Rheumatoid Arthritis

Rheumatoid Arthritis

1. Anatomy of hand

   • Bones
     • Carpal bones
       • proximal row:Scaphoid,Lunate,Triquetrum&Pisiform
       • distal row:Trapesium,Trapezoid,Capitate&Hamate
     • Metacarpals 5
     • Phalanges 14
   • ligaments
     • Ant. palmar radio carpal ligament
     • Post. Dorsal radio carpal ligament
     • Ulnar medial collateral ligament
     • Radial lateral collateral ligament
   • joints
     • The inter carpal joints
     • carpometacarpal joint of the thumb
     • Metacarpophalangeal joints
     • Interphalangeal joints
     • mid-carpal joints
   • Arteries
     • superficial palmar arterial arch
       • formed from the continuation of ulnar artery and superficial branch of radial artery
       • Common digital arteries arise from the superficial palmar arch. Divide into proper digital arteries at the web spaces.
     • Deep Palmar Arterial Arch
       • formed from the continuation of radial artery and deep branch of ulnar artery
       • Branches of the deep arch (from radial to ulnar)  princeps pollicis branch to the radial side of the index finger  branches to the 3 common digital arteries in the 2nd, 3rd, and 4th web spaces
   • Veins
     • distribution of the veins in the hand is widely varied
     • The dorsal venous plexus of the hand and the ensuing cephalic (1) and basilic (2) veins drain the superficial aspects of the hand
   • Muscles
     • Thenar muscles.
       • 1)Abductor pollicis brevis
       • 2)Flexor pollicis brevis
       • 3)Opponens pollicis
       • 4)Adductor pollicis
     • Lumbricals 4
     • Hypothenar muscles.
       • 1)Abductor digiti minimi
       • 2) Flexor digiti minimi
       • 3)Opponens digiti minimi
     • Adductor of thumb.
     • interossei
       • 3 palmar
       • 4 dorsal
   • Nerves
     • median nerve
       • Thenar muscles except Adductor pollicis
       • First 2 lumbricals
       • cutaneous branches
     • ulnar nerve
       • Adductor pollicis
       • Hypothenar muscles.
       • medial 2 lumbricals
       • all interossei

2. signs & symptoms

   • An systemic autoimmune disease characterized by chronic inflammation of joints. Pain,Stiffness,Swelling, warmth,redness,More than one joint is affected and nodular swelling

3. Examination

   • 1-inspection:looking for scars,discoloration.etc
   • 2-palpation:feeling : temperature ,swelling..etc
   • 3-range of movement: abducton,flextion..etc
   • 4-special tests: conformatory tests such as phalens & tinals test .

4. Investigation

   • • C-reactive protein level • Erythrocyte sedimentation rate • Rheumatoid factor assay • Antinuclear antibody assay • Anti−cyclic citrullinated peptide

5. Treatment

   • pharmacological and non pharma.(physiotherapy,alternative medicine ..etc)