Download to read offline
More Related Content
Similar to Extensor compartment of the hand..tesf.pptx
![Hypothalamus short ppt by Dr. Neha [PT].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/hypothalamusbydr-260124145759-b9f94a93-thumbnail.jpg?width=640&height=640&fit=bounds)
Extensor compartment of the hand..tesf.pptx
- 1. Extensor compartment muscles ofthe hand Tesfahun k
- 2. Introduction • Arranged incompartments(6 compartments)
- 3.
- 4.
- 5. Associated Pathology • DeQuervain's tenosynovitis is a stenosing tenosynovial inflammation of the 1st dorsal compartment. • Diagnosis is made clinically with radial sided wrist pain made worse with the Finkelstein maneuver. • Treatment is generally conservative with thumb spica braces, injections and in refractory cases, 1st dorsal compartment surgical release. • •
- 6. Epidemiology • Incidence • verycommon • ~1 per 1000 annually • Demographics • woman > men , 30 - 50 years old • Anatomic location • most commonly in the dominant wrist • Risk factors • overuse • golfers and racquet sports • post-traumatic • postpartum •
- 7. Etiology • Pathophysiology • pathoanatomy •thickening and swelling of extensor retinaculum causes increased tendon friction • NOT considered an inflammatory process • may be related to accumulation of mucopolysaccharides • •
- 8. Presentation • Symptoms • gradualonset • radial sided wrist pain pain exacerbated by gripping and raising objects with wrist in neutral Physical exam Inspection tenderness over 1st dorsal compartment at level of radial styloid motion usually normal wrist motion pain with resisted radial deviation neurovascular exam normal
- 9. provocative tests • Finkelsteinmaneuver • On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is painful • more indicative of EPB > APL tendon pathology • Eichhoff maneuver • ulnar deviated wrist while patient clenches thumb in fist, followed by relief of pain once the thumb is extended even if the wrist remains ulnar deviated • •
- 10. Imaging • Radiographs • recommendedviews-- AP, lateral views of wrist • indications • radiographs usually not indicated • findings • may be used to rule out • - basilar arthritis of the thumb • - carpal arthritis • •
- 11. Differential • Thumb CMCarthritis • Intersection syndrome • FCR tendinitis • •
- 12. Diagnosis • Clinical • diagnosisis made with careful history and physical examination • •
- 13. Treatment • Nonoperative • rest,NSAIDS, thumb spica splint, steroid iinjectin • indications--- first line of treatment • technique • NSAIDS, rest and immobilisation usually first step • steroid injections into first dorsal compartment usually second step • outcomes • overall corticosteriods found to be superior to splinting • concomitant splinting and/or NSAIDs after steriods injection does not improve outcomes • •
- 14. Trt...ctnd • Operative surgical releaseof 1st dorsal compartment indications severe symptoms usually consider after 6 months of failed nonoperative management technique radial based incision proximal to the wrist protect the superficial radial sensory nerve
- 15. Try.. ctd.. • Techniques Surgicalrelease of 1st dorsal compartment approach transverse incision with release on dorsal side of 1st compartment to prevent volar subluxation of the tendon EPB is more dorsal than APL has variable anatomy with APL usually having at least 2 tendon slips and its own fibro-osseous compartment a distinct EPB sheath is often encountered dorsally
- 16. Complications • Sensory branchof radial nerve injury • Neuroma formation • Failure to decompress with recurrence • may be caused by failure to recognize and decompress EPB or APL lying in separate subsheath/compartment • Complex regional pain syndrome • Prognosis • Most cases resolve with non-operative management • High recurrence rate • •
- 17. Extensor Carpi RadialisLongus
- 18. Extensor Carpi RadialisBrevis