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Degenerative Tendon Disease of The Elbow & Hand

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.

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Degenerative Tendon Disease of The Elbow & Hand

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  1. Degenerative Tendon Disease of The Elbow & Hand Presenter: Demy Faheem Dasril Moderator: dr.Syaiful Anwar Hadi, SpOT (K)

  2. Degenerative Tendon Disease Introduction • Usually in weight-bearing joint • More frequent in upper limb

  3. Pathogenesis Local necrosis extending into a tendon / joint capsule Local necrosis calcified (dystrophic calcification) Inflammation Degeneration Weaken structure Pathological tear

  4. Bicipital Tendinitis and Tenosynovitis • Degenerative 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 (+)

  5. Treatment • Local rest arm sling • Analgetic • Surgical :tendon is divided bicipitalgroove

  6. Rupture of The Biceps Tendon • Types: • Proximal : more common • Distal: less common

  7. Proximal Type • Pre-existing degenerative changes • Weaken structure • Contraction:Active flexion Rupture • Sign & symptoms: • Immediate pain • ‘Go away’ sensation

  8. Distal Type • Less common • Weakness of supination & flexion • ‘Ball’ more proximal proximal type • Surgical repair is indicated

  9. Degenerative Tendon Disease of The Elbow • Tennis Elbow • Golfer’s Elbow

  10. Tennis Elbow • Lateral epicondylitis due to pathology in ECR tendon • Pathogenesis is unclear:flexion +extension of elbowbackhand movement • Premature degeneration:origin of the forearm extensor muscle  humerus lateral epicondyle

  11. Clinical Examination • Pain :grasping, dorsiflexion extensor muscle • Pain over the lateral aspect of the elbow • Radiating pain to distal • Cozen sign (+)

  12. Treatment • Local rest spontaneous resolution within 6-12 weeks • Local heat • Physiotherapy • NSAID • Steroid injection • Surgery  abn origin of ECRB is excised

  13. Golfer’s Elbow • Medial epicondylitis • Less common • Pain : grasping, elbow flexion  flexor muscle • Pain over the medial aspect of the elbow on resisted elbow flexion

  14. Treatment • Local rest • Local heat • Physiotherapy • NSAID • Steroid injection

  15. Degenerative Tendon Disease in The Wrist & Hand • De Quervain’sTenovaginitisStenosan • Digital TenovaginitisStenosan (Trigger Finger) • Dupuytren’s Contracture

  16. De Quervain’sTenovaginitisStenosan • Influenced common fibrous sheath: APL and EPB tendon • Repeated forced and movement : typing, gripping • Thickeningconstriction

  17. Women >> men • Wrist painradiates:proximal and distally • Exacerbated by ulnar deviation • Local tenderness:radial styloid • Finkelstein test (+)

  18. Treatment • Steroid injection • Immobilisation of the thumb:splint • Surgical: division of the inflammed and stenotic tendon sheath

  19. Digital TenovaginitisStenosan (Trigger Finger) • Flexor tendon (deep and superficial) enclosed by common tendon sheath • If thickening:stenosis  disturbed gliding movement • Tendon become large proximallyrepeated movement

  20. Finger can be flexed actively and extended passively • ‘Snapping phenomenon’ • Nodular enlargement in the flexor tendon

  21. Treatment • Immobilization in extension • Steroid injection • Surgical: division of fibrous sheath

  22. Dupuytren’s Contracture • Progressive fibrous tissue contracture of the palmar fasciaulnar side • Affects the MCPJ and PIPJ • Men >50 years old • Frequently bilateral

  23. Treatment • Surgical:excision of all abnormal palmar fascia • Post operative:early mobilization

  24. Thank You

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