Hand function in systemic sclerosis: A clinical and ultrasonographic study

Aim of the work: To evaluate hand impairment and functional disability in scleroderma patients using clinical and ultrasonographic (US) measures. Patients and methods: Fifteen scleroderma patients and 10 age and sex-matched healthy controls were studied. Patients underwent clinical examination including modified Rodnan skin score. Hand function assessment included pinch and grip strength measurement, finger range of motion (ROM) assessment, Hand Mobility in Scleroderma (HAMIS) test and Hand Functional Index (HFI). Hand disability was assessed by Health Assessment Questionnaire (HAQ), Scleroderma HAQ Visual Analogue Scale (SHAQ VAS) and Cochin scale. US hand examination included measuring hand skin thickness, screening of the finger flexor and extensor tendons, measuring cartilage thickness of the 2nd MCP joint, anteroposterior thickness of the flexor retinaculum, and surface area of the median nerve. Results: Nine patients had healed digital ulcers while only one patient had active ulcers. Seven patients had arthralgia in the hand joints. The patients had a significant decrease in grip strength and finger ROM. By US, patients showed significant increase in hand skin thickness and flexor retinaculum thickness and a significant decrease in median nerve surface area. Hand disability measures showed variable significant correlations with pinch and grip strength and hand mobility measures which were significantly correlated with US skin thickness of the 2nd inter-metacarpal web space. Conclusions: Hand disability in scleroderma was mainly related to impaired hand mobility and also diminished strength. The use of US in adjunct to clinical examination refines the evaluation of hand impairment in scleroderma.