Soft Tissue Arthritis

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This is called monoarticular juvenile arthritis. In most cases, this arthritis is very mild and, over time, the symptoms may lessen or go away altogether. For some children, this arthritis affects four or fewer larger joints. Joints affected include the knee, ankle, or wrist.

The inflammatory arthritis pathway

Involvement of fingers or toes is unusual. Oligoarticular juvenile arthritis may also cause eye inflammation. To prevent blindness, your child may need regular eye examinations from a doctor who specializes in eye diseases ophthalmologist. Eye problems may continue into adulthood. This type of arthritis is more common in girls than in boys. Polyarticular juvenile arthritis affects five or more smaller joints such as the hands and feet. Usually, the affected joints are on both sides of the body. This type of juvenile arthritis can also affect large joints. Children with a certain antibody in their blood, called IgM rheumatoid factor RF , often have a more severe form of the disease.

Antibodies are proteins in the blood usually used by the body to fight off infection through an immune response. In this form of arthritis, the IgM RF antibody attacks the body's own tissues. Doctors believe that this is the same type of arthritis as adult rheumatoid arthritis. This type of juvenile arthritis causes swelling, pain, and limited motion in at least one joint. Additional symptoms include rash and inflammation of internal organs such as the heart, liver, spleen, and lymph nodes.

Practice Essentials

A fever of at least degrees each day for 2 weeks or longer suggests this diagnosis. If not adequately treated, children with systemic juvenile arthritis may develop arthritis in many joints and have severe arthritis that continues into adulthood. No one knows exactly what causes juvenile arthritis. Researchers believe some children have genes that make them more likely to get the disease. Exposure to something in the environment for example, a virus triggers juvenile arthritis in these children.

Juvenile arthritis is not hereditary, so it is very rare for more than one child in a family to get it. Juvenile arthritis affects each child differently and can last for indefinite periods of time. There may be times when symptoms improve or disappear remissions. There are other times when symptoms worsen flare-ups. Sometimes, a child may have one or two flare-ups and never have symptoms again.

Other children may have frequent flare-ups and symptoms that never go away. Early diagnosis and treatment can control inflammation, relieve pain, prevent joint damage, and maintain a child's ability to function. Your doctor will order a wide range of tests. A complete medical history and physical examination, blood tests, and x-rays will help your doctor rule out other conditions that cause arthritis.

Rheumatoid Arthritis (RA)

He or she will want to know how long your child has had problems with joint pain and swelling, and whether the symptoms have gotten better or worse. Your doctor will want to know whether your child feels stiff when getting up after rest, and whether the joints are swollen. He or she will look for other causes of the symptoms, such as an injury, another illness — such as Lyme disease — or a family history of autoimmune diseases.

Your doctor will examine your child's joints. He or she will check for signs of swelling, warmth and decreased range of motion. Your doctor will also examine the muscles near the affected joints, looking for signs of shrinkage atrophy. Tests on blood, joints, and tissue fluids can help to rule out other conditions that might cause similar symptoms. These tests may also be used to classify the type of juvenile arthritis. X-rays provide clear images of dense structures like bone. Your doctor may order them to look for injuries to bone or for any unusual development of bone.

A child with juvenile arthritis will probably need treatment from a pediatric rheumatologist. This doctor specializes in helping children with arthritis and related conditions. Treatment of juvenile arthritis is designed to reduce swelling, maintain full movement of affected joints, and relieve pain. Because juvenile arthritis may have complications, such as joint contracture, soft-tissue damage such as tendons , or joint problems, any treatment program will also identify, treat, and prevent complications. The pain is worsened when patients position their thumbs inside a closed fist and while ulnar deviating the wrist Finklestein test.


A local steroid injection may be the most effective treatment for De Quervain tenosynovitis. Mark the most sensitive portion of the tendon.

Insert a or gauge, 1-inch needle at a to degree angle into the radial aspect of the anatomic snuffbox parallel to the course of the tendons. Take care not to inject the tendon itself, which is indicated by high resistance. Ganglia are unilocular or multilocular cysts found near or attached to tendon sheaths and joint capsules. They occur in adults ages years old with higher prevalence in females female-to-male ratio. Containing a thick jelly-like fluid, ganglion cysts usually develop spontaneously, possibly due to cumulative trauma.

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A small percentage of ganglia are bound to the flexor tendon sheath. Most ganglia are relatively painless and resolve spontaneously. If pressure from a ganglion causes pain or numbness due to peripheral nerve impingement, aspiration with or without injection of a corticosteroid can be effective. Carpal Tunnel Syndrome. Carpal tunnel syndrome, caused by compression of the median nerve by surrounding structures within the carpal tunnel, most frequently is a result of nonspecific common flexor tenosynovitis possibly due to overuse injury.

Other contributing factors in carpal tunnel syndrome include inflammatory conditions rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus , metabolic disorders diabetes mellitus, obesity, and hypothyroidism , infections, and pregnancy. The symptoms of burning pain and numbness of the palmar thumb and the index and middle fingers usually are worse at night.

The pain may radiate to the forearm, elbow, and shoulder.


If the compression is severe, thenar muscle atrophy and loss of grip strength may develop. A sensation of tingling in the distribution of the nerve produced by tapping over the carpal tunnel Tinel sign or causing a degree wrist flexion for one minute Phalen wrist flexion sign are indicative of carpal tunnel syndrome.

Systemic Pathology _ Dr. Ehab {2018} _25 Arthritis skin and soft tissue

For patients unable to flex the wrist due to arthritis, compression of the median nerve for longer than 30 seconds produces the same effect. Electrodiagnostic studies may help in confirming the diagnosis, but results are operator dependent. Initial treatment should include avoidance of repetitive wrist motions and splinting the wrist in a neutral position. Wrist splinting tends to be more effective if used within three months of the onset of symptoms. Splinting throughout the day provides greater improvement of symptoms, but compliance is improved when splinting is only at night.

In many patients, surgery is eventually required to release the median nerve. A to gauge needle approximately 1 inch in length can be used to inject the carpal tunnel. The needle should be inserted at a to degree angle just proximal to the wrist crease and ulnar to the palmaris longus tendon.

The needle should be advanced toward the web space between the long and ring finger to a depth of approximately 2 cm.

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If the needle meets obstruction or if the patient experiences paresthesias, the needle should be withdrawn and redirected to avoid injecting the body of the tendon or the ulnar nerve. Slowly inject 0.

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Stenosing Digital Tenosynovitis Trigger Finger. Trigger finger occurs when a tendon cannot glide within its sheath because of a nodular thickening or stenosis at the first annular A-1 pulley of the digit. This most commonly is due to repetitive strain injury with gripping activities.