Hand clinics
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Treating patients with osteoarthritis (OA) and rheumatoid arthritis (RA) remains challenging; however, new agents offer the chance for an improved quality of life. As an alternative to traditional nonsteroidal anti-inflammatories, cyclooxygenase-2 inhibitors provide pain relief for OA and RA patients with possible fewer side effects. ⋯ Rheumatoid arthritis research has led to an improved understanding of the inflammatory cascade and an appreciation of the early tissue destruction. A new treatment philosophy has thus emerged along with the development of new biologic agents; the latter, along with combination therapy and a new disease modifying antirheumatic drug, leflunomide, have greatly expanded the chances for disease control in RA patients.
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Pediatric carpal injury is unusual. Because of its rarity and imaging difficulties, the diagnosis is often delayed. ⋯ Pin fixation provides temporary stabilization of displaced injuries without permanently compromising joint motion. In older children, intercarpal fusion may be elected for treatment of intercarpal instability.
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Successful treatments of musculoskeletal injuries in the pediatric population demand a thorough understanding of the basic anatomy and its biomechanics, and the physiology of growth and development of the immature skeleton. In addition, good treatment outcomes rely on the treating physician being an effective teacher to the young athlete and the patient's parents, coaches, and trainers. At the same time, the physician must be a good student in learning the nature of the patient's sports and each patient's athletic ability and aspirations. Most pediatric hand and wrist injuries can be treated nonoperatively with proper immobilization techniques and activity modification, but cases requiring surgical intervention must be recognized promptly to avoid long-term complications.
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The unique function of the boxer's hand requires persistent, forceful punching in a constantly clenched fist posture, therefore, the metacarpophalangeal joints are continually exposed to blunt trauma and highly vulnerable to injury. This injury is traditionally termed boxer's knuckle. Although a myriad of metacarpophalangeal joint derangement is apt to result from isolated or repetitive blows inflicted and absorbed by the hand, the most serious and disabling type of boxer's knuckle is extensor hood disruption. Based on experience with 27 surgical cases, this article describes characteristic extensor hood pathology and operative techniques that have afforded a consistently favorable outcome.
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This article addresses the types of metacarpal and phalangeal fractures seen in a variety of sports. Treatment options are discussed in depth based on the location, configuration, and associated soft-tissue injuries. This article provides a greater understanding of the treatment algorithm to minimize the possibility of long-term functional consequences for the athlete.