Upper Limb Arthritis

Question 1

Name 4 causes of upper limb arthritis?

Answer 1

Degenerate, inflammatory, post-traumatic, septic

Question 2

How often should steroid injections be used in upper limb arthritis?

Answer 2

Once or twice a year

Question 3

What are the pros and cons of joint replacement?

Answer 3

Takes away the pain but there may be loss of range of movement

Question 4

How common in sternoclavicular joint OA? How will it present?

Answer 4

Rare- will present as a swelling with no trauma

Question 5

What are the main treatments for sternoclavicular OA?

Answer 5

Physio and injections

Question 6

Why is surgery not recommended for sternoclavicular joint OA?

Answer 6

Too close to important structures

Question 7

How common is AC joint OA? What condition does it overlap with?

Answer 7

Vey common- overlaps with impingement syndrome

Question 8

What are the main treatments for AC joint OA?

Answer 8

Injections, excision

Question 9

Why does surgical excision of osteophytes in AC joint OA not destabilise the joint?

Answer 9

Because the capsule is maintained, and the clavicle is held in place with ligaments

Question 10

What can glenohumeral joint OA be related to?

Answer 10

Cuff tear, instability, previous surgery, trauma

Question 11

What are some symptoms of OA in the glenohumeral joint?

Answer 11

Pain, crepitus and loss of movement

Question 12

What movement will be most likely to be lost in glenohumeral joint OA?

Answer 12

External rotation

Question 13

How is a partial shoulder replacement done?

Answer 13

Uses hydroxyapatite instead of cement which allows the bone to grow around it

Question 14

What are some complications of shoulder replacement?

Answer 14

Infection, instability, stiffness, nerve damage, loosening

Question 15

What nerve is most likely to be damaged in shoulder replacement?

Answer 15

Axillary

Question 16

How long will a shoulder replacement generally last?

Answer 16

10-15 years

Question 17

What is usually the first sign of OA on an x-ray?

Answer 17

Osteophytes

Question 18

What is cuff tear arthropathy?

Answer 18

A type of degenerative osteoarthritis that develops over time after the rotator cuff has been damaged

Question 19

Why will shoulder replacements fail in cuff tear arthropathy?

Answer 19

Because there is no rotator cuff to hold it in place

Question 20

What type of arthritis is most likely to present at the elbow?

Answer 20

Rheumatoid

Question 21

When will OA occur at the elbow?

Answer 21

Following trauma (especially intra-articular fractures)

Question 22

Arthritic change at the radio-capitellar joint which is not managed conservatively can be managed with what? What are the outcomes?

Answer 22

Surgical excision of the radial head, good pain relief with limited functional loss

Question 23

Severe humero-ulnar arthritis which is not managed conservatively can be treated with what?

Answer 23

Elbow replacement

Question 24

What will be features of elbow RA?

Answer 24

Erosions and instability

Question 25

What will be features of elbow joint OA?

Answer 25

Pain, restricted movement, osteophytes

Question 26

Which joint of the elbow is a secondary stabiliser only and can be excised or replaced?

Answer 26

Radio-capitellar joint

Question 27

What is the only differential for radiocapitellar joint OA?

Answer 27

Tennis elbow

Question 28

Who are elbow replacements successful in?

Answer 28

Older patients (they don't last long enough to use in young patients)

Question 29

What is weight lifting limited to following elbow replacement?

Answer 29

2.5kg

Question 30

OA of the radoiocarpal joint usually occurs as a consequence of what? Give examples.

Answer 30

Trauma: scaphoid non-union or carpal dislocation

Question 31

Wrist instability can be caused by what? When does that occur?

Answer 31

Scapholunate advanced collapse (SLAC) following a FOOSH

Question 32

What happens in SLAC? What is this known as?

Answer 32

The scaphoid and lunate bones move apart from each other which results in a predictable pattern of arthritis (Terry Thomas Sign)

Question 33

What can degenerative arthritis as a result of SLAC progress to?

Answer 33

Scaphoid non-union advanced collapse (SNAC) which results in chronic malunion of the scaphoid

Question 34

What are some treatment options for wrist arthritis?

Answer 34

Fusion of certain bones or total wrist arthrodesis

Question 35

What joints of the hands are most commonly affected by OA?

Answer 35

DIPs

Question 36

What are some symptoms of OA at the DIPs?

Answer 36

Pain, deformity, swelling, Heberden's nodes

Question 37

What also may be associated with Heberden's nodes at the DIPs?

Answer 37

Mucous cysts

Question 38

Who is DIP joint OA most common in?

Answer 38

Post menopausal women

Question 39

What are some conservative managements for DIP joint OA?

Answer 39

NSAIDs, activity modification, capsaicin gel, infections

Question 40

What is the surgical management for mild-moderate DIP joint OA?

Answer 40

Removal of osteophytes and excision of mucous cysts

Question 41

What is the surgical management for severe DIP joint OA?

Answer 41

Arthrodesis (fusion)

Question 42

After the DIPs, what is the second most common site of OA?

Answer 42

Base of the thumb (1st CMC)

Question 43

What is the long name for the base of the thumb joint which is affected by OA?

Answer 43

Trapeziometacarpal joint

Question 44

What treatment is used for acute flare ups of base of thumb OA?

Answer 44

Steroid injections

Question 45

What are some surgical treatments for base of thumb OA?

Answer 45

Excision arthroplasty (trapeziectomy) or fusion

Question 46

Can the PIP joint be affected by OA?

Answer 46

Yes

Question 47

Where are Bouchard's nodes seen?

Answer 47

PIPs

Question 48

What are some surgical managements for PIP joint OA?

Answer 48

Arthrodesis of index finger (to maintain pincer grip) or replacement arthroplasty of other fingers

Question 49

OA rarely affects the MCP joints without a reason. What are some reasons?

Answer 49

Previous injury, occupational strain, gout or infection

Question 50

MCP joint OA can be treated with MCP replacements. What are some risks of this?

Answer 50

Ulnar drift or extensor tendon subluxations

Question 51

What are some surgical options for hand RA?

Answer 51

Synovectomy, tendon realignment, replacement, fusion

Question 52

Psoriatic arthritis can be seen in the hands, what is the main feature which will distinguish it from RA?

Answer 52

Dactylitis (will also more likely be asymmetrical)

Question 53

Does psoriatic arthritis have systemic symptoms?

Answer 53

Yes

Question 54

Which carpal bones can be affected by OA? What is the treatment?

Answer 54

The joints between the scaphoid, trapezium and trapezoid - fusion of these bones or wrist fusion

Question 55

Which joints of the hands does RA spare?

Answer 55

DIPs

Question 56

What are the 3 stages of RA in the hand?

Answer 56

1. Synovitis and tenosynovitis 2. Erosion of joints 3. Joint instability and tendon rupture

Question 57

Subluxations and chronic tenosynovitis in RA can predispose to what?

Answer 57

Extensor tendon ruptures

Question 58

What are some deformities which RA can cause?

Answer 58

Volar MCP joint subluxation, ulnar deviation, swan neck deformity, Boutonniere deformity

Question 59

What happens in a swan neck deformity?

Answer 59

Hyperextension at the PIP, flexion at the DIP

Question 60

What happens in a Boutonniere deformity?

Answer 60

Flexion at the PIP, hyperextension at the DIP

Question 61

When extensor tendons to the wrist rupture, what treatments can be used to preserve function?

Answer 61

Tendon transfer or joint fusions

Question 62

What joints can be replaced or fused in RA of the hand?

Answer 62

PIP and MCP

Question 63

What treatment can be used for arthritis of the distal radioulnar joint?

Answer 63

Resection of the distal ulna