DEFORMITY OF

UPPER EXTREMITY
NURYANI SIDARTA

UPPER EXTREMITY

DEFORMITY

MALLET FINGER
DUPUYTRENS CONTRACTURE
DEQUERVAIN TENOSINOVYTIS
TRIGGER FINGER
RHEUMATOID ARTHRITIS
INTRINSIC MUSCLE TIGHTNESS

MALLET FINGER

MALLET FINGER
BASE BALL FINGER
AN ABNORMAL FLEXION DEFORMITY
AT THE DIP JOINT

BASE BALL FINGER

MALLET FINGER
Hilangnya kekuatan ekstensor pada DIP joint
M.fleksor digit prof ; menarik DIP ke arah fleksi
Terjadi akibat gerak fleksi mendadak pada posisi
DIP joint ekstensi
Dapat diserta fraktur avulsi
Penatalaksanaan; splinting DIP J selama 8
minggu

TREATMENT
INITIAL
REHABILITATION
SURGERY

TRIGGER FINGER

TRIGGER FINGER
AN INFLAMMATION OF THE TENDONS
THAT FLEX THE FINGERS
AS THE SNAPPING, TRIGGERING OR
LOCKING OF A FINGER AS IT IS
FLEXED AND EXTENDED

TRIGGER FINGER
DUE TO LOCALIZED INFLAMMATION
OR A NODULAR SWELLING OF THE
FLEXOR TENDON SHEATH THAT DOES
NOT ALLOW THE TENDON TO GLIDE
NORMALLY BACK AND FORTH UNDER
A PULLEY
OFTEN ENCOUNTERED IN PATIENT
WITH DIABETES AND RA
DUE TO REPETITIVE TRAUMA

SYMPTOMS
PAIN IN THE PIP FINGER
SWELLING, STIFFNESS IN FINGERS ,
PARTICULARLY IN THE MORNING

SYMPTOMS
INTERMITTENT LOCKING IN FLEXION
OR EXTENSION OF THE DIGIT, WHICH
IS OVERCOME WITH FORCEFUL
VOLUNTARY EFFORT OR PASSIVE
ASSISTANCE
LOSS OF RANGE OF MOTION

PHYSICAL EXAMINATION
TENDERNESS
TENDER NODULE OVER THE VOLAR
ASPECT OF THE MCP HEAD
SWELLING OF THE FINGER
PAINFUL CLICKING WHILE MCP
FLEXED
CHRONIC : JOINT FLEXION
CONTRACTURE

FUNCTIONAL LIMITATION
DIFFICULTY WITH GRASPING AND
FINE MANIPULATION OF OBJECTS DUE
TO PAIN, LOCKING OR BOTH
DIFFICULTY WITH INSERTING A KEY
INTO A LOCK, TYPING OR BUTTONING
A SHIRT
GRASPING TOOLS AT HOME OR AT
WORK

TREATMENT
INITIAL
REHABILITATION
SURGERY

INITIAL TREATMENT
GOAL : RESTORE THE NORMAL
GLIDING OF THE TENDON THROUGH
THE PULLEY SYSTEM
LOCAL STEROID INJECTION
SPLINTING OF THE MCP AT 10 TO 15
DEGREES OF FLEXION WITH PIP AND
DIP JOINT FREE, FOR UP TO 6 WEEKS
CONTINOUSLY
ICING, NSAID

REHABILITATION
GOAL : INCREASING FUNCTION AND
DECREASING INFLAMMATION AND
PAIN
ICE MASSAGE, CONTRAST BATHS, US,
IONTOPHORESIS WITH LOCAL
STEROID USE
CUSTOM SPLINT

SURGERY
RELEASE OF A1 PULLEY
SUCCESS RATE : 94% GOOD OR
EXCELLENT RESULTS

de Quervain Tenosynovitis

de Quervain Tenosynovitis
AS INFLAMMATION OF A TENDON AND
ITS ENVELOPING SHEATH
AS A STENOSING TENOSYNOVITIS OF
THE SYNOVIAL SHEATH OF TENDONS
OF ABDUCTOR POLLICIS LONGUS AND
EXTENSOR POLLICIS BREVIS IN THE
FIRST COMPARTMENT OF THE WRIST
DUE TO REPETITIVE USE

de Quervain Tenosynovitis
CHARACTERIZED BY DEGENERATION
AND THICKENING OF THE TENDON
SHEATH
IT IS NOT AN ACTIVE INFLAMMATORY
CONDITION

de Quervain Tenosynovitis

PIANO PLAYING
SEWING
KNITING
TYPING
BOWLING
GOLFING
FLY-FISHING

de Quervain Tenosynovitis
PRIMARILY AFFECTS WOMEN (10:1)
BETWEEN THE AGES OF 35 AND 55
YEARS

SYMPTOM
PAIN IN THE LATERAL WRIST DURING
GRASP AND THUMB EXTENSION
PAIN IN PALPATION OVER THE LATERAL
WRIST
SYMPTOMS ARE OFTEN PERSISTENT FOR
SEVERAL WEEKS OR ONTHS
HISTORY OF CHRONIC OVERUSE OF THE
WRIST AND HAND
STIFFNESS OR NEURALGIA LIKE
COMPLAINT

PE

LOCAL TENDERNESS
MODERATE SWELLING
AROUND THE RADIAL STYLOID
POSITIVE FINKELSTEIN TEST
A COMPREHENSIVE EXAM OF THE
NECK AND UPPER EXTREMITY
SHOULD BE PERFORMED

FUNCTIONAL LIMITATION

DIFFICULTY IN DRESSING
FASTENING OF BUTTONS
SEWING
KNITTING

TREATMENT
INITIAL
REHABILITATION
SURGERY

INITIAL

ICE
NSAID
HEAT
SPLINT
STRAPPING
REST
MASSAGE

REHABILITATION
REDUCE PAIN
TO IMPROVE FUNCTION OF THE
AFFECTED HAND
PHYSICAL MODALITIES
STEROID INJECTION
THUMB SPICA

SURGERY
INCISION OF THE SKIN
SLITTING OR REMOVAL OF A STRIP OF
TENDON SHEATH
SUCCESS RATE : 83-92%

DUPUYTRENS CONTRACTURE

DUPUYTRENS CONTRACTURE

DUPUYTREN CONTRACTURE
A NON MALIGNANT
FIBROPROLIFERATIVE DISEASE
CAUSING PROGRESSIVE AND
PERMANENT CONTRACTURE OF THE
PALMAR FASCIA
USUALY IN FOURT AND FIFTH DIGITS
ON THE ULNER SIE OF THE HAND

DUPUYTREN CONTRACTURE
HAVE A GENETIC PREDISPOSITION
IS BELIEVED TO BE INHERITED AS AN
AUTOSOMAL DOMINANT TRAIT WITH
VARIABLE PENETRANCE
MORE COMMON IN VIKING, RARE IN
NONWHITE POPULATION
COMMONLY IN ELDERLY
ASSOCIATION WITH DM,
SMOKING,ALCOHOL COMSUMPTION, HIV.

SYMPTOMS

PAINLESS ONSET AND PROGRESSION

DECREASED RANGE OF MOTION
LOSS OF DEXTERITY
GETTING THE HAND CAUGHT WHEN
TRYING TO PLACE IT ON ONES PANTPOCKET
ABRASIONS OR ECCHYMOSIS OF THE
DIP AND PIP
IMMOBILITY

Dupuytrens contracture (1)

TREATMENT
INITIAL
REHABILITATION
SURGERY

HAND RHEUMATOID ARTHRITIS

A SYSTEMIC INFLAMMATORY
DISORDER OF UNKNOWN ETIOLOGY
IT IS A PROGRESSIVE CONDITION
THAT RESULTS IN DEFORMITY AND
DYSFUNCTION WHEN SYNOVIAL
INFLAMMATION ERODES CARTILAGE,
BONE AND SOFT TISSUEES

SYMPTOMS

PAIN
STIFFNESS AND SWELLING
INVOLVING PIP AND MCP JOINT
SPARING DIP JOINT
MAY RESULT IN PROGRESSIVE
DEFORMITY AND DISABILITY

PHYSICAL EXAMINATION
JOINT PAIN & INFLAMMATION
JOINT STABILITY
LIMITATION IN ACTIVE AND PASSIVE
RANGE OF MOTION
STRENGTH DEFICITS IN PINCH AND
GRIP
LIMITATION IN HAND DEXTERITY
TYPICAL HAND DEFORMITY

HAND DEFORMITY
BOUTONNIERE DEFORMITY
SWAN NECK DEFORMITY

TREATMENT RA
INITIAL
REHABILITATION
SURGERY

BOUTONNIERE DEFORMITY
COMMON IN PATIENTS WITH
RHEUMATOID ARTHRITIS
MAY OCCUR FOLLOWING TRAUMA OR
OTHER INFLAMMATORY ARTHRITIDES

BOUTONNIERE DEFORMITY
CHARACTERIZED BY
PROXIMAL INTERPHALANGEAL (PIP)
JOINT FLEXION,
DISTAL INTERPHALANGEAL (DIP)
JOINT EXTENSION
HYPEREXTENSION OF THE MCP
VOLAR SUBLUXATION OF THE
LATERAL BANDS

BOUTONNIERE DEFORMITY

TREATMENT
INDIVIDUALIZED
BASED ON THE PATIENTS CURRENT
LEVEL OF FUNCTION, DEFORMITY,
MEDICAL STATUS, LIMITATIONS OF
THE SURGEON AND EXPECTATIONS

SWAN NECK DEFORMITY

SWAN NECK DEFORMITY

Hiperekstensi PIPJ,
fleksi DIPJ
Akibat stretch sisi
volar dalam posisi
PIPJ ekstensi, disertai
kontraktur otot intrinsik
Penyebab: synovitis,
RA
Terapi: operatif;
mengurangi kekakuan
otot intrinsik

Yang termasuk otot intrinsik tangan

M. interossei
M. lumbricales
M. hypotenar

Intrinsic plus position

Fleksi MCP J yang

disebabkan oleh otot
lumbricales dan interossei
MCP J : fleksi
PIP dan DIP J: ekstensi
Posisi ideal untuk
immobilisasi tangan

Intrinsic minus
position
MCP J ekstensi
terjadi fleksi DIP J
Dapat terjadi jika
ada paralisis m.

Penatalaksanaan intrinsic minus

position
Koreksi secara operatif
Capsulodesis MCPJ untuk mencegah
hiperekstensi MCPJ otot ekstensor
ekstrinsik dapat melakukan ekstensi DIPJ
Tendon transfer memungkinkan ekstensi
PIPJ dan fleksi MCPJ

Intrinsik muscle tightness

Kontraktur otot
lumbricales dan
interossei
Tidak dapat
melakukan fleksi IPJ
pada saat ekstensi
MCPJ (Bunnel-Littler
Test)
Penyebab; RA, cedera
tangan
Terapi: operatif

THANK YOU