Bursitis
Carpal Tunnel Syndrome
 Is a condition that results when there is injury to
the bursa that commonly occurs with reduced
friction between tendons, bones and ligaments
 Bursae - are fluid-filled sacs that are lined with
synovium similar to the lining of the joint
surfaces
Bursitis versus Synovitis
• Bursitis is inflammation of the sac between the tendon
and an adjacent bone that the tendon glides over, the sac
is lined with a membrane that produces synovial fluid.
• Synovitis refers to inflammation that occurs in the
tendon sheath (tenosynovitis) or the inner lining of the
joint capsule (synovitis)
Bursitis
Signs and Symptoms:
• Pain around joint - commonly the shoulder,
knee, hip and elbow
• Limited ROM
• Tenderness
• Varying degrees of redness, warmth and
swelling
Bursitis-Management
• R.I.C.E.
• NSAID's and analgesic
• ROM exercises
• Intra articular corticosteroid injections
• Surgery - when calcified deposits or adhesions
have diminished the function of the affected part
Loose bodies
• Small pieces of bone or cartilage floating within
a joint capsule.
• may include pieces of articular cartilage.
• probably reflects a joint trauma or the wearing
away of the articular cartilage that exposes the
surface of the bone beneath, causing it to die and
separate.
Loose Bodies-Manifestations
• painful catching or locking of the joint.
• Limited ROM
• Abnormal gait
• Loose bodies may promote osteoarthritis if they
are not removed or reattached in time.
Loose Bodies
• X-ray, ultrasound, CT scan, or MRI, help find a
loose body.
• Surgery (usually by arthroscopy) to remove the
loose body or repair the kneecap may be needed
if a loose body is causing symptoms
Carpal Tunnel Syndrome
• An entrapment neuropathy that occurs when the
nerve at the wrist is compressed by a thickened
flexor tendon sheath, skeletal encroachment,
edema or soft tissue mass.
• Tarsal Tunnel - foot
Precipitating factors:
• Repetitive hand and wrist movement
• Exposure to cold temperature
• Excessive vibrations in the hand and wrist
• Carpal Tunnel Syndrome
Manifestations:
• Pain especially at night
• Numbness
• Paresthesia
• Weakness along the median nerve
TINEL's sign indicates CTS
Management:
1. Medical
• Is based on the cause
• Use of wrist splints to prevent hyperextension and
prolonged flexion
Advise to avoid repetitive hand and wrist movement
• NSAID's and cortisone injections
• Others-yoga, acupuncture, etc.
2. Surgery is advised in severe cases:
• Open nerve release
• Endoscopic laser surgery
• Open Release for Carpal Tunnel Syndrome
Ganglion
• A collection of gelatinous material near the
tendon sheaths and joints
• Appears as a round, firm, cystic swelling.
• Ganglia can form around any joint, but they are
most frequently found in the wrist and ankles.
They are usually painless and often barely visible as
localized swellings. They typically do not appear to
be inflamed unless they are big
Ganglion
• Common in women who are in their 50's
• Pain may or may not be present
• Weakness of the fingers occur with tendon sheath
involvement
Management involves aspiration, corticosteroid
injection or surgical incision
Dupuytren's disease
• A condition characterized by progressive contracture of
the palmar fascia that causes flexion of the fourth and
fifth fingers, most frequently, the middle finger.
In severe cases, the affected fingers lose function
Dupuytren's disease
• Is caused by inherited autosomal trait
• Occurs frequently in men • Shoes with support
• Heel cups and other orthotic devices
• Occurs frequently to those >50 years • NSAID's

• Associated with arthritis, DM, Gout alcoholism.

Stars as nodule in the palmar fascia, which may or may

not progress so the fibrous thickening extends to involve
the skin in the distal palm and produces a contracture of
the fingers.

Clinical manifestations include dull aching discomfort,

morning numbness,

In the affected fingers. Starts in one hand but eventually

become bilateral cramping and stiffness

Initially, finger stretching exercises can prevent

contractures. Fasciectomies are performed of the palm
and digits to improve function. Finger exercises may
begin in 1-2 post op days.

Achilles Tendonitis/ Tendinitis

• Overuse of the Achilles tendon can cause

inflammation that can lead to pain and swelling.
• Patients tend to experience pain after first
walking in the morning and when getting up
after sitting for long periods of time.
• Patients will also experience pain while
participating in activities, such as when running
or jumping.

Tendonitis

• X-ray is not usually diagnostic but can be used

• Thompson's test helps in the diagnosis of Achilles
rupture.

Thompson's Test

• ✓Patient kneels on the chair or less prone while

examiner squeezes affected calf
• ✓Normally, the foot responds by moving
downward

Tendonitis-Management

• R.I.C.E
• Splinting or casting for up to 6 weeks in
functional position occurs
• Surgical intervention if rupture
• Physical therapy is required for rehabilitation

• Health teaching - advise not to return to full

activity until strength is equal to unaffected
extremity

Plantar Fasciitis

• is inflammation of the fascia that runs along the

bottom of the foot from the heel to the toes
• As the fascia is stretched, microscopic tears
develop at the point where the fascia attaches to
the calcaneous

Plantar Fasciitis

• Pain is localized at the anterior medial aspect of the

heel and diminishes with walking

Management includes:
• Stretching exercises