Management of Upper Limb Arthritis

Question 1

What are the symptoms of arthritis?

Answer 1

Pain, swelling, stiffness, deformity, loss of function

Question 2

What are some causes of arthritis of the upper limb?

Answer 2

Degenerative (OA), inflammatory (RA, gout, psoriasis), post-traumatic, septic

Question 3

What are the basic treatment principles for upper limb arthritis?

Answer 3

Do nothing, rest/analgesia/splintage, steroid injections, replace, fuse, excise

Question 4

What are some features of sternoclavicular joint arthritis?

Answer 4

Rare, swelling/pain at joint

Treatment = physio, injections, rarely excision

Question 5

What are some features of acromioclavicular joint arthritis?

Answer 5

Very common, often overlaps with impingement, may be due to trauma, often presents with tender bump

Question 6

How is arthritis of the acromioclavicular joint treated?

Answer 6

Injections or excision

Question 7

What are some features of glenohumeral joint arthritis?

Answer 7

Less common site than hip/knees, may be due to cuff tear, instability, previous injury or primary OA

Question 8

What are the symptoms of glenohumeral arthritis?

Answer 8

Pain, crepitus, loss of movement (especially external rotation)

Question 9

What are the two surgical options for glenohumeral arthritis?

Answer 9

Hemi-arthroplasty or total arthroplasty

Question 10

What are some complications of shoulder replacements?

Answer 10

Infection, stiffness, instability, nerve damage, loosening

Question 11

How does rotator cuff arthropathy arise?

Answer 11

Rotator cuff centres humeral head in glenoid, if torn then deltoid pulls head upwards, abnormal forces on glenoid leads to OA

Question 12

What is the main surgical option for treating rotator cuff arthropathy?

Answer 12

Reverse polarity shoulder replacement = rotator cuff removed

Complications are common, deltoid function begins to deteriorate after 8-10 years

Question 13

What are some less common surgical methods used to treat rotator cuff arthropathy?

Answer 13

Shoulder fusion and excision arthropathy

Question 14

What are some causes of elbow arthritis?

Answer 14

Most commonly RA = causes instability and erosion

OA = usually only radio-capitellar joint, very stiff, end range pain, reduced ROM

Question 15

What are the treatments for radio-capitellar OA?

Answer 15

Excise or replace

Question 16

What may need to be done for OA of the elbow?

Answer 16

Osteophyte impingement can occur = surgical shaving off of osteophytes

Question 17

What are some features of elbow replacements?

Answer 17

Either constraint or non-constraint, not good for young/active patients, limit to 5lbs/1kg when lifting repeatedly

Question 18

What are the causes of arthritis of the wrist?

Answer 18

Most commonly post-traumatic

RA and OA also occur

Question 19

What are some surgical options for RA of the wrist?

Answer 19

Synovectomy, tendon realignment, replacement, wrist fusion

Question 20

What group of patients are wrist replacements unsuitable for?

Answer 20

Young patients

Question 21

What are some causes of wrist instability?

Answer 21

Scapholunate advanced collapse (SLAC)

Scaphoid non-union advanced collapse (SNAC)

Question 22

What surgery is done to treat wrist instability?

Answer 22

4 corner fusion or proximal row carpectomy

Question 23

What is the treatment for OA of the CMC at the base of the thumb?

Answer 23

Steroid injection, rest, analgesia, surgery (trapeziectomy)