Tiêu đề HANDS PATHOLOGY + LUMPS ✅

HANDS PATHOLOGY & Achilles Tendon Rupture INFLAMMATORY RHEUMATOID ARTHRITIS OF THE HAND Progressive, chronic autoimmune joint disease CF ● Pain, swelling and stiffness of the wrists and fingers joints ● After periods of inactivity (early morning stiffness), >30 minutes ● Weakness of hand (wrist extension & flexion) ● Rheumatoid nodules ● Synovitis / synovial swelling in carpal tunnel → compress median nerve → CTS HAND DEFORMITY Ulnar deviation at MCPJ - Volar subluxation (ant.ly displaced) at MCPJ - Ulnar deviation of digits at MCPJ - Radial deviation at wrist joint - Extensor lag of MCPJ Tx: - Radial hinged ulnar deviation splint - Synovectomy - MCP arthroplasty Boutonniere deformity - PIP flexion, DIP extension - D/t rupture of extensor tendon over PIPJ from trauma / laceration / capsular distension in RA → protrusion of PIPJ through its disrupted tendon→ PIPJ flexion Tx: - PIPJ splint in full extension for 6 weeks - Primary central band repair - PIP arthrodesis - Tendon reconstruction Swan neck deformity - PIP hyperextension, DIP flexion - D/t tear volar plate → imbalance force on Tx: - Double ring splint Iman, Izzaty, Nisa, Lissa (5/3/21) Forti
PIP → rupture terminal tendon causing tendon shortening (on DIP) - Volar plate advancement + PIP balancing with central slip tenotomy Hitchhiker thumb - MCP flexion, interphalangeal joint hyperextension Telescoping fingers - In very severe arthritis damaging joint (arthritis mutilans) Tx: Interposition bone grafting and fusion Iman, Izzaty, Nisa, Lissa (5/3/21) Forti
IX ACR/EULAR Criteria MX LAB FBC Anemia (d/t abn erythropoiesis) ESR/CRP Raised ACPA +ve RF +ve LFT As baseline before tx IMAGING Plain radiograph of wrist joint (AP view) - Early: ST swelling + periarticular osteoporosis - Late: Joint space narrowing + periarticular erosion @ MCPJ & ulnar styloid process NON-OPERATIVE 1. Non-pharmacological ● Physiotherapy ● Occupational therapy ● Splintage (based on hand deformity) - Radial hinged with ulnar deviation splint - Double ring splint - PIPJ splint 2. Pharmacotherapy ● Steroid (analgesia) → 1st line - Prednisolone ● DMARDS → 2nd line - Methotrexate - Leflunomide (if not tolerate to MTX) ● Biological therapy (anti-TNF) → 3rd line - Infliximab - Adalimumab OPERATIVE - If management with conservative not adequate Early Soft tissue procedures: - Synovectomy - Tendon repair / replacement & joint stabilization Iman, Izzaty, Nisa, Lissa (5/3/21) Forti