8058854
Description
Mind Map by Fatma Shwaylia, updated more than 1 year ago
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Created by Fatma Shwaylia
about 7 years ago
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My Hands are Aching
- Anatomy
- Synovial
Joints
- Synovial
Membrane(synovium)
- Produces a synovial fluid
- lubrication, free movement,
and nutrition of the cartilage
since it doesn’t have a blood
supply
- viscous,
non-Newtonian fluid
found in the cavities
of synovial joints.
- hyaluronic
acid
- lubricin
- collagenases
- proteinases
- hyaluronic
acid
- lubrication, free movement,
and nutrition of the cartilage
since it doesn’t have a blood
supply
- Produces a synovial fluid
- They allow free movement
- It doesn’t ossify, except
under certain pathological
conditions.
- Articular surfaces
of the bone
- Hyaline
cartilage(articular
cartilage)
- Hyaline
cartilage(articular
cartilage)
- The entire joint cavity is
covered by a dense fibrous
tissue capsule
- Certain areas of
the dense
fibrous tissue
capsule are
thickened
occasionally by
capsular
ligaments
- Outside of the capsule,
extra-capsular
ligaments are found
- Outside of the capsule,
extra-capsular
ligaments are found
- Certain areas of
the dense
fibrous tissue
capsule are
thickened
occasionally by
capsular
ligaments
- Intra-capsular (intra-articular)
structures can be found;
meniscus, labrum, tendons,
and disc.
- A synovial
sheath .
- a tubular bursa
that surrounds a
tendon.
- a tubular bursa
that surrounds a
tendon.
- Synovial
Membrane(synovium)
- Bones
- 14 phalanges
- 8 Carpals
- Trapezium
- Trapezoid
- Sarah Looks Too Pretty, Try To Catch Her
- Sarah Looks Too Pretty, Try To Catch Her
- Capitate
- Hamate
- Scaphoid
- Lunate
- Triquetrium
- Pisiform
- Trapezium
- 5 metacarpals
- 14 phalanges
- Arteries
- Superficial Palmar Arch
- mainly by ulnar a.)
- is superficial to the long flexor
tendons just deep to the palmar
aponeurosis. On the lateral side
of the palm, the arch
communicates with the superficial
br. of the radial artery.
- mainly by ulnar a.)
- Deep Palmar Arch
- mainly by radial a
- penetrates the origin of the hypothenar muscles;
access the deep plane of the palm to anastomose
with the deep palmar arch derived from the radial
artery.
- mainly by radial a
- Superficial Palmar Arch
- Nerves
- Ulnar N.: medial
2/3 of the palm &
dorsum + medial
11/2 fingers
- Median N.:
Lateral 2/3
of the palm
+ lateral 3
1/2
- Radial n.: lateral 2/3 of the dorsum
of hand + lateral 3 1/2 fingers
- Muscles
- Joints
- Wrist Joint
- Synovial ,
Ellipsoid ,
biaxial
- Articular disc that separates
the head of ulna from the
triquetral .
- Articular disc that separates
the head of ulna from the
triquetral .
- Synovial ,
Ellipsoid ,
biaxial
- Mid-Carpal Joint
- Synovial joints
- Between the
two rows of
carpal bones
- Positioning of the hand in abduction
, adduction , flexion and particularly
extension
- Positioning of the hand in abduction
, adduction , flexion and particularly
extension
- Between the
two rows of
carpal bones
- Synovial joints
- Carpometacarpal Joint
- Between the distal row of carpal
bones and proximal end of the
metacarpal bones .
- more stability than mobility.
- more stability than mobility.
- Between the distal row of carpal
bones and proximal end of the
metacarpal bones .
- Metacarporhalangeal Joints
- Between the distal heads of the
metacarpals and the proximal
phalanges of the digits .
- flexion , extension , abduction ,
adduction , circumduction and
limited rotation .
- flexion , extension , abduction ,
adduction , circumduction and
limited rotation .
- Between the distal heads of the
metacarpals and the proximal
phalanges of the digits .
- Interphalangeal Joints
- Hinge Joints
- Between the phalanges of the hand .
- flexion and extension
- flexion and extension
- Between the phalanges of the hand .
- Hinge Joints
- Wrist Joint
- Synovial
Joints
- Diseases that affect 1 or > joints
- Infectious
diseases
- acute and
chronic
septic
arthritis
- acute and
chronic
septic
arthritis
- Bleeding
- untreated
blood clotting
disorders such
as hemophilia
- untreated
blood clotting
disorders such
as hemophilia
- Inflammatory
diseases-
- autoimmune disorders
such as rheumatoid
arthritis
- autoimmune disorders
such as rheumatoid
arthritis
- Degenerative
diseases
- osteoarthritis
- osteoarthritis
- Infectious
diseases
- Joint Arthritis
- inflammation
of the joints
- the term is used to describe
many rheumatic diseases that
affect the joints.
- Injury
- Degenerative
arthritis
- inflammation, breakdown, and
eventual loss of the cartilage of
the joints.
- hands, feet, spine, and large
weight-bearing joints, such as
the hips and knees.
- Osteoarthritis
- Osteoarthritis
- hands, feet, spine, and large
weight-bearing joints, such as
the hips and knees.
- inflammation, breakdown, and
eventual loss of the cartilage of
the joints.
- Degenerative
arthritis
- Genetic
- Rheumatoid
Arthritis
- signs and symptoms
- fever, malaise,
arthralgias, and
weakness
- progresses to joint inflammation and
swelling
- progresses to joint inflammation and
swelling
- Persistent symmetric polyarthritis
(synovitis) of hands and feet
- hallmark
feature)
- hallmark
feature)
- Progressive articular
deterioration
- Extra-articular
involvement
- Difficulty performing
activities of daily living (ADLs)
- fever, malaise,
arthralgias, and
weakness
- onset is insidious
- Investigations
- Blood Investigations
- Anti-CCP(cyclic
citrullinated
peptide)
- identifying
autoantibodies
- identifying
autoantibodies
- normocytic
anemia
:anemia of
chronic
disease(ACD)
- The most
common
cause is a
long-term
(chronic)
disease.
- The most
common
cause is a
long-term
(chronic)
disease.
- High
Erythrocyte
sedimentation
rate and
C-reactive
protein (CRP)
level
- markers of
inflammation
- markers of
inflammation
- Rheumatoid
factor
(RF)
- RF antibody
can attach to
normal body
tissue,
resulting in
damage.
- RF antibody
can attach to
normal body
tissue,
resulting in
damage.
- Anti-CCP(cyclic
citrullinated
peptide)
- Joint imaging
- Plain x-ray
- symmetric
joint
- soft
tissue
swelling
- space loss
- subchondral
erosions.
- symmetric
joint
- Plain x-ray
- Blood Investigations
- Clinical
Findings
- Rheumatoid
nodules
- firm, noticeable
lumps that form
underneath the
skin
- firm, noticeable
lumps that form
underneath the
skin
- Characteristic
deformities
- Z deformity
of the
thumb
- Z deformity
of the
thumb
- Rheumatoid
nodules
- Pathohistology
- synovial
cell
hyperplasia
and
proliferation
- dense perivascular
inflammatory cell
infiltrates
(frequently
forming lymphoid
follicles)
- RA joint is
hypoxic
- angiogenesis
- angiogenesis
- Activation of
osteoclasts and
chondrocytes
- synovial
cell
hyperplasia
and
proliferation
- Investigations
- History
Taking
- basic patient
details and
statement of
presenting
problem.
- Onset
and
Duration
- Where
- Progression
- Quality
- Quantity
- Aggravating
factors
- Alleviating
factors
- Beliefs
- Onset
and
Duration
- basic patient
details and
statement of
presenting
problem.
- Physical
Examination
of the hand
- Causes
- not fully understood
- not fully understood
- Complications
- Haematological
- Anemia of chronic disease
- Iron deficiency anemia
- Bone
marrow
hypoplasia
with
anemia
- Anemia of chronic disease
- Vasculitis
- Digital arteritis
- Ulcers
- Digital arteritis
- Cardiac
- Pericarditis
- Myocarditis
- Endocarditis
- Pericarditis
- Pulmonary
- Pleural effusions
- Bronchiolitis
- Pleural effusions
- Neurological
- Cervical cord
compression
- Peripheral
neuropathy
- Cervical cord
compression
- Systemic
- Fever
- Weight loss
- Susceptibility to infection
- Fever
- Lymphatic
- Splenomegaly
- Splenomegaly
- Musculoskeletal
- Osteoporosis
- Bursitis
- Osteoporosis
- Haematological
- Pathophysiology
- Autoreactive T cells
are activated by
antigen-presenting
cells presenting
self-peptide to CD4
cells.
- Macrophages exacerbate the
disease by secreting TNF
usually found in rheumatoid
synovial tissues, resulting in
cartilage destruction via effects
on chondrocytes
- Rheumatoid
factors are
released as a
consequence to
the activation
of B cells.
- Macrophages also release
the chemokine IL-8 which
recruit neutrophils that
cause more damages to
the tissues
- Inflammation
- Cartilage damage
and joint space
narrowing
- Bone erosion
- Inflammation
- During the process of the
disease, cells are damaged
releasing anti-DNA. RF then
binds the DNA-anti-DNA
forming a complex that binds
and damages basement
membranes.
- Macrophages also release
the chemokine IL-8 which
recruit neutrophils that
cause more damages to
the tissues
- Rheumatoid
factors are
released as a
consequence to
the activation
of B cells.
- Macrophages exacerbate the
disease by secreting TNF
usually found in rheumatoid
synovial tissues, resulting in
cartilage destruction via effects
on chondrocytes
- Autoreactive T cells
are activated by
antigen-presenting
cells presenting
self-peptide to CD4
cells.
- Management
- Pharmacotherapy
- NSAIDs
- Ibuprofen
Ketoprofen
Acetyl
salicylic
acid
Naproxen
Diclofenac
Indomethacin
Piroxicam
- Ibuprofen
Ketoprofen
Acetyl
salicylic
acid
Naproxen
Diclofenac
Indomethacin
Piroxicam
- Disease Modifying
Anti-Rheumatic Drugs
(DMARDs).
- Methotrexate
- Hydroxychloroquine
- Sulfasalazine
- Leflunomide
- Leflunomide
- Sulfasalazine
- Hydroxychloroquine
- Minocycline
- Control current
inflammatory
features
- Reduce joint
damage and
deformity
- Reduce long-term disability
- Reduce long-term disability
- Reduce joint
damage and
deformity
- Methotrexate
- Non-TNF biologic therapy
- preventing full T-cell activation
- B-Cell Depletion
- Interleukin-1 Receptor
Antagonists
- Interleukin-1 Receptor
Antagonists
- B-Cell Depletion
- preventing full T-cell activation
- NSAIDs
- Physiotherapy
- Cold/Hot Applications
- cold in acute
- where intra-articular
heat increase is
undesired
- cold-pack, ice,
nitrogen spray,
and cryotherapy
- cold-pack, ice,
nitrogen spray,
and cryotherapy
- where intra-articular
heat increase is
undesired
- hot in chronic
- Analgesia
- Relieve muscle
spasms
- elasticity of periarticular
structures obtained
- elasticity of periarticular
structures obtained
- Analgesia
- cold in acute
- Electrical Stimulation
- Transcutaneous
electrical
nerve
stimulation
(TENS)
therapy
- Transcutaneous
electrical
nerve
stimulation
(TENS)
therapy
- Hydrotherapy
- exercises in a pool
- exercises in a pool
- Rehabilitative Treatment
- Joint Protection Strategies
- Joint Protection Strategies
- Therapeutic
Exercise
- swimming,
walking,
and cycling
with
adequate
resting
periods are
recommended
- swimming,
walking,
and cycling
with
adequate
resting
periods are
recommended
- Cold/Hot Applications
- Intermittent splinting
- external supports
applied to body
parts
- decrease inflammation
- relieve pain
- protect a joint
- improve function
- correct deformity
- decrease inflammation
- external supports
applied to body
parts
- Pharmacotherapy
- Prognosis
- 40% of RA
- disabled
within 3
years
- disabled
within 3
years
- 80% are
moderately
to
severely
disabled
- within20 years
- within20 years
- life expectancy
could be
shortened
- 40% of RA
- signs and symptoms
- Rheumatoid
Arthritis
- abnormal
metabolism:
metabolic arthritis.
- Gout or Gouty
arthritis
- buildup of uric
acid in the blood.
- This acid crystallizes and
the crystals deposit in
the joints
- This acid crystallizes and
the crystals deposit in
the joints
- buildup of uric
acid in the blood.
- Gout or Gouty
arthritis
- Autoimmunity
- RA and Systemic
lupus erythematous.
- SLE: It can affect the
skin, joints, kidneys,
brain, and other organs.
- SLE: It can affect the
skin, joints, kidneys,
brain, and other organs.
- RA and Systemic
lupus erythematous.
- Idiopathic
Juvenile
- Juvenile Idiopathic
arthritis
- cause is not fully
understood
- cause is not fully
understood
- Juvenile Idiopathic
arthritis
- Injury
- Infection
- Septic
Arthritis
- most
common in
the knees
and hips
- may lead to
permanent
joint damage
- life
threatening
- life
threatening
- may lead to
permanent
joint damage
- most
common in
the knees
and hips
- Reactive Arthritis
- triggered by an
infection in
another part of the
body
- the knees and the
joints of your
ankles and feet
- the knees and the
joints of your
ankles and feet
- triggered by an
infection in
another part of the
body
- Septic
Arthritis
- the term is used to describe
many rheumatic diseases that
affect the joints.
- inflammation
of the joints
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