Hand Arthritis

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Hand Arthritis

• Rheumatoid Arthritis

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Rheumatoid Arthritis

• Definition
• Tenosynovitis
• Joint Deformities
• Systemic Illness

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How to Recognize

• () RF and ESR
• X-ray pattern of destruction

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Office Management

• Adaptive Devices
• Night Splints

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Tenosynovitis

• Causes tendon rupture
• Pattern ulnar to radial

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When to Refer

• Tenosynovitis gt 3 mo.
• Extensor lag

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How We Treat It

• Early Tenosynovectomy
• Late Tendon Transfers

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Tendon Transfers

• Resect DRUJ
• Synovectomy
• Tendon Transfers

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Tendon Transfers
Tendon Ruptures

• SF EDC EDC IV to V
• SFRF EDC EIP to IV and V

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Tendon Transfers
Tendon Ruptures

• 3 or More Digits Tx FDS to EDC

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MCP Joint Deformities

• Ulnar Drift
• Volar Subluxation

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Office Management

• Night Splints
• Medical management

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How We Treat

• MCP joint arthroplasty

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MCP joint arthroplasty
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MCP joint arthroplasty
Preop
Postop
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PIP Joint Deformities

• Swan Neck
• Boutonniére
• Joint Destruction

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Swan Neck

• PIP joint hyperextends
• Volar plate laxity
• Lateral bands sublux dorsally

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Boutonniére

• PIP joint flexes and DIP extends
• Central slip disrupts
• Lateral bands sublux volarly

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Office Management

• Boutonniére dynamic splint
• Swan neck figure 8 splint (silver ring)

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How We Treat

• Swan neck
• Indicationsflexible joint

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How We Treat

• Boutonniére
• Indicationsflexible joint

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PIP Arthritis

• Arthrodesis versus Arthroplasty?

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PIP Arthroplasty

• Indications
• Pain
• AROM lt 45

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Hand Arthritis

• Osteoarthritis Clinical Presentation
• DIP Heberdens nodes and mucous cysts
• PIP Bouchards nodes
• MCP rare
• Basal thumb joint CMC/STT/Pantrapezial
• Wrist SLAC

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Mucous Cyst

• Do not aspirate!

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Mucous Cyst

• How We Treat

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PIP Arthritis

• Arthrodesis versus Arthroplasty

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Thumb Basal Joint Arthritis

• CMC
• Pantrapezial
• STT

CMC
STT
Pan T
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Office Treatment

• CMC Arthritis
• Opponens Splint
• Injection

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How We Treat

• CMC Arthroplasty

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How We Treat

• CMC Arthroplasty

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STT Arthritis

• Office Treatment
• Opponens splint
• NSAID
• Steroid inject

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STT Arthritis

• Office Treatment
• Opponens splint
• NSAID
• Steriod inject

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STT Arthritis

• How We Treat
• STT Arthrodesis
• Radial Styloidectomy

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SLAC Arthritis

• Office Treatment
• Wrist Splint
• NSAID
• Steroid inject

Stage 1
Stage 2
Stage 3
Stage 4
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How We Treat

• SLAC
• I Styloidectomy
• II III 4-Bone Fusion
• IV Total Wrist Fusion

Stage 1
Stage 2
Stage 3
Stage 4
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4-Bone Fusion
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4-Bone Fusion
Preoperative
Postoperative
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Radiocarpal Arthritis

• Office Treatment
• Wrist Splint
• NSAID
• Steroid Inject

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How We Treat

• Total Wrist Arthrodesis