boutonniere

Nalebuff Classification

Type I - Boutonniere 

- commonest

- MP flexion /  IP hyperextension

- usually EPB rupture with EPL subluxation

Type II

- Boutonniere & Swan Neck

- doesn't exist according to Nalebuff

Conditions

1.  PIPJ Synovitis

- synovectomy via dorsomedial approach

2.  Flexor tenosynovitis

- may cause trigger finger

- trial HCLA

- remove synovits but don't release A1 pulley

- will worsen ulna drift

3.  DIPJ

- rarely affects

Rheumatoid Arthritis Diagnostic Criteria

1987 American College of Rheumatology 

Need 4/7 (MAX RANS)

1. Morning Stiffness

2. Arthritis of 3 areas > 6/52

3. Xray changes

4. Rh factor

5. Arthritis of Hand > 6/52

6. Nodules

7. Symmetric Arthritis > 6/52

Screening of Joints

Neck

-  ROM

Shoulder

- behind head / to mouth

- to back pocket 

Elbows

- flexion / extension elbows 

- pronation / supination with thumb up & elbows by side

Wrist

- flexion / extension

Hand

- make fist with thumb in and out