Upper limb arthritis Flashcards
What are the general symptoms of upper limb arthritis?
Pain Stiffness Loss of function Swelling Deformity
What are the causes of upper limb arthritis?
Degenerative/osteoarthritis
Inflammatory (rheumatoid, gout, psoriasis)
Post-traumatic
Septic
What are the treatment options for upper limb arthritis’?
Rest Analgesia Splint Steroid injections Replace Fuse Excise
How does sternoclavicular arthritis present?
Pain and swelling
How common is sternoclavicular arthritis?
Rare
How can sternoclavicular joint arthritis be treated?
Physiotherapy
Steroid injection
Excision (rarely)
How common is acromioclavicular joint arthritis?
Common
How does acromioclavicular joint arthritis present?
Often in conjunction with rotator cuff impingement
Post-trauma
How can acromioclavicular joint arthritis be treated?
Steroid injections
Excision
How common is glenohumeral joint arthritis compared to knee/hip arthritis?
Uncommon
What are the possible causes of glenohumeral joint arthritis?
Instability
Cuff tear
Previous surgery
Idiopathic
How does glenohumeral joint osteoarthritis present?
Pain
Crepitus
Loss of movement (external rotation)
How can glenohumeral joint arthritis be managed?
Hemiarthroplasty
Total shoulder replacement
What are the possible complications of shoulder replacement?
Infection Instability Stiffness Nerve damage Loosening
How does rotator cuff arthroplathy occur?
Rotator cuff tear means that deltoids are unopposed and so pull head upwards these abnormal forces cause osteoarthritis
How can rotator cuff arthroplathy not be treated?
Traditional shoulder replacement
How does a rotator cuff arthropathy appear on x-ray?
LOSS
Humeral head moves superiorly (loss of normal space)
How should rotator cuff arthropathy be treated?
Reverse geometry shoulder replacement
What are the last resort treatments for arthritis of the shoulder?
Fusion
Excision
What are the causes of arthritis at the elbow?
Rheumatoid arthritis
Osteoarthritis
Where can arthritis of the elbow occur?
Radiocapitellar joint
Ulnohumeral
How does rheumatoid arthritis of the elbow present?
Instability
How does rheumatoid arthritis of the elbow look on x-ray?
Erosions
How does osteoarthritis of the elbow present?
Pain
Reduced movement
How does osteoarthritis of the elbow look on x-ray?
May be radiocapitellar only
Osteophytes
LOSS
How is radiocapitaller osteoarthritis managed? How can it be managed in this way?
Excision
Replacement
It is only a secondary stabiliser
Why might there be reduced movement at the elbow joint?
Osteophyte impingement
When is elbow replacement indicated?
Older patients
Low demand patients
Limited to 5kg/1kg repeatedly
What are the features of wrist osteoarthritis?
Monoarticular/localised
Base of thumb
Associated PIP and DIP joints
What are the features of wrist osteoarthritis on an x-ray?
LOSS
What are the features of wrist rheumatoid arthritis?
Polyarticular Systemic Synovitis Tendon rupture Associated MCP joints
What are the features of wrist rheumatoid arthritis on an x-ray?
Erosions
Late joint space narrowing
How is rheumatoid arthritis of the wrist treated?
Medical (DMARDs)
Steroid injections
Splintage
Surgery
What types of surgery for rheumatoid arthritis of the wrist are available?
Synovectomy
Tendon realignment
Replacement
Fusion
What is scapholunate advanced collapse?
Wrist malalignment due to a complication of post-traumatic or spontaneous osteoarthritis
What is scapholunate non-union advanced collapse?
A complication which occurs with scaphoid fractures
How can scapholunate advanced collapse be treated?
4-corner fusion
Proximal row carpectomy
Total wrist arthrodesis
How does small joint osteoarthritis present?
Pain
Deformity
Heberden’s nodes
Bouchard’s nodes
How is small joint osteoarthritis treated?
NSAIDs Activity modification Capsacian gel (relieves pain and itch) Injections Fusion
How does CMC thumb osteoarthritis present?
Pain increased in pinch grip
Subluxation
Is CMC thumb osteoarthritis common?
Yes
How is CMC thumb osteoarthritis managed?
Rest Analgesia Splints Capsaicin gel Steroid injection Surgery
