Ortho

6/23/99

Wrists

De Quervain's Disease

• Not actually a disease
• Good National Board Questions
• Long tendons w/a synovial sheath—synovitis, inflammation of the synovium
• Inflamed tendon, inflammation f synovium—Stenosing Tenosynovitis
• Repetitive injury
• Adhesions w/in the synovial sleeve
• Synovial sheath cuts down on friction
• Pain in anatomical snuff box—radial styloid
• Tendons—abductor pollicus longus and extensor pollicus brevis—both run through the retinaculum—adhesions leads to stenosis
• Orthopedic test is Finkelstein's test—thumb across palm and jerk quickly

Stenosing Tenosynovitis of Flexor Tendons

• Flexor retinaculum of distal metacarpal
• Thickening in the palm—can lead to occlusion of extension—trigger finger
• The tendon is not able to slide through retinaculum
• Pulsed ultrasound is effective at breaking up adhesions

Ganglionic Cyst

• RA dorsal aspect of the wrist—joint destruction w/release of synovial fluid into surrounding tissues
• Herniation through weakened area of connective tissue
• Makes a little bubble of fluid
• Can disappear on their own
• Some no matter what you do they come back
• Clinically insignificant unless painful and/or limit ROM
• Tx
• Extraction of fluid
• Incision, a couple of stitches to repair area, causes scar that may prevent the fluid from leaking
• Mashing w/a book to distribute the fluid and will be reabsorbed into the body—still may cause scar tissue
• Adjusting the joints in the area

Dupuytren's Contracture

• Limited extension, full flexion
• Problem in the palm of the hand
• Thick collagen formation
• Best to catch early
• Affects 4^th and 5^th digit
• Parafin is greatly helpful
• Adhesive protocol
• Pulsed ultrasound
• Direct manipulation (including soft tissue)
• Dealing in the palm not w/the long tendons but still look to these joints