RHEUMATOID ARTHRITIS-UPPER LIMBS

SUMMARY

WRIST & HAND
1. Hands: the arthritis is symmetric and polyarticular. There is specific involvement of the hands-especially the MCP and PIP joints; the DIP joints are spared!
2. Boutonniere and swan-neck deformities occur in advanced disease, but non-specific.
3. Other deformities: ulnar deviation, volar subluxation, Z deformity of thumb, small muscle wasting, ulnar and median neuropathy.
4. Nails: splinter haemorrhages.
5. Wrist: synovial thickening, Piano key sign (disruption of the radio-ulnar ligament).

PROXIMAL JOINTS
6. Elbows: subcutaneous nodules, olecranon bursitis, ulnar neuropathy.
7. Shoulders: arthritis, adhesive capsulitis, rotator cuff injuries.
8. Axillae: enlarged axillary nodes indicate active disease.
9. Cervical spine: anterior atlanto-axial subluxation due to tenosynovitis of the transverse ligament.

Reference(s)

Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].