Orthopedics Medical News about Rheumatoid arthritis, Hands, Working space

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The working space of the hand in rheumatoid arthritis: Its impact on disability
Journal of Hand Surgery (European Volume), 08/14/09

Dias JJ et al. – Data suggest that the working space of the hand offers the clinician an additional way of assessing the function in rheumatoid arthritis (RA); this concept may benefit the surgeon in pre-operative planning, targeting improvement of joint extension as one of the goals necessary to improve hand function. In order to reduce the functional disability, surgery must endeavour to increase this working space, to make the digits strong and stable and to maximise the use of the finger within this space.

Methods

Main objectives of this study were to:
- Devise a way of calculating the working space in the rheumatoid hand, and
- Evaluate its usefulness by correlating it with conventional measures of hand function
Volumes enclosed by each of 108 hands in 54 RA pts were calculated using individual joint measurements
Difference between the flexion and extension volumes is the ‘working space’ of the hand
Correlations between the working space and parameters of stiffness, pain, deformity, movement, grip and functional disability were performed

Results

Average working space volume was 4921 cc in rheumatoid pts with no visible hand deformity and 1154 cc in the presence of combined finger deformities
Loss in volume was due mainly to loss of extension
Patient Evaluation Measure and the Functional Disability Score were related to changes in the working space
Concept of the working space of the hand may aid the assessment of the rheumatoid hand and help surgical decision-making

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