FREE NEET PG MCQ on 14 Oct 2016

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Question
“Z line” deformity associated with rheumatoid arthritis result from which of the following hand joint changes ?

A. Subluxation of the distal ulna
B. Hyperextension of the PIP joint with flexion of the DIP joint
C. Flexion of the PIP joint with hyperextension of the DIP joint
D. Subluxation of the first MCP joint with hyperextension of the first interphalangeal joint

TIPSImportant Question from NEET PG

Answer : D. Subluxation of the first MCP joint with hyperextension of the first interphalangeal joint
Explanation : 

Z line deformity seen in rheumatoid arthritis result from subluxation of the first MCP joint with hyperextension of the first interphalangeal joint.

Other hand deformities associated with it are:

  • Swan-neck deformity due to  hyperextension of the PIP joint with flexion of the DIP joint
  • Boutonnière deformity due to flexion of the PIP joint with hyperextension of the DIP joint
  • Ulnar deviation due to subluxation of the MCP joints, with subluxation of the proximal phalanx to the volar side of the hand.
  • Piano-key movement of the ulnar styloid due to inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris resulting in subluxation of the distal ulna.

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Reference :

Shah A, St. Clair E. Rheumatoid Arthritis. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19e.

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