CMC, DIP/PIP Arthritis

Question 1

How are mucous cysts treated?

Answer 1

1) observe; 25-60% resolve on their own
2) aspiration; 40% recur
3) excision with osteophyte removal; no recurrence

Question 2

What is the treatment for PIP arthritis?

Answer 2

1) NSAIDs
2) fusion
3) arthroplasty
Fuse using headless compression screws and recreate normal cascade
Index 30 deg, long 35, ring 40, small 45

Question 3

What are some tips for DIP fusion?

Answer 3

1) indicated for debilitating pain d/t DIP arthritis
2) headless screws most reliable
3) 2nd/3rd digit fused in extension, 4th/5th fused in 10 deg flexion

Question 4

What is the supposed etiology of CMC arthritis?

Answer 4

attenuation of the anterior/volar oblique ligament (Beak ligament); leads to instability, subluxation and CMC arthritis

Question 5

What is the classification of CMC arthritis?

Answer 5

Eaton Littler:
I- joint space widening (synovitis)
II- slight narrowing with sclerosis; osteophytes less than 2mm
III- marked narrowing with osteophytes >2mm
IV- pantrapezial arthritis (STT involved)

Question 6

What physical exam findings are common in trapeziometacarpal (CMC) arthritis?

Answer 6

1) positive grind test

2) Fixed hyperextension of MCP; especially during grip

Question 7

Which injection is best for CMC arthritis?

Answer 7

All (steroid, hylgan, saline) are equally effective

Question 8

What tendons are commonly used for trapeziectomy and LRTI for CMC arthritis?

Answer 8

1) FCR most common

2) APL or PL can also be used

Question 9

What patient population would benefit from 1st CMC fusion?

Answer 9

Young male laborer with CMC arthritis; fuse in:
35° radial abduction
30° palmar abduction
15° pronation