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Bimm Talk May2011
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Transcript of Bimm Talk May2011
8/6/2019 Bimm Talk May2011
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AIMSAND OBJECTIVESAim ² to understand the pract ice of common hand cond itions in pr imary care
Object ives
1. To list the common hand cond itions in pr imary care
2. Diagnoses and assess these cond itions
3. Descr ibe the management of these
4. Able to perform s imple hand procedures in pr imary care
5. Develop a personal profess ional de velopment plan in hand surgery for your pract ice
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COMMON CONDITIONSChronic tenosyno vitisTr igger f inger De Quer vain`s tenosyno vitisGanglia
Tenn is elbowOlecranon burs itisCarpal & Cubital Tunnel SyndromeOA Hand jointsRotator cuff tend initis
Subacrom ial impingementFrozen shoulder AC joint d isease
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RESOLUTIONFIBROSISCHRONICITYSPREADEXUDATE
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PARAESTHESIACTS video 2
Cubital tunnel video
Thorac ic outlet syndrome
Rad ial Tunnel syndrome
Cer vical Disc degenerat ive disease
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RADIAL TUNNEL SYNDROME
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CUBITAL TUNNEL SYNDROME
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CARPAL TUNNEL SYNDROME
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DIFFERENTIAL DIAGNOSIS
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RADIAL SIDED WRIST PAIN
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ULNAR SIDEDW RIST PAINECU TENDINITIS
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TRAUMATIC SYNOVITIS PIP J
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TRIGGER FINGER T
R
I
G
G
ER
D
I
G
I
T
S
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THANK YOU
WWW .HANDSURGERYMANUAL.COM
USER NAME : GUESTPASSW ORD: HANDS
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INJECTIONS
W HY?Very useful modal ity and immensely apprec iated by pat ients
Minimal system ic effect
Maximal Local effects
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PREPARATIONS
soluble - l ittle role in inf iltration
(e.g., hydrocort isone)depot - crystall ine, bulky, and relat ively imper vious to degrad ing enzymes(methylpredn isolone acetate, tr iamc inolone aceton ide, tr iamc inolone hexaceton ide)
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POTENCIES
methylpredn isolone acetate has a shorter durat ion of act ion (isrelatively more soluble) than tr iamc inolone hexaceton ide.
cost of tr iamc inolone hexaceton ide, however, is 3-4 times that of methylpredn isolone
Methylprednisolone ² reser ved for superf icial structures such assubcutaneous bursae and flexor tendon sheaths, and when there isconcern about tendon rupture, e.g., rotator cuff tend initis andretrocalcaneal ( Ach illes) bursa inject ions.
Tr iamc inolone hexaceton ide - more effect ive in reduc ing stubborn
syno vitis in a rheumato id knee, wr ist, elbow, or shoulder .
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GUIDELINES FOR DOSAGE/VOLUME OFINFILTRATION
Knee 40-80 mg 3-10ml
Glenohumeral jo int 40-80 mg 3-10 ml
Subacrom ial bursa 20-40 mg 3-5 mlAcrom ioclavicular jo int 10 mg 1-2 ml
Olecranon bursa 20 mg 2 ml
Trochanter ic bursa 20-40 mg 2-5 mlTr igger f inger 10 mg 1 ml
Region Dosage (methylprednisolone acetate or triamcinolone acetonide)Region Dosage (methylprednisolone acetate or triamcinolone acetonide) Volume (corticosteroid + lidocaine) Volume (corticosteroid + lidocaine)
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TECHNIQUEEffective ster ilizat ion - 70-92% ethyl alcohol or povidone- iod ine solut ion (Betad ine)
local anesthet ic, e.g., lidoca ine 1% or 2%, can be used concom itantly
Rest ing an injected jo int for 24-48 hours follow ing inf iltration helps to conf ine thecort icostero id to the injected s ite and enhances local act ion
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GANGLIONAsp irate
Surgery
Digital Block
Digital Tourn iquet
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DIGITSTr igger Digits video
OA PIP and DIP video
Synovitis ² R A, gout
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ADVERSE EFFECTS
Post- inject ion flare
5% of articular inf iltrations and a much larger proport ion of soft t issueinf iltrations .
Rx - single dose of a nonstero idal ant i-inflammatory drug or w ith the use of cold packs
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ADVERSE EFFECTS -CONT.
Skin atrophy,
hypop igmentat ion,
fat pad atrophy, and
tendon ruptureAll above genera ll y due to poor techn ique.
Infection ² rare
Vasovaga l Anaphy l axis ² rare Rx - ep inephr ine
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GENERAL SIDE EFFECTSDiabet ics - trans ient hyperglycem ia,
Arter ial hypertens ion,
Chronic adrenal suppress ion,
Iatrogen ic Cush ing's syndrome,
Menstrual irregular ities,Osteoporos is,
Avascular necros is of bone ² femoral head, K ienboch·s etc