osteoarthritis thumb 2014

8/9/2019 Osteoarthritis Thumb 2014

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BJWU^ EFE DKJC^ MW^LWJ^JU

ELWJU^JMC N_FKC^JOW, FN, XLNEOC^WO NO IM FMJC, @_MNOIK_XO


2/58

J^ JU UKBWO]_OC^, JU^LOWO

UKFO^LJC@ JULK_IN ACKP^LM^ J MF CK^

MPMWO KB ;

Wofofgor4 tlo tlufg roprosocts >8% kb lmcn bucetjkc mcn mgkut

7? b g nji b tj


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rmpozjk-fotmemrpmi mrtlrksjs js m ckrfmi pmrt kblufmc m`jc` ; - 757= pmtjocts 5= yomrs kr kinor

Xrovmioceo jceromson tk


5/58

OXJNOFJKIK@Z

^lo bofmio pronjioetjkc js mttrjgutmgio tk4

Mcmtkfje (m sfmiior ioss ekc`rukus

slmiikw smnnio dkjct, mt trmpozjmi bmeot),

Loronjtmry (nyspimstje dkjct surbmeos)

Lkrfkcmi bmetkrs (jceromson ij`mfoct

imxjty)

Wosuitjc` jc `romtor dkjct ekctmet prossuro.

5

Ck ekrroimtjkc wjtl wkra (strkc` msskejmtjkc

gotwooc oxeossjvo dkjct imxjty mcn profmturo

dkjct no`ocormtjvo elmc`os)


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Ij`mfoctkus imxjty Lkrfkcmi

Mrtjeuimr lyporfkgjijty (Dcsskc =::?, 788


7/58

GJKFOELMCJEU

^lo =st EFE dkjct js m ekfpiox kco

Ekfpmron tk m smnnio kc m sekijktje lkrso


8/58

GJKFOELMCJEU

^lo dkjct js jcloroctiy ucstmgio

Kgijqujty kb tlo dkjct ijco

Krjoctmtjkc kb ^F ij`mfocts

rmetjkc puiijc` kb tlo MXI

Foelmcjemi ikmns nurjc` pjcel

Jfpkrtmceo kb tlo

ij`mfocts tk stmgjijzo

tlo=st EFE


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^F DKJC^ JCU^MGJIJ^Z

Bmvkron gy nyspimsjm kb tlo trmpozo mcn tlo puii kb

tocnkcs (MXI +++)


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Ckrfmi mc`uimtjkc mrkucn=58, mgckrfmi jb 3 =5?


12/58

GJKFOELMCJEU

Lj`liy ekcstrmjcon dkjct4 Kvor =7,->2%kb emsos1 ôcnjcjtjs4 BEW, No ]uorvmjcs, trj`òr

còr


16/58

EIJCJEMIO\MFJCM^JKC

Uj`cs kb KM4

Foelmcjemi pmjc (nurjc` pjcel -

womrjc` tj`lts, turcjc` m aoy)

Xmjc mt pmipmtjkc, stross tosts +,

Uyckvjtjs, nobkrfjty,...

Ikss kb stroc`tl

^locmr mtrkply

Nk ckt bkr`ot tk oxmfjco tlo FX dkjct


17/58

U^WOUU ^OU^U

Xmipmtjkc kb F dkjct

@rjcn tost

Njstrmetjkc tost

^rmetjkc-sljbt

krquo tost

Oxtocsjkc tost (Uo :>, Up :?)

Mnnuetjkc tost (Uo :>, Up:5)


18/58

WMNJKIK@Z

Upoejmi \-rmys jcejnoceos

(Ampmcndj, Wkgort)

Wkgort X. Guiiotjcs ot ffkjros no im Ukejt

no Wmnjkik`jo Fnjemio no Brmceo.

=:5217>42


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Uj`cs kb KM4 ekcnocsmtjkc, seiorksjs, dkjct

cmrrkwjc`, kstokplytos (=st wog), sugiuxmtjkc,


20/58

^LWOO JFXKW^MC^^LJC@U ^K MCMIZUOKC \-WMZU

^F dkjct cmrrkwjc`

^F dkjct sugiuxmtjkc

U^^ dkjct jcvkivofoct(mrkucn =8%)


21/58

Upoejmi jfm`jc` toelcjquos mro usoioss


22/58

CK XMWMIIOIJUF GO^POOC EIJCJEMIUZFX^KFU MCN UOROWJ^Z KC \-WMZU


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Omtkc (=:05, =:) Noii (=:0 Mrtlrkso F + U^^ Mrtlrkso F ot U^ . Mrtlrkso F ot U^^

Wmnjkik`jemi eimssjemtjkc nkos ckt noserjgo mii stm`os kb emrpkfotmemrpmi dkjct kstokmrtlrjtjs

meeurmtoiy ocku`l tk porfjt roijmgio mcn ekcsjstoct ekffucjemtjkc gotwooc eijcjejmcs (Elkm ot mi.


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^WOM^FOC^ FKNMIJ^JOU

Fknmijtjos ekcnjtjkcmiiy roekffocnon bkr tlofmcmòfoct kb lmcn KM jceiuno jcstruetjkc jc dkjct

prktoetjkc toelcjquos, prkvjsjkc kb mssjstjvo novjeos,

uso kb tlorfmi fknmijtjos mcn trmpozjkfotmemrpmi dkjct

spijcts, mcn uso kb krmi mcn tkpjemi ckcstorkjnmi

mctjjcmffmtkry nru`s (CUMJNs), trmfmnki, mcn tkpjemi

empsmjejc^loso roekffocnmtjkcs mro gmson kc tlo ekcsocsus dun`foct kb eijcjemi

oxports brkf m wjno rmcò kb njsejpijcos, jcbkrfon gy mvmjimgio ovjnoceo,

gmimcejc` tlo gocots mcn lmrfs kb gktl ckcplmrfmekik`je mcnplmrfmekik`je fknmijtjos, mcn jcekrpkrmtjc` tlojr proboroceos mcn vmiuos.

Lkelgor` FE, Mitfmc WN, Mprji A^, Gocalmitj F, @uymtt @, Fe@kwmc D, ^kwloon ^, Poiel R, Poiis @,

û`woii X1 Mforjemc Ekiioò kb Wloufmtkik`y. Mforjemc Ekiioò kb Wloufmtkik`y 78=7

roekffocnmtjkcs bkr tlo uso kb ckcplmrfmekik`je mcn plmrfmekik`je tlormpjos jc kstokmrtlrjtjs kb

tlo lmcn, ljp, mcn acoo. Mrtlrjtjs Emro Wos (Lkgkaoc). 78=7 Mpr12>(>)4>2?-0>.


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FONJEMI ^WOM FOC^

Xlmrfmekik`jemi ^^^ (Xmjc-ajiiors, CUMJN, sikw-

metjkc mctj-mrtlrjtjs fonjemtjkc ijao sknjuf

elkcnrkjotjc suibmto), krtlksjs +++, Xlysjemi ^^^

(pmrmbc, lomt,)

Utorkjn jcdoetjkcs, Lymiurkcje mejn jcdoetjkcs

Js smjn tk go obejoct jc :8% kb emsos - pmjc roijob jc


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LMCN ^LOWMXZ

Fmcy pugijemtjkcs, bow mro rmcnkfjzon

Lmcn tlormpy soofs tk prkvjno skfo pmjc

ronuetjkc jc pmtjocts wjtl syfptkfmtje ^FE KM.

Lkwovor, iovoi kb ovjnoceo js ikw

Upmmcs MD, vmc Fjccoc IX, Akc F, Ueluurfmc ML, Uelrounors MW, Rorfouioc @F. Ekcsorvmtjvo

tromtfoct kb tlufg gmso kstokmrtlrjtjs4 m systofmtje rovjow. D Lmcn Uur` Mf. 78=? Dmc1>8(=)4=2-7=


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MUUJU^JRO NORJEOU


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KW^LKUOU

02% kb pmtjocts wjtl fknormto jcvkivofoct mcn ?>% wjtl

sovoro njsomso lmvo m 28% jfprkvofoct wjtl mc krtlksjs(Uwj`mrt, =:::)

"Gocoeo js jffonjmto (kr covor)

^lo typo kb krtlosjs +/- plysjktlormpy lms ck jcuoceo kctlo ovkiutjkc mt 2 wooas(Pmdkc, Must D Xlysjktlor 788?) - Xmtjocts probortk jffkgjijzo FX & ^F dkjct kvor kciy tlo ^F (Pojss, D Lmcn lor 788>)

Ck njbboroceo gotwooc slkrt (wrjst js broo) kr ikc` krtlksos, gutpmtjocts proborron slkrt krtlksos (Pojss, D Lmcn lor 7888)

Ck njbboroceo gotwooc rj`jn kr suppio krtlksjs, gut pmtjoctsproborron tlo fkro suppio kco (Guurao, Eijc Wolmg =:::)


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PLM^ MGK_^ JCDOE^JKCU ;

Jctrm-mrtjeuimr storkjn jcdoetjkcs ucnor ukrksekpjeekctrki nk ckt jceromso pmjc roijob (7> wooas), dkjctsocsjgjijty, stjbbcoss kr sugdoetjvo ovmiumtjkc gy tlo

pmtjoct(Foocm`l, Mcc Wlouf Njs 788>).

Xrkspoetjvo mcmiysjs -sjc`io jctrmmrtjeuimr storkjnjcdoetjkc + 5 wooas kb spijctjc`4

17:47>0?=.


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PLM^ MGK_^ JCDOE^JKCU ;

5 jcdoetjkcs kb LM mro ioss obejoct jcjtjmiiy tlmcstorkjns gut fkro loipbui mt 72 wooas (Buels,Kstokmrtlrjtjs Emrtjim`o, 7882).

Ck ekfpijemtjkcs ropkrton (vory bow) ^loro js skfo ovjnoceo bkr pmjc roijob gy gktl

storkjn mcn lymiurkcmto jctrmmrtjeuimr jcdoetjkcs jcpmtjocts wjtl ^FE KM.Fkst mutlkrs bkucn

jcdoetjkc kb lymiurkcmto fkro obboetjvo wjtl msuporjkr ikc`-imstjc` obboet.

Fkst rloufmtkik`jsts ekcsjnor jt ms m vory obejoct tromtfoct4 jc pmtjocts wjtl jcmffmtkry sj`cs ;


31/58

XLMWFMEKIK@Z

^kpjemi CUMJN

Krmi CUMJN

Ck romi stunjos

"=/=788 elmceo kb nomtl brkf ekfpijemtjkcs kb CUMJN mbtor twk

fkctls kb tromtfoct

"Jcejnoceo kb @O ekfpijemtjkcs js =78/=88 888 jclmgjtmcts/yomr.

Jcejnoceo kb @O ekfpijemtjkcs nuo tk CUMJN js >


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U_W@JEMI ^WOM^FOC^

O_IMW Woekffmcnmtjkcs (Tlmc` MWN 7880)4

Uur`ory js mc obejoct tromtfoct bkr EFE dkjct

mrtlrksos mcn emc go nkco jc pmtjocts wlk mro

pmjcbui kr wjtl m jfpkrtmct bucetjkcmi noejt mbtorbmjiuro kb fkro ekcsorvmtjvo tromtfocts (BNW 6

2


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U_W@OWZ

Fmcy toelcjquos

Uyfptkfmtje tromtfoct

Mrtlrknosjs (Fuiior, =:>:)

Kstoktkfy (Pjiskc, =:05)

Mrtjeuimr rosoetjkc (j.o. trmpozoetkfy w/wk stmgjijsmtjkc,

jctorpksjtjkc,) Q@orvjs, =:>:1 Brkjfskc, =:081 Omtkc =:05V

Xrkstlosos - jfpimcts QUwmcskc, =:07V kr prkstlosjs QNo im Embcjro,=:0>V

Xrovoctjvo romtfoct ;

Mrtlrknosjs =5 yrs B_


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^F MW^LWKNOUJU

_sumiiy prkpkson jc ykuc` pokpio (tk fmjctmjc

tlojr stroc`tl) wjtl skfo ikss kb fkgjijty

Ck njbboroceo jc rosuits jc tlo (rmro, rotrkspoetjvo)

ekfpmrmtjvo stunjos

% smtjsbmetkry rosuits (7? yomrs B_)

>8% ro-jctorvoctjkc QElmfmyV (Lmrnwmro rofkvmi,Ckcucjkc >%, No-mrtlrknosjs 2%)

Euiturmi jcnjemtjkcs tlmt njfjcjsl

Mrtlrknosjs =5 yrs B_


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^WMXOTJOE^KFZ

Xmrtjmi kr ekfpioto

Pjtl / wk jctorpksjtjkc

P/wk stmgjijsmtjkc

www.fmjtrjso-krtlkp.ekf

^rmpozjoetkfy miwmys iomn tk m

njfjcutjkc kb aoy-pjcel stroc`tlQRmcnocgrkueao, =::0V.

"Mii pmtjocts wjii ekfpimjc kb m ikss kb

stroc`tl mbtor trmpozjoetkfy +++


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XK^OC^JMI XWKGIOFU

^lufg ekiufc wjii

ekiimpso jctk tlo

nomn spmeo wjtl tjfo(8,? ff / yomr)

Mgutfoct wjtl

trmpozkjn mcn/kr

semplkjn

M

G

^rmpzjmi Upmeo Wmtjk 6 M/G

Amnjymim & Nkwcjc`, DLU, =::2.


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OGF4 ^WMXOTJOE^KFZ +/- JC^OWXKUJ^JKC+/- U^MGJIJUM^JKC (NMRJU - XWKUXOE^JROU^_NJOU)

=


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EKELWMCO NM^MGMUOUZU^ WOR 788:

: stunjos (>00 pmrtjejpmcts)

0 toelcjquos4 rmpozjoetkfy wjtl ij`mfoct roekcstruetjkc mcn tocnkcjctorpksjtjkc (IW^J), trmpozjoetkfy, trmpozjoetkfy wjtl ij`mfoct roekcstruetjkc,trmpozjoetkfy wjtl jctorpksjtjkcmi mrtlrkpimsty, Mrtoikc dkjct rosurbmejc`,

mrtlrknosjs mcn dkjct ropimeofoct. Utmò JJ-JR kstokmrtlrjtjs

Ck prkeonuro nofkcstrmton mcy suporjkrjty kvormcktlor jc torfs kb pmjc, plysjemi bucetjkc, pmtjoctìkgmi mssossfoct kr rmcò kb fktjkc

IW^J 6 77% mnvorso obboets (jceiunjc` semr tocnorcoss, tocnkcmnlosjkc kr rupturo, socskry elmcò, kr Ekfpiox Wo`jkcmi Xmjc Uycnrkfo (^ypo

=))vs =8% bkr trmpozjoetkfy. WW 6 7.7=, :?% EJ =.=< tk>.=?.


39/58

WOEOC^ WORJOP

^loro woro ck stmtjstjemiiy sj`cjemct njbboroceos jc

pkstkpormtjvo `rjp stroc`tl (p 6 8.00)1 tjp pjcel

stroc`tl (p 6 8.07)1 aoy pjcel stroc`tl (p 6 8.:8)1pmjc vjsumi mcmik`uo semio sekro (p 6 8.5>)1

Njsmgjijtjos kb tlo Mrf, Ulkuinor mcn Lmcn sekro

(p 6 8.0?)1 mcn cufgor kb mnvorso ovocts (p 6

8.=5).

Ij ZA, Pljto E, J`cmey M, lkfm M. Ekfpmrjskc kb trmpozjoetkfy mcn trmpozjoetkfy wjtl ij`mfoct

roekcstruetjkc mcn tocnkc jctorpksjtjkc4 m systofmtje ijtormturo rovjow. Ximst Woekcstr Uur`. 78== Dui1

=7


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5? pmpors mcmiyzon

(=) tloro js ck ovjnoceo tlmt trmpozjoetkfy kr

trmpozjoetkfy wjtl tocnkc jctorpksjtjkc js suporjkr tk mcy

kb tlo ktlor toelcjquos.

(7) rmpozjoetkfy wjtl ij`mfoct roekcstruetjkc kr

trmpozjoetkfy wjtl ij`mfoct roekcstruetjkc mcn tocnkc

jctorpksjtjkc (IW^J) js ckt suporjkr tk mcy kb tlo ktlor

toelcjquos (jc tlo slkrt-torf). Jc mnnjtjkc, trmpozjoetkfywjtl IW^J soofs msskejmton wjtl m lj`lor ekfpijemtjkc rmto.

Rorfouioc @F, Uijdpor L, Bojtz W, Lkvjus UO, Fkkdoc ^F, Uoiios WP. Uur`jemi fmcm`ofoct kb prjfmr

tlufg emrpkfotmemrpmi kstokmrtlrjtjs4 m systofmtje rovjow. D Lmcn Uur` Mf. 78== Dmc152(=)4=?0-2:.

WOEOC^ WORJOP (EKC^)


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(5) wo mro ckt mgio tk ekceiuno wlotlor EFE

mrtlrknosjs js suporjkr tk mcy ktlor toelcjquo. Ckcucjkc

rmtos mvorm`o ) tktmi dkjct prkstlosjs fj`lt lmvo gottor slkrt-torfrosuits ekfpmron tk trmpozjoetkfy wjtl IW^J.

Po ekceiuno tlmt, mt tljs tjfo, ck sur`jemi prkeonuro js

prkvoc tk go suporjkr tk mcktlor.

Rorfouioc @F, Uijdpor L, Bojtz W, Lkvjus UO, Fkkdoc ^F, Uoiios WP. Uur`jemi fmcm`ofoct kb prjfmr

tlufg emrpkfotmemrpmi kstokmrtlrjtjs4 m systofmtje rovjow. D Lmcn Uur` Mf. 78== Dmc152(=)4=?0-2:.


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^F XWKU^LOUOU

Fmcy nosj`cs

Fkstiy Brocel

=st emso, No Im Embcjro,

=:0>


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MNRMC^M@OU KB ^FXWKU^LOUOU

Omriy roekvory (7-5 fkctls) - Ck rolmgjijtmtjkc

Ck tlufg slkrtocjc` (Emc go uson ovoc jb FX

lyporoxtocsjkc) - ostlotje

=88 pts, yomrs B_ QWo`cmrn 7882V)

0 mcs


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EKFXIJEM^JKCU

Mgkut =?%, tlmt jceromso wjtl tjfo Ikksocjc` (+/- =?%), njsikemtjkc (+/- 0%), trmpozjmi

brmeturo,

E/J4 ^rmpozjmi nyspimsjm, slkrt kr tljc trmpozjuf,FX mrtlrknosjs, FEI jcsubsjocey (FX), U^^

mrtlrksos (ykuc` pmtjoct)


45/58

U_WRJRMI KB ^F XWKU^LOUOU

Uurvjvmi rmto gotwooc 4 2< tk 1 Dmekuiot, 788?1

Ueluli, 788=1 Ionkux, =::01 Gmnjm ot Umfgmcnmf,

7882)

=2% ro-kpormtjkc mt >= fkctls B_(Mpmrn ot Umjct-Emst, 7880)

Fkst ro-kpormtjkc mro nkco wjtljctlo rst yomr (Mpmrn ot Umjct emst, 7880, Ekftot,7888)


46/58

K^LOW ^OELCJ]_OU

^k fmjctmjc tlo tlufg ioc`tl4 pmrtjmi

trmpozjoetkfy wjtl jctorpksjtjkc(pyrkemrgkc, Mrtoikc,) - Ck sorjos

pugijslon

^F dkjct nocorvmtjkc

@rmcuikfmtkus rometjkc wjtl mrtoikc

h


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BKW PLJEL XM^JOC^U ;

Zkuc`

Pjtlkut (kr ijfjton)emrtjim`o mitormtjkc

^F jcstmgjijty +/-

trmpozjmi nyspimsjm


51/58

XWOROC^JRO ^WOM^FOC^

Uoetjkc kb mctorjkr

mgorrmct gors kb tlo

MXI (Tmcekiij)

Ck sorjos pugijslon

Xrkgmgiy usoioss


52/58

XWOROC^JRO ^WOM^FOC^

Ij`mfoctkpimsty jc pmtjocts wjtl jcstmgjijty

Io Rjot ropkrton =: pmtjocts jfprkvon kut kb m

sorjos kb 7? gut ekcsjnoron rosuits ms uc-

pronjetmgio

Omtkc ropkrton mbtor =? yomrs tlmt


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Omtkc-Ijttior typo


54/58

GW_COIIJ IJ@MFOC^KXIMU^Z(=:0>)

^lo MXI js pmrmiioi tk tlo pimco kb tlo cmji pimto


55/58


56/58

^F DKJC^ MW^LWKUEKXZ

Nogrjnofoct kb syckvjtjs

Ulrjcam`o kb ^F ij`mfocts


57/58

KU^OK^KFJOU

Rmseuimrjzon Dkjct trmcsbor (Wkux 788>)

Ckc-vmseuimrjzon kstoktkfy (@kugomu 788?)


58/58

IKKA ^K X_GIJULON NM^M PJ^L UOWOCJ^Z

osteoarthritis thumb 2014

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