cumulative trauma disorders l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Cumulative Trauma Disorders PowerPoint Presentation
Download Presentation
Cumulative Trauma Disorders

Loading in 2 Seconds...

play fullscreen
1 / 46

Cumulative Trauma Disorders - PowerPoint PPT Presentation


  • 433 Views
  • Uploaded on

Cumulative Trauma Disorders. CUMULATIVE TRAUMA DISORDERS. CLINICAL EXAMPLES: UPPER EXTREMITY. CUMULATIVE TRAUMA DISORDERS. Carpal tunnel syndrome Dequervain’s tenosynovitis Tennis elbow Impingement syndrome shoulder. CARPAL TUNNEL SYNDROME. DEFINITION DIAGNOSIS INVESTIGATIONS

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Cumulative Trauma Disorders' - reuel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
cumulative trauma disorders2

CUMULATIVE TRAUMA DISORDERS

CLINICAL EXAMPLES:

UPPER EXTREMITY

MUN ORTHOPEDICS

cumulative trauma disorders3
CUMULATIVE TRAUMA DISORDERS
  • Carpal tunnel syndrome
  • Dequervain’s tenosynovitis
  • Tennis elbow
  • Impingement syndrome shoulder

MUN ORTHOPEDICS

carpal tunnel syndrome
CARPAL TUNNEL SYNDROME
  • DEFINITION
  • DIAGNOSIS
  • INVESTIGATIONS
  • TREATMENT
  • CONTROVERSY

MUN ORTHOPEDICS

carpal tunnel syndrome5
Carpal Tunnel Syndrome
  • Definition
    • Compression neuropathy of the median nerve at the wrist
    • Most common diagnosis for WCC claims in the U.S.
    • In France CTS is not an allowable diagnosis

MUN ORTHOPEDICS

carpal tunnel
CARPAL TUNNEL

Palmar aponeurosis

Median nerve

MUN ORTHOPEDICS

carpal tunnel syndrome7
Carpal Tunnel Syndrome
  • Pain and Paresthesias on palmar-radial aspect of hand
  • Often worse at night
  • Risk factors
    • Intrinsic
    • extrinsic

MUN ORTHOPEDICS

carpal tunnel syndrome8
Carpal tunnel syndrome

MUN ORTHOPEDICS

carpal tunnel syndrome9
Carpal Tunnel Syndrome
  • Intrinsic risk factors
    • Anatomic variants
      • Either decreased dimension of carpal tunnel or increased volume of its contents
    • Physiologic variants
      • Diabetes , alcoholism , smoking , pregnancy , rheumatoid arthritis , myxedema
      • All associated with edema

MUN ORTHOPEDICS

carpal tunnel syndrome10
Carpal Tunnel Syndrome
  • Extrinsic factors
    • Hand position
    • Forceful use of hand
    • Repetitive motion
    • Vibration

MUN ORTHOPEDICS

carpal tunnel syndrome11
Carpal Tunnel Syndrome
  • MRI has shown that wrist flexion compresses the median nerve between flexor retinaculum and tendons
  • Minimizing wrist flexion/extension by redesign of tools helps reduce CTS

MUN ORTHOPEDICS

carpal tunnel syndrome12
Carpal Tunnel Syndrome
  • Forceful use of hand has not been well established as a risk factor in epidemiologic studies
  • Repetitive motion is a risk factor for hand pain BUT not specifically for CTS
  • No correlation between hours of keyboard work and CTS

MUN ORTHOPEDICS

carpal tunnel syndrome and vibration
Carpal Tunnel Syndromeand Vibration
  • Hand-arm vibration syndrome
    • Raynaud’s , sensory changes & sclerodactyly
    • Digital nerves mainly
    • Often misdiagnosed as CTS
  • Definite dose-response relationship
    • >50% incidence with >8000 hrs.
  • Carpal tunnel release does not help

MUN ORTHOPEDICS

carpal tunnel syndrome role of work
Carpal Tunnel SyndromeRole of Work
  • Difficult to extrapolate epidemiologic studies to individuals
  • Epidemiologic studies have major flaws
    • Nonrigorous diagnosis
    • Time relationship to starting job
    • Background exposure (79% of time is not at work)
    • Intrinsic risk factors not measured

MUN ORTHOPEDICS

carpal tunnel syndrome16
Carpal Tunnel Syndrome
  • Electrodiagnostic tests
    • Commonly done
    • May not be as sensitive as clinical signs

MUN ORTHOPEDICS

carpal tunnel anatomy
CARPAL TUNNEL ANATOMY

MUN ORTHOPEDICS

carpal tunnel syndrome18
Carpal Tunnel Syndrome

MUN ORTHOPEDICS

carpal tunnel release
Carpal Tunnel Release

MUN ORTHOPEDICS

dequervain s tendonitis
Dequervain’s Tendonitis
  • Tendon entrapment not tenosynovitis
  • Analogous to trigger finger
  • APL & EPB tendons
  • Originally described in 1895 and blamed on “housework”
  • Peritendinous fibrosis not inflammation

MUN ORTHOPEDICS

dequervain s tendonitis22
Dequervain’s Tendonitis
  • No reports that relate incidence of Dequervain’s to frequency or intensity of repetitive work
  • Tender over radial styloid
  • Finklestein’s test

MUN ORTHOPEDICS

finklestein s test
Finklestein’s test

MUN ORTHOPEDICS

dequervain s tendonitis treatment
Dequervain’s TendonitisTreatment
  • Splinting
  • Rest
  • NSAIDS ?
  • Steroid injection - 80% success
  • Surgery

MUN ORTHOPEDICS

tennis elbow lateral epicondylitis
Tennis elbow Lateral epicondylitis
  • Angiofibroblastic tendinosis
    • Not inflammatory
    • ?avascular or degenerative etiology
    • ECRB origin

MUN ORTHOPEDICS

tennis elbow lateral epicondylitis28
Tennis elbow Lateral epicondylitis
  • Associated with repetitive use
    • Occupational
    • Sports
    • Musicians
  • Tender over lateral epicondyle
  • Pain on resisted wrist extension

MUN ORTHOPEDICS

tennis elbow treatment
Tennis elbow Treatment
  • “comfort and cure”
  • NSAIDS
  • Steroid injection
  • Rehab program – 4 months !!
  • Rest
  • Clasps

MUN ORTHOPEDICS

tennis elbow lateral epicondylitis30
Tennis elbow Lateral epicondylitis
  • Surgery when all else fails
  • Literature suggests 80% success rate
  • Optimistic
  • Post-op rehab is 6 months !

MUN ORTHOPEDICS

tennis elbow
Tennis elbow

MUN ORTHOPEDICS

tennis elbow32
Tennis elbow

MUN ORTHOPEDICS

rotator cuff
ROTATOR CUFF

MUN ORTHOPEDICS

rotator cuff34
ROTATOR CUFF
  • Classic example of overuse
  • Prolonged or repetitive overhead use of arms
  • Neer – impingement abrades tendons
  • Continous cycle of overuse without adequate repair

MUN ORTHOPEDICS

overuse syndromes
Overuse syndromes

MUN ORTHOPEDICS

slide36

Impingement Syndromes

  • Subacromial bursitis
  • Rotator cuff tendonitis
  • Bicipital tendonitis
  • AC arthritis
  • Rotator cuff tear

MUN ORTHOPEDICS

impingement syndrome
Impingement Syndrome

MUN ORTHOPEDICS

shoulder anatomy
Shoulder Anatomy

MUN ORTHOPEDICS

acromion morphology
Acromion Morphology

MUN ORTHOPEDICS

slide40

Impingement :Hx & Px

  • Repetitive overhead use of arm
  • Swimmers,pitchers
  • painful arc
  • impingement signs
  • decreased ROM active vs. passive
  • pain with resisted motion

MUN ORTHOPEDICS

slide41

Impingement : treatment

  • Avoidance of offending activity
  • Physiotherapy
  • NSAIDS
  • Corticosteroid injection
  • Surgery : Subacromial decompression

MUN ORTHOPEDICS

slide42

Impingement :Surgery

  • Arthroscopic vs open decompression
  • Cuff repair
  • Excision outer end of clavicle

MUN ORTHOPEDICS

acromioplasty
Acromioplasty

MUN ORTHOPEDICS

rotator cuff tear
Rotator Cuff Tear

MUN ORTHOPEDICS