conditions of the wrist joint and the hand -...
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Conditions of the wrist joint and the hand
H. Myburgh
2012
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Congenital abnormalities
• Unknown aetiology (40-60%)
• Genetic Factors (Down Syndrome- Clinodactily little finger)
• Enviromental causes
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Failure of formation
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Failure of differentiation
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Duplication
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Hypoplasia of the thumb
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Camptodactily
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Dupuytran’s Contracture
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Dupuytran’s Contracture
• Cause: Unknown, Hereditary
• Pathology: Fibromatosis palmar + digital fascia
• Clinical: Middle + old age, Mostly ulnar side of hand
• Surgery for contracture + deformity
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Mallot finger
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De Quervain’s Tenosynovitis
• Middle Aged Women
• Pain + swelling proximal radial styloid
• Stenosing Tenosynovitis APL +EPB
• Finkelstein’s test
• Treatment:-Rest + NSAID
-Steroid injection in sheath
-Surgical Release
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De Quervain’s Tenosynovitis
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Trigger finger
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Trigger finger
• Middle aged (OA, RA, DM, Gout)
• Nodule forms flexortendon which stick in flexor sheath
• Complain of locking of finger
• Has to be straightened passively
• Surgical release
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Tenosynovitis
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Septic Tenosynovitis
• Kanavel’s four signs
• Swelling
• Slight flexion
• Pinpoint tenderness over sheath
• Pain on passive extention
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Septic Tenosynovitis
• Treatment:
• Surgical Drainage
• Antibiotics
• Elevation
• Mobilisation
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Paronychia
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Gout
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OA Heberden’s Nodules
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OA Mucous cyst
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OsteoArthritis
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Osteo Arthritis Quintet
• CMC Arthritis
• DIP Arthritis
• Trigger finger
• De Quervains synovitis
• Carpal tunnel syndrome
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CMC Arthritis
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Rheumatoid Arthritis
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Rheumatoid Arthritis
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Psoriasis
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Ganglion
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Ganglion
• Most common swelling in the wrist
• Mucoid degeneration capsule
• Young adults
• Painless lump
• Slight ache + weakness
• Treatment: Surgery only when troublesome
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Carpal Tunnel Syndrome
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Carpal Tunnel Release
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Radial sided wrist pain
• De Quervains tenosynovitis
• CMC arthritis
• Trigger thumb
• Carpal tunnel syndrome
• Ganglion
• Radial nerve compression
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Kienbock’s Disease
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Kienbock’s Disease
• Young adult
• Pain + stiffness
• Diminished grip strength
• Tenderness over lunate
• Occasionally history of trauma
• Avascular necrosis lunate
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Kienbock’s Disease
• X-ray
• MRI – Early stages
• Treatment- Early Splintage
• Operative: Radial Shortening
Ulnar Lengthening
Intercarpal fusion
Proximal Row Carpectomy
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Carpal Instability
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Lunate Dislocation
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Thank you
THANK YOU
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Additional Pictures
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Soft Tissue Conditions
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Arthritis
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Arthritis
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Arthritis
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Arthritis
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Conditions of the wrist
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Dupuytran’s Contracture