Common tendinopathies of the UE part II Flashcards
DeQuervain’s Tenosynovitis
Inflammation or tendonosis of the sheath of the tendons in the first extensor compartment
DeQuervain’s symptoms
- Pain on the radial side of the thumb when pinching or grasping objects
- Rule out CMC arthritis of the 1st MCP joint.
- typically right by the radial styloid.
6 dorsal extensor compartments (221211)
6 extensor compartments
1- abductor pollicus longus and extensor pollicus brevis
2- extensor carpi radialis longus and extensor carpi radialis brevis
3- Extensor pollicus longus
4- Extensor indicus proprius, EDC
5- Extensor digiti minimi
6- ECU- Extensor carpi ulnaris
Dequervain’s
Etiology
- frequently results from repetitive motion
- Could also result from blunt trauma to the styloid process
- Overuse and improper body mechanics of gripping and wringing
- Pregnancy- prolactin
DeQuervain’s symptoms
- pain with grasp/release activities near base of thumb
- Edema near base of thumb
- Decreased range of motion: specifically in thumb
-separate sheath around the abductor pollicus longus
Intersection syndrome
affects both shealths- compartment 1 and 2 is up at the wrist
DeQuervain’s Diagnosis
- positive Finkelstein’s test
- Pain along first dorsal compartment
- decreased pinch and grip
- A nodule or thickening of the extensor retinaculum
full flexion of fingers; flexion of IP joint of thumb across the palm; ulnar deviation of fist; positive when movement produces pain
May be able to palpate thickening or nodule at the retinaculum.
DeQuervain’s Treatment
-Conservative management through therapy
-Cryotherapy vs heat
-Thumb spica splint
—Splint: Thumb Spica. Wrist 15º extension, thumb MP 10º flexion; thumb MCP midway between palmar and radial abduction
splint doff qd to perform isolated wrist/thumb AROM – progress to PROM
Must be able to oppose to digits 2 and 3
-patient education on activity modification
Surgical
-decompression of first dorsal compartment
(cut retinaculum so that tendon doesn’t have that friction anymore)
Intersection Syndrome
Tenosynovitis of second dorsal compartment where the first dorsal compartment crosses it in the radial dorsal forearm (3 to 6 cm proximal to the location of DeQuervain’s)
-APL/EPB cross the ECRL and ECRB
Crepitis- rice crispies- snapping and popping when moving over it (some fluid bound up in it) soft tissue work is very advantageous to help get fluid and toxins out of there.
Intersection syndrome treatment
- Thumb spica splint with wrist in 15 to 20 degrees of extension.
- Patient education
Surgical
-second dorsal compartment release.
ECU and EDC
Often get inflamed when the cast is removed (during 6 week casting the extensors are free) after cast is off the EDC thinks it can extend the wrist. Abnormal movement pattern and they will get tendonitis back there if not taught how to use ECRL and ECRB
Treatment
Acute- RICE, ice massage, cold packs, ultrasound, iontophoresis, cross friction massage, ASTYM
- Must correct the biomechanics that caused the problem
- Sleeping posture, Activity modification
Chronic Tendonosis
- Heat
- Massage and soft tissue mobilization
- Stretch (Non-composite to composite)
- Joint mobilization if appropriate
- IASTYM
- eccentric exercise
- splint or orthotic
Impingement
- Forward Shoulder
- Scapular Dyskinesia
- Tight pectoralis minor
- Weak serratus anterior
- Sleeping posture
Cross Friction Massage
- Transverse friction massage (also known as cross-friction and cross-fiber massage) is a technique that promotes optimal collagen healing by increasing circulation and decreasing collagen cross-linking, thus decreasing the formation of adhesions and scar tissue.
- Produce traumatic hyperemia and a histamine response to help flush the area of substance P
