Puffy Fingers

Puffy Fingers

1. Muscles of the hand

   • Compartments
     • Thenar
       • Flexor policies brevis
         • Thumb flexion
       • Abductor policies brevis
         • Thumb adduction
       • Opponent Policies
         • opposes thumb
     • Adductor
       • adductor policies oblique
       • adductor policies transverses
     • Subcutaneous tissue of hypothenar eminence
       • Palmaris brevis
         • Wrinkles hypothenar skin
     • Central
       • Lumbricals
         • flexion MCP joint and extension of PIP + PIP joints
     • Palmar interoessi
       • digits adduction
     • Dorsal interosseous
       • digits adduction
   • hypothenar
     • oponens digiti minimi
       • 5th fingers opposition
     • flexor digiti minimi brevis
       • 5th finger flexion
     • adductor digiti minimi
       • 5th finger adduction
   • Anatomical snuff box
     • Boundaries
       • extensor policies longus tendon
       • extensor policies brevis tendon
       • abductor policies longus tendon
   • innervation
     • ulnar nerve
       • rest of muscles
     • median nerve
       • Thenar muscles
       • 1,2 lumbrical ( lateral )
   • Blood supply
     • radial artery
       • deep palmar arch
     • Ulnar nerve
       • superficial palmar branch

2. Signs and Symptoms of RA

   • Tenderness
   • Fever
   • Swelling
   • Fatigue
   • Weight loss

3. Causes

   • Autoimmunity
     • triggered by
       • genetic factors
         • HLA-DR1
           • Which presents citrullinated self-antigens
       • Environmental factors
         • Smoking
           • increased PAD expression
             • citrullination of self-proteins
               • Activation of auto reactive CD4 and B cells
                 • produce
                   • Anti-citrullinated protein antibodies
                   • inflammatory cytokines

4. Rheumatoid Arthritis

   • Chronic systemic autoimmune disease
   • characterized by
     • formation of pannus
       • leading to
         • Cartilage damage
           • Ankylosis
   • extaarticular
     • fever , malaise and weight loss
     • vasculitis
   • Articular
     • stiffness and redness

5. psychological effects

   • body image and sexuality
     • Feeling heavy
     • slow in movement
     • clumsy
   • Pain and fatigue
   • Depression
   • Self efficacy

6. Nerve conduction studies

   • Measure
     • Damage to myelin
   • Demyelination
     • decreased conduction velocity

7. Pharmacology of RA

   • DMARD
   • Anti-TNF a
   • Non-TNF
   • Corticosteroids