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Hand Arthropathy

Common arthropathies involving the hand may be categorized into one of the following: 

  • Degenerative (osteoarthritis, post traumatic) 
  • Inflammatory (rheumatoid, seronegative spondyloarthropathy, and JIA) 
  • Crystaline arthropathy (CPPD and gout) 

One of the most important distinguishing factors between osteoarthritis, rheumatoid arthritis, and CPPD arthropathy is distribution of findings.

Hand Arthropathy

Osteoarthritis: 

  • Asymmetric joint space narrowing
  • Marginal osteophytes
  • Subchondral cystic change
  • Subchondral sclerosis
Hand Arthropathy

Erosive osteoarthritis: 

  • Central, gull-wing erosions, usually involving DIP
Hand Arthropathy

Rheumatoid arthritis: 

  • Soft tissue swelling
  • Periarticular osteopenia
  • Periarticular erosions
  • Diffuse/symmetric joint space narrowing
  • Joint subluxations and ankylosis (if advanced)

 

Hand Arthropathy

CPPD arthropathy: 

  • Joint space narrowing
  • Calcium deposition
  • Subchondral cysts
  • 2nd and 3rd metacarpal hook shaped osteophytes
  • SLAC wrist related to deposition in the scapholunate ligament and subsequent ligament insufficiency
Hand Arthropathy

Gout: 

  • Sharply marginated, juxta-articular erosions with overhanging margins
  • Nodular, soft-tissue swelling/mineralization (tophi)

 

Hand Arthropathy

Psoriatic arthritis: 

  • Diffuse soft tissue swelling resulting in “sausage digit”
  • Mixed erosive and productive changes involving DIPs
  • Periostitis/fluffy periosteal reaction/ “whiskering periostitis”
  • Pencil-in-cup erosions
  • Arthritis mutalans (if severe)

 

Arthritis search pattern can by driven ABCDES characteristics which categorizes distinguishing factors between degenerative, inflammatory, and crystaline arthropathies:

  • Alignment: +/- subluxations/dislocation
  • Bone mineral density: +/-  diffuse or periarticular osteopenia
  • Bone creation: +/- osteophytes, +/- periosteal reaction,  +/- ankylosis
  • Calcification: +/- chondrocalcinosis, +/- soft tissue calcification
  • Cartilage space: asymmetric or symmetric narrowing
  • Distribution: PIP/DIP/CMC (OA), MCP/PIP/intercarpal (RA), MCP with osteophytes (CPPD or hemochromatosis) 
  • Erosions: periarticular erosions (RA), gullwing erosions (erosive osteoarthritis), pencil in cup erosions (psoriatic arthritis), juxta-articular erosions with overhanging margins (gout) 
  • Soft-tissues: symmetric swelling (inflammatory), nodular swelling (gout), asymmetric swelling (OA)  
Hand Arthropathy

Example report negative for arthritis

FINDINGS: 

  • No acute fracture or dislocation. Joint spaces are preserved. No osseous erosions. No periosteal reaction.

IMPRESSION: 

  • No findings of inflammatory arthritis. No erosions.