Enthesopathy

Dr. Jufri Latief, Sp.B., Sp.OT

BAGIAN ORTOPEDI DAN TRAUMATOLOGI

FAKULTAS KEDOKTERAN UMI
MAKASSAR
What is Enthesopathy?

Enthesopathy is a condition that

affects the entheses (e.g.
inflammation of the entheses).
The entheses are sites of
tendinous or ligamentous
attachment to the bone
 Lateral Epicondylitis
(Tennis Elbow)
 Tennis elbow is a painful inflammation of the tendon on
the lateral aspect of the elbow, caused by the pull of the
muscles which extend the wrist and fingers.
Signs and symptoms
 Pain that radiates from the outside of your elbow into
your forearm and wrist
 Pain when you touch or bump the outside of your
elbow
 Pain when you extend your wrist
 A weak grip
 A painful grip during certain activities, such as shaking
hands or turning a doorknob
 Risk factors
 Repetitive stresses the wrists. Tennis
players, carpenters, gardeners, dentists
and musicians may be at particular risk.
 Complications
 Left untreated, can result in chronic pain
Treatment
Non operative
• (NSAIDs)
• Rest, ice, and physical therapy.
• Steroid injection
Operative
 Medial Epicondylitis
(Golfer's Elbow)
 is pain and inflammation on the inner side of the elbow,
where the tendons of the forearm muscles attach to the
bony bump on the inside of the elbow
Signs and symptoms
 Pain and tenderness on the inner side of the
elbow. Sometimes the pain extends along the
inner side of the forearm. Your elbow may feel
stiff, and it may hurt to make a fist. You may
have weakness in your hands and wrists.
 Risk factors
 Repetitive stresses the wrists or fingers.
 Complications
 Left untreated, golfer's elbow can cause
persistent elbow pain.
 Treatment
Non operative
• (NSAIDs)
• Rest, ice, and physical therapy.
• Steroid injection
Operative
STENOSING TENOSYNOVITIS

 Inflammation of a synovial tendon

sheath which severely narrows the space
normally required for a tendon to pass
freely through its tunnel and beneath the
pulleys and ligaments
 Risk Factors
 More common in womenover age 30.
 Diabetics.
 Repetitive bending of the fingers, thumb
and wrist, gripping and grasping
STENOSING TENOSYNOVITIS
 De Quervains Disease
 Trigger Fingers
De Quervains Disease

Stenosing tenovaginitis of the first dorsal extensor

compartment
 DIAGNOSIS
 Local tenderness, pain and swelling
involve thumb
 radiation of pain to the thumb and
forearm are frequent.
 Positive Finklestein test
De Quervain’s
Treatment
Non operative
• Rest
• steroid injection
• anti-inflamatory
operative
Trigger Fingers
stenosing tenovaginitis of the flexor
tendon sheath(A1 pulley)
 Aetiology
 congenital (thumb)
• often not recognised until toddlers
• 30% resolve spontaneously
 acquired (middle aged)
• idiopathic
• traumatic
• diabetes
• rheumatoid
 Signs and symptoms
 Affected finger may stiff and may click when move.
 A bump (nodule) or tenderness at the base of the affected
finger
 Eventually, the finger may not fully straighten.
 Treatment
non operative
• Rest.
• Splinting.
• Finger exercises.
• Avoiding repetitive gripping.
• Nonsteroidal anti-inflammatory drugs
operative
Plantar Fasciitis
&
Heel Pain
What is plantar fasciitis?

Plantar fasciitis is an inflammation of the

plantar fascial tissue, often adjacent to its
insertion into the heel. This may be associated
one or more of the following:
• Pain
• Swelling
• Warmth of the affected area
• Redness of the adjacent skin
 Anatomy of the Plantar Fascia

The plantar fascia is a

fibrous sheath which
extends from the base
of the toes to the heel.
It runs between the
skin/ subcutaneous
fat, and the deeper
muscles, tendons, and
bones.
 Bony Origin of Plantar Fascia

The plantar fascia arises

from the bottom and inside
of the heel bone (medial
calcaneal tuberosity), along
with some of the small
intrinsic muscles of the foot.
 Risk factors
 Structural abnormality of the lower extremity
 Abnormal amount of motion across joints
 Abnormal position of bones & joints
 Increased levels of activity
 Increased body weight
 Loss of elasticity in fibrous tissues
 Systemic disease (eg. Rheumatic disease)
Plantar fasciitis can occur in
any foot type
It more commonly occurs in both
Flatfoot High Arch
(Pes Planus) (Pes Cavus)
and
 What are the symptoms of
Plantar Fasciitis?

Some combination of these are usually present :

 Pain on weight bearing
 May be sharp, dull or burning
 Often worse on first arising
 Painful first few steps after rest
 Walking may be painful
 May throb in the evening
 Puffiness around the heel
 Pulling sensation when walking
 Feels worse in low heeled shoes
 Feels worse in unsupportive shoes
 Symptoms may be long standing
 May increase in severity over time
 Tenderness to pressure is found at
one or more locations

Along the central portion of the

sole of the foot

Just in front of the heel and

toward the inside of the foot

Directly beneath the weight

bearing surface of the heel bone.
Most common with a “heel
spur”
Home Care of Plantar fasciitis
 Ice the sore area after activit
 Stretch the plantar fascia when its not painful
 Wear supportive shoes, such as good runners
 If tolerated, take over-the-counter anti-inflammatory medication
Treatment
Conservative treatment
• Heel stretching exercises
• Shoe inserts
• Night splints
• NSAIDs
• Steroid injections
Surgery
 Rarely surgery is necessary…
There are various techniques to release the plantar fascia from its
attachment to the heel. This procedure is called a Plantar
Fasciotomy. It is reserved for those patients who fail to respond
to more conservative measures.
Achilles tendinitis
 Achilles tendinitis is inflammation,
irritation, and swelling of the Achilles
tendon (the tendon that connects the
muscles of the calf to the heel).
Causes
 overuse
 arthritis
Symptoms
 Pain in the heel
 Swollen and warm.
Physical examination
 Tenderness along the tendon
 Pain in the area of the tendon when the
patient stands on their toes.
Treatment
Non operative
• (NSAIDs)
• Rest, ice, and physical therapy.
• Steroid injection
Operative
Dupuytren’s Contracture

nodular hypertrophy and contracture of the palmar fascia

 Dupuytren’s Contracture
aetiology
 genetic
 geographical
 smoking
 alcohol
 epilepsy
Dupuytren’s Contracture
clinical
 middle aged
 male 10 x female
 nodular thickening in the palm
 contracture of the ring and little finger
 MCPJ and/or IPJ not DIPJ
Dupuytren’s Contracture
treatment
Surgery if :
 rapidly progressive contracture
 inconvenience
Thank You