-Elbows (bilat olecranon bursitis, effusion between lateral epicondyle and olecranon prominence)
-Wrists (piano key sign-volar subluxation on radial side, ulnar drift, proximal carpal row subluxation
ulnarly and distal row subluxation radially)
-Hand/fingers (effusion in index/long fingers, loss of ulnar deviation-see above, trigger finger at MCP,
swan neck deformity)
-Thumb (Flail IP-loss of flexion, Type 1, 2, and 3 deformity)
-Hip (trochanteric bursitis)
-Knee
-ankle (hind foot pronation/flattening of medial longitudinal arch, tarsal tunnel syndrome may develop)
-Feet (MTP synovitis very common-can lead to metatarsalgia, hallux valgus, calcanea spurs claw toe,
ballot toe, morton's neuroma)
Mechanism of Swan neck deformity - ANSWERS-reflex mm spasm of intrinsics due to pain of chronic
MCP synovitis in addition to hypermobility from structurally changed PIP
-Volar capsule of PIP stretched--> lateral bands move dorsally-->tension on flexor digitorum profundus by
the hyperextended PIP flexes the DIP
-Rupture of extensor digitorum communism (at DIP insertion) causing flexor digitroum profundus to pull
DIP into flexion (unrestrained by extensor digitorum communis)
Mechanism for boutineer's deformity - ANSWERSChronic synovitis--> central slip (insertion of extensor
digitorum comminus into middle phalanx lengthens and solar slip of lateral bands occurs--> therefore PIP
forced into flexion
, Bunnell-Littler Test (Intrinsic Plus Test) - ANSWERSTests for passive mm tightness
-passive PIP flexion/MCP flexion
-passive PIP flexion/ MCP extension
Positive: PIP joints are limited in flexion when MCP is in extension=intrinsic mm tightness
*If PIP restricted in both MCP extension and flexion then it is a capsular restriction (not intrinsic mm
tightness)
what is the most common joint to be affected in JIA - ANSWERSknee
What is the difference between type1,2, and 3 deformity in RA - ANSWERS**all in thumb
Type1: IP hyperextension, MCP flexion
-most common
-known as Z deformity
Type2: CMC subluxation and IP hyperextension
-least common
Type 3: CMC subluxation an MCP hyperextension
What is the difference between claw toe and mallot toe - ANSWERSClaw toe: volar subluxation of
metatarsal head with DIP and PIP flexion
Mallot toe: Flexion contracture of the DIP joint (MTP remains neutral)
what may cause mm atrophy around affected joints in RA and where is atrophy most common in RA -
ANSWERS-disuse
-nerve entrapment
-myositis
-steroid induced myopathy
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