Upper Limb Arthritis Management

Question 1

how do upper and lower limb differ in terms of function?

Answer 1

lower = large weight bearing forces, only mobility
upper = large range of movement, fine control

Question 2

symptoms of upper limb arthritis?

Answer 2

pain (not always)
swelling
stiffness
deformity
loss of function

Question 3

what can cause upper limb arthritis?

Answer 3

degeneration (OA)
inflammation (RA, psoriasis, gout)
post-traumatic
septic

Question 4

what are the basic treatments principles for arthritis?

Answer 4

nothing
rest/analgesia
splinting (occasionally in thumb)
steroid injections (only for around 3 months)
replacement
fusion
excise

Question 5

how does sternoclavicular joint arthritis present?

Answer 5

rare

swelling and pain at SC joint

Question 6

how is sternoclavicular joint arthritis treated?

Answer 6

physio
injections
excision (rarely)

Question 7

what can cause acromioclavicular joint arthritis?

Answer 7

trauma
often overlaps with impingement
very common

Question 8

how is acromioclavicular joint arthritis managed?

Answer 8

injection

excision

Question 9

where is fusion used for arthritis?

Answer 9

wrist

Question 10

what can cause glenohumeral joint arthritis?

Answer 10

cuff tear
instability
previous surgery
idiopathic

Question 11

how does glenohumeral joint arthritis present?

Answer 11

pain
crepitus
loss of movement (esp. external rotation)

Question 12

how does AC joint arthritis present?

Answer 12

painful scarf test

very well localised pain at AC joint

Question 13

what are the risks with shoulder replacement?

Answer 13

infection
instability
stiffness
nerve damage
loosening

Question 14

how does rotator cuff tear affect the glenohumeral joint? what are the implications of this?

Answer 14

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

Question 15

describe a reverse geometry shoulder replacement

Answer 15

reverses ball-socket
increases lever arm of deltoid
lengthens deltoid
resurfaces joint
prevents upward migration

Question 16

what are the risks with reverse geometry shoulder replacement?

Answer 16

high complication rate

deltoid may fatigue after around 7 years

Question 17

when is a reverse geometry shoulder replacement used?

Answer 17

only if rotator cuff is not repairable

Question 18

what may be used if a reverse geometry shoulder replacement fails?

Answer 18

excision fusion

Question 19

what is the elbow susceptible to?

Answer 19

RA

OA

Question 20

what are the 2 joints at the elbow?

Answer 20

ulnohumeral

radiocapitellar

Question 21

what does RA cause at the elbow?

Answer 21

erosion

instability

Question 22

what does OA cause at the elbow?

Answer 22

pain
restriction of movement
osteophytes
may be radiocapitellar
can have restriction of movement without pain

Question 23

how is radial capitellar OA managed?

Answer 23

can be excised as radial head is only a secondary stabiliser so not vital
can also be replaced

Question 24

what procedure can be used to remove osteophytes?

Answer 24

OK procedure

Question 25

how successful are elbow replacements?

Answer 25

limited life span | not good for young/active as limited capabilities and usage possible

Question 26

displacement of RA vs OA?

Answer 26

``` RA = polyarticular, systemic, MCP involvement OA = monoarticular, localised, PIP and DIP involvement ```

Question 27

features of RA?

Answer 27

erosions later joint space narrowing than OA synovitis tendon rupture

Question 28

RA medications?

Answer 28

DMARDs (+ short term steroids) | ..

Question 29

what surgeries can be used for RA?

Answer 29

``` synovectomy tendon realignment replacement fusion "a la carte" ```

Question 30

what is the Terry Thomas sign?

Answer 30

gap?/loss of gap? in carpal bones indicating scapholunate advanced collapse (SLAC)

Question 31

what is SNAC wrist?

Answer 31

scaphoid non-union advanced collapse

Question 32

how is SNAC or SLAC wrist treated?

Answer 32

arthrodesis?

Question 33

how does small joint OA present?

Answer 33

most commonly in DIPs pain deformity heberdens or ostlers nodes

Question 34

how is small joint OA treated?

Answer 34

``` NSAIDs activity modification capsaicin gel injections fusion ```

Question 35

what is the 1st and second most common site of OA in the body?

Answer 35

``` 1 = DIPs 2 = base of thumb ```

Question 36

what does base of thumb OA cause?

Answer 36

subluxations of CMC joints | pain (esp. in pinch movement)

Question 37

how is thumb CMC joint OA managed?

Answer 37

rest, analgesia, splints, capsaicin gel steroid injection surgery

Question 38

what are the features of psoriatic arthritis?

Answer 38

inflammatory arthritis skin, nails, hair, hips, knees and hands/wrists affected sausage fingers (dactylitis) pencil in cup X ray features

Question 39

what are the standard general principles of arthritis management for all types?

Answer 39

rest, analgesia, activity modification, splintage injections fusion, replacement, excision surgery

Question 40

name 2 tendon complications of RA

Answer 40

swan neck deformity | boutonniere

Question 41

what is swan neck deformity?

Answer 41

volar plate of PIP joint becomes attenuated small ligaments + lumbrical tendons fall more dorsal to joint centre PIP hyperextension with DIP hyperflexion

Question 42

what is boutonniere?

Answer 42

"buttonhole" extensor hood of PIP joint becomes attenuated hyperflexion of PIP with hyperextension of DIP

Question 43

how are tendon complications of RA managed?

Answer 43

``` splintage surgery (tendon reposition) ```