DOCSLIB.ORG

Top Hand, and Wrist Problems

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Top Hand, and Wrist Problems 12/10/2016 TOP HAND, AND WRIST Disclosures PROBLEMS: HOW TO • None SPOT THEM IN CLINIC Nicolas H. Lee, MS MD [email protected] UCSF Dept of Orthopaedic Surgery Assistant Clinical Professor Hand, Upper Extremity and Microvascular Surgery Dec. 10 th , 2016 Outline Outline • Carpal Tunnel Syndrome •Carpal Tunnel Syndrome • Trigger Finger • • Basal Joint arthritis Trigger Finger • Basal Joint arthritis • De Quervain tenosynovitis • De Quervain tenosynovitis • Mallet Finger • Mallet Finger • Ganglion cyst • Ganglion cyst 1 12/10/2016 Carpal Tunnel Syndrome • Compression of median nerve in carpal tunnel • Irritation of the nerve presents as numbness/pain 10 structures 9 flexor tendons Median nerve https://www.pinterest.com/pin/429812358163325007/ Anatomy (motor) Etiology 1. Idiopathic – most common 2. Anatomic – rare • Thenar Muscle (OAF) 3. Systemic – DM, hypothyroidism • Opponens Pollicis (deep) 4. **** Occupational Exposure • Abductor Pollicis Brevis (superficial) **** “A direct relationship between repetitive work • Flexor Pollicis Brevis activity (eg, keyboarding) and CTS has never been (superficial 1/2) objectively demonstrated.” 1 http://teachmeanatomy.info/upper-limb/muscles/hand/ 2 12/10/2016 Rare anatomic causes Carpal Tunnel Syndrome ● HPI – systemic risk factors Tenosynovitis CMC arthritis ◦ More common in: Ganglion Fracture 1) Diabetics 2) Hypothyroidism 3) Pregnancy (20-45%) Persistent Median artery Acromegaly Abnormal muscle Tumor Carpal Tunnel Syndrome ● CC: ◦ “I wake up at night and my hands are asleep” ◦ “I have to shake them to get the blood flowing again” ◦ “I have to run them under warm water and then I can go back to sleep” ◦ “Fingers go numb when I drive” ◦ “My hand goes numb when I use my cell phone” ◦ “I am always dropping things” Carpal Tunnel Syndrome Cranford, C.S. et al JAAOS Sept 2007; ◦ “Can’t button my shirt” v15 (9): 537-548 3 12/10/2016 Diagnosis Severe thenar atrophy • Thenar Muscles (APB) • Weakness • Atrophy http://nervesurgery.wustl.edu/ www.eatonhand.com Provocative Tests Diagnosis: Tinel ’s Sign ◦ Most Common ◦ Tinel’s (tapping) ◦ Phalen’s (flexion) ◦ Durkan’s (compression) ◦ Reverse Phalen’s 4 12/10/2016 Diagnosis: Phalen ’s Test Reverse Phalen’s test http://morphopedics.wikidot.com/carpal-tunnel-syndrome Carpal Tunnel Syndrome Durkan’s Carpal Compression ● Diagnosis is clinical! ● EMG/NCV 1. Confirmatory 2. Establish a baseline 3. Determine severity 4. r/o cervical radiculopathy 5. r/o peripheral neuropathy 5 12/10/2016 Treatment Stages • Nonoperative Mild Duration < 1 year • Surgical Intermittent numbness Normal sensory and motor EMG: mild CTS Moderate Continuous numbness, paresthesia Abnormal sensory testing EMG: moderate CTS Refer to Hand Severe Surgeon Persistent loss sensory+ motor function Thenar atrophy EMG: severe CTS Nonoperative Treatment Carpal Tunnel Syndrome Injections • Initial treatment for most cases Indication: mild to moderate disease Mainstay: Therapeutic: • Night splints (neutral) 75% of patients have symptom improvement @ 6 weeks • Corticosteroid injections 20% symptom free at 1 year Adjuvant: Diagnostic: Help isolate contribution of carpal tunnel to unclear clinical • NSAIDs presentation • Ergonomic modifications • Occupational therapy for nerve and tendon glides Prognostic • Iontophoresis (+) response: 87% surgical success • Ultrasound therapy (-) response: 54% surgical success 6 12/10/2016 Carpal Tunnel Syndrome Carpal Tunnel Syndrome • When to refer? • Injection Technique • Failure of non-operative treatment • Inject ulnar to palmaris longus or • Moderate to Severe CTS in-line with ring finger • Unclear diagnosis • Start at proximal wrist crease aiming 30-45 degrees distally • 25 or 27 gauge needle, 1 ½ in • 2 cc mix (10mg kenalog: 1 cc lido) Mini-Open Carpal Tunnel Release Surgery • Release transverse carpal ligament • Under local or regional (From Columbia University dept. of neurosurgery website) anesthesia Endoscopic Carpal Tunnel Release http://www.outpatientsurgery.net/ (http://wintman.podbean.com/) 7 12/10/2016 Outline Trigger Finger • Carpal Tunnel Syndrome • Medical Term: Stenosing tenosynovitis •Trigger Finger • Basal Joint arthritis http://quizlet.com/18888253/pd-ms- lecture-2-diseases-flash-cards/ • De Quervain tenosynovitis • 2 subtypes: • Mallet Finger 1. Nodular – localized swelling, “nodule” • Ganglion cyst * more responsive to NSAIDS/steroid injection * 93% success with injection (< 6 mos) 2. Diffuse * diabetics * 48% success with injection Trigger finger Trigger Finger • Physical Examination • Variable presentation • Tenderness at the level A1 pulley • Clicking +/- pain • Locking or clicking over the A1 pulley • Pain @ A1 pulley, no clicking • +/- nodule • Sensation of clicking at PIP joint • Pain radiating up to the forearm • Worse in the morning or night http://www.noelhenley.com/trigger-finger/ 8 12/10/2016 Primary Trigger Finger Pediatric trigger thumb • Most Common • Acquired, NOT congenital! • “Idiopathic ” • Often present with fixed flexion contracture Secondary • Recommendation: 1. Good results with release after • Associated with known disease age 1 (> 90% success) • Disease cause thickening in tendon/pulley 2. May elect to observe b/c 60% • Diabetes Spontaneously resolve within 4 • Rheumatoid arthritis years • Amyloidosis • Sarcoidosis Pediatric Trigger Finger Treatment Options (Adult) NOT the same as adult trigger finger • Nonoperative Ring Splint Always refer to hand surgeon • Observation, activity modification Anatomic anomalies frequently found • NSAIDs • Trigger finger ring/splint Treatment: A1 pulley release and resection of FDS slip • Corticosteroid injection • Operative release • Percutaneous https://www.ncmedical.com/item_1751.html • open **** Studies show steroid injection alone is more effective than splints 9 12/10/2016 Steroid Injection Injection • 70% can resolve after a single • Combination local injection anesthetic and steroid • 57% (level 1 and 2 studies) • Lower success rate • younger patients • Around the tendon in • Diffuse type area of A1 pulley • diabetics • multiple fingers • other upper extremity tendinopathies • No difference in success if injected inside or outside of • Most effective if symptoms less than 6 mos and nodular the sheath! type Risks of injection Injection in Diabetics • Infection • Fat atrophy • Bleaching of skin • Increase blood glucose • Tendon Rupture • Greatest effect 24 hours after • Hyperglycemia in diabetics injection (150% baseline) • Effect lasts up to 5 days 10 12/10/2016 Surgery Percutaneous release • Failure of non-surgical treatment • May be a first line treatment in diabetics • Locked finger http://www.amhandinst.com/triggerfinger.html Open release Trigger Finger • When to refer? • Failure of at least one injection • Locked trigger finger • Unclear diagnosis 11 12/10/2016 Outline Basal Joint = Thumb CMC joint • Carpal Tunnel Syndrome • Trigger Finger •Basal Joint arthritis • De Quervain tenosynovitis • Mallet Finger • Ganglion cyst http://www.noelhenley.com/280/joints-of-the-thumb/ Anatomy History • Do you have difficulty: • pinching, writing • opening a tight jar • Opening doors, keys • carrying a shopping bag • using a knife to cut food 12 12/10/2016 Clinical Exam Nonoperative management • Physical appearance • Tenderness • Specific Tests • Custom made • Grind thermoplastic splint • Off the shelf splint • Activity modification education • Symptom management Van Heest, JAAOS 2008 Thumb CMC OA Thumb CMC OA Injection • Injection into the CMC joint is often painful, especially in more advanced disease • Injection • Distract the joint • Mark the site of injection • Prepare the site of injection • Advance needle to bone and inject small amount http://www.aafp.org/afp/20030215/745.html • Once anesthetized, advance needle into the joint and inject Courtesy of Peter M. Murray, MD 13 12/10/2016 Treatment: Surgical Thumb CMC OA • Later stages • When to refer? • CMC arthrodesis • Failure of non-operative treatment • Unclear diagnosis • Resection arthroplasty • LRTI Outline DeQuervain ’s Tenosynovitis • Carpal Tunnel Syndrome • Trigger Finger • Tendonitis 1 st • Basal Joint arthritis dorsal •De Quervain tenosynovitis compartment • APL: Abductor • Mallet Finger pollicis longus • Ganglion cyst • EPB: Extensor pollicis brevis http://www.orthobullets.com/hand/6006/extensor-tendon-compartments 14 12/10/2016 Anatomy Surface Anatomy APL/EPB Hand Surgery Update IV, Chapter 22, Figure 4a Sheath enclosing APL/EPB becomes narrowed leading to pain and inflammation Symptoms Examination • More common in women (6:1 ratio) • Tenderness over • New mothers tendons at thumb • Pain at the radial wrist/base of thumb side of wrist • May have ‘clunking ’ of the thumb • Pain with thumb motion • Finkelstein’s test • Thumb in fist • Ulnarly deviate 15 12/10/2016 Treatment Dequervain’s tenosynovitis • Conservative • Surgical • Pre-fabricated or custom thumb spica splint • Ice • Activity modification • Patient education DeQuervain ’s Tendonitis De Quervain ’s Tendonitis • Non-operative treatment Success Rates 4: • Injection Technique • NSAIDs alone: 0% • Splinting: 14% • 2cc 1:1 mix of 1% • Injection + splint: 61% lidocaine and water • Injection alone: 83%!!! soluble steroid • Inject inside sheath in line • Injection with tendons and not www.assh.org • Up to 83% success rate, but may require 2 injections subQ • Failure: 1) Poor technique • Should see the http://www.aafp.org/afp/20030215/745.html 2) EPB subsheath compartment fill up • Risk of skin hypopigmentation • Generally limit injection to
Load more

Recommended publications
  • The Nearly Invisible Intraneural Cyst: a New and Emerging Part of the Spectrum
    NEUROSURGICAL FOCUS Neurosurg Focus 42 (3):E10, 2017 The nearly invisible intraneural cyst: a new and emerging part of the spectrum Thomas J. Wilson, MD,1 Marie-Noëlle Hébert-Blouin, MD,2 Naveen S. Murthy, MD,3 Joaquín J. García, MD,4 Kimberly K. Amrami, MD,3 and Robert J. Spinner, MD1 Departments of 1Neurosurgery, 3Radiology, and 4Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and 2Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada OBJECTIVE The authors have observed that a subset of patients referred for evaluation of peroneal neuropathy with “negative” findings on MRI of the knee have subtle evidence of a peroneal intraneural ganglion cyst on subsequent closer inspection. The objective of this study was to introduce the nearly invisible peroneal intraneural ganglion cyst and provide illustrative cases. The authors further wanted to identify clues to the presence of a nearly invisible cyst. METHODS Illustrative cases demonstrating nearly invisible peroneal intraneural ganglion cysts were retrospectively reviewed and are presented. Case history and physical examination, imaging, and intraoperative findings were reviewed for each case. The outcomes of interest were the size and configuration of peroneal intraneural ganglion cysts over time, relative to various interventions that were performed, and in relation to physical examination and electrodiagnostic find- ings. RESULTS The authors present a series of cases that highlight the dynamic nature of peroneal intraneural ganglion cysts and introduce the nearly invisible cyst as a new and emerging part of the spectrum. The cases demonstrate changes in size and morphology over time of both the intraneural and extraneural compartments of these cysts.
    [Show full text]
  • Multiple Pulley Rupture Following Corticosteroid Injection for Trigger Digit: Case Report
    SCIENTIFIC ARTICLE Multiple Pulley Rupture Following Corticosteroid Injection for Trigger Digit: Case Report Cassie Gyuricza, MD, Eva Umoh, BA, Scott W. Wolfe, MD We report a case of pulley rupture following repeated local corticosteroid injections for trigger digit. The treatment involved exploration, tenolysis, and reconstruction using the palmaris longus tendon. (J Hand Surg 2009;34A:1444–1448. © 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.) Key words Corticosteroid, pulley rupture, trigger digit. RIGGER DIGIT, OR stenosing tenosynovitis,isa local corticosteroid injection through a lateral approach condition characterized by painful locking or at the proximal phalanx10 (0.5 mL local anesthetic and Tsnapping of a digit caused by mechanical im- 0.5 mL triamcinolone acetonide 40 mg/mL [Kenalog- pingement of the flexor tendon passing through a hy- 40, Bristol-Meyers Squibb Co, Princeton, NJ]). Her pertrophic A1 pulley. Initial conservative management symptoms of pain temporarily improved, but 4 months of trigger digits with various corticosteroid preparations later, the patient returned with recurrent pain and a is well described.1–4 Side effects, including subcutane- second local corticosteroid injection was administered, ous fat atrophy, pain, depigmentation of the skin, and again using the lateral approach. During the ensuing 8 transient elevation of urine and blood glucose levels in months, the patient had persistent pain and tenderness patients with diabetes, are generally mild and self- over the A2 pulley. The patient also developed pain at limiting.5,6 We are aware of 2 previously reported cases the A1 pulley, and a third injection (0.5 mL local of delayed flexor tendon rupture following corticoste- anesthetic and 0.5 mL triamcinolone acetonide 40 mg/ 7,8 roid injections for trigger digit thought to be the result mL) was given into the palmar surface overlying the A1 of intratendinous injection.
    [Show full text]
  • Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)
    Local Coverage Article: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana Created on 09/28/2019. Page 1 of 33 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Islands Article Information General Information Original Effective Date 10/01/2019 Article ID Revision Effective Date A57079 N/A Article Title Revision Ending Date Billing and Coding: Injections - Tendon, Ligament, N/A Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Retirement Date N/A Article Type Billing and Coding AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2018 American Medical Association.
    [Show full text]
  • Cytomorphological Study of Articular and Periarticular Cystic Lesions Dr.Sneha Saini, Dr.Madhu Sinha , Dr
    International J. of Healthcare and Biomedical Research, Volume: 06, Issue: 04, July 2018, 23- 36 Original article: Cytomorphological study of articular and periarticular cystic lesions Dr.Sneha Saini, Dr.Madhu Sinha , Dr. Natasha S. Gulati , Dr. Abhijit Das, Dr. Man Mohan Mehndiratta 1. Dr.Sneha Saini- Senior Resident, Janakpuri Superspeciality Hospital (JSSH) 2. Dr.Madhu Sinha- Specialist(Pathology), Janakpuri Superspeciality Hospital (JSSH) 3. Dr. Natasha S. Gulati- Specialist(Cytology), Janakpuri Superspeciality Hospital (JSSH) 4. Dr. Abhijit Das- Assistant Professor, Janakpuri Superspeciality Hospital (JSSH) 5. Dr. Man Mohan Mehndiratta, Director, Janakpuri Superspeciality Hospital (JSSH) Corresponding Author: Dr.Sneha Saini , Senior Resident, Janakpuri Superspeciality Hospital (JSSH) ABSTRACT: AIMS AND OBJECTIVES:- To study cytomorphology of articular and periarticular cystic lesions and to assess the efficacy of fine needle aspiration cytology (FNAC) in diagnosis and management of articular and periarticular cystic lesions. MATERIAL AND METHODS:- Our study was a retrospective study done over a period of 2 years from Jan 2015 to Jan 2017 in Cytology section of Pathology department of our hospital. Sixteen cases including ganglion cysts, synovial cysts and popliteal cysts from different articular and periarticular sites were studied. RESULTS:- In our study out of 16 cases, there were 10 (62.5%) cases of ganglion cysts, 3 (18.7%) cases of synovial cysts and 3 (18.7%) cases of popliteal cysts. The male to female ratio (M: F) for these lesions was 1:1.6 and were predominantly found in third decade (21-30 years). CONCLUSION:- FNAC offers a great diagnostic utility in articular and periarticular cystic lesions being an OPD procedure having low cost.
    [Show full text]
  • Your Guide to Trigger Finger Surgery Brian J
    Your Guide to Trigger Finger Surgery Brian J. Bear, MD OrthoIllinois Hand, Wrist, and Elbow Center of Excellence Care Team and Contact Numbers: Brian J. Bear, MD Main Phone line . 815-398-9491 OrthoIllinois Kailey - Lead Nurse . .815-398-9491 324 Roxbury Road Ronda - Surgery Scheduler . 815-484-6969 Rockford, IL Sadie - Office Scheduler . .815-484-6996 TABLE OF CONTENTS Learn about Dr. Bear . 2 What is Trigger Finger/Trigger Thumb?. 3 Surgical Treatment v Description of Trigger Finger Release . 3 The Surgical Experience v Information to Keep in Mind Prior to Surgery . 4 v Pre-Admission Guide for Surgery . 5 v Pre-operative Phase . 6 v Intra-operative Phase . 7 v Post-operative Phase . 8 After Surgery v While You Recover at Home . 9 Commonly Asked Questions . 10-11 What Can I Do After Surgery? . 13 1 Learn More About Dr. Bear I would like to take this opportunity to tell you more about myself and my experience in health care. Originally from Winnetka, Illinois, I attended Northwestern University graduating in 1987, cum laude, president of Mortar Board Senior Honor Society and a member of Phi Betta Kappa. I continued my studies at Northwestern University School of Medicine, receiving my medical degree in 1991 as a member of Alpha Omega Alpha honor society. Following my graduation, I pursued advanced orthopedic training at Cornell Hospital for Special Surgery, which is ranked as the top orthopedic hospital in the United States. In addition, I completed a specialized training fellowship program in elbow and hand surgery at the Mayo Clinic. My practice is focused on shoulder, elbow, hand, microvascular, traumatic, and reconstructive surgery.
    [Show full text]
  • Intraosseous Ganglion Cyst of the Humeral Head in a Competitive Flat Water Paddler: Case Report
    0008-3194/2011/294–301/$2.00/©JCCA 2011 Intraosseous ganglion cyst of the humeral head in a competitive flat water paddler: case report Brad Muir, HBSc (Kin), DC, FRCCSS(C)* Jaclyn A. Kissel, BSc, DC, FRCCSS(C) Dominique Forand Yedon, BScKin, DC, FRCCSS(C) Objective: To present the diagnostic and clinical features Objectif : soumettre un diagnostic et les caractéristiques of an intraosseous ganglion cyst of the humeral head of cliniques d’un kyste ganglionnaire intraosseux de la a female flat water canoe athlete. tête humérale d’une athlète pratiquant le canoë en eau Clinical Features: An 18-year old female flat water plate. canoeist complaining of right shoulder pain following a Caractéristiques cliniques : une canoéiste en eau plate strenuous paddling training camp. de 18 ans se plaint de douleurs à l’épaule droite suite à Intervention and outcome: A trial of passive care un camp d’entraînement très exigeant. was conducted, including soft tissue therapy, spinal Intervention et résultat : un essai de soins passifs manipulative therapy, acupuncture, and rehabilitation. fut mené, notamment la thérapie des parties molles, The patient seemed to be responding with treatment, but la manipulation rachidienne, l’acupuncture et la pain would always resume with paddling. A diagnostic réhabilitation. La patiente semble avoir bien réagi ultrasound displayed mild thickening and effusion in the au traitement, mais la douleur revient lorsqu’elle subacromial/subdeltoid bursae. Continued passive care recommence à ramer. Un ultrason diagnostic démontra was not able to resolve the symptoms and she underwent un épaississement léger et une effusion dans les an MRI which revealed an intraosseus ganglion cyst bourses sous-acromiales/des courts rotateurs de subjacent to the lesser tuberosity and floor of the l’épaule.
    [Show full text]
  • Trigger Finger
    PATIENT EDUCATION Trigger Finger Trigger Finger "Trigger finger" sounds like a malady that might affect gunslingers or hunters. In fact, this common condition results in a finger bent as if to pull a trigger. People over 40 years of age with a history of diabetes or rheumatoid arthritis are especially at risk to develop this condition. How it develops Although the exact cause of trigger finger is unknown, the progression of the condition is well documented. Trigger finger involves the tendons and pulleys in the hand that bend the finger. The tendons connect the muscles of the forearm with the bones of the fingers. Each tendon is covered by a slick lining or sheath. When you bend your fingers, the tendons glide back and forth, guided by a restraining pulley or yoke. When the tendon sheath becomes inflamed, it swells and may develop a knot or thickening in the tendon. The knot passes through the pulley as the finger bends, but gets stuck as the finger straightens. This causes further irritation and results in a vicious circle of irritation, swelling, catching and more irritation until finally, the finger locks in a bent position. Diagnosis No X­rays are needed to diagnose trigger finger. Your doctor will examine your hand and fingers, and use the findings to make the diagnosis. The finger may be swollen and there may be a bump, or nodule, over the joint in the palm of the hand. The finger may be stiff and painful. Although it may seem that the problem is in the knuckles, it is actually at the joint nearest the palm of the hand.
    [Show full text]
  • Common Hand, Wrist and Elbow Problems
    12/15/2018 COMMON HAND, WRIST Disclosures AND ELBOW PROBLEMS: Research Support: HOW TO SPOT THEM IN San Francisco DPH CLINIC Standard Cyborg Nicolas H. Lee, MD UCSF Dept of Orthopaedic Surgery Assistant Clinical Professor Hand, Upper Extremity and Microvascular Surgery Dec. 15th, 2018 DIP joint pathologies Mucous Cyst – ganglion cyst of DIP joint 1. Mucous Cyst 2. Mallet Finger 3. Jersey Finger 1 12/15/2018 Xray Treatment “Jammed Finger” Mallet Finger • Recurrence rate with aspiration/needling? 40-70% • Recurrence rate with surgical debridement of osteophyte? Jersey Finger 0-3% • Do nail deformities resolve with surgery? Yes - 75% 2 12/15/2018 Mallet Finger Mallet finger Soft Tissue Mallet • 6 weeks DIP immobilization in extension • Night time splinting for 4 weeks Bony Mallet http://www.specialisedhandtherapy.com.au/ Red Flag Mallet Finger Red Flag Jersey Finger When to Refer: Flexor Digitorum Profundus (FDP) 1. Big fragment strength testing 2. Volar subluxation of the distal phalanx http://nervesurgery.wustl.edu/ http://www.orthobullets.com REFER ALL JERSEY FINGERS ASAP!!! 3 12/15/2018 Trigger Finger and Thumb Trigger finger • Presentation • Clicking or frank locking • Especially at night or morning • May also present with just pain at the A1 pulley Trigger Finger Primary Trigger Finger • Physical Examination • Most Common • Locking or clicking over the A1 pulley • “Idiopathic” • Tenderness at the A1 pulley • No known cause 4 12/15/2018 Secondary “Congenital” • Associated with known disease • Infantile form • Disease cause thickening in tendon/pulley • “congenital” is a misnomer • Diabetes • Rheumatoid arthritis • Amyloidosis • Sarcoidosis Treatment Options Trigger finger Splinting •Nonoperative • Splint to prevent MCP or •Observation PIP flexion.
    [Show full text]
  • CONSTRUCTION WORK and CUMULATIVE TRAUMA DISORDERS What Are Cumulative Trauma Disorders?
    Connecticut Department of Public Health Environmental and Occupational Health Assessment Program 410 Capitol Avenue MS # 11OSP, PO Box 340308 Hartford, CT 06134-0308 (860) 509-7740 http://www.ct.gov/dph CONSTRUCTION WORK and CUMULATIVE TRAUMA DISORDERS What are Cumulative Trauma Disorders? Cumulative trauma disorders (CTDs) also known as repetitive strain injuries, repetitive motion disorders, overuse syndrome, and work-related musculoskeletal disorders are the largest cause of occupational disease in the United States and the most frequently reported type of occupational disease in Connecticut. CTDs are injuries of the musculoskeletal system (joints, muscles, tendons, ligaments, nerves, and blood vessels) which are caused by over use as a result of stressful work over a period of time. CTDs are usually caused by a combination of the following risk factors common to construction work: • repetitive motions • forceful exertions - pulling, pushing, lifting, and gripping • awkward postures - body positions that are not the natural resting position • static postures - body positions held without moving • mechanical compression of soft tissues in the hand against edges or ridges, such as using tools or objects which press against the palm • fast movement of body parts • vibration, especially in the presence of cold conditions • lack of sufficient recovery time (rest breaks, days off), which will increase the risk of developing a CTD by any of the above factors. Cumulative trauma disorders most often occur in the upper body. Common symptoms of CTDs include pain and swelling of the body parts that are performing work duties involving the above risk factors. Although back injuries are excluded from the definition of CTDs, back injuries are often caused by similar risk factors and occur quite frequently in construction workers.
    [Show full text]
  • De Quervain's Release Standard of Care PT
    BRIGHAM & WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: de Quervain’s Syndrome: Surgical Management Physical Therapy management of the patient who had a release of the first extensor compartment. Case Type/Diagnosis: (diagnosis specific, impairment/dysfunction specific) 11 Since the first description of “washerwoman’s sprain” tenosynovitis of the first dorsal compartment has become a commonly recognized inflammatory disorder. The most radial of the extensor compartments on the dorsum of the wrist is occupied by the tendons of the extensor pollicis brevis and abductor pollicis longus. The tendons are enveloped in an osseofibrous canal lined by synovium, which, when subjected to excessive or repetitive mechanical stresses, responds in a characteristic fashion distinguished by pain, swelling, and limitation of motion of the thumb. In 1895,Fritz de Quervain, a Swiss surgeon, 1 was first credited with the recognition of this disease and so it bore his name. More accurately, Tillaux 2 and Gray 3 referred to this disorder before de Quervain. Anatomy: Twenty-four extrinsic tendons cross the wrist and provide power and dexterity in the hand. Each tendon passes through a series of tight fibrous -osseous canals designed to optimize the balance between motion and force production by maintaining the tendon in close approximation to the joint or joints it controls. There are six separate compartments under the dorsal carpal ligament each lined with a separate synovial sheath membrane. The first one is over the radial styloid and it contains the abductor pollicis longus and the extensor pollicis brevis tendons. These tendons pass through an unyielding osteoligamentous tunnel formed by a shallow groove in the radial styloid process and a tough overlying roof composed by the transverse fibers of the dorsal ligament.
    [Show full text]
  • Common Masses of the Wrist, Hand & Fingers
    Common Masses of the Wrist, Hand & Fingers Pyogenic Granuloma Dupuytren’s Disease Giant Cell Tumor of the Tendon Sheath Pyogenic Granuloma is a red, fleshy, benign upuytren’s Disease is an abnormal thickening of the tissue between the skin and the tendons in the palm iant Cell ,Tumors of the tendon sheath are A skin growth that is typically small but may Dof the hand. Hard knots may form under the skin and in some cases these can become cords that pass Gbenign soft tissue tumors. They are the grow to ½ inch or larger. It may occur in the hand, into the fingers. This may cause pain and may eventually pull the fingers down into the palm – this is known second most common tumor in the hand. fingers, or around the nail bed. They most as Dupuytren’s Contracture. The condition can hinder hand function if left untreated. Occasionally the disease commonly occur after some type of trauma, but can also cause thickening over the top of the knuckles. Symptoms the exact cause is unknown. They consist of a • Firm, non-tender mass typically found on the localized infection with formation of blood vessels. palmar surface of the fingers or hand Symptoms • Most commonly found on the index, middle, Symptoms • A lump, scar-like band, or pit in the palm of the hand, most often seen at the base of the ring finger and ring fingers • Fleshy red vascular mass arising from an • Pain in the affected area of the hand and inability to place the palm flat on a surface • Slow growing and may be present for long area of trauma/infection • Fingers pulling down towards the palm time before becoming symptomatic.
    [Show full text]
  • Intra-Tendinous Patellar Ganglion Cyst Maybe the Unusual Cause of Knee Pain: a Case Report
    Open Access Case Report DOI: 10.7759/cureus.5467 Intra-tendinous Patellar Ganglion Cyst Maybe the Unusual Cause of Knee Pain: A Case Report Mantu Jain 1 , Nabin K. Sahu 1 , Sudarsan Behera 1 , Rajesh Rana 1 , Saroj K. Patra 2 1. Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND 2. Trauma & Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND Corresponding author: Sudarsan Behera, [email protected] Disclosures can be found in Additional Information at the end of the article Abstract Cystic lesion around knee usually presents as painless swelling and diagnosed incidentally by imaging for any internal derangement of the knee. Few cases presented with pain. Intra- tendinous patellar ganglion is very rare in location for the disease. Ganglionic cyst usually treated by aspiration followed by steroid and surgical excision in some cases. We reported a case with anterior knee pain due to patellar intra-tendinous ganglion cyst which treated conservatively with no recurrence even after one year. Categories: Radiology, Orthopedics, Anatomy Keywords: ganglion cyst, patellar intra-tendinous sheath, knee pain Introduction A ganglion is a benign cystic mass containing clear high-viscosity mucinous fluid with a dense fibrous connective tissue capsule lined by flat spindle-shaped cells that is rich in hyaluronic acid and other mucopolysaccharides [1, 2]. Ganglia usually arises from periarticular locations with a variable for predilection intra-articular, extra-articular soft tissue, intraosseous and rarely from periosteal locations [1,3,4]. Majority of the patients are asymptomatic and diagnosed incidentally on imaging. Clinical presentation depends on the location and size of the ganglion.
    [Show full text]