2nd IRF World Conference on Medical Rehabilitation in Rural and LowResource Regions Dhaka, Bangladesh December 1-4, 2012
Title: Dropped fingers sign in Chronic Rheumatoid Arthritis: A case series
Author: Dr. Farooq Azam Rathore FCPS
Institution: Department of Rehabilitation Medicine, Combined Military Hospital,
Lahore Cantt, Pakistan
Introduction:
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown
etiology that primarily involves joints. The arthritis is symmetrical and if uncontrolled
may lead to destruction of joints due to erosion of cartilage and bone which leads to
deformity. Aim is to present three cases of chronic RA presenting with drop finger
sign and describe the pitfalls in the management of rheumatologic disorders in a
developing country.
Methods
Three middle ages patients ( 02 males, 01 female; age range 45-56yrs) diagnosed
as sero-positive RA( duration 7-15 years) presented with weakness of grip and
progressive deformities of hands and feet. All had been using sub-optimal doses of
methotrexate (10 mg/week) for the last so many years.
Results
Patients had classical findings of RA like intrinsic hand muscles wasting, ulnar
deviation of hands, boutonnières and swan neck deformities, Z-deformity of the
thumbs ,synovial thickening at the wrist and rheumatoid nodules ( in two patients).
All patients had dropped finger sign (bilateral in one case) and were unable to
actively extend the fingers. Finger drop sign is a rare complication of chronic RA and
is indicative of extensor tendon rupture at the wrist. Surgery was not considered
because of financial constraints and patient's refusal. Counseling was done and
hand orthosis were provided to improve the function.
Potential implications:
Dropped finger in RA is mostly due to rupture of a long extensor tendon at wrist.
Extensor tendons usually rupture in sequence, starting with the little finger and
progressing radially. Surgical repair is complex and has a high failure rate. Other
possible causes include MCP dislocation, extensor tendon subluxation and posterior
interosseous nerve palsy.
Next steps:
Following is proposed as a food for thought to improve the comprehensive
management of such cases and to improve the practice of rheumatology in this
region
•
A need to conduct Collaborative research ( hospital based epidemiological
survey of rheumatologic disorders)
•
Development of an online atlas of Rheumatological disorders.
•
Developing local best Practice guidelines for diagnosis, management and
rehabilitation
Acknowledgements and disclaimers:
I, FAROOQ RATHORE as submitting author for this abstract take full responsibility
for its integrity and ethical conduct. I certify that each of the co-authors listed has
reviewed this document and approves its submission with their name as listed in the
order listed. I certify that each of the co-authors has agreed that this form lists any
pertinent conflict of interest issues pertaining to their participation in the described
program. My authors and I agree that, should this abstract be accepted for this
meeting, the International Rehabilitation Form has our permission to store,
reproduce, distribute, and otherwise use the abstract and any presentation we may
make; including audio, video, and other media; in any form or format. Full
publications of accepted abstracts must acknowledge first presentation at this
meeting.