eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Intrinsic Plus Hand: Workup

Author: Jessica Nguyen Gillespie, MD, Clinical Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa
Coauthor(s): Bradon J Wilhelmi, MD, Professor and Endowed Leonard J Weiner, MD, Chair of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: May 13, 2009

Workup

Imaging Studies

  • Radiography of the hands should be included as part of the workup for stiff joints.
  • Although radiography is not helpful in diagnosing intrinsic contracture, it may be useful for ruling out other diagnoses or causes of a contracture.

More on Intrinsic Plus Hand

Overview: Intrinsic Plus Hand
Workup: Intrinsic Plus Hand
Treatment: Intrinsic Plus Hand
Follow-up: Intrinsic Plus Hand
Multimedia: Intrinsic Plus Hand
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Jupiter JB, Goldfarb CA, Nagy L, Boyer MI. Posttraumatic reconstruction in the hand. Instr Course Lect. 2007;56:91-9. [Medline].

  2. Brody GS. Management of stiff metacarpophalangeal and interphalangeal joints. In: McCarthy JG, May JW Jr, Littler JW, eds. Plastic Surgery. Vol 7. The Hand, Part 1. Philadelphia, Pa:. WB Saunders, Co;1990:4655-4670.

  3. Watson HK, Weinzweig J. Stiff Joints. In: Green DP, ed: Green's Operative Hand Surgery. 4th ed. Philadelphia, Pa:. Churchill Livingstone;1999:552-562.

  4. Wong JM. Management of stiff hand: an occupational therapy perspective. Hand Surg. Dec 2002;7(2):261-9. [Medline].

  5. Revol M, Servant JM. [Paralysis of the intrinsic muscles of the hand]. Chir Main. Feb 2008;27(1):1-11. [Medline].

  6. Formsma SA, van der Sluis CK, Dijkstra PU. Effectiveness of a MP-blocking splint and therapy in rheumatoid arthritis: a descriptive pilot study. J Hand Ther. Oct-Dec 2008;21(4):347-53. [Medline].

  7. Pitts DG, O'Brien SP. Splinting the hand to enhance motor control and brain plasticity. Top Stroke Rehabil. Sep-Oct 2008;15(5):456-67. [Medline].

  8. Bowers WH, Wolf JW, Nehil JL, Bittinger S. The proximal interphalangeal joint volar plate. I. An anatomical and biomechanical study. J Hand Surg [Am]. Jan 1980;5(1):79-88. [Medline].

  9. Ling MZ, Kumar VP. Myofascial compartments of the hand in relation to compartment syndrome: a cadaveric study. Plast Reconstr Surg. Feb 2009;123(2):613-6. [Medline].

  10. Guyton GP, Shearman CM, Saltzman CL. Compartmental divisions of the hand revisited. Rethinking the validity of cadaver infusion experiments. J Bone Joint Surg Br. Mar 2001;83(2):241-4. [Medline].

  11. Espiritu MT, Kuxhaus L, Kaufmann RA, Li ZM, Goitz RJ. Quantifying the effect of the distal intrinsic release procedure on proximal interphalangeal joint flexion: a cadaveric study. J Hand Surg [Am]. Sep 2005;30(5):1032-8. [Medline].

  12. Lansmeer JMF. The anatomy of the dorsal aponeurosis of the human finger and its functional significance. Anat Rec. 1949;104:31.

  13. Smith RJ. Surgery of the hand in cerebral palsy. In: Pulvertaft RG, ed. Operative Surgery. The Hand. 3rd ed. London, England:. Butterworth;1977:215.

  14. Pitts DG, O'Brien SP. Splinting the hand to enhance motor control and brain plasticity. Top Stroke Rehabil. Sep-Oct 2008;15(5):456-67. [Medline].

  15. Lannin NA, Cusick A, McCluskey A, Herbert RD. Effects of splinting on wrist contracture after stroke: a randomized controlled trial. Stroke. Jan 2007;38(1):111-6. [Medline].

  16. Smith RJ. Intrinsic muscles of the fingers: Function, dysfunction and surgical reconstruction. In: AAOS Instructional Course Lectures. Vol. 24. St. Louis, Mo:. Mosby;1975:200-220.

  17. Harris C, Riordan DC. Intrinsic contracture in the hand and its surgical treatment. J Bone Joint Surg Am. Jan 1954;36-A(1):10-20. [Medline].

  18. Smith RJ. Balance and kinetics of the fingers under normal and pathological conditions. Clin Orthop Relat Res. Oct 1974;92-111. [Medline].

  19. Smith RJ. Intrinsic Contracture. In: Green DP, ed. Green's Operative Hand Surgery. 4th ed. Philadelphia, Pa:. Churchill Livingstone;1999:604-618.

  20. Zancolli EA. Ischemic Contractures. In: McCarthy JG, May JW Jr, Littler JW, eds: Plastic Surgery. Vol 8. The Hand, Part 2. Philadelphia, Pa:. WB Saunders, Co;1990:5033-5052.

[ CLOSE WINDOW ]

Keywords

intrinsic plus position, safe position for hand splinting, hand immobilization, hand stiffness, intrinsic contractures, hand deformity, hand disability, intrinsic muscle contracture, intrinsic tightness test, intrinsic plus test

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jessica Nguyen Gillespie, MD, Clinical Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa
Jessica Nguyen Gillespie, MD is a member of the following medical societies: American Society for Reconstructive Microsurgery, American Society of Plastic and Reconstructive Surgery, Iowa Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Bradon J Wilhelmi, MD, Professor and Endowed Leonard J Weiner, MD, Chair of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Association of Clinical Anatomists, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association for Surgical Education, Plastic Surgery Research Council, and Wound Healing Society
Disclosure: Nothing to disclose.

Medical Editor

Michael S Clarke, MD, Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas R Hunt III, MD, John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association
Disclosure: Tornier Consulting fee Review panel membership

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.