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Rheumatoid Arthritis (prognosis of RA and socioeconomic effects of hand…
Rheumatoid Arthritis
prognosis of RA and socioeconomic effects of hand disability
pain and stiffness
depression and anxiety
decline of mobility and range of motion
persistent joint inflammation
osteoprosis
anemia
heart disease
income
education
occupation
sheath of flexor tendon arrangement and role
ulnar bursae (4 flexor digitorum superficialis and 4 flexor digitorum profundas tendons)
dense plates of fibrous tissue arch over a tendon
synovial sheath of flexor carpi radialis
radial bursae (flexor pollicis longus)
synovial sheath of palmaris longus
digital synovial sheath
autoimmune disease that affect the joints and other structures
movements of joints of hand and wrist
intercarpal joints
synovial
plane
multiaxial
metacarpophalangeal joints
synovial
condyloid
biaxial
wrist joint
synovial
ellipsoid
biaxial
carpometacarpal joints
synovial
thumb
saddle
triaxial
rest 4 digits
plane
multiaxial
proximal and distal interphalageal joints
synovial
hinge
uniaxial
tendons that passes these joints are covered with
systemic manifestation of RA
eyes
scleritis
scleromalacia
heart
conduction defect
inflammation of the heart wall
lungs
pleural effusion
bronchiolitis
MSK
muscle wasting
tenosynovitis
RA can be diagnosed by
drugs used in management of RA
DMARDs
biological therapies
NSAIDs
glucocorticoids
and treatment by
physiotherapy for RA
TENS therapy
exercises
heat and cold therapy
stress ball
thus preventing complications
diagnostic criteria of RA
inflammatory arthritis involving 3 or more joints
positive RF and anti-CCP
the duration of the symptoms is more than 6 weeks
thus giving
anatomy
carpal tunnel
carpal bones make the posterior and sides boundaries
structures that runs within the carpal tunnel
4 flexor digitorum superficialis tendons
4 flexor digitorum profundas tendons
median nerve except the palmar cutaneous branch of median nerve
flexor pollicis longus tendon
synovial sheaths
flexor retinaculum (transverse carpal ligament)
attached medially to the pisiform and hook of hamate
laterally it splits to be attached to the scaphoid (superficial) and trapezium (deep), to enclose on the flexor carpi radialis tendon
hand
bones
metacarpal bones
1st
2nd
3rd
4th
5th
phalanges bones
proximal
intermediate
except in the thumb there is no intermediate phalanx
distal
carpal bones
scaphoid
lunate
triquetrium
pisiform
hamate
capitate
trapizoid
trapezium
muscles
palmaris brevis muscle
1st layer
flexor pollicis brevis
2nd layer
opponens digiti minimi
Adductor pollicis
transverse head
1 more item...
oblique head
1 more item...
opponens pollicis
3rd layer
1 more item...
abductor digiti minimi
flexor digiti minimi brevis
Abductor pollicis brevis
nerve supply
ulnar nerve
palmar cutanous branch of ulnar nerve
skin of base of median palm
dorsal branch of ulnar nerve
skin of medial aspect of dorsum of hand and proximal portions of little and medial half of ring finger
superficial branch of ulnar nerve
palmaris brevis
skin of palmar and distal dorsal aspects of digits 5 and medial side of digit 4 and proximal portion of palm
deep branch of ulnar nerve
hypothenar muscles (abductor, flexor and opponens digiti minimi
4th and 5th lumbricals
all interossei
adductor pollicis
deep head of flexor pollicis brevis
radial nerve
superficial branch
skin of lateral half of dorsal aspects of the hand and thumb and the proximal portions of the dorsal aspects of digits 2 and 3 and the lateral half of digit 4
median nerve
recurrent (thenar) branch of median nerve
abductor pollicis brevis
superficial head of flexor pollicis brevis
opponens pollicis
lateral branch of median nerve
1st lumbrical
skin of palmar and distal dorsal aspect of thumb and the lateral half of the second digit
medial branch of median nerve
2nd lumbrical
skin of palmar and distal dorsal aspects of adjacent sides of 2nd- 4th digits
palmar cutanous branch of median nerve
skin of lateral 2/3 of the palm
thus determining the physiology of the hand and wrist joints
clinical presentation
signs and symptoms
symmetric swelling of multiple joints
pain, swelling, warmth most commonly in MCP, PIP, MTP, ankles, wrist, elbow, shoulder, hip, knee
1 hour of morning stiffness
boutonniere deformity
rheumatoid nodules
swan neck deformity
and
immunological aspect of rheumatoid arthritis
rheumatoid arthritis is a chronic inflammation of the joints, they get deformed and losses their function
autoimmune disease
due to
physical trauma
smoking
environmental toxins
genetics (HLA-DRB1 or 4)
autoantibodies
anti-citrullinated peptide antibodies
anti-RA33
rheumatoid factor
which might effect other body systems