Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Swedish Orthopedic Symposium

Arthritis Management for Primary Care Providers

November 2016

John Miyano, MD

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Introduction: Arthritis in the Hand and Wrist

The Many Flavors of Arthritis

Osteoarthritis

Traumatic Arthritis

Infectious Arthritis

Inflammatory Arthritis

Crystalline Arthritis

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Osteoarthritis of the Thumb Base

CMC (carpometacarpal joint)

STT (scaphotrapeziotrapezoid joint)

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Xray Appearance

Normal Arthritic CMC and STT

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Presentation

CMC Osteoarthritis

Aching in thenar region with radiation to MP joint Pain with pinching and grip Loss of pinch strength Stiffness

STT Osteoarthritis

Aching in the radial (thumb) side of the wrist Pain with radial deviation

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Physical Exam

Enlargement of the CMC joint

Tenderness to palpation

Limited ROM at CMC

Hyperextension at the MP joint

Pain and crepitation with passive motion

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Physical Exam CMC Joint

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Physical Exam STT Joint

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Physical Exam STT Joint

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Management

Medication

Therapy (Bracing)

Steroid Injection

Surgical Reconstruction

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Medication

Acetominophen versus NSAIDs

Oral versus Topical

Glucosamine and Chondroitin

Topical NSAIDs for chronic musculoskeletal pain in adults.Cochrane Database Syst Rev. 2012 Sep 12;(9)

Derry S, Moore RA, Rabbie R.

Acetaminophen for osteoarthritis.Cochrane Database Syst Rev. 2006 Jan 25;(1)

Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G.

Glucosamine and chondroitin sulfate treatment ofhand osteoarthritis.J Hand Surg Am. 2013 Aug;38(8):1638-40.

Erickson JM, Messer TM.

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Therapy

Exercises?

Bracing

Hand-Based Thumb Spica Brace (HBTS)

Assistive Devices

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Steroid Injection

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Time to Consider Surgery?

Aching pain on a daily basis

Sharp pain with activity

Avoiding desired activity

Failed other treatment options

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Surgery

Removal of the trapezium

Stabilization with the FCR tendon

Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition.J Bone Joint Surg Am. 1995 Mar;77(3):346-55.

Tomaino MM, Pellegrini VD Jr, Burton RI.

Orthopedics Symposium for the Primary‐Care Physician 11/04/2016

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Thank you!