Cheatography
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Management , Presentation
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Hand OA
- DIP Joints most affected |
- Can occur at the PIP, base of the thumb (CMC), index and middle MCP joints |
- CMC degeneration usually affects the non-dominant hand |
Causes
- Increases with age (between 50-60) |
- Common in females |
- Genetics |
- Repetitive use |
- Previous injury, lax, misaligned or deformed joint |
- Labour /manufacturing workers |
- Obesity |
- Secondary osteoarthritis - congentical, metabolic, endocrine, neurologic, vascular disorders that cause OA - affects younger people |
Presentation
- DASH Questionnaire |
- Symptoms provoked by activities and relieved by rest |
- If bilateral and symmetrical, swelling, morning stiffness >30 mins - consider inflammatory arthropathy |
- Tenderness of the affected joint |
- Limited ROM and diminished grip (more advanced) |
- Heberden's nodes present along joint lines |
- Radial/ulnar deviation of the affected digit - If digit subluxed towards palm, consider RA |
ACR Criteria
- Hard tissue enlargement in at least 2/10 selected joints (2nd + 3rd DIP + PIP, 1st CMC) |
- >3 swollen joints |
- Hard tissue enlargement of >2 DIP joints or deformity on at least 2/10 selected joints |
Imaging
- Standard for OA |
- Loss of joint space |
- Subchondral sclerosis |
- Osteophytes |
DDx
- Inflammatory Arthropathy (RA, Gout, pseudogout, psoriatic arthritis, reactive arthritis, AS) |
- Lyme Disease |
- F# |
- Infection |
- Neoplasm |
- Myofascial pain syndrome |
- Tendinopathy |
- AVN |
- Neuropathic arthropathy |
- Peripheral neuropathy |
Management
- Soft tissue manipulation |
- Nighttime splint for thumb |
- Exercise |
- ADL Advice |
- Joint mobilisation P/A glide + distraction |
- Topical cream - capsaicin |
- Aerobic, aquatic and resistance exercises |
- If no reaction to conservative care, consider steroid injections and if significant ROM and pain , consider surgical intervention |
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