degenerative tendon disease of the elbow hand n.
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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

Degenerative Tendon Disease of The Elbow & Hand

Presenter: Demy Faheem Dasril

Moderator: dr.Syaiful Anwar Hadi, SpOT (K)

degenerative tendon disease
Degenerative Tendon Disease

Introduction

  • Usually in weight-bearing joint
  • More frequent in upper limb
pathogenesis
Pathogenesis

Local necrosis extending into a tendon / joint capsule

Local necrosis calcified (dystrophic calcification)

Inflammation

Degeneration

Weaken structure

Pathological tear

bicipital tendinitis and tenosynovitis
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 (+)
treatment
Treatment
  • Local rest arm sling
  • Analgetic
  • Surgical :tendon is divided bicipitalgroove
rupture of the biceps tendon
Rupture of The Biceps Tendon
  • Types:
    • Proximal : more common
    • Distal: less common
proximal type
Proximal Type
  • Pre-existing degenerative changes
  • Weaken structure
  • Contraction:Active flexion Rupture
  • Sign & symptoms:
    • Immediate pain
    • ‘Go away’ sensation
distal type
Distal Type
  • Less common
  • Weakness of supination & flexion
  • ‘Ball’ more proximal proximal type
  • Surgical repair is indicated
degenerative tendon disease of the elbow
Degenerative Tendon Disease of The Elbow
  • Tennis Elbow
  • Golfer’s Elbow
tennis elbow
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
clinical examination
Clinical Examination
  • Pain :grasping, dorsiflexion extensor muscle
  • Pain over the lateral aspect of the elbow
  • Radiating pain to distal
  • Cozen sign (+)
treatment1
Treatment
  • Local rest spontaneous resolution within 6-12 weeks
  • Local heat
  • Physiotherapy
  • NSAID
  • Steroid injection
  • Surgery  abn origin of ECRB is excised
golfer s elbow
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
treatment2
Treatment
  • Local rest
  • Local heat
  • Physiotherapy
  • NSAID
  • Steroid injection
degenerative tendon disease in the wrist hand
Degenerative Tendon Disease in The Wrist & Hand
  • De Quervain’sTenovaginitisStenosan
  • Digital TenovaginitisStenosan (Trigger Finger)
  • Dupuytren’s Contracture
de quervain s tenovaginitis stenosan
De Quervain’sTenovaginitisStenosan
  • Influenced common fibrous sheath: APL and EPB tendon
  • Repeated forced and movement : typing, gripping
  • Thickeningconstriction
slide17

Women >> men

  • Wrist painradiates:proximal and distally
    • Exacerbated by ulnar deviation
  • Local tenderness:radial styloid
  • Finkelstein test (+)
treatment3
Treatment
  • Steroid injection
  • Immobilisation of the thumb:splint
  • Surgical: division of the inflammed and stenotic tendon sheath
digital tenovaginitis stenosan trigger finger
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
slide20

Finger can be flexed actively and extended passively

  • ‘Snapping phenomenon’
  • Nodular enlargement in the flexor tendon
treatment4
Treatment
  • Immobilization in extension
  • Steroid injection
  • Surgical: division of fibrous sheath
dupuytren s contracture
Dupuytren’s Contracture
  • Progressive fibrous tissue contracture of the palmar fasciaulnar side
  • Affects the MCPJ and PIPJ
  • Men >50 years old
  • Frequently bilateral
treatment5
Treatment
  • Surgical:excision of all abnormal palmar fascia
  • Post operative:early mobilization