Upper Limb Arthritis Flashcards
what are the general symptoms of arthritis
pain, swelling, stiffness, deformity, loss of function
where does cartilage gets its nutrients from
the synovial fluid
what is the basic treatment for arthritis at the sternoclavicular joint
physio, injection, excision (rare)
what does the scarf test show
acromioclavicular joint pathology/ injury
what can cause glenohumeral joint pain
cuff tear, instability, previous surgery, idiopathic
what can cause acromioclavicular joint pain
may be due to trauma, often overlaps with impingement
how do you treat acromioclavicular arthritis
injection, excision
what are the signs of glenohumeral joint OA
pain, crepitus (grinding), loss of movement (esp external rotation)
what osteophytes are often seen in glenohumeral OA
inferior (on humeral head)
what are the complications of shoulder replacement complications
infection, instability, stiffness, nerve damage, loosening
what is neuropraxia
stretching but not rupture of a nerve
how does a cuff tear lead to OA
deltoid pulls head upwards, abnormal forces on gleaned leads to OA
describe reverse geometry shoulder replacement
reverses the ball and socket (ball in glenoid cavity) increases level arm of deltoid lengthens deltoid resurfaces joint prevents upward migration
what can RA cause in the elbow
erosion and instability
what are the features of OA in the elbow
pain, restriction of movements, osteophytes, may be radiocapitellar only
what is the treatment for radiocapitellar OA
radial head only secondary stabiliser (not vital) so can excise or replace
what are the downfalls of elbow replacements
limited life span
no good for young/ active
limited to 5kg/ 1kg repeatedly
what joint in hand does OA usually affect
PIPs and DIPs
spares MCPs
what are features of RA
polyarticular, systemic, erosions, later joint space narrowing, synovitis, tendon rupture (due to synovitis)
what are the options for rheumatoid surgery
synovectomy,
tendon realignment,
replacement,
fusion
what is the terry thomas sign
injury into outstretched hand can cause scapholunate advanced collapse (SLAC wrist)
What is a SNAC wrist
scaphoid non union advanced collapse
what movements can a fused wrist do
twist but not flex
what joints in the hands in commonly affected by OA
DIP (#1 in body)
base of thumb (1st CMC (carpometacarpal) (#2 in body)
what are the signs of small joint OA
pain, deformity, heberden’s or oster’s nodes
what is the treatment for small joint OA
NSAIDs, activity modification, capsaicin gel, injections, fusion
what is the main sign of base of thumb OA
subluxation of CMCjt causing squaring of hand, pain- esp in pinch movement
what is the treatment for thumb CMCjt OA
rest, analgesia, splints, capsaicin gel, steroid injection, surgery
what is seen on x ray of psoriatic arthritis
similar to RA- pencil in cup
what is seen in the fingers in psoriatic arthritis
dactylitis, skin and nail changes
what is the treatment options for all joints with arthritis
rest/ analgesia/ activity modification/ splintage
injections may provide temporary relief
surgery- fusion, replacement, excision
what are the tendon complications of RA
swan neck deformity,
boutonniere,
describe what causes a swan nwck deformity
volar plate of PIP jt becomes attenuated. small ligaments + lumbrical tendons fall more dorsal to joint centre
describe what causes a boutonniere deformity
extensor hood of PIPjt becomes attenuated
slips of extensor tendon move from dorsal to volar to centre of rotation
causes flexion of PIPjt
middle phalangeal head buttonholes through the extensor hood
lateral slips of extensor tendon stretched around PIPjt causes hyperextension of DIPjts
what is the treatment for swan neck or boutonniere defomities
splintage, surgery (tendon reposition)
