
	Acromioclavicular (AC) Joint Arthritis Arthritis of the Thumb Posttraumatic Arthritis Rheumatoid Arthritis Osteoarthritis

Overview: Arthritis Diagnosis & Treatment

Arthritis represents the cumulative effect that daily living will eventually have on joints. While it may surface more quickly in those who have consistently applied greater pressure on their joints over time, such as athletes or the overweight, or those predisposed to joint degeneration as a result of other conditions, it eventually effects the vast majority in one form or another.

Arthritis means joint inflammation in Latin, ("arth" meaning joint, and "itis" meaning inflammation) and actually represents over 100 different conditions and rheumatic diseases, with symptoms ranging from mild irritation to severe pain and deformity. But, with a growing awareness of the types of injuries and conditions that can contribute to common forms of arthritis in the upper extremity, there is more hope than ever before that many arthritic conditions effecting the musculoskeletal system can be avoided with early treatment - and the debilitating effects of more serious cases overcome with advanced joint restructuring and replacement techniques.

Common Causes of Arthritis
effecting both the young and old, arthritis begins when a stress at a joint prompts the body's natural response system to alert the individual to the vulnerable area through redness, swelling, a burning sensation and/or pain. This stress may be prompted by a repetitive activity and force, or an accident resulting in an injury that never received the proper treatment. If left untreated, the irritation and swelling would continue to stress the joint and surrounding tissue - ultimately leading to the degeneration of the cartilage cushioning the joint and the joint cavity.

Before many of the advanced imaging tools available in orthopedics today, it was difficult to determine the root cause of an irritation. A pressure or stress in one area may shoot pain to a completely different area of the effected limb, postponing proper diagnosis and treatment. A fracture that was not treated properly, or allowed to heal on its own though failed to heal properly, eventually impacts the effected joints.

Today the advances in orthopaedic technology enables orthopedic specialists to more clearly define the source of an injury, repair it precisely and avoid future degenerative conditions that could lead to arthritis. The same technology is helping to identify degenerative conditions earlier and treat them before they become debilitating and require more extensive treatment.

The key to deterring the degenerative effects of arthritis is early diagnosis and treatment.

Also known as acromioclavicular (AC) joint arthrosis and osteoarthritis of the AC joint, AC joint arthritis is the gradual deterioration of the cartilage located at the acromion and the clavicle within the AC joint.

AC joint arthritis is unlike glenohumeral arthritis, or shoulder arthritis, which is the deterioration of the cartilage of the long arm bone, the humerus, located at the socket of the shoulder joint.

Those suffering from AC joint arthritis may experience pain and tenderness near the front of the shoulder and around the joint, discomfort while sleeping, pain during certain arm and shoulder movements that may span the shoulder area, chest and neck, and mild swelling. There may also be a reduction in range of motion.

Risk Factors
Most often diagnosed in those over the age of 40, the primary cause of AC joint arthritis is general use. Though some repetitive activities that place unusual and constant stress on the shoulder joint, or an earlier AC joint injury such as shoulder separation, puts some at greater risk than others for the disease. Also more susceptible to the disease include workers who must use their arms for extended periods of time or athletes involved in overhead lifting. Blunt force to the shoulder, in either contact sports or in an accident, also leave an individual susceptible.

Diagnosis and Treatment
Following a thorough examination and patient history review, an x-ray may be indicated in order to determine the extent of joint damage. A series of x-rays over time can help determine the rate of progression.

Treatment is determined based on the effect the arthritis has had on a patient's joint at the time of diagnosis, as well as the type of joint effected. It may involve conservative treatment - including cold compression, anti-inflammatory medications, refrain from inflammatory activity, cortisone injections, and rehabilitation and occupational therapy to improve range of motion.

In more advanced cases nonresponsive to conservative treatment, either a resection arthropolasty or a complete shoulder replacement may be indicated.

Arthritis of the thumb, also called Basilar joint arthritis because it effects the basilar joint of the thumb, is a common form of arthritis effecting the hand. A form of osteoarthritis, arthritis of the thumb effects the first carpometacarpal joint located near the wrist at the base of the thumb and is generally secondary to a previous injury or trauma to the joint.

The unique ability of the thumb to span across the palm and touch opposing fingers is both a characteristic that distinguishes human beings in the animal kingdom and a range of motion that joint creates vulnerability. The unique shapes of the small bones of the thumb permit this range of movement, with stability of the carpometacarpal joint dependant on several small ligaments that remain close to the joint surfaces while allowing movement. Loosening of these ligaments may result in excessive sliding of the joint surfaces and increase wear on the joint cartilage. This is a degenerative environment that will eventually lead to arthritis if untreated.

If joint degeneration continues to progress, inflammation may occur - resulting in pain when pressure is applied to the joint in pinching and grasping activities. In this environment, joint surfaces are eventually destroyed and bony spurs may develop around the joint. In severe cases, there may be complete joint destruction, an inward collapse of the metacarpal, and deterioration around the trapezium. Other joints may also become effected as they react to the changes.

Basilar joint arthritis will produce pain that progresses over time, eventually discouraging use of the thumb. This correspondingly results in joint weakness and muscle loss. Upon examination, there may be swelling at the base of the thumb as a result of joint inflammation.

Risk Factors
Arthritis of the Thumb more commonly effects women than men and generally occurs after the age of 40. It is most often the result of the same joint conditions prompting osteoarthritis of other joints - joint instability, cartilage deterioration and wear and tear. Many of these conditions are affiliated with common hand injuries and conditions discussed in this section, which, if treated early, can reverse or slow the progression of an environment within the joint that will eventually lead to arthritis of the thumb. A fracture or other traumatic injury can also lead to joint dysfunction and deterioration that can lead to arthritis of the thumb as well.

Diagnosis and Treatment
Following a thorough review of a patient's medical history and physical examination of the thumb, a series of imaging scans will determine joint damage, the severity of the degeneration and the rate of progression.

The best treatment for arthritis of the thumbs varies from patient to patient and is usually determined based on the severity of the condition and the state of the joint environment. If conservative treatment is indicated, it may entail the use of NSAIDs (nonsteroidal anti-inflammatory drugs), the refrain from activity causing stress to the effected area, corticosteroid injections, rehabilitation and occupational therapy. Splinting of the thumb may also be indicated in order to help support it and keep it in a rest position, which will reduce the pain and prevent deformity.

Advanced cases and arthritis may require ligament reconstruction tendon interposition (LRTI) arthroplasty, in order to remove the damaged surfaces within the joint and create a stronger joint. This will eliminate pain, improve hand strength and range of motion necessary for day-to-day activities. Total joint replacement may also be considered.

Posttraumatic arthritis is a form of osteoarthritis (OA) that ultimately results from an earlier traumatic injury or surgery. Generally those classified as an intra articular trauma, or effecting the joint, can often times create an environment vulnerable to joint deterioration – despite treatment and evidence that the injury healed properly.

Risk Factors
Athletes incurring repeated injury to their limbs are at particular risk for posttraumatic arthritis as is the individual sustaining severe injury in an accident.

The effect of this type of arthritis is a gradual deterioration of the joint surface and eventual loss of cartilage of the effected joint. Once the cartilage deteriorates, the joint becomes inflamed. Symptoms may include limited range of motion, small bony growths known as spurs, and general joint pain during periods of activity or after long periods of inactivity.

Diagnosis and Treatment
In treating arthritis, the key is early diagnosis and joint protection. Depending on the severity of the condition, conservative treatment may entail rehabilitative exercises, anti-inflammatory medication and activity modification. Severe joint deterioration may require reconstructive surgery or total joint replacement.

Rheumatoid arthritis (RA) effects nearly one percent of the total population and is one of the most serious inflammatory forms of arthritis. Juvenile rheumatoid arthritis (JRA) is the most common form of childhood arthritis.

RA is an autoimmune disease that mistakenly attacks the synovium fluid necessary for good joint function and joint preservation. As a result, many patients suffering from RA may also suffer over time from Osteoarthritis (OA) as well. With the ability to also effect multiple other organs of the body and generally symmetrically effects a joint on both sides of the body (left wrist and right wrist as well), R A is an aggressive type of arthritis that can effect life span and quality of life if left untreated.

Joint damage can occur early in the disease and continue to progress, though RA symptoms may come and go as this type of arthritis has both active (flare up) and inactive (in remission) periods.

Symptoms can vary, depending on the degree of tissue inflammation, and may include fatigue, loss of appetite, fever, joint stiffness and muscle and joint pain. Firm lumps known as rheumatoid nodules can occur where there is increased joint pressure – such as around the elbows and fingers.

Risk Factors
While the cause of RA is unknown, it is believed to be a genetic disease and may effect more than one person in a family. It is also believed that smoking tobacco may increase a person's risk of developing RA. Women are three times more likely to be effected by the disease than men. And while RA can develop at any age, it most often begins between the ages of 40 and 60. RA often effects the small joints of the hands, wrist and elbow.

Diagnosis and Treatment
A physical examination and thorough patient history review will help in the diagnosis. Other tests that may assist in the diagnosis of RA include a blood test, an x-ray, and a bone scan. Depending on the severity of joint deterioration and other patient factors, the disease may be treated with anti-inflammatory and/or antirheumatic drugs. In cases of severe joint deformity, surgery may be indicated.

Osteoarthritis (OA), also known as degenerative joint disease, is among the most common forms of arthritis in the United States. It begins with the breakdown of joint cartilage and will eventually damage the joint cavity, surrounding tissue and bone if left untreated.

The result of age, obesity or previous injury, OA is a progressive disease that may result in limited range of motion, small bony growths known as spurs, and general joint pain during periods of activity or after long periods of inactivity.

The finger joints and the thumb joints are the joints most affected by OA among all of the upper body joints.

Risk Factors
While the primary cause of OA is age, as a result of increased water content of the once protein-rich cartilage that breaks the cartilage down, it may also be the result of excessive wear and tear - load-bearing joints of an obese individual, or athlete placing continuous stress on certain joints. The disease may also result from a previous injury that created over time an unstable joint environment.