De Quervain’s Tenosynovities
-
Upload
ankit-gujarathi -
Category
Documents
-
view
223 -
download
0
Transcript of De Quervain’s Tenosynovities
-
8/4/2019 De Quervains Tenosynovities
1/34
Dr .Ankit Gujarathi
Resident
DMH,Pune
-
8/4/2019 De Quervains Tenosynovities
2/34
(GRAYS TEXT BOOK)
-
8/4/2019 De Quervains Tenosynovities
3/34
Bones Ha co sist of 27
bo es:
14 ala geal bo es 5 etacarpal bo es
8 Carpal bo es Carpal bo es are ma e p
of two rows of fo r bo esbri ge by flexorreti ac l m w ic formst e carpal t el.
-
8/4/2019 De Quervains Tenosynovities
4/34
-
8/4/2019 De Quervains Tenosynovities
5/34
Ant compartment of hand
-
8/4/2019 De Quervains Tenosynovities
6/34
Handy Thenar group-
-ab ctor pollicis brevis
-flexor pollicis brevis-oppo e s pollicis
-a ctor pollicis(ul ar erve)
y Hypothenar group-
-palmaris brevis-ab uctor igiti mi imi
-flexor igiti mi imi
-oppo e s igiti mi imi
4 lumbricals4 palmar i terossei
4 orsal i terossei
-
8/4/2019 De Quervains Tenosynovities
7/34
Flexor group- Flexor carpi ra ialis
- Flexor carpi ul aris
- Palmaris lo gus (sometimes abse t)- Pro ator teres
- Flexor igitorum superficialis
- Flexor igitorum profundus
- Flexor pollicis longus
-
8/4/2019 De Quervains Tenosynovities
8/34
-
8/4/2019 De Quervains Tenosynovities
9/34
-
8/4/2019 De Quervains Tenosynovities
10/34
-
8/4/2019 De Quervains Tenosynovities
11/34
Median n. Flexor digitorum superficialis and flexor digitorum profundus
enclosed bycommon flexor sheath Flexor pollicus longus enclosed bytendinous sheath of
flexor pollicus longus
-
8/4/2019 De Quervains Tenosynovities
12/34
Post compartment of handy The extensor tendons
gain entrance to the
hand from the forearmthrough a series of sixcanals, fivefibroosseous and onefibrous.
-
8/4/2019 De Quervains Tenosynovities
13/34
tendons of abductor pollicis longus and extensor pollicis brevis tendons of extensor carpi radialis longus and brevis
tendon of pollicis longus
tendons of extensor digitorum, extensor indicis
tendon of extensor digiti minimi
tendon of extensor carpi ulnaris
-
8/4/2019 De Quervains Tenosynovities
14/34
Extensor groupy Superficial-
-anconeus
-brac ioradialis-ext carpi radialis longus
-ext carpi radialis brevis
-ext digitorum
-ext digiti minimi
-ext carpi ulnaris
y Deep-
-supinator
-abductor pollicis longus-ext pollicis brevis
-ext pollicis longus
-ext indicis
-
8/4/2019 De Quervains Tenosynovities
15/34
-
8/4/2019 De Quervains Tenosynovities
16/34
-
8/4/2019 De Quervains Tenosynovities
17/34
-
8/4/2019 De Quervains Tenosynovities
18/34
Extensor retinaculum T ic ening ofdeep
fascia of forearm a wrist
Attac ed laterally toradius and medially tostyloid process ofulnaand triquetrum
Forms six fibrous
compartments forextensor tendonspassing from forearminto and.
-
8/4/2019 De Quervains Tenosynovities
19/34
Causey Idiopat ic
y Overuse injuries
y Blac berry t umb
y Associatedwit RA
Swiss ysici -D Q r i(1895)
-
8/4/2019 De Quervains Tenosynovities
20/34
Path
-
8/4/2019 De Quervains Tenosynovities
21/34
What it is?y Stenosing tenosynovitis of the abductor pollicis
longus and extensor pollicis brevis tendons.
ySmall compartment
y Myxoid degeneration of tendon
-
8/4/2019 De Quervains Tenosynovities
22/34
Symptomsy Pain
y Tenderness
y Swellingy ifficulty in gripping
-
8/4/2019 De Quervains Tenosynovities
23/34
DiagnosisFinkelstein test Eichoff test
-
8/4/2019 De Quervains Tenosynovities
24/34
D/Dy OAof 1st carpo-metacarpal joint
(above test ve)
y Intersection syndrome-
y Wartenbergs syndrome
-
8/4/2019 De Quervains Tenosynovities
25/34
Treatmenty Conservative treatment
- rest on a splint
-the injection of a steroid preparation
y Surgery
First6 wee s
-
8/4/2019 De Quervains Tenosynovities
26/34
Thumb-spica splint.
-
8/4/2019 De Quervains Tenosynovities
27/34
Local steroid
-Met ylprednisolone 40 mg/triamcilone 40mg + lingocaine 1%-Maximally abduct t umb (accentuates abductor tendon)-Aim 30-45 degrees proximally toward radial styloid
-max two repetition in 7 days
-
8/4/2019 De Quervains Tenosynovities
28/34
Surgeryy 6 w from onset of symptoms
(Harvey et al 1975)
-local anest etic agent-tourniquet
-P and
-Incisiondorsal to volar oblique or longitudinal
-
8/4/2019 De Quervains Tenosynovities
29/34
-
8/4/2019 De Quervains Tenosynovities
30/34
Superficial radial nerve
-
8/4/2019 De Quervains Tenosynovities
31/34
Opening sheath
-
8/4/2019 De Quervains Tenosynovities
32/34
? Surgery failurey (1) formation of a neuroma in a severed branch of
the superficial radial nerve.
y
(2) volar subluxation of the tendon when toomuch of the sheath is removed.
y (3) failure to find and release a separate aberranttendon within a separate compartment.
y (4) hypertrophyof scar from a longitudinal skinincision.
-
8/4/2019 De Quervains Tenosynovities
33/34
Surgical modifications-
to avoid subluxationy McMahon et al
(distally based slip of brac ioradialis tendon)
y Ramesh and Britton(used t e extensor retinaculum )
y Wilson et al
(Distally based radial forearm fascia-fat flap)
y Littler, Freedman, and Malerich
(reconstruction of first extensor compartment )
-
8/4/2019 De Quervains Tenosynovities
34/34
Take home message
-wait for 6 w s
-2 max trial of local steroids
-don't operate immediately