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A person suffering from acute infection should not be treated already having history of peptic ulcer purchase loratadine 10mg online allergy medicine recall. Effects on Endocrine Function Thus purchase generic loratadine on-line allergy web, cortisol has profound inhibitory effects on cel- 1 generic loratadine 10mg allergy shots reaction. Therefore order loratadine us allergy forecast livermore ca, lular immunity, for which it is frequently used for preven- it inhibits growth. Therefore, it inhibits also suppresses production of antibodies and, therefore, thyroid functions. Dysfunctions of Glucocorticoids Cushing’s syndrome This is a pathological condition that occurs due to hyper- secretion of glucocorticoids. American Neurosurgeon, developed neurosurgery as a branch of medicine, and he is often called as the 4. He had pioneered mine-N-methytransferase), the enzyme that catalyzes in the study of functions hypothalamus, pituitary the formation of epinephrine from norepinephrine. In absence of glucocorticoids, body due to increased pituitary activity, which was later named after him as can not cope with stress even in mild intensity. Cushing’s diseaseand the cortisol excess is due to adrenocortical tumor as Cushing’s syndrome. Adrenal tumors (adenoma or carcinoma) for maintenance of vascular reactivity to catechola- 3. Features the features of Cushing’s syndrome according to their Rapid Actions of Steroid frequency of occurrences are: As steroids act though transcription of genes in the cells, 1. Centripetal obesity and overweight: This is due to it takes hours to days for their full actions to manifest. Fat pad in has been observed that some of the steroid actions occur lower neck and interscapular region gives the typical within few minutes. Note the presence of centripetal obesity, moon face, buffalo hump, pendulous abdomen with stria over it, poor muscle development and thin limbs, easy bruisability, poor wound healing (infections). Salt and water retention contri- causes ecchymoses and bruises (subcutaneous and bute to it. Hypertension: Patient develops hypertension due to teolysis in the skeletal muscle and reduced bone mass. Poor wound healing: Hyperglycemia promotes growth significant mineralocorticoid activity. Also, decreased tensinogen secretion by cortisol and direct action of immunity favors growth of the organism. Osteoporosis develops due to decreased bone mine- ing of the skin that results in formation of striae. Ecchymoses: the skin and subcutaneous tissue are collapse of vertebral bodies and pathologic fractures thin as a result of protein catabolism. Emotional changes may be profound ranging from irri- Etiology tability to frank psychosis. Some may have secondary metastasis, amyloidosis and cytomegalovirus increase in facial hair and acne. Diagnosis Diagnosis is based on demonstrating increased cortisol Clinical Features production (increased plasma level of cortisol) and Features, in order of their frequency are as follows: failure to suppress cortisol secretion by dexamethasone 1. Hypotension: Hypotension occurs due to decreased If the disease is due to tumor of adrenals or pituitary, surgi- mineralocorticoid activity and decreased vascular cal resection of the tumor is required. Patient develops rapid hypoglycemia on fasting; stress Hypofunction of adrenal gland may be primary or secon- causes collapse. Infection (usually tubercular infection, but fungal and Treatment viral infection may also cause) Hormone replacement is mainstay of therapy. This occurs due to 21b-hydroxylase deficiency, which Secondary adrenal insufficiency: decreases the synthesis of glucocorticoids and mineralo- 1. Thus, steroids in This is the condition of hyposecretion of glucocorticoid this syndrome are converted to excess of androgen that that results from progressive destruction of the adrenals. Scientist contributed Thomas Addison (1793–1860) was an English Features Physician and Scientist. Addison first gave a clue Excess androgen secretion in females causes masculinization to the significance of the adrenal glands by giving and precocious pseudopuberty or female pseudoher- the details of their deficiencies. Receding hairline Thomas Addison Source: On the constitutional and local effects (1793–1860) 4. Secondary hyperaldosteronism: Aldosterone secretion may increase in congestive heart failure, cirrhosis of liver, and neph- ritic syndrome. Increased cytosolic calcium increases aldosterone other functions (for details, refer to Chapter 75). The reabsorption + Also, acute decrease in plasma Na or increase in of NaCl causes osmotic reabsorption of water. Aldosterone Escape Phenomenon Mechanism of Action of Aldosterone Increased reabsorption of salt and water by aldosterone Aldosterone binds with the cytoplasmic receptor. This increases new protein synthesis that heart that causes further distention of atria during alters cell function. This the gene activated by aldosterone is sgk gene (serum and is called aldosterone escape phenomenon as kidney glucocorticoid regulated kinase gene). Aldosterone increases insertion of these channels on Hyperaldosteronism can be divided broadly into two cate- cell membrane and also increases their activity. This is due to the cause of excess aldosterone secretion is due to adrenal + + disease. The usual causes are aldosterone-producing stimulation of the activity of Na -K exchanger, which + increases intracellular accumulation of Na. Physiological Actions of Aldosterone Conn’s Syndrome Electrolyte and Water Balance This is the major cause of primary hyperaldosteronism. It + the main function of aldosterone is to increase Na and occurs due to the tumor (adenoma) of zona glomerulosa + + water reabsorption and to promote K and H excretion of adrenal cortex. For Na reabsorption, aldosterone acts primarily on P cells (principal cells) of collecting duct and (due to impairment of urinary concentrating ability). Hypokalemia, hypernatremia and low renin in plasma, + and metabolic alkalosis are usual laboratory findings. Aldosterone increases Na and water reabsorption by following mechanisms: + Secondary Hyperaldosteronism 1. It increases the number of Na channels in the Increased aldosterone secretion due to activation of renin- epithelial cells of the kidney tubule. It occurs in congestive heart failure, cirrhosis of liver + and decreases K concentration. Renin secreting tumor (primary deficiency, hyponatremia is associated with hyperkalemia. Note, decreased renin secretion occurs (hence, no activation of renin-angiotensin-aldosterone axis) in primary aldosteronism; therefore, edema is not a feature. In secondary aldostero- nism, renin secretion is more (activation of renin-angiotensin-aldosterone axis) hence, edema is usually a feature. These changes Bartter Syndrome correlate with the change in 17 α-hydroxylase activity. The disease occurs due to mutation in the Na -K -2Cl cotransporter gene, which results in high renin acti- Functions of Adrenal Androgens vity and increased aldosterone synthesis.
A positive by fow cytometry permits the percentage of cells in each phase of Schick reaction suggests that diphtheria immunization is the cell cycle to be determined order loratadine 10 mg online allergy forecast pasadena ca. Longpass Shortpass Bandpass 460 500 540 460 500 540 460 500 540 the Casoni test is a diagnostic skin test for hydatid disease in humans induced by Echinococcus granulosus infection buy loratadine online now allergy treatment for babies. In sensitive individuals discount loratadine 10mg without prescription allergy testing fort worth, a wheal and fare response develops within 30 min following intradermal inoculation of a tape- worm or hydatid cyst fuid extract buy cheap loratadine 10 mg line allergy symptoms from alcohol. The ticular fuorescent dye is optimized by placing a flter in front of multiple needles advance 2 to 3 mm into the skin. Also called the detector which allows a narrow range of wavelengths to pass tine test. The Montenegro test is a diagnostic assay for South American leishmaniasis induced by Leishmania brasilien- Laser sis. The intracutaneous injection of a polysaccharide antigen derived from the causative agent induces a delayed hypersen- sitivity response in the patient. It was developed by Robert Koch for use in tuberculin skin tests nearly a century ago. Time Romer reaction (historical): Romer in 1909 described erythematous swelling following intracutaneous injection of Laser diphtheria toxin in small quantities. The Lr is the occurs when the particle is in the center of the beam, and the maxi- smallest amount of toxin which, after mixing with one unit of mum amount of scatter is achieved. As the particle leaves the laser, antitoxin, will produce a minimal skin lesion when injected the pulse comes back down to the baseline. However, the procedure is not without danger, as even individual by intradermally injecting the antibodies, which a scratch test with highly diluted penicillin preparations in become anchored to mast cells through their Fc receptors. This is followed hours or even days later by intravenous injection of antigen mixed with a dye such as Evans Blue. Vascular permeability factors act on the vessels to permit Sheath tube plasma and dye to leak into the extravascular space, forming Vent tube a blue area that can be measured with calipers. The lymphocytes are gated, markers are set using a two-color isotype control, then subse- Forword-angle quent immunofuorescence analyses of the remaining fles are light scatter detector completed. Histamine-release assays Cells sorted may be informative in urticaria, asthma, and atopic derma- titis patients. By contrast, the cover slip abrasion of the skin which is then covered with a glass slide. Also termed a Rebuck window, named for the A skin window is a method to observe the sequential changes individual who perfected the method. The frst cells to appear are polymorphonuclear gen–antigen complex to an insoluble support such as dextran particles or Sepharose®. The patient’s serum is then passed over the allergen-support complex, which permits specifc 104 250 IgE antibodies in the serum to bind with the allergen. After 200 103 washing to remove nonreactive protein, radiolabeled antihu- 150 man IgE antibody is then placed in contact with the insoluble 102 support where it reacts with the bound IgE antibody. Both the 100 1 allergen and the anti-IgE antibody must be present in excess 10 50 for the test to be accurate. The amount of radioactivity on the R3 0 0 10 beads is proportional to the quantity of serum antibody that 100 101 102 103 104 100 101 102 103 104 is allergen specifc. A standard quantity of radiolabeled IgE Immunoradiometry is a radioimmunoassay method in which is added to the serum sample to be assayed. The patient’s IgE competes with the radiolabeled IgE on a “sandwich” technique using radiolabeled antibody, or antibody attached to the beads. Add IgE Add anti-IgE (test sample) (labeled) * * Ag covalently bound to * * * cellulose disc Anticytokine Addition of * Labeled anti-IgE antibody * cytokine etc. A few days following antigen adminis- tration, antibodies appear in the circulation and eliminate Strain refers to genetically identical animals such as mice the antigen at a much more rapid rate than occurs in nonim- or rats used in medical research. Splenic and liver macrophages express Fc receptors that bind antigen–antibody complexes as well A transgenic animal is an animal into whose genome a for- as complement receptors which bind those immune com- eign gene has been introduced. This is followed gene into a mouse can be by either microinjection into a pro- by removal of immune complexes through the phagocytic nucleus of an egg that has been fertilized recently or through action of mononuclear phagocytes. The egg that has received the foreign gene is also describes an assay to evaluate the antibody response transferred to the oviduct of a pseudopregnant female. If the by monitoring the rate at which a radiolabeled antigen is gene becomes integrated into a chromosome, it is passed on eliminated in an animal with specifc (homologous) anti- to the progeny through the germ line and will be expressed bodies in the circulation. Natural transcriptional promoters and enhanc- ers, or exogenous regulatory elements engineered into it may Immune clearance: See immune elimination. Following incubation of the lymphoid cells and tumor cells in vivo, the mixture is injected into the Foreign gene: See transgenic mice. T lymphocytes that are specifcally immune to the A knock-in transgene is a transgene with a specifc muta- tumor cells will inhibit tumor growth and provide informa- tion that is fanked by sequences that are homologous to the tion related to tumor immunity. The forward genetics approach is a method of mutating a gene in an experimental animal to prove that gene’s role in a A dominant negative transgene is a transgene whose prod- particular disease and determining whether or not that muta- uct is a protein that is not functional and disrupts the endo- tion produces the disease of interest. Isolate into Termination fertilized pronucleus Promoter sequences Cloned gene Transgenics refers to the transfer of needed genes into an eggs Enhancer fragment organism for the purpose of providing a missing protein Gene which these genes encode. Eggs are reimplanted into pseudopregnant female A germ-free animal is one such as a laboratory mouse, raised under sterile conditions, where it is free from exposure Study of hybrid gene expression occurs to microorganisms and is not exposed to larger organisms. Most diffcult is the ability to maintain a virus-free environ- Transgenic is a term that describes an organism that has ment for these animals. Much has been learned about the role of cytokines, develop following injection of several hundred gene copies cell surface receptors, signaling molecules, and transcription into pronuclei are transgenic mice. They are in a designated cell or tissue following induction by a specifc highly signifcant in immunologic research. A transgenic mouse is a mouse developed from an embryo Knockout gene is a descriptor for the generation of a mutant into which foreign genes were transferred. Transgenic mice organism in which the function of a particular gene has been have provided much valuable information related to immu- completely eliminated (a null allele). A sequence been introduced and stably incorporated into germ-line cells insertion targeting approach may be used. Homologous recombination techniques can be used breakpoints and are inherited as simple Mendelian traits. Studies with transgenic mice have yielded much data about Knockout mice deprived of functional genes that encode cytokines, cell surface molecules, and intracellular signaling cytokines, cell surface receptors, signaling molecules, and molecules. Transgenic organisms are animals or plants into which for- eign genes that encode specifc proteins have been inserted. Genetic knockout is a technique to introduce precise However, controlling the site of gene insertion has not been genetic lesions into the mouse genome to cause “gene disrup- accomplished yet. Insertion into some positions may even tion” and generate an animal model with a specifc genetic lead to activation of the host’s own structural genes. Specifc defects may be introduced into any murine gene by permitting investigation of this alteration in vivo.
A order loratadine 10 mg on-line milk allergy symptoms in 5 year old,B: the atlanto-occipital joint lies anterior to the posterolateral columns of the spinal cord and is bounded by the anterior atlanto-occipital ligament anteriorly and the posterior atlanto-occipital ligament posteriorly loratadine 10 mg mastercard allergy symptoms baby. The vertebral artery ascends within the cervical spine via the transverse foramen and then exits the C1 transverse foramen and turns medially to course diagonally across the posteromedial aspect of the atlanto-occipital joint to join with the contralateral vertebral artery at the level of the medulla to form the basilar artery which enter the foramen magnum in the midline generic loratadine 10 mg with mastercard allergy symptoms video. The vertebral artery ascends within the cervical spine via the transverse foramen and then exits the C1 transverse foramen and turns medially to course diagonally across the posteromedial aspect of the atlanto-occipital joint to join with the contralateral vertebral artery at the level of the medulla to form the basilar artery which enter the foramen magnum in the midline cheap loratadine 10mg without prescription allergy shots blue cross blue shield. This diagonal turn provides an excellent landmark when performing ultrasound- guided atlanto-occipital nerve block. The joint is susceptible to arthritis and is frequently traumatized during acceleration/deceleration injuries (Figs. The pain following such injuries is often initially attributed to soft tissue injury such as muscle strain and/or bruising. The pain is ill-defined and dull in nature, involving the upper neck and occipital region (Fig. Pain emanating from the atlanto-occipital joint is exacerbated with lateral range of motion and flexion and extension of the upper cervical spine. The patient suffering from pain from the atlanto-occipital joint will frequently complain of neck pain, occipital and suboccipital headaches, preauricular pain, and limited range of motion. The patient may experience an exacerbation of pain at extremes of range of motion as well as sleep disturbance, nausea, and difficulty in concentrating. There is an atypical vertical migration with the apex of the dens ventral to the clivus and collapse of the subaxial cervical spine producing severe kyphotic deformity. A high-frequency linear transducer is placed in the transverse position slightly off the midline over the upper cervical vertebra and the vertebral artery is identified as it passes through the transverse foramina (Figs. The artery is then traced cranially by slowly moving the transducer in a cranial direction until the vertebral artery is seen to turn medially in front of the atlanto-occipital joint (see Fig. In most patients, the atlanto-occipital joint can be identified just lateral to the point where the vertebral artery turns medially (Figs. The joint should be assessed for presence of osteophytes, erosions, and effusions (Fig. The surrounding soft tissues to be assessed for any abnormal mass or 16 collection of fluids consistent with abscess formation. In an occasional patient, the vertebral artery overlies the complete extent of the joint as the artery courses from lateral to medial to join the contralateral vertebral artery. The ultrasound transducer is placed in the transverse plane just off the midline at the level of the upper cervical vertebra and the vertebral artery is identified. Longitudinal Doppler image of the vertebral artery as it traverses the cervical intervertebral foramen. Color Doppler image demonstrating relationship of the vertebral artery to the atlanto-occipital joint. Longitudinal ultrasound image of the atlanto-occipital joint demonstrating osteophyte formation. The clinician should always maintain a high index of suspicion for the presence of cervical spine instability in these clinical settings and should use extreme care when positioning the cervical spine for imaging or interventional pain management procedures. While Doppler is very useful in the identification of vertebral artery and its relationship to the atlanto-occipital joint when performing injections of this structure, the use of computerized tomography to identify bony abnormalities and magnetic resonance imaging to identify soft tissue pathology should strongly be considered in any patient who may have pain emanating from the upper cervical spine. In: Comprehensive Atlas of Ultrasound-Guided Pain Management Injection Techniques. In: Comprehensive Atlas of Ultrasound- Guided Pain Management Injection Techniques. The joint is made up of four distinct subunits that all aid in the positioning of the sense organs as well as to help position the head to eat and drink. Most important of the subunits is the pivot-type articulation that is made up of the odontoid process (also known as the dens) of the axis (C2) and the surrounding ring formed by the bony anterior arch of the atlas and the dense transverse ligament (Figs. This articulation allows lateral rotation of the skull of approximately 72 degrees in either direction from the midline and is susceptible to damage by trauma and rheumatoid arthritis as well as a number of other diseases. In addition to the pivot-type joint between atlas and axis, the median atlantoaxial joint articulates anteriorly between the front of the odontoid process and the anterior arch of atlas and posteriorly between the back of the odontoid process and the internal surface of the transverse ligament. Laterally, the lateral atlantoaxial joint provides an arthrodial articulation between the lateral masses of atlas and axis. The most important of the articular subunit of the atlantoaxial joint is the pivot-type articulation that is made up of the odontoid process (also known as the dens) of the axis (C2) and the surrounding ring formed by the bony anterior arch of the atlas and the dense transverse ligament. This articulation allows lateral rotation of the skull of approximately 72 degrees in either direction from the midline and especially is susceptible to damage by trauma and rheumatoid arthritis. Joint stability is primarily maintained by the joint capsule and the transverse ligament of atlas as well as the anterior and posterior atlantoaxial ligaments which surround and strengthen the joint (Fig. The vertebral artery ascends via the transverse foramen of the cervical spine, traveling across the lateral one-third of the atlantoaxial joint. The artery ultimately exits the C1 transverse foramen and turns medially to course diagonally across the posteromedial aspect of the atlanto-occipital joint to join with the contralateral vertebral artery at the level of the medulla to form the basilar artery. The course of the vertebral artery provides an important landmark when identifying the atlantoaxial joint with ultrasound (Fig. The C2 nerve root exits above the C2 vertebra and provides some motor innervation to the suboccipital muscles. The fibers of the medial branch of the C2 nerve root dorsal primary ramus form the greater occipital nerve. Fibers from the C2 nerve root interconnect with fibers of the C1 and C3 nerves which may help explain the overlapping pain symptomatology when any of these nerves are traumatized or inflamed (Fig. The ligaments surrounding the atlantoaxial joint help provide joint stability and are susceptible to trauma. The distribution of pain emanating from the atlantoaxial joint is often ill-defined due to the interconnection of fibers from the C2 nerve root with fibers of the C1 and C3 nerves. The joint is susceptible to arthritis and is frequently traumatized during acceleration/deceleration injuries. The pain following such injuries is often initially attributed to soft tissue injury such as muscle strain and/or bruising. The pain is ill-defined and dull in character involving the upper neck and occipital region (Fig. Pain emanating from the atlantoaxial joint is exacerbated with lateral rotation and flexion and extension of the joint and surrounding upper cervical spine. It frequently coexists with pain from the atlanto-occipital joint and the C2/C3 facet joints due to convergence of fibers from these anatomic structures with trigeminal afferent fibers via the trigeminocervical nucleus. The patient suffering from pain from the atlantoaxial joint will frequently complain of neck pain, occipital and suboccipital headaches, preauricular pain as well as a limited range of motion with exacerbation of pain at the extremes of range of motion. The unique anatomic structure of the atlantoaxial joint also makes it susceptible to instability which may be exacerbated when the joint is subjected to trauma. A number of diseases are associated with atlantoaxial instability and they are listed in Table 2. The clinician should look carefully for atlantoaxial joint abnormalities and/or instability in patients who have sustained trauma to the joint or who are suffering from the diseases listed in Table 2. Rheumatoid arthritis–associated arthropathy of the atlantoaxial joint frequently causes erosion of the odontoid process which can result in joint instability and increased susceptibility to joint dislocation.
The collagen vascular diseases generally manifest as a polyarthropathy rather than a monoarthropathy limited to the first carpometacarpal joint buy cheap loratadine line seasonal allergy medicine for 3 year old, although first carpometacarpal pain secondary to the collagen vascular diseases responds exceedingly well to ultrasound-guided intra-articular injection of the first carpometacarpal joint loratadine 10 mg on-line allergy testing lancaster pa. Interestingly order loratadine 10mg amex allergy forecast for chicago, osteoarthritis of the thumb occurs over 20 times more frequently in elderly females when compared with elderly males purchase loratadine with american express allergy forecast norwalk ct. This is thought to be due to sexual dimorphism in the shape of the joint with the female joint having a significantly smaller trapezial articular surface when compared with males of the same age. Calcium pyrophosphate dihydrate crystal deposition disease involving the joints of the wrist and hand. Calcification of the triangular cartilage is evident in the ulnar compartment of the wrist (arrow). Also noted is exuberant degenerative change in the first carpometacarpal joint, secondary to crystal deposition. Activity, including pinching and gripping motions, makes the pain worse, with rest and heat providing some relief. Sleep disturbance is common with awakening when patients roll over onto the affected upper extremity. Some patients complain of a grating, catching, or popping sensation with range of motion of the joint, and crepitus may be appreciated on physical examination. Watson stress test is positive in patients who suffer from inflammation and arthritis of the carpometacarpal joint of the thumb. Watson test is performed by having the patient place the dorsum of the hand against a table with the fingers fully extended and then pushing the thumb back toward the table (Fig. Watson stress test is positive in patients who suffer from inflammation and arthritis of the carpometacarpal joint of the thumb. Watson test is performed by having the patient place the dorsum of the hand against a table with the fingers fully extended and then pushing the thumb back toward the table. Functional disability often accompanies the pain associated with many pathologic conditions of the first carpometacarpal joint. Patients will often notice increasing difficulty in performing their activities of daily living and tasks that require gripping or pinching objects such as writing with a pen or pencil or opening a jar. If the pathologic process responsible for the first carpometacarpal pain is not adequately treated, the patient’s functional disability may worsen and muscle wasting and ultimately a frozen first 520 carpometacarpal joint may occur. Plain radiographs are indicated in all patients who present with first carpometacarpal joint pain (Fig. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. The ulnar aspect of the first carpometacarpal joint opens approximately 35 degrees with radially directed stress which is strongly suggestive of a complete tear of the ulnar collateral ligament. The transducer is placed on the ulnar side of the thumb for long- and short-axis scans. The thin hyperechoic band superficially is the adductor aponeurosis (solid arrow), which can be demonstrated by flexing the interphalangeal joint of the thumb. A small linear high-frequency ultrasound transducer is placed in a longitudinal parallel axis over the base of the first metacarpal lying against the volar radial aspect of the thumb and a survey scan is taken (Fig. The transducer is slowly moved proximally along the volar radial aspect of the thumb until the hypoechoic cleft between the base of the thumb and the distal articular surface of the trapezium is in the center of the image (Fig. The joint is then evaluated for arthritis, synovitis, effusion, fracture, crystal arthropathy, infection, and ganglion cyst (Fig. The adjacent tendons are then evaluated for tendinopathy, tendinitis, tear, rupture, tumor, and extrinsic compression (Figs. Color Doppler may 521 help demonstrate neovascularity of compromised tendons of the thumb (Fig. A: Correct patient position for ultrasound-guided intra-articular injection of the first carpometacarpal joint. B: Correct position for ultrasound transducer for ultrasound evaluation of the first carpometacarpal joint. B: Despite the extensive joint space narrowing, ultrasound can be used to place a needle (arrow) deep to the thickened joint capsule for therapeutic injection. A: Longitudinal view of the flexor tendon (T) of the thumb demonstrates a homogeneous hypoechoic solid mass (cursors) overlying the tendon. B: Longitudinal view of the distal interphalangeal joint of the ring finger of a different patient demonstrates the deep flexor tendon (T) and a homogeneous hypoechoic solid mass (cursors) overlying the tendon. Transverse view of the flexor tendon (T) of the thumb demonstrates a hypoechoic homogeneous soft tissue mass (m) surrounding the superficial, lateral, and deep aspects of the tendon. Longitudinal (A) and transverse (B) thenar ultrasound images demonstrating tendinitis of the flexor pollicis longus tendon. Longitudinal view of the proximal thumb demonstrates a hypoechoic soft tissue mass (m) adjacent to the flexor tendon (T). The clinician should have a high index of suspicion of joint injury in the setting of trauma, given the laxity and weakness of the joint capsule of the first carpometacarpal joint. Osteoarthritis of the thumb carpometacarpal joint in women and occupational risk factors: a case-control study. Radiographic thumb osteoarthritis: frequency, patterns and associations with pain and clinical assessment finding in a community-dwelling population. Technique for intra-articular injection of the carpometacarpal joint of the thumb. The second metacarpal articulates primarily with the trapezoid and secondarily with the trapezium and capitate (Fig. The third metacarpal articulates primarily with the capitate, with the fourth metacarpal articulating with the capitate and hamate. The carpometacarpal joints of the fingers are shaped differently than the first carpometacarpal joint in that the curvature of the distal articular surface of the base of the metacarpal is more dome shaped making for a more stable joint as it articulates with its corresponding carpal bones (Fig. Each joint is lined with synovium and the ample synovial space allows for intra-articular placement of needles for injection and aspiration. Compared to the first carpometacarpal joint, the carpometacarpal joints of the fingers have a denser and tighter joint capsule and stronger transverse and interosseous ligaments. These differences combined with a much more limited range of motion when compared with the range of motion of the first carpometacarpal joint all contribute to greater joint stability, although fracture and subluxation still occur. The carpometacarpal joints of the fingers are also susceptible to overuse and misuse with resultant inflammation and arthritis. Differences between the first metacarpal joint and the carpometacarpal joints of the fingers. The articular cartilage of the carpometacarpal joints of the fingers are susceptible to damage, which left untreated, will result in arthritis with its associated pain and functional disability. Osteoarthritis is the most common form of arthritis that is seen in the carpometacarpal joints of the fingers which results in pain and functional disability, with rheumatoid arthritis, posttraumatic arthritis, and crystal arthropathy also causing arthritis of the carpometacarpal joints of the fingers (Fig.
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