protection or healing in early-phase clinical trials. Adult MSCs are the most extensively explored as potential regenerative medicine for OA because of their efficacy in chondrocyte differentiation and their immunomodulatory properties. In this review paper, we highlighted current knowledge and future perspectives regarding preclinical tests, clinical application, and MSC-based/related products for curing OA.