degenerative tendon disease of the elbow & hand
DESCRIPTION
Degenerative Tendon Disease of The Elbow & Hand. Presenter : Demy Faheem Dasril Moderator : dr. Syaiful Anwar Hadi , SpOT (K). Degenerative Tendon Disease. Introduction Usually in weight-bearing joint More frequent in upper limb . Pathogenesis. - PowerPoint PPT PresentationTRANSCRIPT
Degenerative Tendon Disease of The Elbow & Hand
Degenerative Tendon Disease of The Elbow & HandPresenter: Demy Faheem DasrilModerator: dr. Syaiful Anwar Hadi, SpOT (K)Degenerative Tendon DiseaseIntroductionUsually in weight-bearing jointMore frequent in upper limb
PathogenesisLocal necrosis extending into a tendon / joint capsule
Local necrosis calcified (dystrophic calcification)
Inflammation
Degeneration
Weaken structure
Pathological tearBicipital Tendinitis and TenosynovitisDegenerative changes in the tendon of the long head of the biceps muscle chronic inflammation of synovial sheath within the bicipital groove
Anterior pain aggravated by active supination Yergason sign (+)TreatmentLocal rest arm slingAnalgeticSurgical : tendon is divided bicipital grooveRupture of The Biceps TendonTypes:Proximal : more commonDistal : less common
Proximal TypePre-existing degenerative changesWeaken structureContraction : Active flexion RuptureSign & symptoms:Immediate painGo away sensationDistal Type
Less common
Weakness of supination & flexion
Ball more proximal proximal type
Surgical repair is indicatedDegenerative Tendon Disease of The ElbowTennis ElbowGolfers Elbow Tennis ElbowLateral epicondylitis due to pathology in ECR tendonPathogenesis is unclear : flexion + extension of elbow backhand movementPremature degeneration : origin of the forearm extensor muscle humerus lateral epicondyle
Clinical ExaminationPain : grasping, dorsiflexion extensor muscle
Pain over the lateral aspect of the elbow
Radiating pain to distal
Cozen sign (+)
TreatmentLocal rest spontaneous resolution within 6-12 weeksLocal heatPhysiotherapyNSAIDSteroid injectionSurgery abn origin of ECRB is excised
Golfers Elbow Medial epicondylitisLess commonPain : grasping, elbow flexion flexor musclePain over the medial aspect of the elbow on resisted elbow flexion
TreatmentLocal restLocal heatPhysiotherapyNSAIDSteroid injection
Degenerative Tendon Disease in The Wrist & HandDe Quervains Tenovaginitis StenosanDigital Tenovaginitis Stenosan (Trigger Finger)Dupuytrens ContractureDe Quervains Tenovaginitis StenosanInfluenced common fibrous sheath : APL and EPB tendonRepeated forced and movement : typing, grippingThickening constriction
Women >> menWrist pain radiates : proximal and distallyExacerbated by ulnar deviationLocal tenderness : radial styloidFinkelstein test (+)
TreatmentSteroid injectionImmobilisation of the thumb : splintSurgical : division of the inflammed and stenotic tendon sheath
Digital Tenovaginitis Stenosan (Trigger Finger)Flexor tendon (deep and superficial) enclosed by common tendon sheathIf thickening : stenosis disturbed gliding movementTendon become large proximally repeated movement
Finger can be flexed actively and extended passivelySnapping phenomenonNodular enlargement in the flexor tendonTreatmentImmobilization in extensionSteroid injectionSurgical : division of fibrous sheath
Dupuytrens ContractureProgressive fibrous tissue contracture of the palmar fascia ulnar sideAffects the MCPJ and PIPJMen > 50 years oldFrequently bilateral
TreatmentSurgical : excision of all abnormal palmar fasciaPost operative : early mobilization
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