Osteoarthritis of the Fingers Heberden’s Nodes

 

Osteoarthritis is a degenerative condition of the cartilage. There is no clear etiology identified for osteoarthritis. Osteoarthritis is not related to tumor, inflammation, infection, gout, or trauma. Osteoarthritis is different from rheumatoid arthritis which is an inflammatory condition. The distal interphalangeal joint (DIP) is the joint that is most often involved with osteoarthritis. The trapeziometacarpal joint (TM) is the second most involved joint with osteoarthritis. When the trapeziometacarpal joint is involved, it causes pain with weak pinch and grip. Osteoarthritis of the fingers involves the following: DIP (Heberden’s Nodes). Heberden’s nodes are bony swellings (osteophytes) that can develop in the distal interphalangeal joints (DIP) due to the effects of osteoarthritis on these joints. Heberden’s nodes are a sign of osteoarthritis caused by osteophytes formation (bony outgrowth) of the articular cartilage in response to repeated microtrauma at the joint. Heberden’s nodes are more common in women than in men. PIP (Bouchard’s nodes) are also associated with osteoarthritis, and they are similar bony growths which develop in the proximal interphalangeal (PIP) joints. Bouchard’s nodes, like Heberden’s nodes, may or may not be painful. Swollen, hard, and painful finger joints (Heberden’s and Bouchard’s nodes) is the classical signs of DIP and PIP joint osteoarthritis. A mucous cyst is a small, fluid-filled sacs that form between the DIP joint of the finger and the bottom of the fingernail are another sign of osteoarthritis. The best treatment for the mucous cyst is surgical excision of the cyst and removal of the underlying osteophyte to decrease the risk of recurrence.

SLAP Tear Diagnosis & Treatment

 

A SLAP tear is a tear that occurs where the biceps tendon inserts into the superior labrum. A SLAP tear is different from a Bankart lesion. A Bankart lesion is a lesion of the anterior inferior labrum, and it usually occurs with shoulder dislocation. SLAP tear is not common and can be hard to diagnose. Symptoms include pain deep within the shoulder or in back of the shoulder, pain when throwing a ball with decrease in velocity and the feeling of having a dead arm after pitching, pain with overhead activity which mimics impingement syndrome, and SLAP tear typically affects throwing athletes. When the biceps tendon is involved, pain may also be located at the front of the shoulder. SLAP tear can be an isolated lesion or it can be associated with internal impingement, articular sided cuff tear, or associated with instability. For clinical examination diagnosis of SLAP tear, usually the O’Brien test is the most commonly used test. Multiple tests are usually used (anterior slide test, clunk test, etc.). MRI with contrast is usually helpful. To perform the O’Brien’s test, the patient is standing or sitting with the arm at 90 degrees of flexion, 10 degrees of adduction, and full internal rotation with the forearm pronated. Do internal rotation of the arm with pronated forearm. The examiner applies pressure to the forearm and instructs the patient to resist the applied downward force. Pain at the shoulder joint suggests a SLAP lesion. Decrease in pain of the shoulder joint on supination of the arm is suggestive of a SLAP tear. Decrease in pain on supination of the arm. A normal labrum is seen on coronal MRI, and the normal superior labrum will show a black signal. The superior labrum is completely dark and triangular. A bright signal within superior labrum indicates a SLAP tear. Type II is the most common type. Type III is a bucket handle tear. White area with dye inside highlights the area of the tear. Treatment includes physical therapy, anti-inflammatory medication, injections, and surgery when conservative treatment fails. Surgery can be labral debridement for minor tearing and fraying. Biceps tenodesis is becoming popular; it is a procedure that cuts the biceps tendon where it attaches to the labrum and reinserts it in another area, usually in front of the shoulder. Biceps tenotomy is a procedure that cuts the biceps tendon from the glenoid and lets it fly. Releasing the long head of the biceps tendon from its attachment allowing it to fall into the upper arm out of the shoulder joint. Biceps tenotomy is probably suitable for some elderly patients. The patient may get a Popeye deformity and cramping of the upper arm. SLAP repair is a procedure which uses sutures to anchor the torn labrum to the glenoid. It is usually done for athletes and patients under the age of 40 years old.