CS: Arthritic Hand- MCP & PIP Pathology

CS:  Arthritic Hand- MCP & PIP Pathology

– [Voiceover] The following
is an introduction to the arthritic hand. Scanning technique is
of particular importance while scanning the
metacarpal phalangeal joints or the proximal
interphalangeal joints due to the slight transducer
pressure and its capability of compressing useful synovial tissues. Begin with copious gel heeping
over the area of interest. First, utilize the index finger
as a primary palpation point as well as a stabilizer for
the ultrasound transducer. Also, use the thumb as a stopping point for the transducer’s
depth over the gel heep. Try first to observe this
gel heep and the position of the fingers before
looking at the screen. Our first observation
highlighted here in white is the distal metacarpal head,
and highlighted in purple, the normal anatomical metacarpal notch. The next highlighted bone
is the middle phalanx. Note the joint space
here in the normal image also reveals a normal-appearing
hyaline cartilage, highlighted here in dark blue. The light blue indicates the
normal physiologic amount of synovial fluid. The yellow layer indicates
the normal synovial membrane. Observe its attachment point
into the metacarpal notch. In red, we see highlighted
here a normal-appearing areolar connective tissue layer. In green, highlighted
is the extensor tendon as it passes over the joint. The purple layer is simply
a subcutaneous fat layer, followed by the orange
layer, which is the actual cutaneous layer or skin. In this video clip, I will
demonstrate the sensitivity to probe pressure on the synovial capsule. Observe the simple fluid
displacing while the transducer is depressed, upon letting up on the
probe pressure we see the simple fluid emerging from
the joint highlighted here. The following study demonstrates
severe synovial thickening in early rheumatoid arthritis. Here we have highlighted
the normal-appearing distal metacarpal head and
metacarpal notch with no erosion. Here is the proximal phalanx followed by the normal
amount of physiologic fluid, and our severely inflamed
synovial membrane as it inserts to the metacarpal notch. Highlighted in red is the
areolar connective tissue layer followed by the common extensor tendon which appears distended due to the thickened structures beneath it. In purple is the subcutaneous
layer followed by the orange layer, which
is the cutaneous layer. And also the very important gel heep keeping this structures
from being compressed. Confirm inflammatory
conditions with power doppler. Pulsed wave doppler is
a tool that measures the velocity of blood flow. We will now look at a similar joint, the proximal interphalangeal
joint, or the PIP joint, which is distal to the
metacarpal phalangeal joint and more commonly
affected by osteoarthritis than rheumatoid arthritis. It has very similar
construction to the MCP joint. Highlighted here is the
proximal phalanx followed by the middle phalanx and the
normal physiologic fluid, followed by the synovial capsule
highlighted here in yellow. And the extensor tendon,
highlighted here in green. The subcutaneous layer in purple and the orange cutaneous layer. When evaluating osteoarthritis,
the primary changes are observed in the
cortical surface rather than the synovial lining. These cortical growths make
the joint almost impossible to see on a static image. In yellow is the synovial lining which appears normal in thickness. Here we have a little
excess joint effusion and the extensor tendon
appears fairly normal, as do the subcutaneous
and cutaneous layers. So that we see the full
extent of this growth and its effects on the soft tissue, always remember to use a gel heep.


  • Nabil Iskander says:


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