Introduction Forms include primary osteoarthritis DIP highest joint forces in hand undergoes more wear and tear associated with Heberden's nodules (caused by osteophytes) mucous cysts can lead to draining sinus septic arthritis nail ridging nail can be involved splitting/ridging deformity loss of gloss PIP Bouchard nodes joint contractures with fibrosis of ligaments erosive osteoarthritis condition is self limiting, patients are relatively asymptomatic, but can be destructive to joint more common in DIP seen in middle aged women with a 10:1 female to male ratio Presentation Symptoms of primary osteoarthritis pain deformity Symptoms of erosive osteoarthritis intermittent inflammatory episodes articular cartilage and adjacent bone destroyed synovial changes similar to RA but not systemic Imaging Radiographs recommended views AP, lateral and oblique of hand findings erosive osteoarthritis will show cartilage destruction, osteophytes, and subchondral erosion (gull wing deformity) Treatment DIP Arthritis nonoperative observation, NSAIDs indications first line of treatment for mild symptoms operative fusion indications debilitating pain and deformity technique fusion with headless screw has highest fusion rate (nonunion in 10%) 2nd and 3rd digit fused in extension 4th and 5th digit fused in 10-20° flexion Mucous Cyst nonoperative observation indications first line of treatment as 20-60% spontaneously resolve operative mucous cyst excision + osteophyte resection indications impending rupture may need to do local rotational flap for skin coverage outcome osteophytes MUST be debrided or mucous cyst will recur PIP Arthritis nonoperative observations, NSAIDs indications first line of treatment in mild symptoms operative collateral ligament excision, volar plate release, osteophyte excision indications predominant contracture with minimal joint involvement fusion indications border digits (index and small PIP) middle and ring finger OA if there is angulation/rotation deformity, ligamentous instability or poor bone stock technique headless screw fixation has highest fusion rates recreate normal cascade of fingers / PIPJ flexion angles index- 30°, long- 35°, ring- 40°, small- 45° silicone arthroplasty for middle and ring PIPJ radial collateral ligament should be intact to tolerate pinch grip indications central digits (long and ring finger) good bone stock no angulation or deformity outcomes results are similar for both dorsal and volar approaches Erosive osteoarthritis nonoperative splints, NSAIDs indications tolerable symptoms operative fusion indications intolerable deformity technique position of fusion same as above
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.50) A 54-year-old gentleman presents to your office with a mass on top of the distal phalanx that has enlarged over the last nine months. His main complaint is significant tenderness to palpation over the mass. There is no pain with forcible movement of his fingers. A clinical photo is shown in Figure A. A dedicated radiograph of the distal phalanx is shown in Figure B. What treatment option is most appropriate for the best patient outcome? Review Topic QID: 711 FIGURES: A B 1 Observe 8% (295/3827) 2 Needle aspiration 4% (157/3827) 3 Fusion of distal interphalangeal joint 15% (564/3827) 4 Removal of bone spur and cyst 71% (2732/3827) 5 Obtain infectious work-up 2% (63/3827) Select Answer to see Preferred Response PREFERRED RESPONSE 4 (OBQ10.258) A 38-year-old woman complains of a painful finger mass of 4 months duration. A photograph of the mass is provided in Figure A. The decision is made to proceed with surgical excision. Which of the following is an advantage of surgical excision with joint debridement as opposed to aspiration? Review Topic QID: 3354 FIGURES: A 1 Reduced rate of infection of the DIP joint 2% (60/2660) 2 Less post-procedure pain 0% (11/2660) 3 Improved DIP range of motion 1% (38/2660) 4 Decreased risk of mass recurrence 95% (2515/2660) 5 Reduced risk of metastasis from seeding the mass into the joint 1% (25/2660) Select Answer to see Preferred Response PREFERRED RESPONSE 4