hands

hands

1. anatomy of the hands

2. sensory receptors and tracts

   • photoreceptors, chemoreceptors, mechanoreceptors, nociceptors, thermoreceptorsrs
   • path of sensation
   • tests for the pathways of sensation
     • romberg's test for dorsal column system
     • pain/temperature sensation for anterolateral system

3. joint classification

4. synovial sheath

   • fibrous layer (supportive and protective)
   • synovial layer (lines the tendons + produces the synovial fluid)
     • synovial fluid can be analysed to give better diagnosis for some diseases like osteonecrosis, PVS, trauma, etc..
   • function

5. physical examination of the wrist

   • 1. introduction 2. inspection 3. palpation 4. movement
   • special tests :
     • Phalen’s test
     • Tinel’s sign
     • Finkelstein’s test
     • Check the function: e.g. key grip , undo a button

6. Rheumatoid arthritis

   • long-term autoimmune disorder that primarily affects joints
   • results in warm, swollen, and painful joints
   • Investigations of Rheumatoid arthritis
     • Establish diagnosis using MRI, X-ray, ESR and CRP
     • Monitor disease damage using X-ray imaging and functional assessment
     • Monitor drug safety using urinalysis, CBC, liver function test

7. Immunological Aspect of RA

   • Systemic Autoimmunity
   • HLA-DR4 gene = higher susceptibility to RA
   • Main players of RA:-
     • T-cells, B-cells, TNF, IL-1, IL-6, I L-7, macrophages
   • Autoantibodies
     • Rheumatoid Factor, Anti-citrullinated peptide antibodies, Anti-RA33

8. NERVE CONDUCTION IN THE HAND

   • nerve conduction in RA
     • nerve entrapment: increased pressure on a nerve
       • wrists (median nerve entrapment/carpal tunnel syndrome) and elbow (ulnar nerve entrapment)

9. Management of Rheumatoid arthritis

   • physiotherapy, rehabilitation (exercising, stretching, resting)

10. medication for RA

    • DMARDS
      • Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide
    • Biological therapies
      • infliximab, etanercept

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