Upper limb arthritis

Question 1

What are the general symptoms of upper limb arthritis?

Answer 1

Pain
Stiffness
Loss of function
Swelling 
Deformity

Question 2

What are the causes of upper limb arthritis?

Answer 2

Degenerative/osteoarthritis
Inflammatory (rheumatoid, gout, psoriasis)
Post-traumatic
Septic

Question 3

What are the treatment options for upper limb arthritis’?

Answer 3

Rest 
Analgesia
Splint
Steroid injections
Replace
Fuse
Excise

Question 4

How does sternoclavicular arthritis present?

Answer 4

Pain and swelling

Question 5

How common is sternoclavicular arthritis?

Answer 5

Rare

Question 6

How can sternoclavicular joint arthritis be treated?

Answer 6

Physiotherapy
Steroid injection
Excision (rarely)

Question 7

How common is acromioclavicular joint arthritis?

Answer 7

Common

Question 8

How does acromioclavicular joint arthritis present?

Answer 8

Often in conjunction with rotator cuff impingement

Post-trauma

Question 9

How can acromioclavicular joint arthritis be treated?

Answer 9

Steroid injections

Excision

Question 10

How common is glenohumeral joint arthritis compared to knee/hip arthritis?

Answer 10

Uncommon

Question 11

What are the possible causes of glenohumeral joint arthritis?

Answer 11

Instability
Cuff tear
Previous surgery
Idiopathic

Question 12

How does glenohumeral joint osteoarthritis present?

Answer 12

Pain
Crepitus
Loss of movement (external rotation)

Question 13

How can glenohumeral joint arthritis be managed?

Answer 13

Hemiarthroplasty

Total shoulder replacement

Question 14

What are the possible complications of shoulder replacement?

Answer 14

Infection
Instability 
Stiffness
Nerve damage
Loosening

Question 15

How does rotator cuff arthroplathy occur?

Answer 15

Rotator cuff tear means that deltoids are unopposed and so pull head upwards these abnormal forces cause osteoarthritis

Question 16

How can rotator cuff arthroplathy not be treated?

Answer 16

Traditional shoulder replacement

Question 17

How does a rotator cuff arthropathy appear on x-ray?

Answer 17

LOSS

Humeral head moves superiorly (loss of normal space)

Question 18

How should rotator cuff arthropathy be treated?

Answer 18

Reverse geometry shoulder replacement

Question 19

What are the last resort treatments for arthritis of the shoulder?

Answer 19

Fusion

Excision

Question 20

What are the causes of arthritis at the elbow?

Answer 20

Rheumatoid arthritis

Osteoarthritis

Question 21

Where can arthritis of the elbow occur?

Answer 21

Radiocapitellar joint

Ulnohumeral

Question 22

How does rheumatoid arthritis of the elbow present?

Answer 22

Instability

Question 23

How does rheumatoid arthritis of the elbow look on x-ray?

Answer 23

Erosions

Question 24

How does osteoarthritis of the elbow present?

Answer 24

Pain

Reduced movement

Question 25

How does osteoarthritis of the elbow look on x-ray?

Answer 25

May be radiocapitellar only Osteophytes LOSS

Question 26

How is radiocapitaller osteoarthritis managed? How can it be managed in this way?

Answer 26

Excision Replacement It is only a secondary stabiliser

Question 27

Why might there be reduced movement at the elbow joint?

Answer 27

Osteophyte impingement

Question 28

When is elbow replacement indicated?

Answer 28

Older patients Low demand patients Limited to 5kg/1kg repeatedly

Question 29

What are the features of wrist osteoarthritis?

Answer 29

Monoarticular/localised Base of thumb Associated PIP and DIP joints

Question 30

What are the features of wrist osteoarthritis on an x-ray?

Answer 30

LOSS

Question 31

What are the features of wrist rheumatoid arthritis?

Answer 31

``` Polyarticular Systemic Synovitis Tendon rupture Associated MCP joints ```

Question 32

What are the features of wrist rheumatoid arthritis on an x-ray?

Answer 32

Erosions | Late joint space narrowing

Question 33

How is rheumatoid arthritis of the wrist treated?

Answer 33

Medical (DMARDs) Steroid injections Splintage Surgery

Question 34

What types of surgery for rheumatoid arthritis of the wrist are available?

Answer 34

Synovectomy Tendon realignment Replacement Fusion

Question 35

What is scapholunate advanced collapse?

Answer 35

Wrist malalignment due to a complication of post-traumatic or spontaneous osteoarthritis

Question 36

What is scapholunate non-union advanced collapse?

Answer 36

A complication which occurs with scaphoid fractures

Question 37

How can scapholunate advanced collapse be treated?

Answer 37

4-corner fusion Proximal row carpectomy Total wrist arthrodesis

Question 38

How does small joint osteoarthritis present?

Answer 38

Pain Deformity Heberden's nodes Bouchard's nodes

Question 39

How is small joint osteoarthritis treated?

Answer 39

``` NSAIDs Activity modification Capsacian gel (relieves pain and itch) Injections Fusion ```

Question 40

How does CMC thumb osteoarthritis present?

Answer 40

Pain increased in pinch grip | Subluxation

Question 41

Is CMC thumb osteoarthritis common?

Answer 41

Yes

Question 42

How is CMC thumb osteoarthritis managed?

Answer 42

``` Rest Analgesia Splints Capsaicin gel Steroid injection Surgery ```