Tendinitis%20and%20Tenosynovitis%20Upper%20and%20lower%20limbs

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Tendinitis and TenosynovitisUpper and lower limbs

• Physio and Occupational therapy
• by ICM Robertson

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Definitions

• Tendinitis - inflammation in a tendon
• Tendinosis - degeneration of a tendon
• Tenosynovitis - inflammatory process in tendon
  sheath

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Histology
Degenerative Tendon
Normal
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Tenosynovitis Bacterial
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Bacterial TenosynovitisFinger flexors

• Pain on extension
• Local tenderness
• Pyrexia

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Bacterial Flexor synovitisTreatment

• General anaesthetic
• Bloodless field
• Drain debride
• Irrigate sheath
• Antibiotic
• Hand baths
• Physiotherapy

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Tuberculous synovitis

• Thickened synovium
• Painless
• Raised ESR
• Positive TB Skin test

• Treatment
• Anti TB drugs
• Early mobilisation

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Rheumatoid Arthritis
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Rheumatoid synovitis

• Thickened tendon sheaths
• Other signs of RA e.g. small joint inflammation
• Treatment
• Medical (NSAIDS, Steroids etc.)
• Synovectomy

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De QuervainsStenosing Synovitis

• EPL Abd Pollicis brevis

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De QuervainsStenosing Synovitis

• Diagnosis - Finkelsteins test

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De QuervainsStenosing Synovitis

• Treatment
• Splints
• Local Steroid
• Mobilisation

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Trigger Finger

• Causes
• Rheumatiod
• Trauma

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Trigger Finger

• Treatment
• Steroid Injection
• Incise Flexor Sheath

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Rotator Cuff Lesions

• Supraspinatus
• Calcific tendinitis
• Impingement Syndrome
• Tear of rotator cuff
• Biceps Tendinitis

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Anatomy
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Anatomy Cuff Tear
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Impingement Syndrome

• Cause
• Supraspiatus tendinosis
• Abnormal anterior acromion
• Clinical
• Painful mid arc
• tender anterior to acromion

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Torn Supraspinatus

• Tendinosis supraspinatus
• leads to rotator cuff rupture

Drop arm test
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Torn Supraspinatus

• Weakness at mid arc

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Impingement SyndromeRotator cuff arthropathy

• X ray
• Superior migration humaral head
• Osteoarthritis

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Treatment - Impingement syndrome

• Conservative
• Physiotherapy
• Local Steroid

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Treatment - Impingement syndrome

• Conservative
• Physiotherapy

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Treatment - Impingement syndrome

• Operative
• Indications
• failed conservative Rx

Acromioplasty
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Impingement syndromePostop. Physiotherapy
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Calcific Tendinitis

• Cause
• Dystrophic Ca
• Tendinosis Supraspinatus
• Symptoms
• Pain acute in deltoid

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Biceps tendinitis

• Shoulder pain
• Tenderness in Biceps groove

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Biceps tendinitis

• Shoulder pain
• Tenderness in Biceps groove

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Biceps tendinitis

• Yergasons sign
• Pain - biceps groove on external rotation

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Biceps tendinitis
Rupture
Yergasons Sign
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Adhesive Capsulitis
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Adhesive Capsulitis

• Pain esp. at night
• Limited motion
• Often diabetic

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Adhesive Capsulitis
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Frozen shoulder

• Treatment
• Physiotherapy mobilise shoulder
• MUA resistant cases

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Patellar tendinitis

• Overuse injury - Jumpers Knee
• A cause of anterior knee pain
• Patellar tendon - young athlete
• Quadriceps tendon - older athlete

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Patellar tendinitis

• Jumpers knee
• Tender at inferior pole patella

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Achilles tendinosis

• Chronic heel pain in the athlete

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Achilles tendinosis

• Treatment
• Reduce sporting activity
• Shoe heel raise

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TendinosisFlexor hallucis longus

• Pain on standing on toes
• Ballet dancers

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Shin Splints

• Pain in posterior medial border of distal tibia
• Running sports
• Differential diagnosis - stress
• fracture
• Treatment - diminish
• activity