The fixed lupus hand deformity and its surgical correction
Evans, J.A.; Hastings, D.E.; Urowitz, M.B.
Journal of Rheumatology 4(2): 170-175
1977
ISSN/ISBN: 0315-162X PMID: 881693 Document Number: 116990
In a prospective study of 125 patients with SLE , 3 females developed fixed hand deformities. All had arthritis for more than 10 yr, and had been treated with a mean daily dose of 15 mg of prednisone. The hand deformities consisted of irreducible metacarpophalangeal (MCP) subluxation and/or dislocation without erosion or destruction of the MCP joints, resulting in hyperflexion of the fingers in the palm. Two patients had dislocation of the carpometacarpal joints in both hands. One patient developed reducible swan-neck deformities in the 2nd to 5th fingers of both hands and a 2nd patient developed Boutonniere deformities in 2 fingers of 1 hand and clinodactyly of both 5th fingers. Because the deformity at the MCP joints resulted from soft tissue contractures in the intrinsics and long flexors, and because the cartilage of the MCP joint was preserved, a joint replacement was not considered. Metacarpal osteotomy and shortening was performed to decompress the contracted soft tissues. At follow-up (18-96 mo.), the hands remained corrected and all patients were able to perform normal activities.