Upper limb arthritis

Question 1

What are the different causes of upper limb arthrtiis?

Answer 1

Degenerate
Inflammatory (RA, psoriasis, gout)
Post-traumatic
Septic

Question 2

How can steronoclavicular joint arthritis be treatead?

Answer 2

PT
Steroid injections
Exicion - very rare, dont do in tayside bc need CT surgeon

Question 3

What movements are sore in ACJ arthritis?

Answer 3

Full abduction when arms are by ears

Scarf test

Question 4

What is the treatemtn of ACJ arthritis?

Answer 4

Steroid injections

Excision - mumford procedure

Question 5

What pathologies can occur around the glenohumeral joint?

Answer 5

Cuff tear
Instability
Previous surgery
Idiopathic

Question 6

How will glenohumeral joint OA present?

Answer 6

Pain
Crepitus (grinding)
Loss of movement esp/ external rotation

Question 7

What shoulder pathologies cause a loss of external rotation?

Answer 7

Locked posterior dislocation
OA
Frozen shoulder

Question 8

What are the x-ray changes in glenohumeral OA?

Answer 8

Inferior osteophyte is very classical

Question 9

What complications can arise due to a shoulder replacement?

Answer 9

Infection
Instability
Stiffness
Nerve damage (neuropraxia) 
Loosening

Question 10

What will happen to the humerus if the rotator cuff tears?

Answer 10

Rotator cuff centres humeral head on glenoid so if torn the deltoid will pull the head upwards

Question 11

What is a reverse geometry shoulder replacement?

Answer 11

Reverses ball and socket
Increases lever arm of deltoid and therefore lengthens deltoid
Resurfaces joint
Prevents upward migration

Question 12

How does RA affect the elbow?

Answer 12

Erosion

Instability

Question 13

How will OA affect the elbow joint?

Answer 13

Pain
Restriction of movement
Osteophytes
Can be radiocapitellar only

Question 14

What can be done to treat radiocapitellar OA?

Answer 14

Excise

Replace

Question 15

Compare OA to RA

Answer 15

OA: monoarticular, localised, osteophytes, early jt space narrowing, base of thumb, PIP + DIPs
RA: polyarticular, systemic, erosions, later joint space narrowing, synovitis, tendon rupture, MCP, carpus

Question 16

What surgery can be done to help with RA?

Answer 16

Synovectomy
Tendon realingment
Replacement
Fusion

Question 17

What joint does well with arthrodesis?

Answer 17

Wrist

MCP

Question 18

What is the terry thomas sign?

Answer 18

Space between the scaphoid and lunate bones

Question 19

What pathology will show a terry thomas sign?

Answer 19

SLAC (scapholouante advanced collapse) wrist

Question 20

What is SNAC wrist?

Answer 20

Sacphoid nonunion advanced collapse

Question 21

How will OA affect the small joints of the hands?

Answer 21

DIPs common
Pain
Deformity
Heberden’s nodes

Question 22

How will OA affect the thumbs?

Answer 22

Trade-off of opposable thumbs and results in subluxation of CMCJ
Pain in pinch

Question 23

How will OA of the thumb look on examination?

Answer 23

Squaring of the hand

Compensatory hyperextension of the MCP joint

Question 24

How will psoriatic arthrtis present?

Answer 24

Inflammatory arthrtiis
Systemic symtpoms in skin, hair, nails
Affects hips, knees, hands and wrisits
Causes dactylitis

Question 25

What will psoriatic arthrtis look like on x-ray?

Answer 25

Pencil in cup

Question 26

What is a swan neck deformity?

Answer 26

Volar plate of PIP becomes attenuated
Hyperextension at PIP
Flexion at DIP

Question 27

What is a boutonniere deformity?

Answer 27

Extensor hood of PIP becomes attenuated

Flexion at PIP and hyperextension at DIP