Upper Extremity: JRA

- Wrist:
    - exam: flexed & ulnarly deviated
    - synovectomy:
         - synovectomy is most indicates before joint changes occur;
    - flexion deformity:
         - 30 deg wrist flexion deformity can be treated by serial splinting & casting;
              - wedging cast can also be used to correct the deformity w/caution to avoid subluxation;

- Hand:
    - MP synovitis is more often seen in the seropositive child;
    - fingers extended, swollen, and radially deviated;
    - synovectomy, repositioning of extensor tendon over MP joint, & intrinsic transfer for tightness may be performed.
    - swan neck deformity in children: treat w/ splint;
    - boutonniere deformity;
    - injection of tendon sheaths w/ corticosteroids often improves ROM
    - tendon ruptures are rare in children and, unlike those in adults, can be rx'ed by primary repair rather than tendon transfer.

- Shoulder:
    - shoulder involvement usually occurs in polyarticular JRA (50%) & in systemic form (80%);
    - loss of internal rotation & abduction is common;
    - children w/ systemic JRA are likely to have severe shoulder involvement

Juvenile rheumatoid arthritis.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 21, 2012 4:24 pm