Aching pain in the hand

Aching pain in the hand

1. Classification of joints

   • Fibrous joints
   • Cartilagenous joints
   • Synovial Joints
     • Plane joint
     • Hinge Joint
     • Ball & Socket joint
     • Saddle Jpint
     • Pivot Jpint
     • Ellipsoid Joint

2. Anatomy of the hand

   • Bones of the hand
     • • Cutaneous innervation of the hand
         • Ulnar nerve = Medial 2/3 of the palm & dorsum + medial 11/2 fingers.
         • Median nerve = Lateral 2/3 of the palm + lateral 3 1/2 fingers + their nail beds
         • Radial nerve = Lateral 2/3 of the dorsum of hand + lateral 3 1/2 fingers.
     • Carpals
       • Proximal row
         • Scaphoid
         • Lunate
         • Triquetrium
         • Pisiform
       • Distal row
         • Trapezium
         • Trapezoid
         • Capitate
         • Hamate
   • Joints
   • Muscles

3. Rheumatoid Arthritis

   • What is it?
     • Systematic autoimmune disease in which the body’s immune system mistakenly attacks the joints
   • Pathogenesis
   • Complications
     • Carpal tunnel syndrome
     • Widespread inflammation
     • Joint damage
     • Cardiovascular disease
     • Cervical myelopathy
   • Investigations
     • Imaging
       • Early x-ray results will show the beginnings of joint erosion characteristic of the disease
     • Rheumatoid Factor tests
       • Is an antibody that is detectable in the blood of approximately 80% of adults with rheumatoid arthritis
       • Normal range = rheumatoid factor is less than 14 IU/ml
     • Erythrocyte sedimentation rate
     • C Reactive Protien
   • Risk Factor
     • Gender
     • Age
     • Genetics
     • Testesterone
     • stress
   • Management
     • DMARD
       • Symptom Control
       • Modify the course of disease
       • Methotrexate
       • Hydroxychloroquine
       • Sulfasalazine
       • Leflunomide
     • Biological therapies
       • TNF inhibitors
         • Etanercept
         • Infliximab
         • Adalimumab
         • Mechanism of Action
           • Bind to TNF in the joint and in the circulation, preventing its interaction with TNF receptors
       • Non-TNF biologic therapy
         • Abatacept
           • Preventing full T-cell activation
         • Rituximab
           • B-Cell Depletion
         • Anakinra
           • Interleukin-1 Receptor Antagonists
     • Glucocorticoids
   • Role of Physiotherapy
     • Asses & manage
     • Relieve physical pain
     • Increase mobility, improve balance
     • Provides posture correction
     • Make individual independent
   • Analgesics
     • Narcotics
       • Types of receptors
         • Mu receptor
         • Kappa receptor
         • Delta receptor
         • Sigma receptor
       • Mechanism of action
         • Reducing presynaptic Ca++ influx
         • Postsynaptic hyperpolarization
       • Side effects
     • NSAIDs
       • Clinical applications
         • Rheumatoid arthritis
         • Osteoarthritis
         • Acute gout
         • Dysmenorrhoea
         • Metastatic bone pain
         • Headache, migraine and postoperative pain
       • Mechanism of Action
         • NSAIDs inhibit cyclo-oxygenase enzyme (COX) and so inhibit the formation of inflammatory mediators.
       • Side Effects
     • Acetaminophen
       • Maximum daily dose 4 g
       • Side Effects

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