Orthopedics 5th year, 5th lecture (Dr. Ariwan)
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The document discusses several common orthopedic hand problems including congenital anomalies, acquired deformities, infections, and contractures. It describes the pathology, clinical features, and treatment options for conditions like mallet finger, boutonniere deformity, swan neck deformity, trigger finger, Dupuytren's contracture, nail fold infection, pulp infection, and deep fascial space infections. The treatment principles focus on antibiotics, drainage of abscesses, splinting, and rehabilitation.
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3. Carpal tunnel syndrome results from median nerve compression at the wrist and is the most common upper limb neuropathy. Treatment involves splinting, injections, or surgery to release the transverse carpal ligament.
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Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
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Claw hand, also known as intrinsic minus hand, is caused by an imbalance between strong extrinsic flexors and deficient intrinsics. It is characterized by hyperextension of the MCP joints and flexion of the PIP and DIP joints.
There are several types of claw hand including partial and total. Partial is due to ulnar nerve paralysis and results in clawing of just the ring and little fingers. Total claw hand is caused by combined median and ulnar nerve palsies and leads to clawing of all five fingers.
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Claw hand, or intrinsic minus hand, is caused by paralysis of the intrinsic hand muscles due to ulnar nerve injury. This results in hyperextension of the MP joints and flexion of the PIP and DIP joints, impairing hand function. Management involves restoring flexion at the MP joints and extension at the PIP joints through static procedures like capsulotomy or dynamic tendon transfers. Dynamic transfers use expendable donor tendons like the ECRL/ECRB to restore finger flexion and grip strength. Legendary orthopedic surgeon Dr. Paul Brand pioneered many tendon transfer techniques for treating leprosy-related hand deformities and rehabilitating patients.
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1) Median nerve injuries can result in loss of motor function to key muscles in the forearm and hand. Tendon transfers can help restore function by transferring muscles still innervated to replace lost functions.
2) Common tendon transfers include using the superficialis or EIP tendon to restore thumb opposition. The BR or ECRL can be used to restore thumb or index finger flexion.
3) Rehabilitation after tendon transfer focuses initially on splinting the transfers and mobilizing other joints, followed by gentle active and assisted range of motion exercises to strengthen and condition the transfers.
Small group teaching in anatomy
The ulnar nerve originates from the brachial plexus and passes behind the medial epicondyle of the humerus at the elbow before entering the palm of the hand. It is commonly injured at the elbow, where it lies behind the medial epicondyle, often due to fractures of the medial epicondyle, and at the wrist, where it is superficial and vulnerable to cuts and stab wounds in front of the flexor retinaculum. The document provides details on the anatomical course and sites of potential injury of the ulnar nerve.
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1. Entrapment neuropathies occur when nerves are compressed, most commonly the median nerve at the carpal tunnel or the ulnar nerve at the elbow.
2. Symptoms depend on the affected nerve but typically begin with tingling and pain, followed by numbness and possible muscle weakness.
3. Carpal tunnel syndrome results from median nerve compression at the wrist and is the most common upper limb neuropathy. Treatment involves splinting, injections, or surgery to release the transverse carpal ligament.
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This document discusses anatomy and injuries of the hand flexor tendons. It begins with the anatomy of the flexor tendon system including the fibrous pulley system. It then covers the different zones of flexor tendon injury and techniques for repair. The goals of repair are to control scar formation and allow for early motion rehabilitation. Post-operative therapy is critical and usually involves early passive motion or early active motion protocols. Complications can include adhesion, rupture, or flexion contractures.
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This document discusses hand deformities that can occur in rheumatoid arthritis. It describes how persistent joint inflammation and destruction from RA can lead to articular cartilage erosion, tendon rupture, and capsular stretching, resulting in progressive joint instability and deformities. Common deformities include swan neck, boutonniere, and ulnar deviation of the fingers. The wrist can develop subluxation and collapse. Tenosynovitis is also common in RA and can cause tendon dysfunction and rupture over time. Early treatment is important to prevent permanent hand deformities.
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The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
ulnar Entrapment Neuropathy and double crush syndrome
Nerve entrapment occurs when a nerve becomes compressed as it travels through tight spaces in the body. The ulnar nerve is commonly entrapped at the elbow, where it passes through the cubital tunnel, or at the wrist in Guyon's canal. Symptoms include numbness, tingling, and weakness. Treatment involves modifying activities that cause compression, splinting, and sometimes surgery to decompress the nerve. The double crush syndrome can occur when a nerve is compressed at multiple sites, worsening symptoms.
Ulnar nerve
The ulnar nerve arises from the brachial plexus and provides motor innervation to muscles in the forearm and hand, and sensory innervation to the palmar and dorsal surfaces of the medial one and a half fingers. In the forearm, it passes behind the medial epicondyle of the humerus and gives off branches, then travels deep to the flexor carpi ulnaris muscle. In the hand, it terminates by innervating the intrinsic hand muscles except the thenar muscles, and providing sensation to the palmar surface of the medial hand. Damage to the ulnar nerve can occur at the elbow or wrist and results in characteristic motor and sensory deficits depending on the location of injury.
Foot drop
This document provides information about foot drop, including its definition, causes, symptoms, diagnosis, treatment, and rehabilitation exercises. Foot drop is the inability to lift the front of the foot and can be caused by nerve damage or muscle weakness. Symptoms include dragging the front of the foot when walking. Treatment may include splinting, foot braces, exercises to strengthen muscles, electrical stimulation, or surgery in severe cases. Physical therapy focuses on exercises to improve dorsiflexion like toe curls and strengthen ankle muscles.
Median Nerve Injury and Carpal Tunnel Syndrome
Carpal tunnel syndrome results from median nerve compression in the carpal tunnel of the wrist. It is caused by narrowing of the tunnel or swelling of its contents. Symptoms include numbness, tingling and pain in the hand and fingers. Conservative treatments include splinting and steroid injections while surgery involves cutting the transverse carpal ligament to relieve pressure on the median nerve. Recurrence after surgery can occur due to incomplete release, scarring or persistent swelling.
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Similar to Orthopedics 5th year, 5th lecture (Dr. Ariwan)
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The document discusses various injuries and conditions affecting the hand and fingers. It describes tendon injuries like extensor digitorum tendon injuries at the DIP joint and trigger finger. It also discusses conditions that cause flexion deformities like boutonniere deformity. Infections are summarized including paronychia, felon, and flexor tenosynovitis. Treatment options involving splinting, antibiotics, and surgery are provided.
Hand infections
This document discusses various types of hand infections, including paronychia (infection of the nail fold), felon (deep space infection of the distal pulp), pyogenic flexor tenosynovitis (infection of the flexor tendon sheath), and deep space infections. Staphylococcus aureus is a common cause. Treatment involves antibiotics, surgical drainage if abscesses are present, splinting, and irrigation. Prompt treatment is important to prevent complications such as tendon necrosis or osteomyelitis.
Sugical anatomy of hand and its infections
1. The document discusses the anatomy and clinical infections of the hand. It describes the parts of the hand and their blood supply, nerves and fascial spaces.
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Hand infections
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- Surgical drainage and debridement may be needed for established infections to prevent complications like joint stiffness or contractures. Appropriate antibiotic use and incision placement are important for optimal outcomes.
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Hand infections
The document discusses various hand infections including paronychia, felon, pyogenic flexor tenosynovitis, and deep space infections. Paronychia typically involves the nail fold and is usually caused by Staphylococcus aureus, while a felon is a deep pulp space abscess of the finger that requires surgical drainage. Pyogenic flexor tenosynovitis is a surgical emergency that infects the closed flexor tendon sheath and can lead to tendon necrosis if not promptly drained.
Trigger Finger
Trigger digits, also known as stenosing tenosynovitis, is a common condition where the tendons in the fingers get inflamed and swollen, making it difficult or impossible to flex and extend the finger smoothly. There are two main types - nodular, where a distinct nodule is felt, and diffuse, where the swelling is less defined. Treatment depends on the type and duration of symptoms. For early nodular cases or diffuse cases of less than 6 months, non-invasive treatments like splinting, NSAIDs, massage and steroid injections are usually effective. For longstanding or severe cases, surgical release of the tendon sheath may be necessary if conservative treatments fail.
Acute hematogenous osteomyelitis
1) Acute hematogenous osteomyelitis is a bacterial infection of bone marrow and bone predominantly seen in children. Staphylococcus aureus is the most common causative organism.
2) It typically involves the metaphysis of long bones. Presentation includes fever, pain, swelling, and elevated inflammatory markers. Diagnosis is made through imaging and biopsy.
3) Treatment involves prolonged intravenous antibiotics for 6 weeks along with surgical drainage if abscesses are present. The goal is to remove necrotic tissue and prevent complications like bone deformity, arthritis, or chronic osteomyelitis.
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This document discusses various tendon conditions around the hand and wrist. It begins by defining tendinopathy, tenosynovitis, stenosing tenosynovitis, tendinosis, and tendinitis. It then discusses the tendons commonly affected in the wrist and hand, including the 6 extensor compartments. Specific tendinopathies of the hand and wrist are defined, including stenosing tenosynovitis, De Quervain's tenosynovitis, intersection syndrome, and others. The etiology, pathophysiology, signs and symptoms, diagnosis, and management of stenosing tenosynovitis, De Quervain's tenosynovitis, and intersection syndrome are discussed
Tendinopathies of wrist and hand
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This presentation gives general overview of different types of hand infections and their surgical management especially the incisions
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Trigger finger - adult and congenital
This document discusses trigger finger, which is caused by thickening of the flexor tendon that gets caught on the edge of the A1 pulley when flexing the finger. It describes the anatomy of the tendon pulley system in the hand. Trigger finger is most common in the ring finger and is often due to repetitive trauma. Symptoms include inability to smoothly flex or extend the finger and locking of the finger. Treatment involves splinting, NSAIDs, corticosteroid injections, and surgery to release the A1 pulley if conservative measures fail. Pediatric trigger thumb has a different etiology and presentation compared to adults and usually requires surgery for release.
Complications of rhinosonusitis
Rhinosinusitis can lead to serious orbital, intracranial, and bony complications if not properly treated. The document describes the various classifications of orbital complications including preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. It also details intracranial complications such as meningitis, epidural/subdural empyema, brain abscess, and cavernous sinus thrombosis. Treatment involves antibiotics, surgical drainage if needed, and management of the underlying sinusitis. Failure to improve or clinical deterioration despite treatment indicates the need for more aggressive management.
Mbbs final part 1 2019 paper discussion
This document provides a summary of 11 medical topics:
1. Juvenile nasopharyngeal angiofibroma, a rare benign tumor most commonly found in adolescent males.
2. Faucial diphtheria, a potentially life-threatening infection caused by Corynebacterium diphtheriae that can form a membrane over the tonsils and pharynx.
3. Bell's palsy, an idiopathic facial nerve paralysis that causes an inability to close the eye or control facial muscles on one side of the face.
4. Bone anchored hearing aids, a surgical implant that transmits sound through bone conduction to the cochlea for patients who
osteomyelitis
This document discusses osteomyelitis, an inflammatory process that affects bones. It begins by defining osteomyelitis and listing predisposing factors. It then discusses various classifications of osteomyelitis including acute suppurative, chronic, diffuse sclerosing, focal sclerosing, proliferative periostitis, and alveolar osteitis. For each classification, it provides details on clinical features, pathogenesis, radiographic findings, and treatment approaches.
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