Rheumatoid Arthritis
Epidemiology
50% rheumatoid patients have elbow pathology
- 80% also have shoulder pathology
- 90% hand and wrist
Always consider entire upper limb
50% rheumatoid patients have elbow pathology
- 80% also have shoulder pathology
- 90% hand and wrist
Always consider entire upper limb
Relatively rare
Average age 50
Men 4:1 Women
Usually dominant arm
Primary
- associated with strenuous manual labour
Secondary
- trauma
- OCD
- synovial chondromatosis
- valgus extension overload / MCL insufficiency
Education
Lifestyle Management
- weight loss
- reduce sport
Physiotherapy
Orthotics
- walking stick
- braces
Pharmaceuticals
- NSAIDS
- acetominophen
- glucosamine
Injections
- cortisone
- hyaluronic acid
Natural History of ACL deficient knee is variable
- functional instability 15% - 90%
- progression to OA is variable
Depends on level of patient demands / activity
1. Late meniscal injury in ACL deficient knee
15-25%
2. Function
Daniels Am J Sports Med 1994
- 292 ACL defecients knees
>55 Often mid 30's
Fracture talus through articular cartilage into subchondral bone
- 2° force transmitted from distal tibia
Osteochondritis dissecans v osteochondral fracture
6% ankle sprains
Average age = 25
M > F
Painful prominence of lateral eminence of 5th metatarsal head
Type I deformity
- prominent lateral condyle 5th metatarsal head
- lateral condylectomy
Type II deformity
- lateral bowing of 5th metatarsal
- chevron osteotomy
Painful restriction of dorsiflexion of the great toe
- secondary to degenerative changes in MTPJ
- initially pain and synovitis
- osteophytes don't form medially or on plantar aspect
Two peaks
1. Adolescence F > M
2. Middle Age M > F
Often Idiopathic
Trauma
Inflammation of achilles tendon; insertional or noninsertional
Tendonitis / Tendonosis / Rupture
Triceps surae
- medial and lateral gastrocnemius
- soleus
- surrounded by paratenon which allows gliding and supplies nutrition
Inserts middle 1/3 calcaneal tuberosity
- 2 x 2 cm area
- 90o rotation distally
Retrocalcaneal bursa (x2)
Gastrocnemius tendon 10-25 cm long
- soleus 3-10 cm
- inserts superior calcaneal tuberosity
- fibres spiral 90°
- fibres that lie medially in proximal portion become posterior distally
- allows elastic recoil & energy storage
Plantaris present in 90% population
- medial to T Achilles
Poor blood supply midportion
- mesotenal vessels