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Answer :
Final answer:
Boutonniere deformity in rheumatoid arthritis involves PIP joint flexion and DIP joint hyperextension. While tenotomy can correct this deformity, it should be part of a broader treatment approach. The deformity itself is caused by the disruption of the extensor mechanism and dorsal subluxation of the lateral cords.
Explanation:
The question seems to refer to the condition known as Boutonniere deformity, which is commonly associated with rheumatoid arthritis (RA). This deformity involves flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint on a finger. In addressing the specific choices given:
a) The assertion that Boutonniere deformity is not associated with metacarpophalangeal (MCP) and DIP pathology is not entirely accurate. While the hallmark of Boutonniere deformity is PIP joint flexion and DIP joint hyperextension, RA can cause pathology at any joint in the finger, including MCP and DIP joints.
b) A tenotomy can indeed correct a Boutonniere deformity. This procedure involves cutting the tendon to release tension, allowing for improved joint positioning. However, it must be clearer that this procedure is complementary to other methods, such as splinting and physical therapy.
c) Arthrodesis may be considered a treatment option for a stiff PIP joint, although it is generally a last resort due to the potential loss of joint movement.
d) Boutonniere deformity is caused by the disruption of the extensor mechanism, leading to dorsal subluxation or displacement of the lateral bands that are part of the extensor apparatus. Therefore, this option is correct.
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