R di Radiographs h off the th normall hand, h d wrist i t and d elbow joints. Radiographs g p illustrating g common orthopedic pathology of the hand, wrist and elbow joints. j

OBJECTIVES • •

REVIEW THE SURFACE, SURFACE APPLIED AND RADIOLOGICAL ANATOMY OF THE HAND & WRIST FAMILIARISE YOURSELF WITH COMMON ORTHOPAEDIC DISORDERS OF THE HAND & WRIST

NORMAL BONES OF THE HAND

SURFACE ANATOMY OF WRIST AND HAND

Figure 1. Drawing illustrates the normal arterial anatomy of the hand

Connell, D. A. et al. Radiographics 2002;22:583-599

Copyright ©Radiological Society of North America, 2002

INNERVATION OF THE HAND

Bones of the hand,, dorsopalmar p projection: p j

1. Styloid process of the radi s radius 2. Styloid process of the ulna 3. Ulnar notch of radius 5. First metacarpal 6. Second metacarpal 7. Third metacarpal 8. Fourth metacarpal 9 Fifth metacarpal 9. 10. Shaft of proximal phalanx of middle finger 11. Shaft of middle phalanx of middle finger 12. Sesamoid bone

Normal xx-ray ray of the hand

Common joint disorders of the hands

Hand deformities in rheumatoid arthritis

Joseph Holoshitz, M.D., University of Michigan Medical School)"

Hand Rheumatoid Arthritis

Osteoarthritis

Joints affected by osteoarthritis

Joints in the hands affected by osteoarthritis

Hand deformities in osteoarthritis

Severe Osteoarthritis of the Hand

This XRay shows destruction of cartilage with hypertrophy of articular surfaces

Hand deformities in Gouty arthritis

Chronic Gouty Arthritis Gouty tophi containing uric acid crystals

Radiograph showing sharply "punched-out" bony defects of the distal radius and proximal phalynx of the middle finger and thumb.

Psoriatic Arthritis For further information: Voice: (503) 244-7404 Fax: (503) 245-0626 E-mail

Psoriatic Arthritis Description and Photos Index

Symptoms Diagnosis Age of Onset / Developmental Factors Treatments Types of Psoriatic Arthritis NPF Booklet on Psoriatic Arthritis Photo/Xray: Symmetric Psoriatic Arthritis (Feet) Photo: Distal Interphalangeal Predominant (Fingers) See Also: Types of Psoriasis Archive Index SymptomsPsoriatic arthritis is a specific type of arthritis that occurs in approximately 10 percent of the people who have psoriasis. It can start slowly, with mild symptoms, or develop quickly. Generally, one or more of the following symptoms may appear: Discomfort, stiffness, pain, throbbing, swelling, or tenderness in one or more joints and reduced range of joint motion; Affecting distal joints (the joint closest to the fingernail) in the fingers or toes, lower back, wrists, knees, or ankles with swelling of the involved fingers and toes suggesting a sausage appearance; Morning stiffness and tiredness; Nail changes may occur; e.g., the nail p from its nail mayy separate bed and pits may appear; Inflammation of the eye, such as conjunctivitis. DiagnosisPsoriatic arthritis is similar to three other forms of arthritis which may occur with psoriasis: rheumatoid, gout, and Reiter's syndrome. The diagnosis of psoriatic arthritis is made on the basis of a medical history and physical examination, blood studies, and x-rays of the joints that have symptoms. A certain antibody generally present in rheumatoid arthritis is not usually found in the blood of psoriatic arthritis patients. A blood test for the antibody will distinguish between rheumatoid arthritis and psoriatic arthritis. Fluid drawn from the affected joints can be examined to resolve the diagnosis of gout or psoriatic arthritis. Age of Onset / Developmental FactorsPsoriatic arthritis may develop at any age, but most often it begins between the ages of 30 and 50. A number of factors seem to be associated with the development of arthritis. Heredity has been shown to be a significant factor. Recent studies have shown certain genetic markers which occur more often in people who develop psoriatic arthritis. Also, there is speculation that the immune system may play a role. Certain bacteria have been identified as possible triggering factors and trauma has also been observed to trigger psoriatic arthritis. TreatmentsA warm, stable climate may have some influence on psoriatic arthritis symptoms, but diet has not been found to be beneficial in altering its course. Treatments for mild psoriatic arthritis may include nonsteroidal antiinflammatory medicines such as aspirin and ibuprofen. Heat, warm water soaks, exercise programs, splints, and physical therapy can also be used. When psoriatic arthritis is not relieved or is more severe, more potent medications may be required, e.g., methotrexate, gold injections and capsules, sulfasalazine, etretinate and even PUVA. Surgery may also be required in some cases. The Five Types of Psoriatic Arthritis Symmetric Arthritis Symmetric arthritis is much like rheumatoid arthritis. It usually affects multiple pairs of joints and can be disabling. The associated psoriasis is often severe. About 50 percent of people with this form of psoriatic arthritis will develop variable degrees of progressive, destructive disease, although it is less severe than rheumatoid arthritis. Asymmetric Arthritis Asymmetric (not occurring in the same joints on both sides of the body) arthritis usually involves only one to three joints. It can affect any joint, such as the knee, hip ankle and wrist. One finger can be involved or many can be affected. The joints may be warm, tender and red. Individuals may experience periodic joint pain which is usually responsive to medical therapy. Distal Interphalangeal Predominant (DIP) This form of arthritis occurs in abo t fi about five e percent of people with psoriatic arthritis. It involves primarily the distal joints of the fingers and toes (the joint closest to the nail), and sometimes is confused with osteoarthritis, a chronic arthritis of noninflammatory character. Spondylitis In about five percent of individuals, inflammation of the spinal column is the predominant symptom. Inflammation and stiffness of the neck, lower back, sacroiliac, or spinal vertebrae are common symptoms making motion difficult. There may be peripheral disease in the hands, arms, hips, legs and feet. Spondylitis can also attack connective tissue such as ligaments. Arthritis Mutilans This is a severe, deforming and destructive arthritis which affects less than five percent of people with psoriatic arthritis. It principally affects the small joints of the hands and feet, although there is frequently associated neck or lower back pain. This type can progress over months and years. Arthritic flares and remissions tend to coincide with skin flares and remissions. NPF Booklet on Psoriatic Arthritis For an more detailed information on psoriatic arthritis, contact the NPF and request a copy of the NPF booklet on psoriatic arthritis. All NPF members are entitled to copies of NPF Booklets on a variety of topics. Symmetric Psoriatic Arthritis Distal Interphalangeal Predominant

Distal Interphalangeal Predominant

Normal Anatomy of the Wrist

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Rheumatoid Arthritis of the Wrist

Frontal images of both the right (above) and left wrists (below) show advanced changes of rheumatoid arthritis soft tissue swelling (yellow arrows), narrowing of the radiocarpal joint space (blue arrow). erosions (red arrows), destruction of the ulnar styloid (green arrow). T

.

Note the symmetric appearance of the disease

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Common fractures of the Wrist Scaphoid fracture

Acknowledgements: www.joint-pain-expert.net/scaphoid-fracture.html

Colle’s Colle s Fracture Caused by a fall on an outstretched hand

transverse fracture of the radius just proximal to the wrist, with dorsal displacement and angulation of the distal fragment

Dinner – fork deformity

Acknowledgements : imageinterpretation.co.uk/wrist.html

MUSCLES OF THE FOREARM

Radiograph oh the elbow (Labelled)

Acknowledgements: Wesley Norman, PhD

Normal radiographs of the Elbow joint

Lateral A/P

Fractures of the Elbow

Intra-articular Fracture of radial head Supracondylar fracture Acknowledgements: www.joint-pain-expert.net/supracondylar-fract...

Acknowledgements to The XRay Library, Dept. of Radiology, the University of the Witwatersrand Witwatersrand, Johannesburg And to the following g Internet Resources for use of images g in this presentation 1. 1 2. 3. 4. 5. 6. 7. 8.

www. learningradiology www learningradiology.com com www.ucgc.org/segments/foot-injury/ Joseph Holoshitz, M.D., University of Michigan Medical School National Psoriasis Foundation www.joint-pain-expert.net/talus-fracture.html www.joint-pain-expert.net/navicular.fract... www.imageinterpretation.co.uk/ankle.html g p Wesley Norman