Degenerative Tendon Disease of The Elbow & Hand

Degenerative Tendon Disease of The Elbow & HandPresenter: Demy Faheem DasrilModerator: dr. Syaiful Anwar Hadi, SpOT (K)Degenerative Tendon DiseaseIntroductionUsually in weight-bearing jointMore frequent in upper limb

PathogenesisLocal necrosis extending into a tendon / joint capsule

Local necrosis calcified (dystrophic calcification)

Inflammation

Degeneration

Weaken structure

Pathological tearBicipital Tendinitis and TenosynovitisDegenerative 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 (+)TreatmentLocal rest arm slingAnalgeticSurgical : tendon is divided bicipital grooveRupture of The Biceps TendonTypes:Proximal : more commonDistal : less common

Proximal TypePre-existing degenerative changesWeaken structureContraction : Active flexion RuptureSign & symptoms:Immediate painGo away sensationDistal Type

Less common

Weakness of supination & flexion

Ball more proximal proximal type

Surgical repair is indicatedDegenerative Tendon Disease of The ElbowTennis ElbowGolfers Elbow Tennis ElbowLateral epicondylitis due to pathology in ECR tendonPathogenesis is unclear : flexion + extension of elbow backhand movementPremature degeneration : origin of the forearm extensor muscle humerus lateral epicondyle

Clinical ExaminationPain : grasping, dorsiflexion extensor muscle

Pain over the lateral aspect of the elbow

Radiating pain to distal

Cozen sign (+)

TreatmentLocal rest spontaneous resolution within 6-12 weeksLocal heatPhysiotherapyNSAIDSteroid injectionSurgery abn origin of ECRB is excised

Golfers Elbow Medial epicondylitisLess commonPain : grasping, elbow flexion flexor musclePain over the medial aspect of the elbow on resisted elbow flexion

TreatmentLocal restLocal heatPhysiotherapyNSAIDSteroid injection

Degenerative Tendon Disease in The Wrist & HandDe Quervains Tenovaginitis StenosanDigital Tenovaginitis Stenosan (Trigger Finger)Dupuytrens ContractureDe Quervains Tenovaginitis StenosanInfluenced common fibrous sheath : APL and EPB tendonRepeated forced and movement : typing, grippingThickening constriction

Women >> menWrist pain radiates : proximal and distallyExacerbated by ulnar deviationLocal tenderness : radial styloidFinkelstein test (+)

TreatmentSteroid injectionImmobilisation of the thumb : splintSurgical : division of the inflammed and stenotic tendon sheath

Digital Tenovaginitis Stenosan (Trigger Finger)Flexor tendon (deep and superficial) enclosed by common tendon sheathIf thickening : stenosis disturbed gliding movementTendon become large proximally repeated movement

Finger can be flexed actively and extended passivelySnapping phenomenonNodular enlargement in the flexor tendonTreatmentImmobilization in extensionSteroid injectionSurgical : division of fibrous sheath

Dupuytrens ContractureProgressive fibrous tissue contracture of the palmar fascia ulnar sideAffects the MCPJ and PIPJMen > 50 years oldFrequently bilateral

TreatmentSurgical : excision of all abnormal palmar fasciaPost operative : early mobilization

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