Management of Upper Limb Arthritis

Question 1

Symptoms of upper limb arthritis?

Answer 1

PAIN, swelling, stiffness, deformity and loss of function

Question 2

Types of upper limb arthritis?

Answer 2

Degenerative (OA)

Post-traumatic (secondary OA)

Inflammatory (RA, psoriatic, gout)

Septic

Question 3

Principles of treating upper limb arthritis?

Answer 3

Rest/analgesia/splintage

Steroid injections

Joint replacement

Fusion (rarely used now)

Excision (may be an option in elderly patients with decreased functional requirements)

Question 4

Signs of sternoclavicular joint arthritis and treatment?

Answer 4

Rare but it causes swelling/pain at the SC joint

Treatment include physiotherapy, injections and, rarely, excision

Question 5

Describe acromioclavicular joint arthritis and treatment

Answer 5

Very common; it may be due to trauma

It often overlaps with shoulder impingement

Treatment:
• Injections
• Excision

Question 6

Describe glenohumeral joint arthritis and causes

Answer 6

Less common than hip/knee and may occur due to:
• Rotator cuff tear
• Shoulder instability
• Previous surgery
• Idiopathic

Question 7

Symptoms and signs of GH joint arthritis?

Answer 7

Pain, crepitus (grinding) and loss of movement (esp. LOSS OF EXTERNAL ROTATION)

Question 8

Complications of shoulder joint replacements?

Answer 8

Infection

Instability (increased risk of dislocation)

Stiffness

Nerve damage

Loosening of the joint

Question 9

Describe how cuff tears can lead to OA

Answer 9

The rotator cuff centres the humeral head on the glenoid; if torn, the deltoid pulls the head upwards

Abnormal forces on the glenoid lead to OA; an anatomic shoulder replacement will fail

Question 10

How does reverse geometry shoulder replacement help arthritis?

Answer 10

Reverses the ball and socket which:
• Increases the level arm of the deltoid 
• Lengthen the deltoid
• Resurfaces the joint
• Prevents upward migration

But this is new surgery and may have complications

Question 11

Treatment of radiocapitellar OA?

Answer 11

Radial head is only a secondary stabiliser and so it is not vital, thus it can be:
• Excised
• Replaced

Question 12

Wrist problems?

Answer 12

RA

OA

Post-traumatic

Instability

Question 13

Compare OA and RA?

Answer 13

Monoarticular vs polyarticular

Localised vs systemic

Osteophytes/sclerosis and early joint space loss vs erosions and joint space loss later

Common at PIP, DIPs and at the base of the thumb vs at the MCPs and carpus

In RA, synovitis occurs and can cause tendon rupture

Question 14

Surgery for RA?

Answer 14

Surgery is rare in RA, due to DMARDs:
• Synovectomy
• Tendon realignment
• Fusion

Question 15

Describe a Scapholunate Advanced Collapse (SLAC)

Answer 15

Most common pattern of degenerative arthritis in the wrist; it can be post-traumatic or OA

Widening of the scapholunate interval on imaging has been called the “Terry Thomas sign”

Question 16

Describe OA at the base of the thumbs

Answer 16

2nd most common site of the body affected by OA (very common)

Results in subluxation of the carpometacarpal joint; there is pain, esp. with pinching

Question 17

Treatment of OA at the CMC joint?

Answer 17

Rest, analgesia, splints and capsaicin gel

Steroid injections

Surgery

Question 18

X-ray signs of psoriatic arthritis?

Answer 18

Pencil in cup deformity on X-ray and similar radiographic signs as in RA

Question 19

Treatment of Boutonniere and swan-neck deformities in RA?

Answer 19

Splintage

Surgery (tendon reposition)