35431203
"My Hands are Aching"
- Anatomy of the HAND
- Bones
- Joints
- Causes of Swollen Joints
- Acute
- Chronic
- Osteoarthritis
- Rheumatoid arthritis
- Osteoarthritis
- Acute
- Causes of Swollen Joints
- Synovial Fluid
Contents
- Water
- Inorganic salts & macromolecules
- Hyaluronic acid
- Lubricin
- Aggrecans
- Neutrophils, Lymphocytes, Monocytes,
Macrophage
- Water
- Intrinsic
muscles
- Blood supply
- Innervation
- Bones
- Examination of the hand
- extrinsic flexors
- Flex thumb IP joint
- Stabilize PIP and have patient flex each DIP in succession
- Volar flex wrist
- Flex thumb IP joint
- intrinsic muscles
- Touch small finger to the thumb so the nails are parallel
- Flex MCP and straighten PIP
- Pinch paper between thumb and radial side of index finger in the first webspace
- Touch small finger to the thumb so the nails are parallel
- Neurological
- Radial c5-c8
- Median c5-T1
- Ulnar c8-T1
- Radial c5-c8
- Special tests:
- Phalen’s Test (test for carpal tunnel syndrome)
- Tinel’s Test (test for carpal tunnel syndrome)
- Finkelstein’s Test (test for DeQuervain’s Tenosynovitis)
- Phalen’s Test (test for carpal tunnel syndrome)
- extrinsic flexors
- Autoimmunity: RHEUMATOID ARTHRITIS
- Normal Immune tolerance mechanism:
- Loss of self-tolerance
- 1- Bystander T cell activation
- 2- Molecular mimicry
- 3- Polyclonal lymphocyte activation
- 4- Altered self
- 5- Release of sequestered antigens
- 6- Availability of cryptic epitopes
- 1- Bystander T cell activation
- Complications of RA:
- Symmetric swelling of
small peripheral joints
- Symmetric swelling of elbows,
shoulders, hips, and knees
- Anemia in Rheumatoid Disease
- due to reduction in RBC production by bone marrow.
- due to reduction in RBC production by bone marrow.
- Prognosis:
- Progression when diagnosed
- Presence of rheumatoid nodules
- Positive for rheumatoid factor or anti-CCP
- decrease life span by 10-15 years but highly variable
- Progression when diagnosed
- Symmetric swelling of
small peripheral joints
- Normal Immune tolerance mechanism:
- Pathogenesis of RA
- Infiltration of synovial membrane with:
- Lymphocytes
- Plasma cells
- Dendritic cells
- Macrophages
- Cytokines involved:
- TNF, IL-1, IL6 and IL-15
- TNF, IL-1, IL6 and IL-15
- Lymphocytes
- Investigations:
- From History + Physical Examination:
- Morning stiffness
- Symmetrical swelling of 3 or more joints
- Rheumatoid nodules
- Morning stiffness
- Imaging & laboratory findings:
- Radiographic changes of RA (X-ray\MRI)
- High ESR or C-reactive protein
- RF+ and\or Anti-ccp+
- Radiographic changes of RA (X-ray\MRI)
- From History + Physical Examination:
- Management:
- Pharmacological
- Non-pharmacological
- Pharmacological
- Psychological effect:
- Infiltration of synovial membrane with:
- Epidemiology of RA:
- Prevalence: 0.5-1%
- 3 cases per 10,000 population
- More common in women
- Prevalence: 0.5-1%
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