Upper limb arthritis Flashcards
What are the different causes of upper limb arthrtiis?
Degenerate
Inflammatory (RA, psoriasis, gout)
Post-traumatic
Septic
How can steronoclavicular joint arthritis be treatead?
PT
Steroid injections
Exicion - very rare, dont do in tayside bc need CT surgeon
What movements are sore in ACJ arthritis?
Full abduction when arms are by ears
Scarf test
What is the treatemtn of ACJ arthritis?
Steroid injections
Excision - mumford procedure
What pathologies can occur around the glenohumeral joint?
Cuff tear
Instability
Previous surgery
Idiopathic
How will glenohumeral joint OA present?
Pain
Crepitus (grinding)
Loss of movement esp/ external rotation
What shoulder pathologies cause a loss of external rotation?
Locked posterior dislocation
OA
Frozen shoulder
What are the x-ray changes in glenohumeral OA?
Inferior osteophyte is very classical
What complications can arise due to a shoulder replacement?
Infection Instability Stiffness Nerve damage (neuropraxia) Loosening
What will happen to the humerus if the rotator cuff tears?
Rotator cuff centres humeral head on glenoid so if torn the deltoid will pull the head upwards
What is a reverse geometry shoulder replacement?
Reverses ball and socket
Increases lever arm of deltoid and therefore lengthens deltoid
Resurfaces joint
Prevents upward migration
How does RA affect the elbow?
Erosion
Instability
How will OA affect the elbow joint?
Pain
Restriction of movement
Osteophytes
Can be radiocapitellar only
What can be done to treat radiocapitellar OA?
Excise
Replace
Compare OA to RA
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
What surgery can be done to help with RA?
Synovectomy
Tendon realingment
Replacement
Fusion
What joint does well with arthrodesis?
Wrist
MCP
What is the terry thomas sign?
Space between the scaphoid and lunate bones
What pathology will show a terry thomas sign?
SLAC (scapholouante advanced collapse) wrist
What is SNAC wrist?
Sacphoid nonunion advanced collapse
How will OA affect the small joints of the hands?
DIPs common
Pain
Deformity
Heberden’s nodes
How will OA affect the thumbs?
Trade-off of opposable thumbs and results in subluxation of CMCJ
Pain in pinch
How will OA of the thumb look on examination?
Squaring of the hand
Compensatory hyperextension of the MCP joint
How will psoriatic arthrtis present?
Inflammatory arthrtiis
Systemic symtpoms in skin, hair, nails
Affects hips, knees, hands and wrisits
Causes dactylitis
What will psoriatic arthrtis look like on x-ray?
Pencil in cup
What is a swan neck deformity?
Volar plate of PIP becomes attenuated
Hyperextension at PIP
Flexion at DIP
What is a boutonniere deformity?
Extensor hood of PIP becomes attenuated
Flexion at PIP and hyperextension at DIP
