OKOJ, Volume 6, No. 2

Rheumatoid Hand: Swan-Neck Deformity

Swan-neck deformity, characterized by proximal interphalangeal (PIP) joint hyperextension, distal interphalangeal (DIP) joint flexion, volar plate incompetence, and dorsal laxity of the lateral bands, is common in patients with rheumatoid arthritis. The deformity is the end result of synovitis of the joints, tendon sheaths, and ligaments, which disrupts the balance of flexion and extension forces across a joint and results in deformity, weakness, and loss of function. Management of swan-neck deformity is based on the flexibility of the PIP joint, integrity of the articular cartilage, and functional level of the patient. Nonsurgical treatment for swan-neck deformity, including extension block splinting, is considered for patients with preserved function. Surgical management involves procedures that limit PIP joint hyperextension and restore DIP joint extension, including DIP joint arthrodesis, tenodesis of the flexor digitorum superficialis, reconstruction of the oblique retinacular ligament, volar PIP joint dermodesis, and lateral band translocation. In late-stage disease, soft-tissue procedures alone may not result in lasting correction of deformity.

    • Keywords:
    • rheumatoid arthritis

    • rheumatoid hand deformity

    • finger deformity

    • rheumatoid factor

    • rheumatoid hand

    • RA

    • tenosynovitis

    • swan neck deformity

    • Subspecialty:
    • Hand and Wrist

Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents and is characterized by posteroinferior displacement of the capital femoral epiphysis on the metaphysis through the physis. Symptoms of SCFE at presentation include hip, groin, and knee pain. Ambulatory patients may also present with a limp. SCFE is classified as stable when the patient can walk on the involved extremity and unstable when the patient cannot walk, with or without crutches. The standard of care for both stable and unstable SCFE is in situ percutaneous single-screw fixation, and this treatment has a high probability of success. An additional screw confers more strength, but carries a higher complication rate. For patients with severe SCFE, removal of the femoral neck prominence in combination with a valgus derotational osteotomy can restore a good range of motion and provide a satisfactory weight-bearing surface.

    • Keywords:
    • SCFE

    • slipped upper femoral epiphysis

    • hip disorder

    • slipped hip

    • adolescent hip disorder

    • femoral head displacement

    • Salter-Harris physeal fracture

    • Salter-Harris fracture

    • hip pain

    • hip joint pain

    • Subspecialty:
    • Pediatric Orthopaedics

Sports Trauma: Cervical Spine Injuries and On-Field Examination

Understanding cervical spine injuries and how they occur in contact sports such as football, lacrosse, and hockey is critical for the prevention of injury and for the on-field management of the injured athlete. Cervical spine injuries occur at all levels of play, from the high school to the professional level, and are usually caused by high-energy collisions between players, resulting in acceleration and deceleration of the head and neck. On-field evaluation of the player with a potential cervical spine injury begins with an assessment of the injured player's breathing and neurologic status. Radiographs should be obtained if necessary, and MRI should be performed if there is evidence of radiculopathy or brachioplexopathy. The decision to allow an injured athlete to return to play depends on 1) whether the injury has healed; and 2) the risk of reinjury. Contraindications to return to play include significant stenosis, ongoing weakness or paresthesias, significant loss of motion at more than one spinal segment, and any upper cervical injury.

    • Keywords:
    • C-spine injuries

    • sports-related spinal injury

    • sports-related spine injury

    • sports-related neck injury

    • burners

    • brner syndrome

    • stingers

    • spinal cord injury

    • SCI

    • Subspecialty:
    • Trauma

    • Sports Medicine

    • Spine