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Technique to demonstrate knee effusion. moving fluid. You can do a bulge sign, ballot, do a patellar tap. In this case you can just squeeze the fluid and see/ feel the fluid moving.
GIF
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Marked MTP swelling on plantar surface - rheumatoid
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ILD with rheumatoid arthritis Clubbing but NOT in all digits.
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Best remission rates of all early arthritis cohorts CATCH cohort BUT low penetration of advanced therapies. Key - early effective Rx with MTX at optimal doses and often sc, combining csDMARDs and close f/u with a T2T strategy.
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ClinicalPearl Look at 2nd MCP. Where is the swelling? Joint or tendon sheath?
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Draining a large knee effusion. You can enter knee medically, laterally, and either side of suprapatellar area. Note nearly horizontal angle of needle which may reduce a traumatic tap after much fluid is removed.
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Tight skin on L forehead since childhood and weak on R side of body. Note eyebrow also is gone. What type of nonsystemic scleroderma is this and why might she be weak?
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This patient has arthritis and these nails. Describe the nails and guess what type of inflammatory arthritis. Hint perhaps not classical nail findings.
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How to demonstrate tenosynovitis- milk it to increase pressure and show a fluid wave. Rheumatoid arthritis often has extensor carpi ulnaris involvement and is often associated with an ulnar styloid erosion.
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When injecting a knee while pt is sitting, the infrapatellar fat pads are the hint of where to go either medically or laterally. Helps with landmarking.
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Injection of medial knee with intra-articular steroid. Find inferior part of patella and move medically. Feel joint line and inject towards middle of joint, perpendicular to patient. easy. Hint - infrapatellar fat pads if present are where you should enter joint.
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Injection. Easy. Find point of maximal tenderness on palpating and should localize to that area with resisted extension of the wrist.
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Diffuse scleritis
Other ocular manifestations of RA
keratoconjunctivitis sicca
Episcleritis
scleritis
Sclerosing keratitis
Posterior scleritis
Retinal vasculitis
Full
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No trauma. What are you worried about?
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Another hand with tuft resorption and pseudoclubbing. Some angles at nail beds are lost but most are preserved
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A side effect from several CMC steroid injections. Thin skin and a permanent bruise. We are taking a break from injecting this area as skin May break open if repeating.
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Findings of inflammatory arthritis. bursa at 1st MTP, R 5th MTP bunionette = 5th MTP erosion nearly always esp in rheumatoid arthritis and splaying of toes esp R 2,3 from MTP u chronic synovitis. See if you can find anything else.
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The 2 sides of 1st CMC osteoarthritis Severe subluxation of CMC with squaring and rotation of prox phalanx on palmar side. Can’t extend thumb - can’t ‘hitch hike’
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A 13-year-old boy presented to the orthopedic clinic with a 1-week history of pain in both knees
Diagnosis?
Hoffa’s syndrome
Patellar tendon avulsion
Pes anserine bursitis
Osteomyelitis of the proximal tibia
Osgood–Schlatter disease
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Beware what lurks beneath. Red eye in a pt with severe sero+ what is it and what to do?
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