Scleroderma of the hand

Assessment of light touch sensation in the hands of systemic sclerosis patients

INTRODUCTION

Systemic sclerosis is a relatively rare connective tissue disorder characterized by severe and progressive fibrosis of the skin. Due to the current lack of available information on this subject, the aim of the present study was to assess light touch sensations in the hands of patients with systemic sclerosis.

METHODS

We completed a cross-sectional comparative study. Light touch sensations were evaluated in 30 individuals, including 15 patients with systemic sclerosis who exhibited changes in the dermis of their hands without loss of the distal phalanx and 15 subjects who did not exhibit changes in the upper limbs (control group). The groups were age- and sex-matched. Tactile sensory evaluations were performed using the Semmes-Weinstein monofilament test and the two-point discrimination test.

RESULTS

Statistically significant differences were found between groups in the monofilament test. The study group had lower scores across all points of the hand when compared with the control group. Differences were also found when dominant and non-dominant hands were compared (p<0.05). Statistically significant differences were found between groups for a subset of the assessed points in the two-point discrimination test.

CONCLUSIONS

The results of a monofilament test showed that tactile sensation, specifically light touch and deep pressure sensations, is altered in the hands of systemic sclerosis patients.

Musculoskeletal involvement in systemic sclerosis

Musculoskeletal (MSK) involvement is a very frequent manifestation of patients with systemic sclerosis (SSc). There are several reports about clinical trials assessing musculoskeletal involvement in SSc. However, only few controlled studies have been conducted. The prevalence of musculoskeletal symptoms, clinical and radiographic findings has been assessed. The most important articular (arthralgia, synovitis, contractures), tendon (tendon friction rubs, tenosynovitis) and muscular manifestations (myalgia, muscle weakness, myositis) should be carefully evaluated during the assessment of SSc patients, because these are not only common, but substantially influence the quality of life and some of them also have predictive value concerning disease activity and severity.

Intrinsic contractures of the thumb

A wide range of conditions can lead to intrinsic contractures of the thumb. A thorough understanding of the normal and pathologic anatomy as well as the disease processes and their effect on thumb function is essential in understanding and treating these contractures. Because intrinsic contractures of the thumb rarely present in isolation, a patient-specific approach based on functional needs is required. Prevention of iatrogenic contractures and progression of predictable contractures regardless of etiology is the health care provider's primary responsibility.

Determinants of Hand Attractiveness—A Study Involving Digitally Manipulated Stimuli

Although attractiveness of the human hand is of significance in the social and mating context, thus far it has attracted little scientific interest. In this study, young women and men were presented with pairs of digitally manipulated images of opposite-sex hands and asked to indicate the hand perceived to be the more attractive in each pair. The hands within a pair differed from one another by a single feature: shape averageness, femininity, finger length, second-to-fourth-digit ratio, or skin smoothness. All these features, with the exception of the digit ratio, were shown to increase hand attractiveness in each sex in both dorsal and ventral views. Skin smoothness was preferred more strongly in female than in male hands. Women also tended to prefer medium degrees of shape femininity and skin smoothness in male hands compared to both high and low levels. Adaptive and non-adaptive (related to perceptual bias) mechanisms underlying these preferences are discussed.

Reconstructive hand surgery for scleroderma joint contractures

Systemic scleroderma can cause significant hand deformity and functional impairment. Surgery is often avoided due to the perceived risks of wound healing. The most common surgical procedures have been digital sympathectomy, arthrodesis or arthroplasty of the proximal interphalangeal (PIP) or both, and metacarpophalangeal (MCP) joints. We describe herein successful soft tissue hand surgery in 2 patients for treatment of scleroderma claw deformities without the use of arthrodesis or arthroplasty. At the MCP joint, the tight capsules were excised, and the collateral ligaments and volar plates were released. At the PIP joints, the volar plates were released and the tight palmar skin was released, resulting in marked improvement of joint position. Intensive hand therapy was used to maximize function. In these 2 patients with claw deformity, we found that tight volar skin was the main contributor to flexion contracture at the PIP level. In contrast, joint capsule contracture was the main contributor to hyperextension deformity at the MCP level.