my hands are aching

my hands are aching

1. anatomy of the hand

   • joints in the hand
     • Ellipsoid
       • radiocarpal joint
       • metacarpophalangeal of the fingers
       • carpometacarpal of the fingers
     • hinge
       • metacarpophalangeal of the thumb
       • interphalangeal
     • plane
       • intercarpal
     • saddle
       • carpometacarpal of the thumb
   • anatomy of the carpal tunnel
     • carpal tunnel syndrome
       • compression to the median nerve causing numbness in the thumb and index and middle fingers
   • nerve supply
     • median nerve
     • radial nerve
     • ulnar nerve
   • blood supply
   • anatomy of tendon sheath
     • layers
       • fibrosis tendon sheath
       • synovial sheath
         • synovial fluid
           • functions
             • reduction of friction
             • shock absorption
             • nutrient and waste transportation
           • composition
             • lubricin
             • hyaluronan
             • proteinases
             • proteins
   • 27 bonres
     • 8 carpals
     • 5 metacarpals
     • 14 bones in thefingers
   • muscles
   • physiology of the hand
     • wrist joint
       • ulnar deviation
       • radial deviation
       • flexion
       • extention
     • fingers
       • thumb
         • oppostion
       • abduction
       • adduction

2. Rheumatoid arthrities

   • signs & symptoms
     • morning stiffness
       • due to the swelling
     • joint pain, swelling
     • more than one joint is effected
       • especially small joints
       • joints at both sides
     • characteristic deformity of the hands
       • Z deformity of the thumb
       • button hole deformity
       • swan neck deformity
   • diagnostic criteria ( 4 criteria present for 6 weeks)
     • RF+
     • Rheumatoid nodules
     • radiographic changes erosions
     • symmetric arthritis
     • arthritis of hand joints
     • morning stiffness >1 hour
     • unequivocal periarticular osteopenia
     • arthritis of > 3 joints areas
   • defenition
     • an autoimmune disease in which the immune system attacks the joints
   • pathophysiology
     • infiltration of the synovial membrane with lymphocytes, plasma cells, dendritic cells, macrophages
     • interactions between T cells and B cells lead to the production of cytokines and autoantibodies (RF)
     • synovial macrophages produce proinflammatory cytokines ( TNF, IL-1, IL-6, IL-15)
       • act on the synovial fibroblasts to promote swelling of the synovial membrane
         • activation of osteoclasts and chondrocytes
   • lab test
     • latex test and RF
     • CRP
       • an acute phase serum protein that acts as a surrogate for the proinflammatory IL-6
     • ESR
       • in inflammation some proteins cause RBCs to stick together and fall more quickly than normal
   • anemia of chronic inflammation
     • bone marrow is producing high amount of WBCs so it's crowded and less RBCs are produced
   • stages of RA
     • moderate RA ( stage II)
     • stage IV
     • severe RA ( stage III)
     • Early stage ( stage I)
   • complications
     • Eye problems
     • kidney and liver problems
     • peripheral neuropathy
     • vasculitis
     • pregnancy complications
   • radiograph of RA
   • other systemic effects of RA
     • cardiac disease
     • renal disease
     • skin manifestation
     • haematologic manifestation
     • pulmonary manifestation
   • epidemiology
     • most common in autoimmune disease
     • occurs at twice the rate in women than men
     • the incidence increase with Age
   • management of RA
     • NSAIDs
     • DMARDs
       • mechnism of actin
       • methotrexate, sulfasalazine , hydroxychloroquine, azathioprine
   • physiotherapy
     • cold\hot application
     • electrical stimulation
     • hydrotherapy
   • rahabilitative treatment
     • therapeutic exercise
     • massage therapy
     • therapy gloves
     • rest and splinting
       • to help decrease inflammation
       • properly position joints

3. examination of the hand

   • look
     • dorsum, palm, nails, fingers, skin
   • feel
     • muscles, tendons, joints, nerves
   • move
     • wrist, fingers, thumb
   • special tests
     • finkelstein's test
     • phalen's test
     • tinel's test

4. beliefs and compliance

   • the patient feels susceptible to the illness or it's complications
   • patients are worried about diminishing effectiveness of medication over time
   • patients are afraid of dependence on the long-term medication
   • cultural and superstitious beliefs contradict the treatment

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