Discussion on pictures - Hands


These are some of the common abnormalities in rheumatological conditions involving the hands.


1.
















This is sclerodactyly in scleroderma. Note the thickening of the skin and telangiectasias. There can be many causes for ulceration in these patients.



2.





This is classic rheumatoid arthritis. Note the involvement of wrist, metacarpophalangeal and proximal interphalangeal joints with sparing of distal interphalangeal joints.

Deformities include
1. Volar subluxation at the wrist
2. Z thumb
3. Ulnar deviation at MCP joints
4. Boutonnieres
5. Swan neck



3.




This is psoriatic arthritis. Note the involvement of distal interphalangeal joints. There are nail changes characteristic of psoriatic arthritis. Not only those, but there's psoriatic rash as well in the web between 3rd and 4th fingers of the left hand!!


4.



This is osteoarthritis. PIP and DIP affected with prominent osteophyte formation. They are called Herbeden's and Bouchard's nodes.

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