A selection of images from the Queen Mary's rheumatology image bank illustrating some features of arthritis and other musculoskeletal conditions.
It's important to remember the key features of an inflammatory arthritis, which are early morning stiffness and soft tissue swelling in particular of the metacarpophalangeal joints of the hands - representing synovitis. This may become more apparent if the patient is asked to make a fist.
In contrast, the distribution of joint involvement in osteoarthritis is shown below - the proximal interphalangeal joints may be involved, but the swelling of these (and the distal joints, as here) is bony rather than soft tissue.
The arthritis associated with psoriasis is not usually symmetrical, and may be associated with nail dystrophy. On the left below note the index distal joint, and ring proximal joint (with nail pit in the former) and on the right the typical nail dystrophy in florid form.
This patient in his late 20s was referred to the department with hand pain. He had old Perthe's disease resulting in the X-ray changes seen above, and was at the point of being confinded to a wheelchair because of the pain walking. Surgery had been agreed upon, although the risks had been made clear to him, but he was at the critical point - "I cannot go on like this".
He was so determined to avoid his wheelchair that he struggled everywhere on a pair of elbow crutches; although his pain was in the classicial "inflammatory" joints - the MCPs - it was likely to be due to crutch-walking. A decision on treating his hands was therefore deferred until he had had his hip replacement.
In the same clinic as the patient above this lady in her 50s presented with a painful thumb. She had tuberculosis as a child which had affected her lefthip and had spent five years of her childhood in hospital. She had a marked limp and required a built-up shoe. However she had no pain - hardly surprising because the X-ray showed complete fusion of the joint. Surgery would have achieved nothing, except perhaps to leave her less able to walk due to the long-term muscle loss from disuse.
This patient had a motorcycle accident 12 years ago. He started to develop knee pain and asked for it to be examined; however, while sitting in the chair he demonstrated himself the examination technique for assessing cruciate ligament integrity - or, in his case, lack of it. Click on the image for a movie (note - your computer must be able to run Quicktime (.MOV) files and you may need to allow activeX access if you use Google's pop-up blocker).
