Common Conditions occurring due to Desk jobs

1. Common Conditions
occurring due to
Desk jobs
Dr. Deepthi Nandan Adla
MS(Orth)osm, MSc (Orth eng.) UK, FRCS, FRCS(Tr&Orth), CCT UK
Consultant Orthopaedic Surgeon (Upper limb)
Apollo Hospitals, Hyderabad

2. Repetitive strain
 Conditions occurring due to repeated use of a certain
movement
 Forceful exertions
 Repetition
 Awkward postures
 Mostly affects office workers
 Sedentary jobs

3. Conditions
 Musculoskeletal
 Cervical spondylosis
 Shoulder impingement
 Tennis elbow/Golfers elbow
 Trigger finger/ DeQuervain’s tenosynovitis
 Nerve related
 Carpal tunnel syndrome
 Cubital Tunnel syndrome
 Nerve root compression

4. Symptoms
 Muscle/tendon problems
 Pain
 Swelling
 Weakness
 Nerve related
 Tingling/altered sensation
 Weakness

5. Tendon problems:
Dequervain’s History
 New, repetitive activity
 Pain over thumb side of
the wrist
 Pain on making a fist,
grasping or holding
objects

6. Examination
 Swelling
 Thickening
 Tenderness

7. Treatment
 Activity modification
 NSAID
 Splintage – thumb widely abducted
 Some reports of low success rates
 Most reports suggest ineffective

8. Steroid Injection
 60 – 80% improved
 Soluble steroid
 One or two injections
 depigmentation
 fat atrophy

9. Surgical Release
 Day case procedure
 Local anaesthesia
 Transverse incision
 Release tendon

10. Tennis/Golfers elbow
 First described by Runge in 1873
 ‘Schreibers Krampfes’ (writers cramps)
 Incidence
 General population: 0.6%
 Tennis players: 9%
 Age:
 35 and 50 years,
 with an equal distribution between males and females
 Associated Rotator cuff problems: 20-40%

11. Etiology
 Multiple microtraumatic events
 Disruption of the internal structure of the tendon and
degeneration of the cells and matrix JBJS 81:259-278 (1999)
 Hypovascular zones
 Eccentric tendon stresses
 Microscopic degenerative response

12. Presentation
 Pain
 outer aspect (Tennis elbow )of elbow/ inner aspect (Golfers)
 Increases with activity
 Lifting objects
 Sometimes pain at rest
 Palapation
 Tenderness
 Special test
 Resisted wrist extension
 Elbow flexion
 Elbow Extension

13. Investigation
 X ray
 Bony spur
 Calcification
 Arthritis
 Ultrasound
 Tendon integrity
 Synovitis of Elbow

14. Non- Operative Treatment options
 Topical NSAIDs
 Oral NSAIDs
 Orthotic devices
 Physiotherapy
 Autologous blood injection-79% had
improvement of Nirschl scores
J Hand Surg [Am]. 2003 Mar;28(2):272-8

15. Literature: Steroid/Physio/wait
 RCT
 6 weeks Pain/function improved in:
 92% (57) of steroid group
 47% (30) for physiotherapy
 32% (19) for wait-and-see
 One year:
 69% (43) for injections
 91% (58) for physiotherapy
 83% (49) for a wait-and-see policy Lancet 2002

16. Operative treatment
 Surgery to repair the tendon

17. Conclusion
 Confirm diagnosis
 Need assessment by surgeon to confirm diagnosis
 NSAIDs
 Physio
 Surgey if:
 Unresolved after non op treatment
 H/O trauma and pain after injury
 Tear in the tendon

18. Carpal Tunnel Syndrome
 Incidence: 1-3 cases per 1000 persons per year
 Prevalence: 50 cases per 1000 persons
 aged in their 30s and 50s
 Women are affected 2-3 times more often

19. Association of CTS in computer
workers
 BMC Musculoskeletal Disorders 2008, 9:134

20. Symptoms
 Pins and needles
 Pain
 The pain may travel up the forearm.
 Numbness of finger
 Dryness of the skin
 Weakness of muscles

21. Anatomy
Contents:Nine flexor tendons
 Tendons
 Median Nerve

22. Cause of carpal tunnel syndrome
 Nerve function v/s pressure in tunnel (healthy people)
 Tingling @ 40mmhg
 Complete motor and sensory block at 50 mmHg
 Carpal tunnel pressure:
 5.3 mmHg during rest
 16.8–18.7 mmHg static on the mouse
 28.8–33.1 mmHg while dragging mouse

23. Examination
 Dry pulps
 Wasting of Thenar muscles
 Tinels

24. Investigations
 Nerve conduction test
 Confirm Diagnosis
 Assess nerve function
 Double
crush/Polyneuropathy
 Prognosis
 Base line, if recurrence

25. Non-operative
 Night splint
 (good for patients with
nocturnal symptoms)
 Activity modification (avoid
aggravating activity)
 NSAIDs

26. Treatment
 NSAIDS
 Physiotherapy
 Activity modification
 Surgery

27. Operative treatment
Indications:
 Failed non-operative treatment
 Motor weakness
Procedure:
 Local anesthesia.

29. Shoulder Impingement
syndrome
 Pain in shoulder
 Increases with activity
 Clicking sensation in shoulder
 Pain with overhead activities/
reaching for seat belt, changing
gears/wearing cloths

30. Assessment
 Shoulder surgeon to assess to
confirm diagnosis
 Complex joint
 Needs thorough knowledge
 Understanding poor among general
orthopedic surgeons
 Newer techniques available to help
improve pain

31. Treatment
 Pain medication
 Activity modification
 Physio
 To improve scapular position
 Strengthen a specific group of muscles
 Injection into shoulder
 To be done by shoulder specialist

32. If not treated
 Continued rubbing of
tendon in shoulder
 Tear of tendon
 Arthritis

33. Procedure
 General anaesthetic
 Key hole/arthroscopic surgery
 2-3 small cuts around shoulder
 Assess shoulder and the tendons
 Shaving of the boney spur

35. Results
 90-95% good results
 Pain (sharp catching pain) improves
 If wear/tear changes in tendon some residual pain is
possible

36. Conclusion
 Prevention better than cure
 Regular exercises
 Try activity modification
 Physiotherapy
 If still not better: Surgery
 Exceptions:
 Nerve compressions: carpal/ cubital tunnel
 Tendon tear in shoulder (Rotator cuff tear)

37. Thank you
Contact:
deepthi.adla@gmail.com
7893844800