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Flashcards in Arthritic conditions Deck (21):
1

What is basilar thumb arthritis?

Describe its epidemiology?

Arthritis of the Carpal- metcarpal joint

  • Common arthritis of the hand
  • 2nd only to DIPJ arthritis

2

Decribe the pathoanatomy of basilar thumb arthritis?

Due to Attenuation of the Anterior OBLIQUE Ligament - Beak Ligament

which -> instability, subluxation, arthritis of CMC joint

3

Can you describe the trapezial metacarpal joint anatomy?

It is bicaoncave saddle joint

Trapezium has a palmar groove for Flexor carpi radialis tendon

  • Ligaments
  • anterior oblique ligament  is the primary stabiliser restraint to subluxation of CMC Joint
  • Intermetacarpal ligaments
  • Post oblique ligaments
  • Dorsal - radial capsule- ruptured in CMC dislcation
  • Biomechanics- CMCJ reactive force is x13 in pinch

A image thumb
4

Describe the classfication of basilar thumb arthritis?

EATON and LITTLER

stage 1- slight joint space widening (pre-arthritis)

Stage II- slight narrowing CMCJ w sclerosis, Osteophytes <2mm

stage III- Marked narrowing CMCJ w osteophytes >2mm

Stage IV- Pantrapezial Arhtritis (STT involved)

http://www.orthobullets.com/hand/6054/basilar-thumb-arthritis

5

What are the symptoms and Signs of Basilar thumb arthritis? 

Symptoms

  • Pain at base of thumb
  • Difficulty pinching/ gasping
  • Concomitant carpal tunnel syndrome

O/E

  • Painful CMC gring test- combined axial compression/circumduction
  • Swelling and crepitus
  • Metacarpal adduction & web space contractures- later
  • Adjacent MCP fixed hyperextension - during pinch- EPB potentiatin the mcp hyperextnesion deformity

A image thumb
6

What position is the thumb in for xray to rv cmcj ?

What is seen on the xray?

Xary beam centred on trapezum and metacarpal with thumb flat on cassett with thumb hyperpronated

see::

eaton and littler classification

  • joint space narrowing
  • osteophytes,
  • hyperextension of MCPJ

A image thumb
7

What is the TX for basilar thumb arthritis?

Non operative

Mild symptoms- NSAIDs, BRACING (thumb spica orthrosis), Symptomatic TX

injection of hyalgan- no diff for pain relief and improvement in rom cf placebo/corticosteriods

Operative

 


  • Stage 1- ligament reconstruction with FCR-

     joint hypermobile and unstable




  • Early stage- CMC arthroscopy and debridement





  • Early stages minimal arthritis- Extension osteotomy of 1st MC-





    redirects forces to dorsal , more univolved portion of 1st CMCJ- studies show 93% improved at 7 years





  • Stage II- IV = Trapezial resection + LTRI ( ligament reconstruction and tendon interposition)- most common

FCR/ APL/PL sounf FCR to suspend Metacarpal

expect 25% Subsidence postop- improved grip/pinch strength

  • Stage II-III in young male labourers- trapeziometacarpal arthrodesis and fusion

CMCJ fused in 35 degrees abduction, 30 palmar abduction, 15 degrees pronation

OC= gd relief of pain, stability and length preservation, NU 12%, decreaed rom- unable to put hand flat on table

  • MC hyperextension >30- Volar capsulodesis, EPB tendon transfer, semsoid function, MCP fusion
  • Arthoplasty- silicone- not recommended- fracture/subluxation and silicone synovitis

8

Describe primary osetoarthritis in the DIPj?

  • Highest forces in the hand- more wear and tear
  • Associated with Heberden's nodes ( caused by ostephytes)
  • Mucous cysts- > sinus, septoic arthritis and nail ridging
  • Nails- loss gloss, deformity, splitting

A image thumb
9

Describe primary osetoarthritis in the PIPj?

  • Bouchard nodes
  • Joint contracture with fibrosis of ligaments

A image thumb
10

What is erosive osteoarthritis?

  • Condition is self limiting,patients are relatively asymptomatic but can be destructive to joint
  • More common in DIPJ
  • Seen in middle aged women 10:1 F: males

11

Describe the symptoms of OA of hand?

Pain and deformity

12

Describe the Symptoms of erosive osteoarthritis?

  • Intermittent inflammatory episodes
  • Articular cartilahe adn adjacet bones destroyed
  • Synovial changes similar to RA but not systemic
  • xrays will show cartilage detruction/osteophytes/sunchondral erosion

13

Describe the TX for DIPJ arthritis?

Non operative- first line

  • Observation & NSAIDs

Operative-

  • Pain/deformity= Fusion
  • Rusion w headless screw most realible- NU 10%
  • 2/3 digits fused in extension, 4/5 fused 10-20o

14

Describe the tx of mucous cyst?

Non operative

Observation- first line as 20-60% resolve

Operative

Impending rupture= Cyst excision and osteophyte resection- may need local rotational flap fo rskin coverage

15

Describe tx of PIPJ Arthritis?

Non operative

First line/ mild symptoms- Observations & NSAIDs

Operative

  • Fusion-  for border digits/ poor bone stock
  • Headless screw highest fixation rates
  • In cascade- index 30o,long 35o,ring40o,small 45o
  • Silicone Arthroplasty- no angular deformity, long/ring finger, Gd bone stock
  • Collateral ligament excision, volar plate release, osetophyte excision-Contracture & minimal joint movement

 

16

What is the tx of erosive osteoarthritis?

Non operative

  • Splint

 

Operative

  • Fusion- for intolerable deformity 



  • Headless screw highest fixation rates 





  • In cascade- index 30o,long 35o,ring40o,small 45o
     

17

Name the different forms of wrist arthritis?

  • SLAC wrist-=Scapholunate advanced collapse-most common
  • STT arthrosis- 2nd common
  • SNAC- Scaphoid non union advanced collapse
  • DRUJ arthrosis-
  • Pisotriquetrial arthrosis

18

What is the mechanism of wrist arthritis?

  • Degenerative- primary OA
  • Post- traumatic-> SNAC/SLAC/DRUJ
  • Inflammatory- RA
  • Congential - Madelung's deformity
  • Idiopathic- 2ary to Keinbock's/Preiser's disease

19

Describe the pathoanatomy of wrist arthritis?


SLAC 


Injury to SL ligament --> palmar rotary subluxation of scaphoid --> incongruency of joint surfaces --> arthrosis of radiocarpal joint --> arthrosis of capitolunate joint 

radiolunate typically spared
 

SNAC


proximal portion of scaphoid remains attached to lunate while distal scaphoid flexes

leads to early arthritis between radial styloid and distal scaphoid

like SLAC, radiolunate typically spared
 

Rheumatoid arthritis 


wrist becomes supinated, palmarly dislocated, radially deviated, and ulnarly translocated

early disruption of DRUJ leads to dorsal subluxation of ulna (Caput-ulna)
 

 

20

What imaging is required to identify pisotriquetral arthritis?

xray- Lateral in 30 degrees of supination

21

What is the TX of wrist arthritis?

Non operative

Mild/moderate symptoms

  • NSAIDs, Bracing, Intra-articular steriod injections

Operative

Aim at addressing diseased area

SLAC-radial styloidectomy & scaphoid satbilisation-> Pin/Ain denervation-> Prox row carpectomy->scaphoid excision & 4 corner fusion->Wrist fusion

SNAC-inlay ( russe) bone graft-> interposition (fisk) bone graft)->Vascular bone graft from radius

Pisotriquetral arthritis- excision of pisiform

DURJ abutment syndrome- Darrach's procedure,sauve- kapanje, partial ulna resection and interposition, ulnar head replacement

RA- Darrach's procedure,sauve- kapanje,Pin/Ain denervation, wrist fusion