Dr. Ebraheim’s educational animated video describes the conditions of arthritis of the fingers

Arthritis of the Fingers
Diagnosing arthritis of the fingers can be difficult. Arthritis can affect any joint in the body but it is commonly seen in the joints of the fingers. The different types of arthritis and the pattern of joint involvement include osteoarthritis, psoriatic arthritis, gouty arthritis, rheumatoid arthritis. Heberden’s nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP) and may or may not be painful. Heberden’s nodes are caused by the formation of osteophytes due to repeated trauma at the joint and usually occurs during middle age. Bouchard’s nodes are bony growths that can form on the proximal interphalangeal joints of the finger (PIP). Bouchard’s nodes, like Heberden’s nodes, may or may not be painful. Bouchard’s nodes are typically associated with limited motion of the affected joint. Mucous cysts are small, fluid-filled sacs that form between the DIP joint of the finger and the bottom of the fingernail. The best treatment is surgical excision of the cyst and removal of the underlying osteophyte to decrease the risk of recurrence. It is an anti-inflammatory form of arthritis, and it is sometimes mistaken for osteoarthritis. Dactylitis is also referred to as “sausage digit”. It is inflammation of the entire digit. Sausage fingers is a major finding of psoriatic arthritis. Nail pitting is small depressions in the finger nails, and it is most common in people who have psoriasis. Gout is a form of inflammatory arthritis that is sometimes called “gouty arthritis”. Gouty arthritis will mimic infection and may develop in people who have high levels of uric acid in the blood. The uric acid can form needle like crystals in the joint and cause pain, tenderness, swelling, and tenosynovitis. Periarticular erosions seen on x-ray may also be present with gout of the finger joints. Periarticular erosions are usually multiple and bilateral with sclerotic borders. In juvenile rheumatoid arthritis, it is ANA positive in 30% of the time. Rheumatoid factor is negative in a child and later on it may become positive, and there is shortened digits. Polyarticular rheumatoid arthritis (JRA) is a form of juvenile rheumatoid arthritis that affects five or more joints; it is polyarticular in about 30%. Pauciarticular juvenile idiopathic arthritis (JIA) is a form of juvenile rheumatoid arthritis that affects less than five joints; it is pauciarticular in about 50%. In pauciarticular onset juvenile idiopathic arthritis, check the iris of the eye for iridocyclitis. In polyarticular rheumatoid arthritis, check cervical spine for subaxial instability. Rheumatoid arthritis of the hand occurs more in females than in males. Rheumatoid arthritis has spontaneous remissions and exacerbations. The disease can have a systemic nature. Rheumatoid arthritis is typically poly-articular, bilateral and symmetrical, and most commonly affects the hands and feet. The patient complains of pain and stiffness of the joints, especially in the morning (morning stiffness). X-rays show periarticular erosions at the time of diagnosis. Osteopenia and minimal osteophyte formation favor the diagnosis of rheumatoid arthritis. Early (acute) rheumatoid arthritis has symptoms of hot, swollen, tender joints (synovitis). Complicated rheumatoid arthritis has symptoms of digital vasculitis, ecchymosis, skin atrophy, and nodules. Advanced rheumatoid arthritis has symptoms of swelling of the MCP joint, lateral slippage of extensor tendons and tendon ruptures, ulnar deviation of fingers, and x-ray shows destruction of the MCP joints with subluxation, ulnar deviation, and wrist destruction. Finger deformities include mallet finger, boutonniere, and swan neck. The thumb is also involved. These changes occur due to proliferation, inflammation and hypertrophy of the synovium. Involvement of the distal radioulnar joint is usually associated with rupture of the extensor digiti minimi.

0:00 Introduction
0:07 Arthritis of the Fingers
0:47 Osteoarthritis
2:03 Psoriatic Arthritis
2:44 Gouty Arthritis
3:33 Rheumatoid Arthritis
5:52 Rheumatoid Manifestations in the Hand
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Dr. Ebraheim’s educational animated video describes painful conditions associated with the knee, the etiology, signs and symptoms, diagnostic tests and special maneuvers, and treatment options.
Common knee problems:
Patellar chondromalacia
•chronic pain due to softening of the cartilage beneath the kneecap.
•Chronic knee pain from mild to complete erosion of the cartilage in the back of the kneecap.
•Pain in the front of the knee.
•Occurs more in young people.
•Becomes worse from climbing up and down the stairs.
•Treatment: usually therapy, NSAIDS.
Patellar bursitis
•Pain and inflammation located in the front of the kneecap.
•The bursa becomes inflamed and fills with fluid at the top of the knee.
•Causes pain, swelling, tenderness and a lump in the area on top of the kneecap.
Ligament injury
Lateral collateral ligament rupture: usually occurs as a result of sports activities.
Medial collateral ligament rupture: injury to the ligament on the inner part of the knee. The most commonly injured knee ligament.
Anterior cruciate ligament tear:
•involves a valgus stress to the knee.
•Usually the patient will have swelling and hematoma.
•Lachman’s test is positive.
•MRI is diagnostic.
Patellar tendonitis
•Inflammation and pain located inferior to the knee cap area.
Meniscal Tear
•Meniscus is a cushion that protects the cartilage of the knee.
•Injury will cause pain on the medial or lateral side of the knee.
•Outer 30% of meniscus has blood supply.
•mcMurrays test is positive.
•History of locking, swelling and instability of the knee.
•MRI is helpful.
Arthritis of the knee joint
•Characterized by progressive wearing away of the cartilage of the joint.
•The knee is a common part of the body that is most affected by arthritis.
•Decreased joint space.
Baker’s cyst
•Swelling in the back of the knee filled with synovial fluid.
•Cyst between the semimembranous and medial gastrocnemius muscles.
Gout
•Type of arthritis or joint inflammation caused by an excessive level of uric acid in the blood.
•Can affect any joint especially the big toe.
•Crystals look like needles and have a negative birefringence.

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Arthritis is the condition in which the articular cartilage is damaged, worn out or torn, which causes the pain in the joints. There are two types of Arthritis named as Osteoarthritis, which is degenerative and Rheumatoid Arthritis, in which the patients get the joint tumours.

Dr. Vijay Sharma, Consultant Orthopaedics and Joint Replacement Surgeon at Narayana Multispeciality Hospital, Jaipur shared the information about the Joint pain and Arthritis, Its causes, symptoms, and the available treatment options for the patients.

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Dr. Ebraheim’s educational animated video explains the condition of knee pain and arthritis – total knee replacement.
This video describes knee pain, knee examination, knee diagnosis and treatment .knee pain relief may need surgery .this video describes knee arthritis animation, knee arthritis symptoms, diagnosis, x rays and treatment
Knee arthritis treatment will include physiotherapy, knee injection and total knee replacement.
DR Nabil Ebraheim UTMC Toledo.
The cartilage of the knee is complex and it is made of elastic comprehensive structure.
The normal articular cartilage is called hyaline cartilage; it provides a smooth, gliding surface to help the motion of the joint.
There is about 2cc of the synovial fluid inside the knee that helps in the motion and lubrication of the joint.
Between the hyaline cartilage which is called the articular cartilage you can see the meniscus, the lateral and the medial, the meniscus is a shock absorbing cartilage or cushion between the articular cartilages.
The hyaline cartilage has 4 layers:
1- The superficial layer.
2- The middle layer.
3- The deep layer.
4- The calcified layer
After the calcified layer you find the bone.
These cartilage cells are supposed to live forever.
Good cartilage cells are sterile; they can’t make more cartilage if these cartilage cells are destroyed.
If the cartilage is subjected to excessive wear, trauma, injury, overuse, excessive weight or improper alignment, then the cartilage will wear away leaving the bone to rub against bone.
The cartilage doesn’t have the ability to heal itself by hyaline cartilage, but sometimes it can heal itself by inferior type of cartilage called fibrocartilage, especially if the area that needs to be repaired is small.
What is the treatment of the arthritis of the knee?
1- Medication: people respond differently to medications, the doctor select the type, dosage and duration of the treatment, the medication has to be safe and effective.
Ask the doctor about the side effect of the medication.
There are several medications for example: NSAIDS.
2- Losing Weight: it’s advisable to lose about 5% of the body weight, especially if the BMI was above 25.
3- Low Impact Physical Therapy: such activities like swimming or cycling, adds less stress on the knees, life style modification to protect the knee will slow the progress of the arthritis, there is a strong evidence that physical therapy will help the patient.
The physiotherapy will decrease the pain, will improve the function, increase the strength, the range of motion; physiotherapy should be individualized with program that meets the patient’s needs, the life style, and expectations.
4- The physician will also use intra-articular injection of steroids; viscosupplementation, or hyaluronic acid, injection will relieve the patient’s pain and disability.
5- Other injection methods:
– Gene therapy
– PRP
– Growth factor
– Stem cells
6- Other treatment options:
– Acupuncture
– Massage
– Glucosamine
– Chondroitin sulfate
– Valgus directing brace
– Wedges in the foot
– Arthroscopic debridement and lavage
7- Assistance devices:
– Cane
– Shock absorbing shoe
– Shoe inserts
– Knee sleeves
– Support brace
8- Arthroscopy shouldn’t be done in arthritis unless there is loose body or meniscal tear causing mechanical symptoms of recurring lacking, catching, swelling and pain.
There are some guide lines from the American Academy of Orthopaedic Surgeon AAOS: these guidelines are suggestive, and the treatment of the arthritis patient should be individualized and based on:
– The doctor’s clinical judgment.
– The patient’s clinical situation.
– The evidence tested and published.
It is a combination of all of these factors.
If it works for you, it may not work for your neighbor.
So basically arthritis can be minimal, and anything can help the arthritis ion this situation.
But if the arthritis is moderate then the physician has many options for treatment and none of those options are predictable in the result.
When the arthritis is severe, total knee is the most predictable option for treatment of arthritis.
You have to reduce the pain and improve the function of the knee.

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Orthopaedic hip and knee surgeon, Julius Oni, M.D., discusses treatment options for those dealing with hip joint pain. He explains the warning signs of a serious hip problem and describes what a total hip replacement is and the recovery process. Learn more at: http://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/hip-knee/

Questions answered:
1. What are the warning signs of a hip problem? (0:02)
2. Are their certain actions that are known to bother someone with a hip problem? (0:33)
3. What is a total hip replacement? How is the procedure performed? (0:57)
4. What factors make a patient a good candidate for hip replacement surgery? (1:30)
5. Which members are included on the care team when a patient is receiving a total hip replacement? (2:01)
6. How long does the procedure take? How long does a patient have to stay in the hospital? (2:24)
7. How long is the recovery process following a total hip replacement? Are there any challenges? (2:44)
8. Is there a preferred time or age for a patient to have hip replacement surgery? (3:14)
9. What are the major risks associated with hip replacement? (3:58)
10. How much pain relief or increased mobility should a patient expect following a total hip replacement? (4:29)
11. Will a patient need physical therapy? If so, for how long? (4:50)
12. What are the nonsurgical treatments available to someone with hip pain? (5:07)

Learn more at: http://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/hip-knee/
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