Upper Limb Arthritis Management Flashcards
how do upper and lower limb differ in terms of function?
lower = large weight bearing forces, only mobility upper = large range of movement, fine control
symptoms of upper limb arthritis?
pain (not always) swelling stiffness deformity loss of function
what can cause upper limb arthritis?
degeneration (OA)
inflammation (RA, psoriasis, gout)
post-traumatic
septic
what are the basic treatments principles for arthritis?
nothing rest/analgesia splinting (occasionally in thumb) steroid injections (only for around 3 months) replacement fusion excise
how does sternoclavicular joint arthritis present?
rare
swelling and pain at SC joint
how is sternoclavicular joint arthritis treated?
physio
injections
excision (rarely)
what can cause acromioclavicular joint arthritis?
trauma
often overlaps with impingement
very common
how is acromioclavicular joint arthritis managed?
injection
excision
where is fusion used for arthritis?
wrist
what can cause glenohumeral joint arthritis?
cuff tear
instability
previous surgery
idiopathic
how does glenohumeral joint arthritis present?
pain
crepitus
loss of movement (esp. external rotation)
how does AC joint arthritis present?
painful scarf test
very well localised pain at AC joint
what are the risks with shoulder replacement?
infection instability stiffness nerve damage loosening
how does rotator cuff tear affect the glenohumeral joint? what are the implications of this?
if torn, the deltoid pulls the humeral head upwards
abnormal forces on glenoid fossa leads to OA
anatomical shoulder replacement will fail until tear is fixed
describe a reverse geometry shoulder replacement
reverses ball-socket increases lever arm of deltoid lengthens deltoid resurfaces joint prevents upward migration
what are the risks with reverse geometry shoulder replacement?
high complication rate
deltoid may fatigue after around 7 years
when is a reverse geometry shoulder replacement used?
only if rotator cuff is not repairable
what may be used if a reverse geometry shoulder replacement fails?
excision fusion
what is the elbow susceptible to?
RA
OA
what are the 2 joints at the elbow?
ulnohumeral
radiocapitellar
what does RA cause at the elbow?
erosion
instability
what does OA cause at the elbow?
pain restriction of movement osteophytes may be radiocapitellar can have restriction of movement without pain
how is radial capitellar OA managed?
can be excised as radial head is only a secondary stabiliser so not vital
can also be replaced
what procedure can be used to remove osteophytes?
OK procedure
how successful are elbow replacements?
limited life span
not good for young/active as limited capabilities and usage possible
displacement of RA vs OA?
RA = polyarticular, systemic, MCP involvement OA = monoarticular, localised, PIP and DIP involvement
features of RA?
erosions
later joint space narrowing than OA
synovitis
tendon rupture
RA medications?
DMARDs (+ short term steroids)
..
what surgeries can be used for RA?
synovectomy tendon realignment replacement fusion "a la carte"
what is the Terry Thomas sign?
gap?/loss of gap? in carpal bones indicating scapholunate advanced collapse (SLAC)
what is SNAC wrist?
scaphoid non-union advanced collapse
how is SNAC or SLAC wrist treated?
arthrodesis?
how does small joint OA present?
most commonly in DIPs
pain
deformity
heberdens or ostlers nodes
how is small joint OA treated?
NSAIDs activity modification capsaicin gel injections fusion
what is the 1st and second most common site of OA in the body?
1 = DIPs 2 = base of thumb
what does base of thumb OA cause?
subluxations of CMC joints
pain (esp. in pinch movement)
how is thumb CMC joint OA managed?
rest, analgesia, splints, capsaicin gel
steroid injection
surgery
what are the features of psoriatic arthritis?
inflammatory arthritis
skin, nails, hair, hips, knees and hands/wrists affected
sausage fingers (dactylitis)
pencil in cup X ray features
what are the standard general principles of arthritis management for all types?
rest, analgesia, activity modification, splintage
injections
fusion, replacement, excision surgery
name 2 tendon complications of RA
swan neck deformity
boutonniere
what is swan neck deformity?
volar plate of PIP joint becomes attenuated
small ligaments + lumbrical tendons fall more dorsal to joint centre
PIP hyperextension with DIP hyperflexion
what is boutonniere?
“buttonhole”
extensor hood of PIP joint becomes attenuated
hyperflexion of PIP with hyperextension of DIP
how are tendon complications of RA managed?
splintage surgery (tendon reposition)
