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Hypertrophic osteoarthropathy is one of many distant effect disorders due to cancer, with lung cancer being the most common cause but also occurring with ovarian or adrenal malignancies. A distant effect disorder, or a paraneoplastic syndrome , affects distant areas and thus is not related to local compression or obstruction effects from the tumor.
[7]: 361 In cases of recurrent or resistant disease, multiple surgeries, total joint arthroplasties, or amputation may be required. [ 9 ] : 1 A multidisciplinary approach, supplementing surgery or other treatments, can also improve outcomes in cases of recurrent TGCT. [ 25 ]
The disease generally affects only one of the larger weight bearing joints (hip, ankle, knee) – although the elbow, and wrist can also be affected. It rarely involves the temporomandibular joint (TMJ) and most publications are case reports. [3] Synovial chondromatosis occurs twice as commonly in males as females and usually in their forties.
Joint pain is a common symptom we all experience at some point or another. Painful joints can have a significant impact on quality of life and the ability to do daily activities.
The TMC joint is a synovial joint between the trapezium bone of the wrist and the metacarpal bone at the base of the thumb. This joint is a so-called saddle joint (articulatio sellaris), unlike the CMC joints of the other four fingers which are ellipsoid joints. [17] This means that the surfaces of the TMC joint are both concave and convex.
This is the mainstay of synovial sarcoma treatment and is curative in approximately 20–70% of patients, depending on the particular study being quoted. [ 17 ] Conventional chemotherapy , (for example, doxorubicin hydrochloride and ifosfamide ), to reduce the number of remaining microscopic metastases . [ 16 ]
Total wrist arthrodesis is the standard surgical treatment for patients with stage IV wrist osteoarthritis. During this procedure the carpal bones are all fused together and are then fastened to the distal radius. [14] This procedure eliminates all wrist motion, but heavy labor is still possible. [19]
The patient's own description is the best measure of pain; they will usually be asked to estimate intensity on a scale of 0–10 (with 0 being no pain and 10 being the worst pain they have ever felt). [10] Some patients, however, may be unable to give verbal feedback about their pain.