Impairment of hand function can lead to severe disability. Congenital Acquired • Rheumatoid arthritis (Fig. 32) • Trauma (mal-united fracture) • Burns • Volkmann’s ischaemic contracture Figure 32 Rheumatoid hand. These lesions will be recognisable at birth. Arthrogryposis multiplex congenita is due to non-differentiation of mesenchymal tissues, often together with a neurogenic element, the combination producing gross contractures. There will be a clear history of previous trauma and burns. In the early phases, there will be little deformity, the patient merely complaining of thickening in the palm near the base of the ring finger. Eventually, the patient will complain of being unable to straighten the ring and little fingers. The grip is also affected. Check for a history of epilepsy, cirrhosis or diabetes. By the time the hand is deformed, the patient is usually well aware of the diagnosis. There is pain and swelling of the joints with weakness of the hand, together with gross deformity.
Hand Deformities
Causes
Early changes include synovitis of the wrist, metacarpophalangeal joints and proximal interphalangeal joints. In severe advanced changes, there is massive tendon swelling over the dorsal surfaces of the wrists, severe muscle wasting, ulnar deviation of the metacarpophalangeal joints and swan-neck deformity of the fingers.
History
Congenital
Acquired
Trauma and burns
Dupuytren’s contracture
Rheumatoid arthritis
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Deformities
