DEFORMITY OF UPPER EXTREMITYNURYANI SIDARTA

UPPER EXTREMITY

DEFORMITY

MALLET FINGERDUPUYTRENS CONTRACTUREDEQUERVAIN TENOSINOVYTISTRIGGER FINGERRHEUMATOID ARTHRITISINTRINSIC MUSCLE TIGHTNESS

MALLET FINGER

MALLET FINGER

BASE BALL FINGERAN ABNORMAL FLEXION DEFORMITY AT THE DIP JOINT

BASE BALL FINGER

MALLET FINGERHilangnya kekuatan ekstensor pada DIP jointM.fleksor digit prof ; menarik DIP ke arah fleksiTerjadi akibat gerak fleksi mendadak pada posisi DIP joint ekstensiDapat diserta fraktur avulsiPenatalaksanaan; splinting DIP J selama 8 minggu

TREATMENTINITIALREHABILITATIONSURGERY

TRIGGER FINGER

TRIGGER FINGERAN INFLAMMATION OF THE TENDONS THAT FLEX THE FINGERSAS THE SNAPPING, TRIGGERING OR LOCKING OF A FINGER AS IT IS FLEXED AND EXTENDED

TRIGGER FINGERDUE TO LOCALIZED INFLAMMATION OR A NODULAR SWELLING OF THE FLEXOR TENDON SHEATH THAT DOES NOT ALLOW THE TENDON TO GLIDE NORMALLY BACK AND FORTH UNDER A PULLEYOFTEN ENCOUNTERED IN PATIENT WITH DIABETES AND RADUE TO REPETITIVE TRAUMA

SYMPTOMSPAIN IN THE PIP FINGERSWELLING, STIFFNESS IN FINGERS , PARTICULARLY IN THE MORNING

SYMPTOMS

INTERMITTENT LOCKING IN FLEXION OR EXTENSION OF THE DIGIT, WHICH IS OVERCOME WITH FORCEFUL VOLUNTARY EFFORT OR PASSIVE ASSISTANCELOSS OF RANGE OF MOTION

PHYSICAL EXAMINATIONTENDERNESS TENDER NODULE OVER THE VOLAR ASPECT OF THE MCP HEADSWELLING OF THE FINGERPAINFUL CLICKING WHILE MCP FLEXEDCHRONIC : JOINT FLEXION CONTRACTURE

FUNCTIONAL LIMITATIONDIFFICULTY WITH GRASPING AND FINE MANIPULATION OF OBJECTS DUE TO PAIN, LOCKING OR BOTHDIFFICULTY WITH INSERTING A KEY INTO A LOCK, TYPING OR BUTTONING A SHIRTGRASPING TOOLS AT HOME OR AT WORK

TREATMENTINITIALREHABILITATIONSURGERY

INITIAL TREATMENTGOAL : RESTORE THE NORMAL GLIDING OF THE TENDON THROUGH THE PULLEY SYSTEMLOCAL STEROID INJECTIONSPLINTING OF THE MCP AT 10 TO 15 DEGREES OF FLEXION WITH PIP AND DIP JOINT FREE, FOR UP TO 6 WEEKS CONTINOUSLYICING, NSAID

REHABILITATIONGOAL : INCREASING FUNCTION AND DECREASING INFLAMMATION AND PAINICE MASSAGE, CONTRAST BATHS, US, IONTOPHORESIS WITH LOCAL STEROID USECUSTOM SPLINT

SURGERYRELEASE OF A1 PULLEYSUCCESS RATE : 94% GOOD OR EXCELLENT RESULTS

de Quervain Tenosynovitis

de Quervain TenosynovitisAS INFLAMMATION OF A TENDON AND ITS ENVELOPING SHEATHAS A STENOSING TENOSYNOVITIS OF THE SYNOVIAL SHEATH OF TENDONS OF ABDUCTOR POLLICIS LONGUS AND EXTENSOR POLLICIS BREVIS IN THE FIRST COMPARTMENT OF THE WRIST DUE TO REPETITIVE USE

de Quervain TenosynovitisCHARACTERIZED BY DEGENERATION AND THICKENING OF THE TENDON SHEATH IT IS NOT AN ACTIVE INFLAMMATORY CONDITION

de Quervain TenosynovitisPIANO PLAYINGSEWINGKNITINGTYPINGBOWLINGGOLFINGFLY-FISHING

de Quervain TenosynovitisPRIMARILY AFFECTS WOMEN (10:1)BETWEEN THE AGES OF 35 AND 55 YEARS

SYMPTOMPAIN IN THE LATERAL WRIST DURING GRASP AND THUMB EXTENSIONPAIN IN PALPATION OVER THE LATERAL WRISTSYMPTOMS ARE OFTEN PERSISTENT FOR SEVERAL WEEKS OR ONTHSHISTORY OF CHRONIC OVERUSE OF THE WRIST AND HANDSTIFFNESS OR NEURALGIA LIKE COMPLAINT

PELOCAL TENDERNESS MODERATE SWELLINGAROUND THE RADIAL STYLOID POSITIVE FINKELSTEIN TESTA COMPREHENSIVE EXAM OF THE NECK AND UPPER EXTREMITY SHOULD BE PERFORMED

FUNCTIONAL LIMITATIONDIFFICULTY IN DRESSINGFASTENING OF BUTTONSSEWINGKNITTING

TREATMENTINITIAL REHABILITATIONSURGERY

INITIALICENSAIDHEATSPLINT STRAPPINGRESTMASSAGE

REHABILITATIONREDUCE PAINTO IMPROVE FUNCTION OF THE AFFECTED HANDPHYSICAL MODALITIESSTEROID INJECTIONTHUMB SPICA

SURGERYINCISION OF THE SKINSLITTING OR REMOVAL OF A STRIP OF TENDON SHEATHSUCCESS RATE : 83-92%

DUPUYTRENS CONTRACTURE

DUPUYTRENS CONTRACTURE

DUPUYTREN CONTRACTUREA NON MALIGNANT FIBROPROLIFERATIVE DISEASE CAUSING PROGRESSIVE AND PERMANENT CONTRACTURE OF THE PALMAR FASCIAUSUALY IN FOURT AND FIFTH DIGITS ON THE ULNER SIE OF THE HAND

DUPUYTREN CONTRACTUREHAVE A GENETIC PREDISPOSITION IS BELIEVED TO BE INHERITED AS AN AUTOSOMAL DOMINANT TRAIT WITH VARIABLE PENETRANCEMORE COMMON IN VIKING, RARE IN NONWHITE POPULATIONCOMMONLY IN ELDERLYASSOCIATION WITH DM, SMOKING,ALCOHOL COMSUMPTION, HIV.

SYMPTOMSPAINLESS ONSET AND PROGRESSIONDECREASED RANGE OF MOTIONLOSS OF DEXTERITYGETTING THE HAND CAUGHT WHEN TRYING TO PLACE IT ON ONES PANT-POCKETABRASIONS OR ECCHYMOSIS OF THE DIP AND PIPIMMOBILITY

Dupuytrens contracture (1)

TREATMENTINITIALREHABILITATIONSURGERY

HAND RHEUMATOID ARTHRITISA SYSTEMIC INFLAMMATORY DISORDER OF UNKNOWN ETIOLOGYIT IS A PROGRESSIVE CONDITION THAT RESULTS IN DEFORMITY AND DYSFUNCTION WHEN SYNOVIAL INFLAMMATION ERODES CARTILAGE, BONE AND SOFT TISSUEES

SYMPTOMSPAINSTIFFNESS AND SWELLINGINVOLVING PIP AND MCP JOINTSPARING DIP JOINTMAY RESULT IN PROGRESSIVE DEFORMITY AND DISABILITY

PHYSICAL EXAMINATIONJOINT PAIN & INFLAMMATIONJOINT STABILITYLIMITATION IN ACTIVE AND PASSIVE RANGE OF MOTION STRENGTH DEFICITS IN PINCH AND GRIPLIMITATION IN HAND DEXTERITYTYPICAL HAND DEFORMITY

HAND DEFORMITYBOUTONNIERE DEFORMITYSWAN NECK DEFORMITY

TREATMENT RAINITIALREHABILITATIONSURGERY

BOUTONNIERE DEFORMITYCOMMON IN PATIENTS WITH RHEUMATOID ARTHRITISMAY OCCUR FOLLOWING TRAUMA OR OTHER INFLAMMATORY ARTHRITIDES

BOUTONNIERE DEFORMITYCHARACTERIZED BY PROXIMAL INTERPHALANGEAL (PIP) JOINT FLEXION, DISTAL INTERPHALANGEAL (DIP) JOINT EXTENSION HYPEREXTENSION OF THE MCPVOLAR SUBLUXATION OF THE LATERAL BANDS

BOUTONNIERE DEFORMITY

TREATMENTINDIVIDUALIZEDBASED ON THE PATIENTS CURRENT LEVEL OF FUNCTION, DEFORMITY, MEDICAL STATUS, LIMITATIONS OF THE SURGEON AND EXPECTATIONS

SWAN NECK DEFORMITY

SWAN NECK DEFORMITYHiperekstensi PIPJ, fleksi DIPJAkibat stretch sisi volar dalam posisi PIPJ ekstensi, disertai kontraktur otot intrinsikPenyebab: synovitis, RATerapi: operatif; mengurangi kekakuan otot intrinsik

Yang termasuk otot intrinsik tanganM. interosseiM. lumbricalesM. hypotenar

Intrinsic plus positionIntrinsic minus positionMCP J ekstensi terjadi fleksi DIP J Dapat terjadi jika ada paralisis m. intrinsikFleksi MCP J yang disebabkan oleh otot lumbricales dan interosseiMCP J : fleksiPIP dan DIP J: ekstensiPosisi ideal untuk immobilisasi tangan

Penatalaksanaan intrinsic minus position Koreksi secara operatifCapsulodesis MCPJ untuk mencegah hiperekstensi MCPJ otot ekstensor ekstrinsik dapat melakukan ekstensi DIPJTendon transfer memungkinkan ekstensi PIPJ dan fleksi MCPJ

Intrinsik muscle tightnessKontraktur otot lumbricales dan interosseiTidak dapat melakukan fleksi IPJ pada saat ekstensi MCPJ (Bunnel-Littler Test)Penyebab; RA, cedera tanganTerapi: operatif

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