AFFECTION OF SOFT TISSUE ( TENNIS ELBOW).pptx

TENNIS ELBOW N STUFF

1. TENNIS ELBOW LATERAL EPICONDYLITIS DR.N.M.SHIRSAT PROF ORTHO DUPMCH, JALGAON

2. This is a condition characterised by pain and tenderness at lateral epicondyle of the humerus due to non specific inflammation at the origin of the extensor muscles of forearm.

3. CLINICAL FEATURES PAIN --------------AGGREVATES BY PUTTING EXTENSOR TENDONS TO STRETCH TENDERNESS--- LOCALISED TO LATERAL EPICONDYLE OF HUMERUS ELBOW MOVEMENT ARE NORMAL

4. Xray ----- NAD Treatment Analgesics Hot fomentation Ultrasonic therapy Stretching exercise Inj. Depomedrol locally Surgery -------- Intractable cases

5. GOLFERS ELBOW This is a condition where inflammation is at origin of the flexor tendons at medial epicondyle of the humerus.

6. DUPUYTREN’S CONTRACTURE CONTRACTURE OF THE PALMAR APOONEUROSIS This is the condition characterised by a flexion deformity of one or more fingers due to thickening and shortening of palmar aponeurosis.

7. CAUSES Unknown Hereditary predisposition Increased incidence of disorder among cirrhotic patients and epileptic patient on sodium hydantoin.

8. PATHOANATOMY Palmer aponeurosis is thin but tough membrane underneath palmar skin Proximally continuation with palmaris longus Distally 4 sheaths blends with flexor sheaths of flexor tendon up to middle phalynx

9. IN DUPUYTEREN’S CONTRACTURE:- The aponeurosis thickened and contracts Flexion of MP joint and PIP joints

10. CLINICAL FEATURES The ring finger – most commonly affected Generally limited to medical 3 fingers Sometimes associated with a thickening of - Planter fascia -Penile fascia ( Peyronie’s disease)

11. IN EARLY STAGES :- Thickening of palmar aponeurosis is felt at base of ring and little fingers LATER STAGES :- Flexion at MP joint and PIP joints of fingers No involvement of dip joint of fingers

12. TREATMENT Early cases ------------------------------------------- Stretching Elderly patients with mild deformity ------- No treatment Surgical excision ----------------------------------- In deformed cases with hampering of activity

13. TRIGGER FINGER/THUMB This is a condition resulting from the constriction of the fibrous digital sheath so that free glinding of the contained flexor tendon does not occur.

14. CLINICAL FEATURES Pain at base of affected fingers Locking of finger: -As the sheath further thickens the contained tendon gets swollen proximal to it -The swollen segment of the tendon does not enter the sheath when an attempts is made to straighten the finger from flexed position -This locking can be overcome either by strong effort in which cases the finger extends with a snap like trigger of a pistol or by extending the finger passively with other hand.

15. TREATMENT Early cases---------------- Local ultrasound therapy Long standing case------ Local inj. Depomedrol Intractable cases--------- Surgery -Splitting of tight tendon sheath

16. GANGLION It is the most common cystic swelling on the dorsum of wrist . It results from mucoid degeneration of the tendon sheath or joint capsule.

17. CLINICAL FEATURES SWELLING ----- CYSTIC VAGUE PAIN

18. TREATMENT Aspiration of cyst + inj. Hyalase Surgical excision ---------------- Recurrence cases.

19. PLANTER FASCITIS It occurs as a result of inflammation of the planter aponeurosis at its attachment on the tuberosity of calcaneum.

20. CAUSES OF HEEL PAIN

21. CLINICAL FEATURES Pain -------------- worst in early morning and often improves with activity Tenderness------- marked tenderness over medial aspect of calcaneal tuberosity (Site of attachment of planter fascia) XRAY (heel) ankle - lateral Sharp bone spur projecting forwards from tuberosity of calcaneum

22. TREATMENT Hot fomentation Local massage with analgesic Use of heel pad / soft wear Local inj. Depomedrol

23. FIBROMYALGIA This is a widespread disease characterized by multiple tender points affecting whole body more than 3 months.

24. IT IS KNOWN TO BE ASSOCIATED WITH:- - Irritable bowel -Headache -Dysmenorrhea -Chronic fatigue syndrome Etiology is not known but it is proposed to be a part of fatigue syndrome

25. DIFFERENTIAL DIAGNOSIS Hypothyroidism SLE Hyperparathyroidism Osteomalacia

26. TREATMENT Patient counselling Avoidance of aggravating factors Physical therapy Antidepressants

27. MERALGIA PARAESTHETICA CAUSE :- Entrapment of lateral cutaneous nerve of thigh in fascia just medial to the anterior superior iliac spine.

28. CLINICAL FEATURE Feeling of tingling numbness burning in distribution of lateral cutaneous nerve of thigh.

29. TREATMENT Analgesics Local hydrocortisone Surgical decompression (sometimes)

30. FROZEN SHOULDER PERIARTHRITIS SHOULDER:- This is a disease of unknown etiology where the glenohumeral joint becomes painful and stiff because of loss of resilience of joint capsule , possibly with adhesions between its folds. Often there is history of preceding trauma The disease is more common in diabetes

31. CLINICAL FEATURES Pain and stiffness of shoulder

32. TREATMENT Self limiting disease --------- 6 to 9 months Analgesics Hot fomentation Physiotherapy ---------------- Shoulder mobilization exercise strengthening

33. TREATMENT Intra articular inj. Hydrocortisone Manipulation under anesthesia (MUGA) Surgical Arthroscopic capsular release

34. PAINFUL ARC SYNDROME This is a clinical syndrome in which there is pain in the shoulder and upper arm during the mid – range of glenohumeral abduction . ( because of impingement of rotator cuff)

35. COMMON CAUSES:- Minor tear of supraspinatus tendon Supraspinatous tendinitis Calcification of supraspinatus tendon Subacromial bursitis Fracture of greater tuberosity

36. CLINICAL FEATURES:- The space between upper end of humerus and the acromion gets compromised , so that during mid- abduction the tendon of rotator cuff gets nipped between greater tuberosity and acromion.

37. PATIENT CAN DO ABDUCTION 30*------------- PAINLESSLY 30* TO 120* ---------- PAINFUL 120* TO 180* ----------- PAINLESS

38. INVESTIGATION Xray Ap view Axial view Calcific deposit Fracture of greater tuberosity / acromion USG Shoulder MRI Shoulder

39. TREATMENT Analgesic , anti – inflammatory drugs Ultrasound therapy for tender points Injection hydrocortisone in subacromial space Excision of anterior – prominent part of acromion.

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