Entesopathies Z. Rozkydal I.Ortopedická klinika MU v Brně.
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Transcript of Entesopathies Z. Rozkydal I.Ortopedická klinika MU v Brně.
Entezopathy
Patological changes of insertionsof tendons, ligaments and joint capsules into the bone
Dystrophia, microrupturesof Sharpey´s filaments from boneinflammation, periostitisossifications, metaplasia
Epicondylitis radialis humeriTennis elbow
Pain with activity of extensorsTendernessPainfull supinationPainful resisted dorsiflexion of the wristand of the third fingerChair test
Tennis elow- the cause
EntesopathyBursitisOssifications of insertion of extensorsPainfull annular ligamentPainful synovial plicaOsteochondrosis dissecansPressure od radial nerveReferred pain from cervical spine and shoulder
Tennis elbow
Conservative treatment:Rest, NSAIDStretching, slingCorticoids locallyfysiotherapyOrthesis or immobilisation
Operative treatmentOp. sec. HohmanOp. sec. Boyd- Mc Leod
Golf elbow -Epicondylitis ulnaris humeri
Entesopathy of insertions of flexorson ulnar epicondylePain, tendernesResisted movements
Treatment:Conservative
OperativeDistalisation of flexor´s insertion
Bursitis of olecranon
Swelling and fluidTenderness
Treatment:Aspiration, NSAIDBandage, immobilisation Corticoids locally
Risk of pyogenic inflammation
M. de Quervain
Stenosing tenosynovitis oflong abductor and short extensorof the thunb
Tenderness over styloid processFinkelstein test
TreatmentRest, orthesis, plaster NSAID, corticoidsSurgery
Bursitis and entesopathies in hip region
Greater trochanter Ischial tubercleBursa ileopectineaGracilis syndrom (natažené tříslo)Spina iliaca ant. sup.Spina iliaca ant inf.
Prepatelar bursitis
Bursitis of pes anserinus
Bursitis in the knee region
Therapy: Rest, aspiration, corticoidsNSAID, surgery
Baker´s cyst
Bursa gastrocnemio- semimembranaceaIs connected with joint spaceSwelling, soft mass in popliteal regionLimited movementsPressure onto large veins inpopliteal region.
Secondary to pathology in the knee
Therapy:Conservative – aspiration, local corticoids, NSAIDSurgery
Jumper´s knee- distal pole of the patella
m. Osgood- Schlatter
Entesopathy in ligaments insertion
Entesopathy at Gerdy´s tubercle
Entesopathies in knee region
Bursitis and entesopathies in the foot
AchillodyniaCalcaneal spurHaglund´s exostosisOsteophytes – dorsalOs tibiale externum
Achillodynia
Painful Achillis tendonand it´s insertion
DegenerationHaemorhage, rupturesPeritenonitis
The risk of rupture
Achillodynia
Conservative treatment:
Rest, taping, NSAIDPhysiotherapyOrthesisNo corticoids !
Surgery:PeritenonectomyExcision of necrotic tissue
Entesopathy at the spine
Painfull insertions of ligaments and tendons:Transverse or spinal processScapula, pelvis
Painful shoulder
Tenosynovitis of tendon of long head of bicepsRupture of tendon of long head of bicepsSubacromial bursitisSupraspinatus tendinitis Rotator cuff ruptureImpimgement syndrom Frozen shoulder syndromOsteoarthritis of glenohumeral jointDisorders of acromioclavicular jointInflammationsTumorsReferred pain from cervical spine
Tenosynovitis of long head of biceps
TendernessResisted flexion and supination of the elbow
Therapy:Corticosteroids locallyRest, slingNSAID
Rupture of long head of biceps
Therapy:
Rest, slingNSAIDSurgery – up to 40 yearsConservative- over 40 years
Surgery:key hole fixation to the humerusSuture to the short head of biceps
Subacromialis bursitis
InflammationWhite fluidSevere, burning painRestricted movementsTendernessCalcifications
Conservative treatment:Rest, slingLavage with 2 needlesCorticosteroids locallyNSAIDPhysiotherapy
Surgery:Removal of bursa
Subacromial bursitis
Supraspinatus tendinitis
Tenderness over greater tuberosityLimited movements
Therapy:Rest, NSAIDCorticosteroidsPhysiotherapy
Rotator cuff
Rotator cuff:m. supraspinatusm. infraspinatusm. teres minorm. subscapularis
Function:First 30 ° of abductionPressure of the humeral headinto glenoid cavityDepressor of the humeralhead
Rupture of rotator cuff
Partial rupture:
Severe painPainful arcPainful abductionKeeps the arm in positionof adjusted abduction
Ultrasonography
Management: conservative
Rupture of rotator cuff
Complete rupture:No active abductionLifting of the shoulder
Managemet:suture: ASK, openattachment to greater tuberosity
Impingement syndrom
Greater tuberosity impingesto distal surface of acromion andcoracoacromial ligament
Narrowing of subacromial space
Impingement syndrom
The cause:
Spure of acromionChange of contoursof acromionDistal osteophytes of acromio- clavicular jointProminence of gr. tuberosity
Impingement syndrom
Stages:1. Swelling, hemorhage of supraspinatus
2. Fibrosis, tendinitis, bursitis degenerative changes of cuff
3. Rupture od rotator cuff and long biceps tendon
Impingement syndrom
Symptoms:Painful arcImpingement signImpingement testJobe test
X-ray:Narrowed subacromial spaceY view- outlet viewArthrographyUltrasonography
Impingement syndrom
Therapy:1. stage: conservativeRest, NSAID,Physiotherapy,Local corticosteroids
2. stage: the same+ bursectomy, arthroscopy
3. stage: ASK or surgerySubacromial decompressionNeer- acromioplastyASK
Frozen shoulder- capsulitis adhesiva
Progressive limitation of movementsPainNo motivation for movement
Shrinkage of capsuleAdhesions in distal recesusTightening of soft tissueMuscle spasmLow capacity of joint space
The cause
All conditions limitingjoint movements:Impingement syndromArthrosis of AC jointPosttraumatic conditionsInflammationsThoralic outlet syndromTumors of the lungsDisorders of pleuraCardiac disorders
Frozen shoulder
Management:Long lasting periodHeatPassive movementsPositioning Active movementsPhysioterapyNSAIDLocal corticosteroidsASK- decompressionRedressement forceRemoval of adhesions