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Presented by : Rumondang Naibaho, Claudia M.F. Kurube Otto Parandangi, Syukri La Ranti Faqi Nurdiansyah Tutor : dr. Teuku Nanta dr. Jecky Chandra
Symptoms
Sign Look: posture, Pain: localized or colour, hair, scarred, refered wasting, deformity, Deformity: suddenly lump or slowly Swelling: localized or Feel: temperature, texture, pulse, many joints tenderness simultantly Move: active and Loss of functions: passive movements handling tools, holding glass,etc Sensory symptoms and motor weaknes: neurolgical deficit
Examination
a)
b)
c) d)
e)
f) g) h) i)
Resting position Full flexion Full extension Power grip Finger abduction Pinch grip Pin prick Light touch Stereognosis
Congenital Variations
Hand and foot are much the commonest sites of congenital variations in the musculoskeletal system Cause:
Inherited genetic defect Chromosome disorder Viral infection, radiation, drug administration during first 2 month of
There are seven groups clinical disorder Early recogniton and definitive treatment as soon as feasible and preferable before the age of 3 years. Psycological support is important
ACQUIRED DEFORMITIES
INTRODUCTION
Deformity of the hand may be result from disorder of the skin, subcutaneous tissue, muscle, tendons, joints, bones of neuromuscular function
ACQUIRED DEFORMITIES
SKIN CONTRACTURE MUSCLE CONTRACTURE TENDON LESSION JOINT DISORDER BONE DISORDER NEUROMUSCULAR DISORDER
SKIN CONTRACTURE
MUSCLE CONTRACTURE
Volkmanns Ischemic Contracture Shortening Of The Intrinsic Muscle
TENDON LESSION
D
C A. MALLET FINGER B. RUPTURED EXTENSOR POLLICIS LONGUS C. SWAN NECK DEFORMITY E
JOINT DISORDER
JUVENILLE CHRONIC ARTHRITS SYSTEMIC LUPUS ERYTHEMATOUS TRAUMA
NEUROMUSCULAR DISORDER
DUPUYTRENS CONTRACTURE
INTRODUCTION
DUPUYTRENS CONTRACTURE is a nodular hypertrophy and contracture of the superficial palmar fascia. It is inhereted as an autosomal dominant trait More common in male, increase with age, at an early stage means aggressive disease.
PATHOLOGY
Proliferation of myofibroblasts in fibrous tissue within the palmar fascia and fascial bands within the fingers contract flexion deformities of the MCP and PIP joints. Fibrous attachments to the skin lead to puckering. The digital nerve is displaced or enveloped, but not invaded, by fibrous tissue.
CLINICAL FEATURES
The palm is puckered, nodular and thick Pain flexion deformities
TREATMENT
Operation
INTRODUCTION
A flexor tendon may become trapped at the entrance to its sheath. On forced extension it passes the constriction with a snap (triggering). The usual cause is thickening of the fibrous tendon sheath ( often following local trauma or unaccustomed activity).
CLINICAL FEATURES
The patient notices that the finger clicks as he or she bends it, when the hand is unclenched, the affected finger remains bent at the PIP joint, but with further effort it suddenly straightens with a snap. A tender nodule can be felt in front of the MCP joint.
TREATMENT
Early cases injection of methylprednisolone carefully placed into the tendon sheath. Refractory cases need operation.
RHEUMATOID ARTHRITIS
INTRODUCTION
The hand, more than any other region, is where rheumatoid arthritis carves its story Rheumatoid arthritis consist of 3 stage: o Stage 1 synovitis of joints and of tendon sheaths. o Stage 2 joint & tendon erosions prepare the ground for mechanical derangement. o Stage 3 joint instability & tendon ruptur cause progressive deformity and loss of function.
CLINICAL FEATURES
STAGE 1 Stiffness, painfull,swelling of the fingers, the MCP joints, the PIP joints or the wrist. Carpal tunnel compression STAGE 2 slight radial deviation of the wrist and ulnar deviation of the fingers correctable swan-necking STAGE 3 Deformities are the rule
rheumatoid nodules
Symmetric
Swelling of tendon sheaths a drop finger or mallet thumb (from extensor tendon rupture)
weakness
An isolated boutonniere
RADIOLOGY IMAGING
Stage 1: the x-rays show only soft tissue swelling and osteoporosis around the joints. Stage 2: joint space narrowing and small periarticular erosions appear; these are commonest at the metacarpophalangeal joints and in the styloid process of the ulna. Stage 3: Joint deformity and dislocation are common.
TREATMENT
Stage 1 : treatment is directed essentially at controlling the systemic disease and the local synovitis. Stage 2 : to prevent deformity. synovectomy followed by physiotherapy Stage 3 :deformity is combined with articular destruction. soft tissue correction alone will not suffice.
OSTEOARTHRITIS
Osteoarthritis
80% of people over the age of 65 have radiological signs of osteoarthritis in one or more joints of the hand, include DIP, PIP, MCP, and Carpo-metacarpal joints, most of them are asymptomatic.
It often starts with pain in one or two fingers; the distal joints become swollen and tender, usually spreading to all the fingers of both hands. (Heberdens nodes)
TREATMENT
Treatment is usually symptomatic Non-operative Analgesic Appropriate rest Operative
RAYNAUDS DISEASE
RAYNAUDS DISEASE
Raynauds syndrome is produced by a vasospastic disorder which affects mainly the hands and fingers. precipitated by cold; the fingers go pale and icy, then dusky blue (or cyanotic) and finally red. Between attacks the hands look normal.
RAYNAUDS DISEASE
Raynauds phenomenon is the term applied when these changes are associated with an underlying disease such as scleroderma or arteriosclerosis.
Treatment : The hands must be kept warm. Calcium channel blockade, iloprost infusions or digital sympathectomy (surgical removal of the sympathetic plexus around the digital arteries)
Clinical features
History of trauma (a superficial abrasion, laceration or penetrating wound) Painfull, swollen, fevers Examination: the finger or hand red and swollen, exquisitely ten over the site of tension, examined for lymphangitis and swollen gland, sign of septicaemia. X-Ray: Osteomyelitis or septic
(a) Acute nail-fold infection (paronychia) (b) Chronic paronychia (c) Pulp-space infection (felon or whitlow) of the thumb due to a prick-injury on the patients own denture
(a) Septic arthritis of the terminal interphalangeal (b) Infected insect bite.
Principles of treatment
Rest, splintage and elevation
Antibiotics
Drainase
Rehabilitation
This position in which the ligaments are at their longest and splintage is least likely to result in stiffness
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