ROLE OF THE FINGER FLEXORS IN RHEUMATOID DEFORMITIES OF THE METACARPOPHALANGEAL JOINTS.

HEN LOOKING for the major cause of deformity in the rheumatoid W metacarpophalangeal joint, several clinical observations offer clues. The characteristics of the early deformity recur with remarkable consistency, being comprised of varying degrees of luxation of the proximal phalanx in a volar and an ulnar direction, and deviation in an ulnar dir~ti0n.l.~ Secondly, the deformity has both passive and dynamic aspects. Passively, the finger can be luxated and deviated more than normal, even though it may be readily returned to a normal position in many patient^.^^^ Dynamically, the finger tracks along a more luxated and ulnarly deviated path during voluntary active flexion.? The passive deformity implies a loss of integrity of the specific structures normally preventing deviation and luxation. This damage in turn is indicative of forces acting consistently in the direction of the passive deformity. The dynamic deformity implies a new balance of forces during MCP flexion, which are in dynamic equilibrium only when the finger is tracking along a more ulnar and luxated path. In fact, some patients are totally unhble to

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