Pitfalls

• Unrecognized instability of the cervical spine can result in disastrous consequences during anesthetic and operating room maneuvering.

• Complications related to deformity are usually related to surgical technique.

Physical Examination

The cervical spine range of motion is full and nontender. The posture of the index finger demonstrates a 20-degree flexion contracture with pain on attempted range of motion. Palpation of the distal interphalangeal (DIP) joint is tender with associated enlargement of the joint consistent with the presence of osteophytes. There is no evidence of erythema, drainage, or open wounds. Attempts at assessing pinch strength are associated with pain.

Diagnostic Studies

Cervical spine radiographs fail to identify potential instability. Two views of the hand demonstrate severe degenerative changes in the long finger DIP joint with joint space narrowing, sclerosis, and subcortical erosions with osteophyte formation

Differential Diagnosis

Degenerative joint disease Rheumatoid arthropathy Septic joint

Diagnosis

Degenerative Joint Disease of the Index Distal Interphalangeal Joint with Underlying Rheumatoid Arthritis

Distal interphalangeal joint disease in the rheumatoid patient encompasses a spectrum of injury patterns ranging from degenerative joint disease to inflammatory

Osteophyte Formation Cervical SpineOsteophyte Formation Cervical Spine

Figure 71—1. (A,B) Radiographs demonstrating severe degenerative changes in the long finger distal interphalangeal (DIP) joint with joint space narrowing, sclerosis, erosions, and osteophyte formation.

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