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Article
October 16, 1954

AVASCULAR NECROSIS OF THE PHALANGES OF THE HANDS (THIEMANN'S DISEASE)

Author Affiliations

San Diego, Calif.

JAMA. 1954;156(7):711-713. doi:10.1001/jama.1954.02950070039009c
Abstract

In 1909, H. Thiemann described a typical, localized, epiphysial disease of the fingers and toes. As a rule the disease involves both hands; it generally affects the proximal interphalangeal joints of the middle fingers of both hands, but in a good proportion of the cases described the second, third, fourth, and, occasionally, fifth fingers have been affected. The lesions attack both hands but not always the same joints. The disease has been associated with similar lesions in the great toe and in the first tarsometatarsal joint. The disease was noted only in late childhood and during adolescence. The onset is usually insidious, sometimes with a history of trauma or exposure of the hands to cold. Fusiform swelling of the proximal interphalangeal joint occurs and is associated with some restriction of movement. No skin changes are present as a rule. Cases have been described by Esau, Dahs, Kloiber, Weil, Dessecker, and

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