Upper Limb Arthritis Flashcards
Name 4 causes of upper limb arthritis?
Degenerate, inflammatory, post-traumatic, septic
How often should steroid injections be used in upper limb arthritis?
Once or twice a year
What are the pros and cons of joint replacement?
Takes away the pain but there may be loss of range of movement
How common in sternoclavicular joint OA? How will it present?
Rare- will present as a swelling with no trauma
What are the main treatments for sternoclavicular OA?
Physio and injections
Why is surgery not recommended for sternoclavicular joint OA?
Too close to important structures
How common is AC joint OA? What condition does it overlap with?
Vey common- overlaps with impingement syndrome
What are the main treatments for AC joint OA?
Injections, excision
Why does surgical excision of osteophytes in AC joint OA not destabilise the joint?
Because the capsule is maintained, and the clavicle is held in place with ligaments
What can glenohumeral joint OA be related to?
Cuff tear, instability, previous surgery, trauma
What are some symptoms of OA in the glenohumeral joint?
Pain, crepitus and loss of movement
What movement will be most likely to be lost in glenohumeral joint OA?
External rotation
How is a partial shoulder replacement done?
Uses hydroxyapatite instead of cement which allows the bone to grow around it
What are some complications of shoulder replacement?
Infection, instability, stiffness, nerve damage, loosening
What nerve is most likely to be damaged in shoulder replacement?
Axillary
How long will a shoulder replacement generally last?
10-15 years
What is usually the first sign of OA on an x-ray?
Osteophytes
What is cuff tear arthropathy?
A type of degenerative osteoarthritis that develops over time after the rotator cuff has been damaged
Why will shoulder replacements fail in cuff tear arthropathy?
Because there is no rotator cuff to hold it in place
What type of arthritis is most likely to present at the elbow?
Rheumatoid
When will OA occur at the elbow?
Following trauma (especially intra-articular fractures)
Arthritic change at the radio-capitellar joint which is not managed conservatively can be managed with what? What are the outcomes?
Surgical excision of the radial head, good pain relief with limited functional loss
Severe humero-ulnar arthritis which is not managed conservatively can be treated with what?
Elbow replacement
What will be features of elbow RA?
Erosions and instability
What will be features of elbow joint OA?
Pain, restricted movement, osteophytes
Which joint of the elbow is a secondary stabiliser only and can be excised or replaced?
Radio-capitellar joint
What is the only differential for radiocapitellar joint OA?
Tennis elbow
Who are elbow replacements successful in?
Older patients (they don’t last long enough to use in young patients)
What is weight lifting limited to following elbow replacement?
2.5kg
OA of the radoiocarpal joint usually occurs as a consequence of what? Give examples.
Trauma: scaphoid non-union or carpal dislocation
Wrist instability can be caused by what? When does that occur?
Scapholunate advanced collapse (SLAC) following a FOOSH
What happens in SLAC? What is this known as?
The scaphoid and lunate bones move apart from each other which results in a predictable pattern of arthritis (Terry Thomas Sign)
What can degenerative arthritis as a result of SLAC progress to?
Scaphoid non-union advanced collapse (SNAC) which results in chronic malunion of the scaphoid
What are some treatment options for wrist arthritis?
Fusion of certain bones or total wrist arthrodesis
What joints of the hands are most commonly affected by OA?
DIPs
What are some symptoms of OA at the DIPs?
Pain, deformity, swelling, Heberden’s nodes
What also may be associated with Heberden’s nodes at the DIPs?
Mucous cysts
Who is DIP joint OA most common in?
Post menopausal women
What are some conservative managements for DIP joint OA?
NSAIDs, activity modification, capsaicin gel, infections
What is the surgical management for mild-moderate DIP joint OA?
Removal of osteophytes and excision of mucous cysts
What is the surgical management for severe DIP joint OA?
Arthrodesis (fusion)
After the DIPs, what is the second most common site of OA?
Base of the thumb (1st CMC)
What is the long name for the base of the thumb joint which is affected by OA?
Trapeziometacarpal joint
What treatment is used for acute flare ups of base of thumb OA?
Steroid injections
What are some surgical treatments for base of thumb OA?
Excision arthroplasty (trapeziectomy) or fusion
Can the PIP joint be affected by OA?
Yes
Where are Bouchard’s nodes seen?
PIPs
What are some surgical managements for PIP joint OA?
Arthrodesis of index finger (to maintain pincer grip) or replacement arthroplasty of other fingers
OA rarely affects the MCP joints without a reason. What are some reasons?
Previous injury, occupational strain, gout or infection
MCP joint OA can be treated with MCP replacements. What are some risks of this?
Ulnar drift or extensor tendon subluxations
What are some surgical options for hand RA?
Synovectomy, tendon realignment, replacement, fusion
Psoriatic arthritis can be seen in the hands, what is the main feature which will distinguish it from RA?
Dactylitis (will also more likely be asymmetrical)
Does psoriatic arthritis have systemic symptoms?
Yes
Which carpal bones can be affected by OA? What is the treatment?
The joints between the scaphoid, trapezium and trapezoid - fusion of these bones or wrist fusion
Which joints of the hands does RA spare?
DIPs
What are the 3 stages of RA in the hand?
- Synovitis and tenosynovitis 2. Erosion of joints 3. Joint instability and tendon rupture
Subluxations and chronic tenosynovitis in RA can predispose to what?
Extensor tendon ruptures
What are some deformities which RA can cause?
Volar MCP joint subluxation, ulnar deviation, swan neck deformity, Boutonniere deformity
What happens in a swan neck deformity?
Hyperextension at the PIP, flexion at the DIP
What happens in a Boutonniere deformity?
Flexion at the PIP, hyperextension at the DIP
When extensor tendons to the wrist rupture, what treatments can be used to preserve function?
Tendon transfer or joint fusions
What joints can be replaced or fused in RA of the hand?
PIP and MCP
What treatment can be used for arthritis of the distal radioulnar joint?
Resection of the distal ulna
