arthritis

AVN  

Largely related to degree of displacement

Incidence

Hawkins Type I

- 0% to 13% 

Hawkins Type II 

- 20% to 50% 

- usually only patchy and not a problem (rarely collapses)

Options

Darrach's

- distal ulna excision

- best for elderly RA patient

Bower's interpositional hemiarthoplasty

Technique

Epidemiology

Extremely common

- 90% by 10 years have wrist problems

Principles

Landsmeer 1961

- treat wrist at same time as treat fingers or will recur

Frequently combine procedures

- synovectomy

- tendon transfer

- ulna procedure

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Rotator cuff

- often deficient

Bone stock

- often deficient

Glenoid

- often posterior version 

Management

Options

1.  TSR

Indications

- cuff intact

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Definition

Joint effusion / pain / swelling in two or more joints

- > 6 weeks

- patient > 16 years

Variations

- number of joints affected: oligoarticular (<5)  v polyarticular (5 or more)

- rheumatoid factor positive or negative

- systematic symptoms (rash / fever / lympadenopathy / organomegaly)

Epidemiology

1:10,000

Familial clusters

HLA-gene associations