Degenerative Tendon Disease of The Elbow & Hand Presenter:
Demy Faheem Dasril Moderator: dr. Syaiful Anwar Hadi, SpOT (K)
Presenter: Demy Faheem Dasril Moderator: dr. Syaiful Anwar Hadi,
SpOT (K)
Slide 2
Degenerative Tendon Disease Introduction Usually in
weight-bearing joint More frequent in upper limb Introduction
Usually in weight-bearing joint More frequent in upper limb
Slide 3
Pathogenesis Local necrosis extending into a tendon / joint
capsule Local necrosis calcified (dystrophic calcification)
Inflammation Degeneration Weaken structure Pathological tear Local
necrosis extending into a tendon / joint capsule Local necrosis
calcified (dystrophic calcification) Inflammation Degeneration
Weaken structure Pathological tear
Slide 4
Bicipital Tendinitis and Tenosynovitis Degenerative 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 (+)
Degenerative 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
(+)
Slide 5
Treatment Local rest arm sling Analgetic Surgical : tendon is
divided bicipital groove Local rest arm sling Analgetic Surgical :
tendon is divided bicipital groove
Slide 6
Rupture of The Biceps Tendon Types: Proximal : more common
Distal : less common Types: Proximal : more common Distal : less
common
Slide 7
Proximal Type Pre-existing degenerative changes Weaken
structure Contraction : Active flexion Rupture Sign & symptoms:
Immediate pain Go away sensation Pre-existing degenerative changes
Weaken structure Contraction : Active flexion Rupture Sign &
symptoms: Immediate pain Go away sensation
Slide 8
Distal Type Less common Weakness of supination & flexion
Ball more proximal proximal type Surgical repair is indicated
Slide 9
Degenerative Tendon Disease of The Elbow Tennis Elbow Golfers
Elbow Tennis Elbow Golfers Elbow
Slide 10
Tennis Elbow Lateral epicondylitis due to pathology in ECR
tendon Pathogenesis is unclear : flexion + extension of elbow
backhand movement Premature degeneration : origin of the forearm
extensor muscle humerus lateral epicondyle Lateral epicondylitis
due to pathology in ECR tendon Pathogenesis is unclear : flexion +
extension of elbow backhand movement Premature degeneration :
origin of the forearm extensor muscle humerus lateral
epicondyle
Slide 11
Clinical Examination Pain : grasping, dorsiflexion extensor
muscle Pain over the lateral aspect of the elbow Radiating pain to
distal Cozen sign (+) Pain : grasping, dorsiflexion extensor muscle
Pain over the lateral aspect of the elbow Radiating pain to distal
Cozen sign (+)
Slide 12
Treatment Local rest spontaneous resolution within 6-12 weeks
Local heat Physiotherapy NSAID Steroid injection Surgery abn origin
of ECRB is excised Local rest spontaneous resolution within 6-12
weeks Local heat Physiotherapy NSAID Steroid injection Surgery abn
origin of ECRB is excised
Slide 13
Golfers Elbow Medial epicondylitis Less common Pain : grasping,
elbow flexion flexor muscle Pain over the medial aspect of the
elbow on resisted elbow flexion Medial epicondylitis Less common
Pain : grasping, elbow flexion flexor muscle Pain over the medial
aspect of the elbow on resisted elbow flexion
Slide 14
Treatment Local rest Local heat Physiotherapy NSAID Steroid
injection Local rest Local heat Physiotherapy NSAID Steroid
injection
Slide 15
Degenerative Tendon Disease in The Wrist & Hand De
Quervains Tenovaginitis Stenosan Digital Tenovaginitis Stenosan
(Trigger Finger) Dupuytrens Contracture De Quervains Tenovaginitis
Stenosan Digital Tenovaginitis Stenosan (Trigger Finger) Dupuytrens
Contracture
Slide 16
De Quervains Tenovaginitis Stenosan Influenced common fibrous
sheath : APL and EPB tendon Repeated forced and movement : typing,
gripping Thickening constriction Influenced common fibrous sheath :
APL and EPB tendon Repeated forced and movement : typing, gripping
Thickening constriction
Slide 17
Women >> men Wrist pain radiates : proximal and distally
Exacerbated by ulnar deviation Local tenderness : radial styloid
Finkelstein test (+) Women >> men Wrist pain radiates :
proximal and distally Exacerbated by ulnar deviation Local
tenderness : radial styloid Finkelstein test (+)
Slide 18
Treatment Steroid injection Immobilisation of the thumb :
splint Surgical : division of the inflammed and stenotic tendon
sheath Steroid injection Immobilisation of the thumb : splint
Surgical : division of the inflammed and stenotic tendon
sheath
Slide 19
Digital Tenovaginitis Stenosan (Trigger Finger) Flexor tendon
(deep and superficial) enclosed by common tendon sheath If
thickening : stenosis disturbed gliding movement Tendon become
large proximally repeated movement Flexor tendon (deep and
superficial) enclosed by common tendon sheath If thickening :
stenosis disturbed gliding movement Tendon become large proximally
repeated movement
Slide 20
Finger can be flexed actively and extended passively Snapping
phenomenon Nodular enlargement in the flexor tendon Finger can be
flexed actively and extended passively Snapping phenomenon Nodular
enlargement in the flexor tendon
Slide 21
Treatment Immobilization in extension Steroid injection
Surgical : division of fibrous sheath Immobilization in extension
Steroid injection Surgical : division of fibrous sheath
Slide 22
Dupuytrens Contracture Progressive fibrous tissue contracture
of the palmar fascia ulnar side Affects the MCPJ and PIPJ Men >
50 years old Frequently bilateral Progressive fibrous tissue
contracture of the palmar fascia ulnar side Affects the MCPJ and
PIPJ Men > 50 years old Frequently bilateral
Slide 23
Treatment Surgical : excision of all abnormal palmar fascia
Post operative : early mobilization Surgical : excision of all
abnormal palmar fascia Post operative : early mobilization
