Download - TENOSYNOVITIS PPT
Tenosynovitis
Dr. Diyar A. SalihPlastic surgery resident
June, 2010 Kurdistan, Sulaimani
Tendonitis: Tendon
Tenosynovitis: Tendon + Synovium
1) Mesenchymal syndrome: multiple area of inflammation & tenosynovitis
Features
SleepSize discrepancy
Repetitive motion
Diagnosis
1) Pain at the wrist (specific comp), exacerbated by wrist movement.
2) Tenderness on examination.3) Grip strength decreased.4) Complete pain relieve by a small
amount of LA agent injection in to the compartment.
Treatment1) Conservative: for the first occurrence:
Modification of activities & avoiding heavy loading Steroid injection (into the involve sheath) Splinting (short term pain Mx) Elastic bands (esp. Tennis elbow) NSAID
2) Surgical: Synovial sheath decompression Size reduction Tendon rerouting through another compartment Postoperative splinting for 2 weeks & elevation
Triamcinolone 3-4 mgNo systemic or minimal local SENo more than 2 injection into the same areaIf the first injection failed to resolve the symptoms, there is no indication for the second injection (consider surgery)Avoid high dose:
1) Soft tissue atrophy2) Skin pigment disturbance
Trigger finger
A1
Painful nodule
Abrupt motion (Triggering)Usually painful
1) Under LA2) Pneumatic cuff3) Minimal dissection4) A2 pulley & NVB preserved5) Confirmed by Pt to flex digit6) Transverse incision: higher complication7) Index finger: radial side incised8) FPL: Transverse incision (preserve radial digital
nerve)
Congenital Trigger thumb
Notta node:Pathological thickening of FPL at MCPJ
Rx:1) Conservative: monitoring
up to 6 month of age.2) Spontaneous resolve
(some cases) 3) Surgical:
FPL tendon release through transverse incision at MCPJ
A1 pulley released No tendon size
reduction is attempted.
De Quervain tenosynovitis
1st Ext. compEPB
APL
There is a high degree of anatomical variation in the position of & no. of APL tendon, it is common to find separation of APL & EPB tendon by a septum.
Radial side pain
Finklestein test
Performed in steps:1. Ulnar deviation of the wrist2. Passive adduction of CMCJ3. Passive flexion of MCPJ 1
2
3
1st compartment surgical release
Intersection syndrome
ECRL
ECRB
1) Conservative: Modification of activities & avoiding heavy loading Steroid injection (into the involve sheath) Splinting (wrist in mild extension)
2) Surgical: Second dorsal compartment synovial sheath
decompression Postoperative splinting for 2 weeks (wrist in moderate
extension) & elevation
EPL tendonitis
3rd comp
Lister tubercle
Increased friction & tendonitis
ECU tendonitis
Ulnar sided wrist pain
Triangular fibrocartilage complex
ECU tendonitis
If conservative failed:Surgical Rx:1) Preserve volar
support2) ECU size reduction3) Rerouted through
fourth ext. compartment.
FCU tendonitis
Sharp curve over ridge of Trapezium
Trapezium ridge
Causes of pain in this site:1) Undetected scaphoid
fracture2) Basilar joint arthritis3) Ganglion cyst
Treatment:1) Conservative2) Surgical (synovial
sheath release)
Palmar cutaneous branch of median nerveRuns along flexor carpi radialis
Degenerative arthritis & bone spur formation ??
Lateral epichondylitis(Tennis elbow)
Burned out tendonitis
DxRx: often resolve with time.
1) Conservative: including elastic band at the border of the proximal and middle third of the muscle.
2) Surgical: weakening & tearing
of ECRB origin. ECRB origin &
periosteum excised (if replaced by granulation tissue as a result of chronic or recurrent inflammation).
ECRB
Power grip reduced
Lateral epichondylitis(Tennis elbow)
Radial nerve compression may coexist
Not limited to Tennis players
Surgical: 1) tearing & weakening of ECRB origin2) Excision: granulation tissue.
Medial epichondylitis
Pronator-flexor mass origin
DxRx:
1) Conservative2) Surgical:
weakening & tearing of PT-flexor mass origin.
Origin & periosteum excised (if replaced by granulation tissue as a result of chronic or recurrent inflammation).
Ulnar nerve protected.
Cubital tunnel syndrome
Coexist & differentiate from
Thank you