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Tenosynoviti

s
Dr. Diyar
A. Salih
Plastic
surgery
resident
June, 2010
Kurdistan,
Sulaimani
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Tendonitis: Tendon
Tenosynovitis: Tendon
Synovium
1! "esenchymal syndrome:
multi#le area o$
in$lammation %
tenosynovitis
&eatures
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Slee#

Si'e
discre#ancy

(e#etitive
motion
Diagnosis
1) Pain at the wrist (specific comp),
exacerbated by wrist movement.
2) Tenderness on examination.
3) Grip strenth decreased.
!) "omp#ete pain re#ieve by a sma##
amo$nt of %& aent in'ection in to
the compartment.
Treatment
1! )onservative( for the first occ$rrence(

)odification of activities * avoidin heavy


#oadin

Steroid in*ection (into the invo#ve sheath)

+p#intin (short term pain )x)

,#astic bands (esp. Tennis e#bow)

-+&./
1! Surgical(

+ynovia# sheath decompression

+i0e red$ction

Tendon rero$tin thro$h another


compartment

Postoperative sp#intin for 2 wee1s *


e#evation
2
Triamcino#one 33! m
2
-o systemic or minima# #oca# +,
2
-o more than 2 in'ection into the
same area
2
.f the first in'ection fai#ed to
reso#ve the symptoms, there is no
indication for the second in'ection
(consider s$rery)
2
&void hih dose(
1) +oft tiss$e atrophy
2) +1in piment dist$rbance
Trigger $inger
A
1
Pain$ul nodule
A+ru#t motion
,Triggering!
-sually #ain$ulClick to edit Master text styles
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1! -nder .A
2! Pneumatic cu$$
/! "inimal dissection
0! A2 #ulley % 123 #reserved
4! )on$irmed +y Pt to $le5 digit
6! Transverse incision: higher
com#lication
7! 8nde5 $inger: radial side incised
9! &P.: Transverse incision ,#reserve
radial digital nerve!
)ongenital Trigger
thum+
1otta node:
Patho#oica#
thic1enin of 4P%
at )"P5
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(5:
1! )onservative:
monitoring u# to 6
month o$ age.
2! S#ontaneous
resolve ,some
cases!
/! Surgical:
0! &P. tendon
release through
transverse
incision at ")PJ
4! A1 #ulley released
6! 1o tendon si'e
reduction is
attem#ted.
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De :uervain
tenosynovitis
1st ;5t.
com#
;P3
AP.
There is a high
degree o$
anatomical
variation in the
#osition o$ % no. o$
AP. tendon, it is
common to $ind
se#aration o$ AP. %
;P3 tendon +y a
se#tum.
(adial side #ain
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&in<lestein
test
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Performed in steps(
1. 6#nar deviation of the
wrist
2. Passive add$ction of
")"5
3. Passive f#exion of )"P5
1
2
3
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1st
com#artment
surgical release
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8ntersection
syndrome
;
)
(
.
;
)
(
3
1!)onservative(

)odification of activities * avoidin heavy #oadin

Steroid in*ection (into the invo#ve sheath)

+p#intin (wrist in mi#d extension)


1!Surgical(

+econd dorsa# compartment synovia# sheath


decompression

Postoperative sp#intin for 2 wee1s (wrist in


moderate extension) * e#evation
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;P. tendonitis
/rd
com#
.ister tu+ercle
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8ncreased
$riction %
tendonitis
;)- tendonitis
-lnar sided
=rist #ain
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Triangula
r
$i+rocartil
age
com#le5
;)- tendonitis
8$ conservative
$ailed:
Surgical (5:
1! Preserve
volar su##ort
2! ;)- si'e
reduction
/! (erouted
through
$ourth e5t.
com#artment.
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&)-
tendonitis
+harp c$rve over ride
of Trape0i$m
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Tra#e'i
um
ridge
)auses o$ #ain in
this site:
1! -ndetected
sca#hoid
$racture
2! 3asilar *oint
arthritis
/! >anglion cyst
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Treatment:
1! )onservativ
e
2! Surgical
,synovial
sheath
release!
Palmar cutaneous +ranch o$
median nerve
(uns along $le5or car#i radialis
Degenerative
arthritis % +one
s#ur $ormation ??
.ateral
e#ichondylitis
,Tennis el+o=!
3urned out
tendonitis
2
D5
2
(5: o$ten resolve =ith
time.
1! )onservative:
including elastic
+and at the +order
o$ the #ro5imal
and middle third
o$ the muscle.
2! Surgical:
/! =ea<ening %
tearing o$ ;)(3
origin.
0! ;)(3 origin %
#eriosteum
e5cised ,i$
re#laced +y
granulation tissue
as a result o$
chronic or
recurrent
in$lammation!.
;)(3
Po=er gri#
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.ateral
e#ichondylitis
,Tennis el+o=!
(adial nerve com#ression
may coe5ist
1ot limited to Tennis
#layers
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Surgical:
1! tearing % =ea<ening o$
;)(3 origin
2! ;5cision: granulation tissue.
"edial
e#ichondylitis
Pronator@
$le5or mass
origin
2
D5
2
(5:
1! )onservative
2! Surgical:
/! =ea<ening %
tearing o$ PT@
$le5or mass origin.
0! Arigin %
#eriosteum
e5cised ,i$
re#laced +y
granulation tissue
as a result o$
chronic or
recurrent
in$lammation!.
4! -lnar nerve
#rotected.
)u+ital
tunnel
syndrome
)oe5ist % di$$erentiate $rom
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