hand

Biopsy Anatomical Approach

Region specific approaches

 

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

 

Lower Limb

 

Thigh

 

Rheumatoid MCPJ

Deformity

 

Ulna drift & volar dislocation

 

Rheumatoid MCPJRheumatoid MCPJ Ulnar Deviation

 

Causes of MCPJ Deformity

 

Ulna Drift / Ulna Dislocation

 

1.  Physiological

Compartment Syndromes

Upper limb fasciotomyForearm Fasciotomy Closure

 

1.  Antebrachial Compartment Syndrome

 

Aetiology

 

Supracondylar fracture of humerus

Both bone forearm fractures

 

Examination

 

Management Summary

Rheumatoid Hands Xray

 

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

Inflammatory Arthritis

Conditions

 

Acro-osteolysis

SLE

Scleroderma

Psoriasis

 

Acro-osteolysis

 

Definition

 

Absorption of distal tuft of phalanx

 

DDx

 

Psoriasis

Scleroderma / Raynauds

Frost Bite

Hyperparathyroidism

Diabetes

Vasculitis

Leprosy

RA rarely

Gout

 

Hemiplegia

Problems

 

1.  Lower limb

 

All walk

- Ankle > knee > hip

 

Ankle

- most require operations for ankles

 

LLD

- unilateral underdevelopment

- LLD 0-5cm (average 2cm)

 

2.  Lower limb

- one handedness

- decrease movement in swing

- astereogenesis

- usual upper limb contractures

 

RA Hand Exam

Screening of Joints

 

Neck

-  ROM

 

Shoulder

- behind head / to mouth

- to back pocket 

 

Elbows

- flex / extend elbows 

- pronation / supination with thumb up & elbows by side

 

Wrist

- flexion / extension

 

Hand

- make fist with thumb in and out 

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