osteoarthritis

DDx

OA

Psoriasis

CREST (scleroderma)

RA (rare form)

Other seronegative arthropathies

Hyperparathyroidism

Reactive arthropathy

Gout

Subluxation & dislocation

Diagnosis

Pisotriquetral view

- forearm positioned 30° supinated off the neutral position

- loss of symmetry between the pisiform and triquetrum is required for the diagnosis

- carpal tunnel view may be helpful in further assessment of the joint

Osteoarthritis

Clinical

More common problem

Options

Darrach's

- distal ulna excision

- best for elderly RA patient

Bower's interpositional hemiarthoplasty

Technique

Definition

Degenerative arthritis at trapeziometacarpal joint (CMC)

- trapezoid - metacarpal

Epidemiology

Commonest hand joint involved in OA 

Most common in older women                                      

Epidemiology

Extremely uncommon

Stability provided by joint capsule /costoclavicular & interclavicular ligaments 

Recurrent instability uncommon

Many apparent dislocations in adolescents may be growth plate injuries 

-will remodel without treatment

If OA from chronic dislocation may resect SCJ

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Epidemiology

Male & Females > 60 years

- X-ray evidence of OA

Symptomatic 

- 25% females

- 15% males

Affected joints

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

Epidemiology

Relatively rare

Average age 50

Men 4:1 Women

Usually dominant arm

Aetiology

Primary

- associated with strenuous manual labour

Secondary

- trauma

- OCD

- synovial chondromatosis

- valgus extension overload / MCL insufficiency

Epidemiology

1 in 10 patients with symptomatic knees have isolated PFJ OA

Aetiology

Obesity

Repetitive deep flexion

Malalignment

Lateral patella tightness

Blunt trauma

Symptoms

Anterior knee pain

- rising from chair