Carpal Tunnel Syndrome

Scleroderma. The dermis is characterized by large reticular dermal collagen bundles that are oriented parallel to the epidermis. The large size and loss of basket-weave pattern of these collagen bundles are abnormal. No appendages are apparent, as these are destroyed in the disease process.

scleroderma: early stage

Scleroderma: hand, amputated distal digits

FIGURE 50.4 Rheumatoid arthritis. (A) Early. (B) Advanced.

Median nerve entrapped in the carpal tunnel results in pain, numbness, and impaired function of the hand and fingers.

FIGURE 13-1. Open carpal tunnel release. The carpal tunnel is a fibroosseous canal. Associated bones which contribute to its boundaries include the hook process of the hamate (H), capitate (C), trapezoid (Td), pisiform (P), triquetrum (Tq), lunate (L), scaphoid (S), and trapezium (Tm). The roof is formed by the flexor retinaculum.

Radiographs of the MCP joints of a patient with rheumatoid arthritis demonstrate loss of joint space and some overlap of the metacarpal head on the proximal phalanx, indicating early palmar subluxation of the proximal phalanx. These findings are usually seen in a progressive fashion, with the radial side being worse.

Swan-neck deformity of the index finger in a patient with rheumatoid arthritis. Hyperextension of the proximal interphalangeal (PIP) joint and flexion deformities of the metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints.

A: A 55-year-old female with a type III deformity secondary to rheumatoid arthritis.

Rheumatoid arthritis. (A) The hyperplastic synovium from a patient with rheumatoid arthritis shows numerous finger-like projections, with focal pale areas of fibrin deposition. The brownish color of the synovium reflects hemosiderin accumulation derived from old hemorrhage. (B) A microscopic view reveals prominent lymphoid follicles (Allison - Ghormley bodies), synovial hyperplasia and hypertrophy, villous folds, and thickening of the synovial membrane by fibrosis and inflammation. (C) A hi...

Rheumatoid nodule. (A) A patient with rheumatoid arthritis has a mass on a digit. (B) A microscopic view of a rheumatoid nodule shows a central area of necrosis surrounded by palisaded macrophages and a chronic inflammatory infiltrate.

FIGURE 26.4. Gross appearance of chronic interstitial pneumonia in rheumatoid arthritis. Zones of honeycombing can be seen in the posterior subpleural regions. Some contraction and thickening of the lung also are noted, along with pleural thickening.

Figure 6.85. Atrophy of the thenar muscles in a 50-year-old woman. This condition resulted from long-standing compression of the median nerve at the wrist (carpal tunnel syndrome).

<bold>FIG. 65.12.</bold> Destructive arthritis of an isolated distal interphalangeal joint with osteolysis of the proximal phalanx.

<bold>FIG. 65.14.</bold> Prominent metatarsophalangeal joint involvement with subluxation and cupping of the base of the proximal phalanges. The big toe distal interphalangeal joint shows characteristic marginal erosions.

<bold>FIG. 77.2.</bold> Face of a 19-year-old woman with diffuse cutaneous systemic sclerosis. Note loss of normal skin folds and retraction of lips.

<bold>FIG. 77.6.</bold> Close-up hand roentgenogram of a 46-year-old woman with limited cutaneous systemic sclerosis. Note extensive subcutaneous calcinosis.

<bold>FIG. 77.11.</bold> Photomicrograph of the lung of a 52-year-old woman with diffuse cutaneous systemic sclerosis who died as the result of respiratory insufficiency. Note the dramatic interstitial fi osis and dilatation of air sacs (honeycomb lung).

<bold>FIG. 77.20.</bold> A child with linear scleroderma involving the left lower extremity with evidence of a left knee flexion contracture. There is a plaque of morphea on the right thigh.

FIG. 2.17. Juvenile dermatomyositis and scleroderma. A: Atrophic, hypopigmented lesions overlying extensor surfaces of interphalangeal joints, with periungual erythema typical of juvenile dermatomyositis. B: Linear scleroderma involving left lower extremity in a 12-year-old girl.

FIGURE 19-11.?Advanced rheumatoid arthritis. The hands show swelling of the joints and deviation of the fingers.

Figure 10-5 <bold>INFLAMMATORY VERSUS DEGENERATIVE ARTHRITIS.A. Inflammatory Arthritis (Rheumatoid Arthritis).</bold> The most prominent feature is the uniform bicompartmental loss of joint space.<bold> B. Degenerative Arthritis (Degenerative Joint Disease).</bold> In contrast, selective loss of a single compartment joint space in a non-uniform manner is apparent.<bold><italic>COMMENT:</bold></bold> This is an important differential feature between inflammatory and degenerative joint changes.

Figure 10-195 <bold>SCLERODERMA: ACROOSTEOLYSIS. A. PA Hand.</bold> Note the early resorption of the distal tufts (<italic>arrows</bold>). Incidentally noted is a bandage (<italic>arrowhead</bold>). <bold>B. PA Hand.</bold> Observe the advanced resorption of the distal tufts.

Linear scleroderma: leg

Morphea: abdomen

<bold>FIG. 107.2.</bold> An anteroposterior view of the hips in a 23-year-olf female patient with osteonecrosis of both femoral heads <italic>(arrows)</bold>, associated with systemic lupus erythematosus.

<bold>FIG. 107.5.</bold> An anteroposterior view of the knee in a 23-year-old female patient with osteonecrosis of the femoral condyle <italic>(arrow)</bold> associated with systemic lupus erythematosus.