tenosynovitis ppt
DESCRIPTION
A power-point presentation of Tenosynovitis of the hand tendons, by Dr. Diyar Abdulwahid Salih, a plastic surgery resident, Sulaimani, Kurdistan.TRANSCRIPT
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Tenosynovitis
Dr. Diyar A. SalihPlastic surgery resident
June, 2010 Kurdistan, Sulaimani
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Tendonitis: Tendon
Tenosynovitis: Tendon + Synovium
1) Mesenchymal syndrome: multiple area of inflammation & tenosynovitis
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Features
SleepSize discrepancy
Repetitive motion
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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.
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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
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Trigger finger
A1
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Painful nodule
Abrupt motion (Triggering)Usually painful
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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)
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Congenital Trigger thumb
Notta node:Pathological thickening of FPL at MCPJ
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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.
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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.
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Radial side pain
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Finklestein test
Performed in steps:1. Ulnar deviation of the wrist2. Passive adduction of CMCJ3. Passive flexion of MCPJ 1
2
3
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1st compartment surgical release
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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
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EPL tendonitis
3rd comp
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Lister tubercle
Increased friction & tendonitis
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ECU tendonitis
Ulnar sided wrist pain
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Triangular fibrocartilage complex
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ECU tendonitis
If conservative failed:Surgical Rx:1) Preserve volar
support2) ECU size reduction3) Rerouted through
fourth ext. compartment.
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FCU tendonitis
Sharp curve over ridge of Trapezium
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Trapezium ridge
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Causes of pain in this site:1) Undetected scaphoid
fracture2) Basilar joint arthritis3) Ganglion cyst
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Treatment:1) Conservative2) Surgical (synovial
sheath release)
Palmar cutaneous branch of median nerveRuns along flexor carpi radialis
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Degenerative arthritis & bone spur formation ??
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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
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Lateral epichondylitis(Tennis elbow)
Radial nerve compression may coexist
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Not limited to Tennis players
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Surgical: 1) tearing & weakening of ECRB origin2) Excision: granulation tissue.
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Medial epichondylitis
Pronator-flexor mass origin
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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
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Thank you