This document discusses various types of arthritis and their characteristics. It covers frozen shoulder, impingement syndrome, rotator cuff tears, tennis and golfer's elbow, spondyloarthropathies like ankylosing spondylitis and psoriatic arthritis, septic arthritis, gout, and pseudogout. For each condition, it describes the affected areas, symptoms, diagnostic criteria, pathogenesis, clinical features, management, and sometimes radiological findings. The document provides an overview of approaches to different forms of arthritis for medical practitioners.

1. APPROACH TO
ARTHRITIS
MODERATOR – DR NASIR SHAMAS CONSULTANT IN DEPT OF
GENERAL MEDICINE
By Dr DEVARJUN PANNU ( DNB 1st year Dept of General Medicine JLNM Srinagar)

5. Frozen shoulder
◦ Also known as adhesive capsulitis
◦ Pain & restriction of all movements of the shoulder (global stiffness)
◦ External rotation - first to be affected and usually self limiting
◦ 10% Bilateral
Associated conditions –
 DM
Hyperlipidemia
Hypothyroidism , Hyperthyroidism
Hemiplegia
Following injury or surgery to shoulder
Diagnosis
• mainly clinical
• x-ray - Normal
• MRI - capsulitis

6. Impingement syndrome
Also known as painful are syndrome having mid - abduction pain ( 60° - 120° )
Causes I. Subacute tendonitis of supraspinatus
2.calcification
3. Sub acromial bursitis
4. Abnormally shaped acromion
- Hawkin's test - with the elbow flexed to 90° the shoulder passively flexed to 90°, and internally
rotated
on injecting anaesthetic agents into subacromian space, pain reduces 1 Rom 1
Treatment - Avoid painful and overhead activities a Physiotherapy - stretching 1 range of motion
exercises
◦ Strengthening exercises
◦ NSAIDS
◦ Steroid injection into subacrómian space
◦ Arthroscopic subacromial decompression

7. Rotator cuff tear - arthropathy
◦ In young - due to Trauma
◦ In elderly - due to Degeneration
◦ MC tendon to rupture - Supraspinatus
◦ Forgotten tendon of rotator cuff - Subscapularis
◦ On injecting anaesthetic agent into subacromian space,
◦ no effect on Range of movement

8. Rotator cuff tear
Treatment -I. Avoid painful and overhead activities
2. Physiotherapy
3.NSAIDS
4. Arthroscopic repair if repairable
If irreparable
Young pt we go for Tendon transfer (Latissimus dorsi)
Elderly we go for
Reverse shoulder Arthroplasty

9. Tennis elbow and golfer's elbow
wrist extensors originate from lateral epicondyle
wrist flexors originate from medial epicondyle
Tennis elbow - inflammation of lateral epicondyle - lateral epicondyitis muscle
affected - Extensor carpi radialis brevis
Test : extension of wrist against resistance
known as cozen's test
Golfers elbow - medial epicondylitis , Muscle affected Flexor carpi radialis
Test - Reverse Cozen's test - Flexion of the wrist against resistance
1. Conservative – Rest , Splint , NSAIDS , Physiotherapy
2.Surgically release of the cuprit muscle
3. Platelet rich plasma

10. Spondyloarthropathies
◦ RF negative (sero -negative arthropathy )
◦ Young population affected , males > Females
◦ HLA -B27 present in 90% of population affected
◦ Extra - articular manifestation: uveitis where as (In RA - scleritis)
Includes:
• Ankylosing spondylitis (mc)
• Enteropathic arthritis - associated with inflammatory Bowel Disease
• Psoriatic arthritis
• Reiter's syndrome : has 3 components Conjunctivitis , urethritis , Polyarthritis
• Reactive arthritis: Reaction to infection like Chlamydia and Shigella

11. Ankylosing spondylitis - Pathogenesis)
Axial > Peripheral
Spine , sacroiliac joint (most common), hip
• It is a Enthesopathy
clinical features
1. males > females young
2. Low back ache / gluteal pain (indicative of sacroilitis )
3. uveitis
4. Early morning stiffness

12. ◦ Diagnostic criteria-
◦ Sacroilitis - (essential criteria)
◦ Decreased lumbar spine movement, Decreased chest expansion ,
Inflammatory back pain Are the Supportive criteria
◦ sacrolitis: illac area affected first, identified first on MRI > Xray
◦ Pathogenesis:
◦ • Enthesitis - inflammation of enthesis (site of attachment of ligament /
tendon)
◦ Erosion and destruction then
◦ calcification and bone formation

13. Radiological features of ankylosing
spondylitis
Blurring / haziness of sacroiliac joint
◦ Juxta articular sclerosis
◦ In spine , we find vertebrae syndesmophytes
◦ Squaring of vertebrae
◦ Bamboo spine , Dagger sign
Clinical tests
◦ Decreased chest movement
◦ Decreased lumbar spine movement
◦ For sacroilitis : Patrick test / Faber test/ Figure of 4 test
◦ For lumbar spine :schober / modified schober test
management: Exercise
◦ NSAIDS + pain surgeries - correct deformities

14. Psoriatic arthritis
Diagnostic criteria: Caspar criteria
History of psoriasis
RF negative , Dactylitis , Nail changes
◦ males = females
◦ middle age affected
◦ Joints involved is asymmetrical : oligoarticular involvement (MC)
◦ MC joint involved: DIP
Clinical Features:
◦ Dactilitic - Sausage digits
◦ Shortening of digits
◦ Arthritis mutilans
◦ Telescoping of fingers
◦ Arthritis mutians :
◦ erosive arthritis of ends of hand and feet
X-ray findings - Pencil n cup deformity
◦ destruction of terminal ends of phalanges
Treatment - methotrexate

15. Septic arthritis
◦ infection of the joint , most common in children.
◦ most common site is knee But in infants is Hip joint
◦ Route - hematogeneous
Causative organism: overall - Staphylococcus aureus
◦ In sexually active individuals - Gonococcus
◦ IV. drug abusers - Pseudomonas
Clinical features
◦ Fever
◦ Toxic chid with inflammatory signs
◦ No joint movement
◦ Patellar tap sign +
◦ Position of ease where Hip-flexion, abduction, external rotation and Knee in flexion
management:
◦ Blood investigations
◦ X- ray = increased joint space
◦ •MRI
◦ • USG - Arthrocentesis (Aspiration)
◦ Treatment Arthrotomy – irrigation , Debridement of joint

16. Crystal deposition diseases - Gout
Crystal depositión in synovium causing local inflammation and joint destruction
◦ purine metabolism defect
◦ Raise in uric acid levels ( N : 3.5 - 6.5 mg/dl )
◦ mc joint : 1st metatarsophalangeal joint
Radiological findings
◦ Joint destruction
◦ Punched - out lesions
IOC: aspiration of synovial fluid monosodium urate crystals + , Needle shaped
◦ Negatively birefringent
Treatment
 Acute phase : There is swelling / tophi , pain: NSAID - Indomethacin (DOC)
Colchicine (side effect - Diarrhoea)
 Chronic phase:
◦ xanthine oxidase inhibitors like Alopurinol, Febuxostat
◦ uricosuric drugs like - probenecid

17. Crystal deposition diseases –
Pseudogout
◦ females > males elderly
◦ larger joints involved (MC – knee)
◦ Calcium pyrophosphate dihydrate (CPPD) deposition
◦ Polygonal shape positively birefringent

18. Thanking you