Management of Upper Limb Arthritis Flashcards
What are the symptoms of arthritis?
Pain, swelling, stiffness, deformity, loss of function
What are some causes of arthritis of the upper limb?
Degenerative (OA), inflammatory (RA, gout, psoriasis), post-traumatic, septic
What are the basic treatment principles for upper limb arthritis?
Do nothing, rest/analgesia/splintage, steroid injections, replace, fuse, excise
What are some features of sternoclavicular joint arthritis?
Rare, swelling/pain at joint
Treatment = physio, injections, rarely excision
What are some features of acromioclavicular joint arthritis?
Very common, often overlaps with impingement, may be due to trauma, often presents with tender bump
How is arthritis of the acromioclavicular joint treated?
Injections or excision
What are some features of glenohumeral joint arthritis?
Less common site than hip/knees, may be due to cuff tear, instability, previous injury or primary OA
What are the symptoms of glenohumeral arthritis?
Pain, crepitus, loss of movement (especially external rotation)
What are the two surgical options for glenohumeral arthritis?
Hemi-arthroplasty or total arthroplasty
What are some complications of shoulder replacements?
Infection, stiffness, instability, nerve damage, loosening
How does rotator cuff arthropathy arise?
Rotator cuff centres humeral head in glenoid, if torn then deltoid pulls head upwards, abnormal forces on glenoid leads to OA
What is the main surgical option for treating rotator cuff arthropathy?
Reverse polarity shoulder replacement = rotator cuff removed
Complications are common, deltoid function begins to deteriorate after 8-10 years
What are some less common surgical methods used to treat rotator cuff arthropathy?
Shoulder fusion and excision arthropathy
What are some causes of elbow arthritis?
Most commonly RA = causes instability and erosion
OA = usually only radio-capitellar joint, very stiff, end range pain, reduced ROM
What are the treatments for radio-capitellar OA?
Excise or replace
What may need to be done for OA of the elbow?
Osteophyte impingement can occur = surgical shaving off of osteophytes
What are some features of elbow replacements?
Either constraint or non-constraint, not good for young/active patients, limit to 5lbs/1kg when lifting repeatedly
What are the causes of arthritis of the wrist?
Most commonly post-traumatic
RA and OA also occur
What are some surgical options for RA of the wrist?
Synovectomy, tendon realignment, replacement, wrist fusion
What group of patients are wrist replacements unsuitable for?
Young patients
What are some causes of wrist instability?
Scapholunate advanced collapse (SLAC)
Scaphoid non-union advanced collapse (SNAC)
What surgery is done to treat wrist instability?
4 corner fusion or proximal row carpectomy
What is the treatment for OA of the CMC at the base of the thumb?
Steroid injection, rest, analgesia, surgery (trapeziectomy)
