Summary Arthritis of the DIP and PIP joints are very common forms of osteoarthritis seen in the hand and can be associated with pain and deformity. Diagnosis is made radiographically with joint space narrowing seen in the DIP and PIP joints of the fingers. Mucous cysts are often present on clinical inspection of the DIP joint. Treatment is observation if patient is minimally symptomatic. Operative mucous cyst excision, osteophyte resection, or joint fusion may be indicated depending on severity of symptoms and the stage of disease. Epidemiology Incidence Common DIP arthritis is the most common arthritis of the hand DIP > thumb CMC > PIP > MCP Etiology 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) Diagnosis Radiographic diagnosis confirmed by history, physical exam, and radiographs 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 Volar approach has better range of motion and lower revision rate, compared to dorsal approach Erosive osteoarthritis nonoperative splints, NSAIDs indications tolerable symptoms operative fusion indications intolerable deformity technique position of fusion same as above
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ17SE.30) A 28-year-old female ski instructor sustained a fracture-dislocation of her index finger proximal interphalangeal joint (PIPJ) 10 years ago in a roller derby contest. The fracture was treated with distraction arthroplasty. The patient never retained functional range of motion. Additionally, since the injury, the patient has had increasing pain and a mild, progressive rotational deformity. Her radiograph is shown in Figure A. The patient is healthy with the exception that she is homozygous for factor V Leiden. She has attempted non-operative management but her symptoms are unbearable. What surgical intervention is the most appropriate for this patient? QID: 211435 FIGURES: A Type & Select Correct Answer 1 Ray resection 2% (34/1927) 2 PIPJ silicone arthroplasty 18% (352/1927) 3 PIPJ pyrocarbon arthroplasty 7% (144/1927) 4 PIPJ arthrodesis 69% (1322/1927) 5 Vascularized PIPJ transfer from the second toe 3% (66/1927) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 3354 FIGURES: A Type & Select Correct Answer 1 Reduced rate of infection of the DIP joint 2% (95/3995) 2 Less post-procedure pain 1% (21/3995) 3 Improved DIP range of motion 2% (66/3995) 4 Decreased risk of mass recurrence 94% (3758/3995) 5 Reduced risk of metastasis from seeding the mass into the joint 1% (39/3995) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic 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? QID: 711 FIGURES: A B Type & Select Correct Answer 1 Observe 7% (400/5448) 2 Needle aspiration 4% (210/5448) 3 Fusion of distal interphalangeal joint 14% (767/5448) 4 Removal of bone spur and cyst 73% (3958/5448) 5 Obtain infectious work-up 2% (89/5448) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos Cleveland Combined Hand Fellowship Lecture Series 2018-2019 Finger Stiffness - John Delaney, MD John Delaney Hand - DIP and PIP Joint Arthritis D 10/1/2020 96 views 0.0 (0) Hand⎪DIP and PIP Joint Arthritis Hand - DIP and PIP Joint Arthritis Listen Now 14:36 min 9/8/2020 297 plays 0.0 (0)