Upper Limb Arthritis Flashcards
How does OA usually present in the sternocalvicular joint?
joint swelling
pain
How are sternoclavicular and acromioclavicular OA usually managed?
physio
injection
excision (rare)
What other pathology is usually coupled with acromioclavicular OA?
Impingement
May be due to trauma
Shoulder OA of the glenohumeral joint is more common than arthritis of the Hip or Knee. TRUE/FALSE
FALSE
Hip/knee arthritis is more common
What can predispose to shoulder OA?
cuff tear
instability
previous surgery
idiopathic
What symptoms are usually apparent in shoulder OA?
- Pain
- crepitus (grinding)
- loss of movement (esp external rot.)
What are the complications of a shoulder replacement?
Infection Instability Stiffness Nerve damage Loosening
How do rotator cuff tears lead to OA of the shoulder?
Rotator cuff centres humerus on glenoid
=> If rotator cuff is torn, deltoid pulls head upwards
- Abnormal forces on glenoid from humerus in new position leads to OA
What is the point of a Reverse Geometry Shoulder Replacement?
- increases lever arm of deltoid
- lengthens deltoid
- resurfaces joint
- prevents upward migration of humerus
What types of arthritis is the elbow prone to developing?
RA and OA
Describe the difference between a rheumatoid X-Ray and an osteoarthritis X-Ray?
RA:
- Erosion
- Instability
OA: L - Loss of joint space O - Osteophytes S - Subchondral sclerosis S - Subchondral Cysts
Is it vital to replace the radial head in radiocapitellar OA?
Not necessarily
It is only a secondary stabiliser
What section of the humerus may be cut through if osteophytes are beginning to cause impingement?
The olecranon fossa
What is the downside to an elbow replacement?
Doesn’t last very long => not good for younger pts
Limited weight bearing to 5kg or 1kg repeatedly
What types of arthritis can be found in the wrist?
RA and OA
How are rheumatoid arthritis deformities of the hand treated?
- steroid injections
- splintage/aids
- surgery = synovectomy/tendon realign/fusion
What X-Ray sign is seen in a Scapholunate advanced collapse (SLAC)?
Large gap between the scaphoid and lunate
What are Heberdens Nodes?
OA in the DIPs
How are heberdens nodes (or small joint arthritis in general) treated?
- NSAIDS, activity modification, capsaicin gel
- Injections
- fusion
What symptoms can OA of the thumb base cause?
subluxation of CMC joint
pain especially in pinch
What X-Ray sign is often seen in psoriatic arthritis?
Pencil-in-cup deformity
What joints does psoriatic arthritis most commonly affect?
Hips, knees, hands/wrists
Describe the difference between a “Swan neck” deformity of the fingers and a “Boutonniere” deformity
Swan Neck:
PIP = hyper-extended
DIP = flexed
Boutonniere:
PIP = flexed
DIP = hyper-extension
How are swan neck and boutonniere deformities managed?
Splinting to neutral
Surgery - tendon repositioning