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American Journal of Physical Medicine & Rehabilitation:
doi: 10.1097/PHM.0b013e31822de9fe
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Radial Deviation of Distal Interphalangeal Joint Because of Overuse of Hand Pincers Tool

Jang, Ki Un MD; Seo, Cheonghoon MD; Lee, Dong Kyung PhD; Kim, Kyoo Sang MD

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From the HanGang Sacred Heart Hospital, Hallym University Medical College, Seoul (KUJ, CS); and Industrial Safety & Health Research, Rural Living Division, Rural Development Administration, Korea Occupational Safety & Health Agency (KOSHA), Incheon, South Korea (DKL, KSK).

All correspondence and requests for reprints should be addressed to: Ki Un Jang, MD, HanGang Sacred Heart Hospital, Hallym University Medical College, 94-200 YeongDeungPo-Dong, YeongDeungPo-Ku, Seoul, South Korea.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

We surveyed 50 workers who used a specific hand tool: leather pincers (Fig. 1). This is a small nipper used to pick up a sheet of leather in the leather manufacturing process. Each corner of a large piece of wet leather is pinched up to be stretched very quickly and highly repetitively, overloading the worker’s hands. Digit arthropathy was found in 14 of the 50 workers. The thumb interphalangeal joint was affected in 15 digits in nine workers, the second-finger distal interphalangeal (DIP) joint was affected in 11 fingers in seven workers, and the third DIP joint was affected in seven fingers in five workers.

Figure 1
Figure 1
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Radiographic radial lateral angulation of the second and third DIP joints was found in six fingers in five workers (Fig. 2). Ulnar angulation of the DIP joint was not found. The Job Strain Index1 score was 7.59 for the leather pincer work. This score means that there is a very high risk of distal upper limb disorders. Specifically, the pincer task loaded the second finger DIP joint with radial deviation stress.

Figure 2
Figure 2
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An extensive literature search failed to reveal any other reports of radial deviation of the DIP joints. Nonetheless, musculoskeletal physicians should be aware of this DIP joint change. Degenerative joint disorders involving the fingers typically affect the DIP and PIP joints. In a biomechanical analysis of the loads on the finger joints, Radin et al.2 found that pinch-grip forces were greatest across the DIP joint and that a fine pinch grip resulted in greater mechanical stress to the DIP joint, whereas power grips affected the metacarpophalangeal joints predominantly.3 Most older people are reported to have ulnar deviation; the metacarpophalangeal joint had a mean ulnar angulation of 9.04 degrees in an older population, which was greater than the mean of 2.3 degrees in young people, suggesting that ulnar drift is related to aging.4

What was the cause of the radial deviation in the workers we examined? Pressure pushing the fingers consistently into radial deviation is a proposed cause. The hand posture of the workers using leather pincers presses the DIP joints of the second and third fingers into radial deviation. Our findings imply that prolonged repetitive mechanical loading on the finger joints could affect the development of a rare, unique arthropathy or deformity.

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REFERENCES

1. Moore JS, Garg A: The Strain Index: A proposed method to analyze jobs for risk of distal upper extremity disorders. Am Ind Hyg Assoc J 1995; 56: 443–56

2. Radin EL, Parker HG, Paul IL: Pattern of degenerative arthritis. Preferential involvement of distal finger-joints. Lancet 1971; 1: 377–9

3. Williams WV, Cope R, Gaunt WD, et al.: Metacarpophalangeal arthropathy associated with manual labor (Missouri metacarpal syndrome). Clinical, radiographic, and pathologic characteristics of an unusual degeneration process. Arthritis Rheum 1987; 30: 1362–71

4. Wigzell FW: Ulnar deviation of the fingers as a clinical sign in the elderly. Age Ageing 1976; 5: 132–40

© 2013 Lippincott Williams & Wilkins, Inc.

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