Ahmed Al-Jabri

1. CLINICAL SERIES: ARTHRITIS BY: Ahmed AL-Jabri R2

3. Normal Joint..

4. Articular Vs. Periarticular Clinical feature Articular Periarticular Anatomic structure Painful site Pain on movement Swelling Synovium, cartilage, capsule Diffuse, deep Active/passive, all planes Common Tendon, bursa, ligament, muscle, bone Focal “point” Active, in few planes Uncommon

5. Inflammatory Vs. Noninflammatory Feature Inflammatory Noninflammatory Pain (when?) Swelling Erythema Warmth AM stiffness Systemic features î ESR, CRP Synovial fluid WBC Examples Yes (AM) Soft tissue Sometimes Sometimes Prominent Sometimes Frequent WBC >2000 Septic, RA, SLE, Gout Yes (PM) Bony Absent Absent Minor (< 30 ‘) Absent Uncommon WBC < 2000 OA, AVN

6. Inflammatory Vs. Noninflammatory Feature Inflammatory Mechanical Morning stiffness Fatigue Activity Rest Systemic >1 h Profound Improves Worsens Yes < 30 min Minimal Worsens Improves No

16. WHAT DO WE HAVE ?

17. Olecranon bursitis

20. What is the expected WBC counts in aspirated synovial fluid from a patient with septic arthitis ?

26. Pathogenesis

47. Shoulder – Posterior Approach Tap

48. Shoulder – Anterior Approach Tap

49. Elbow – Lateral Approach Tap Flex elbow 90 o Prep skin Insert needle in palpable bony notch between lateral epicondyle and olecranon

50. Elbow – Lateral Approach Tap

51. Elbow – Posterior Approach Tap

52. Wrist Approach Tap

53. Wrist Approach Tap

54. Wrist Approach Tap

57. Knee – Lateral Approach Tap

58. Knee – Lateral Approach Extend knee, quadriceps and patella relaxed so patella can move mediolaterally. Needle into joint space just lateral to patella near its upper pole, parallel to the posterior (articular) surface. Tap

59. Knee – Lateral Approach Tap

60. Knee – Medial Approach Tap

61. Knee – Medial Approach Tap

62. Knee – Medial Approach Tap

63. Knee – Medial Approach Tap

64. Knee – Medial Approach Tap

65. Ankle Tap Palpate the medial and lateral malleoli with your thumb and index finger. The joint space is located one to one and a half cm above the line joining the tips of the malleoli.

66. Ankle Tap Palpate the dorsalis pedis artery and choose a puncture site anywhere on the anterior aspect of the ankle, avoiding the dorsalis pedis artery.

67. Ankle – Lateral Approach Tap

68. Ankle – Medial Approach Tap

71. Synovial Fluid Analysis Normal Non-inflammatory Inflammatory Infectious Trans-parent Transparent Cloudy Cloudy Clear Yellow Yellow Yellow <200 <2000 200 – 50,000 >50,000 <25% <25% >50% >50% Negative Negative Negative Positive Appear-ance Clarity WBCs PMNs Culture

73. gout

75. Acute Gouty Arthritis