Proximal Interphalangeal Joint

Bouchard s nodes Bony outgrowths on the proximal interphalangeal joints due to osteoarthritis. 

On examination, joint swelling may be visible or may be apparent only by palpation. The tissue feels soft and spongy and may appear erythematous and warm, especially early in the course of the disease. Chronic joint deformities commonly involve subluxations of the wrists, metacarpophalangeal joints, and proximal interphalangeal joints (swan-neck deformity, boutonniere deformity, ulnar deviation). 

Arthritic symptoms, with back pain, bilateral proximal interphalangeal joint involvement, arthralgia of the knees, elbows, and wrists, and the so-caUed shoulder-arm syndrome with cervicobrachial neuralgia can occur (9). 

A 23-year-old woman took oral misoprostol 600 micro-grams/day twice when she was 7 weeks pregnant to induce an abortion. At 12 weeks she developed a Varicella infection. At 15 weeks, ultrasound showed a fetus of 14.5 weeks size with several abnormalities. After amniocentesis at 17 weeks, an elective abortion was performed. The fetus had amputation deformities at the proximal interphalangeal joints of four fingers, with... 

Proximal interphalangeal joints Bouchard s nodes (osteophytes)... 

Volar plate injuries occur due to forced hyperextension of the proximal interphalangeal joint (PIPJ). There is avulsion of the insertion of the volar plate from the epiphysis at the base of the middle phalanx volarly, often only seen on the lateral or oblique radiographs (Fig. 19.17). Large fragments may require internal fixation. If they are unrecognised or progress to malunion, a swan neck deformity will... 

Bunnel-LUtler test evaluates the tightness of the intrinsic muscles of the hand. The metacarpophalangeal joint is held in extension and the patient tries to move the proximal interphalangeal joint into flexion. If the proximal interphalangeal joint does not flex, then the intrinsic muscles are tight or the joint capsule is contractured. The metacarpophalangeal joint is rested briefly and then retested. If the proximal interphalangeal joint stUl cannot flex, the problem is in the joint capsule. 

Osteopathic treatment Is aimed toward keeping the palmar fascia as free as possible the metacarpophalangeal and proximal Interphalangeal joints should be mobilized to prevent secondary joint immobilization and tethering of the flexor tendons. Myofascial release techniques and stretching is useful. Surgical Intervention may be required. 

Fig. 5.25. Psoriatic dactylitis. Longitudinal 17-5 MHz US image over the proximal interphalangeal joint of the middle finger in a 45-year-old woman with psoriatic arthritis shows extensive destruction of the articular surface (arrowheads) of the middle phalanx (MPh). Coexisting deformity (arrow) of the head of the proximal phalanx (PPh) and heterogeneous appearance of para-articular soft-tissues (asterisks) is found. The findings correspond to the radiographic sign referred to as the pencil-incup deformity...

The hand skeleton is formed by five rays made of the metacarpal bones and the phalanges and includes three hinge-type articulations that are of US interest the metacarpophalangeal joint, the proximal interphalangeal joint and the distal interphalangeal joint. 

Fig. 11.29a,b. Partial tear of the central slip of the extensor tendon, a Longitudinal and b transverse 15-7 MHz US images over the midline dorsal aspect of the proximal interphalangeal joint of the index linger reveal thickening of the central slip arrow) suggesting a partial tear. No effusion is seen inside the dorsal synovial recess. PP, proximal phalanx MP, middle phalanx... 

Fig. 11.53a,b. Interphalangeal joint synovitis, a Longitudinal 15-7 MHz US image over the palmar aspect of the proximal interphalangeal joint with b diagram correlation demonstrates mild effusion inside the volar synovial recess (arrowheads) of the joint. Note the relationship of this recess with the palmar plate (asterisk), the flexor tendons (ft) and the edge of the head of the proximal phalanx (star). In b, the dorsal recess (arrow) of the joint is also depicted. PP, proximal phalanx MP, middle phalanx... 

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