The relation of gout and rheumatism to Dupuytren's contraction of palmar fascia, with results of treatment by Adams' operation : being a thesis for the M.B. degree at Cambridge University / by Charles Edward Hedges.

Hedges, Charles Edward, 1866-

Date:: [1897]

Credit: The relation of gout and rheumatism to Dupuytren's contraction of palmar fascia, with results of treatment by Adams' operation : being a thesis for the M.B. degree at Cambridge University / by Charles Edward Hedges. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$He wore splints two montlis Jifter operation. Fing’ers of botli hands are better and straigliter. lie is well able to follow his employment. The fingers are somewhat contracted and are gradtially becoming more so. 1 le wears no splints at the present time. 3. S. L., male, 32, letterpress printer, admitted March 21, 1892, complaining of bent lingers, and in consequence being unable to properly follow his employment. Condition of hand before operation.—The ring and little fingers of the right hand in a state of forcible flexion ; the other fingers of both hands are normal. Operation on March 30, 1892, by Mr. Willett.—Multiple sub- cutaneous incisions by a small tenotomy knife ; in all, nine punctures made between the skin and fascia, and fascia divided by cutting downwards ; the fingers were then at once forcibly straightened and bandaged to a hand splint. Splint was re- moved on April 20, and left off as the skin over the outer side of metacarpal bone, on outer aspect of its palmar surface and on inner side of little finger, liad sloughed. The notes say patient left the Hospital improved. On ]\Iay 16, 1895, three years after the operation, the state of the hand is as follows :—Both fingers are (juite straight; the tense band can still be felt running up to both the ring and little finger of right hand. I’atient is unable to flex these two fingers at inter-phalangeal joints, nor can they be forcibly bent to any great degree; the joints are somewhat flattened and thickened. Flexion at the metacarpo - phalangeal joints is perfect. On account of the inability to flex the two joints I have mentioned, he was unable to further follow his employ- ment. So although in his case the fingers were straightened, the fingers became practically useless to him in his occupation. The grasp of the thumb, index, and middle finger is good. 4. E. J. M., 53, porter, was admitted into Hospital on ^larch 16, 1892, suffering from a contracted left ring-finger. It did not much interfere wdth his work. Condition of hand before operation.—ring-finger was bent chiefly at metacarpo-phalangeal joint, so that tip of this finger was bent to within one inch of palm, and little finger also some- what flexed ; all other fingers normal. Operation on March 18, 189-) 'Thomas Smith. Ihe contracted band of fascia was divided subcutaneously in several places with a tenotomy knife, finger partially straightened and bandaged on to a back splint, which the patient wore for two weeks after the operation.$