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Adult Acquired Flatfoot Deformity (18:00) Clifford Jeng, MD Mercy Medical Center Institute for Foot and Ankle Reconstruction Baltimore, Maryland Achilles Tendon Ruptures (18:20) Clifford Jeng, MD Mercy Medical Center Institute for Foot and Ankle Reconstruction Baltimore, Maryland Pares de Fricción polietilenos (Polyethylene Bearing) [Spanish] (23:07) Enrique Gomez Barrena Cirugia Orthopedica y Traumatologia Universidad Autonoma de Madrid Madrid, Spain La magnitud de las fracturas de cadera (The Magnitude of Hip Fractures) [Spanish] (9:11) Pedro Carpintero-Benitez Department of Orthopedics University Hospital Reina Sofia Cordoba, Spain Artroplastias en las displasias y en las luxaciones de cadera (Arthoplasty in Dysplasia and Dislocation) [Spanish] (29:37) Miguel Cabanela Mayo Clinic Rochester Department of Orthopedic Surgery Rochester, MN Tritanio (Porous metals in Reconstructive Surgery) [Spanish] (25:16) Miguel Cabanela Mayo Clinic Rochester Department of Orthopedic Surgery Rochester, MN THR Ceramics on Ceramics [Spanish] (15:00) Prof. Enrique Guerado, MD Director, Department Of Orthopaedic Surgery and Traumatology Hospital Costa del Sol University of Málaga Selecciín de pacientes en las prítesis de recubrimiento [Spanish] (15:40) Dr. Xavier Gallart Hospital Clinico de Barcelona Avances en la Navegación para PTC [Spanish] (17:12) Dr. Josep Riba Hospital Clinico de Barcelona Fractures of the Pelvic Ring by Anteroposterior Mechanism (13:46) Dr. Placido Zamora-Navas Associate Professor Department of Surgery Trauma Surgeon Virgen de la Victoria University Hospital Malaga, Spain Anatomy of the Pelvis and Acetabulum (17:07) Dr. Placido Zamora-Navas Associate Professor Department of Surgery Trauma Surgeon Virgen de la Victoria University Hospital Malaga, Spain Complication of the Surgical Treatment of the Fracture of the Acetabulum (18:03) Dr. Placido Zamora-Navas Associate Professor Department of Surgery Trauma Surgeon Virgen de la Victoria University Hospital Malaga, Spain Modular Implants for Hip Replacement Revision [Spanish] (15:48) Dr. Jorge Ballester Hospital La Esperanza Barcelona, Spain Osteoporotic Fractures (13:21) Professor Rajesh Malhotra, MBBS, MS Department of Orthopedics All India Institute of Medical Sciences New Delhi, India Trauma Scoring Systems (13:39) Phil Grieve, MB, BCH, BAO, MRCSED Year 4 Specialist Registrar/Senior Resident London, England Heel pain (10:04) Clifford Jeng, MD Mercy Medical Center Institute for Foot and Ankle Reconstruction Baltimore, Maryland Gender concerns in total knee replacement (8:47) Kirby D. Hitt, MD Head of Adult Reconstruction & Joint Replacement Surgery Scott and White Hospital Temple, Texas Tarsal Tunnel Syndrome (11:29) Clifford Jeng, MD Mercy Medical Center Institute for Foot and Ankle Reconstruction Baltimore, Maryland Improving clinical recognition of the Marfan syndrome (8:10) Paul D. Sponseller, MD Professor and Head of the Division of Pediatric Orthopedics The Johns Hopkins Hospital Baltimore, Maryland Orthopedic Hyperguide Introduction (2:18) Rainer Kotz, MD Allgemeines Krankenhaus Wien Meizinische Universität Wien Dept. of Orthopaedics Wien, Austria Use of Botulinum Toxin to Prevent and Treat Post-traumatic Elbow Contractures (14:11) Melvin P. Rosenwasser, MD Professor of Orthopedic Surgery, Robert E. Carroll Professor of Hand Surgery Columbia University College of Physicians and Surgeons New York, New York Rheumatoid Arthritis of the Elbow (36:26) Charles Sorbie MB, ChB Professor of Surgery Queen’s University Kingston, Ontario, Canada General Thoughts on Subcapital Fractures of the Hip (18:21) Charles Sorbie MB, ChB Professor of Surgery Queen’s University Kingston, Ontario, Canada Compartment syndromes: Update & review (8:48) Frank J. Frassica, MD Chairman, Department of Orthopedic Surgery Chief, Adult Division and Musculoskeletal Oncology The Johns Hopkins Hospital Baltimore, Maryland Predicting fracture through benign skeletal lesions with quantitative computed tomography (4:16) Frank J. Frassica, MD Chairman, Department of Orthopedic Surgery Chief, Adult Division and Musculoskeletal Oncology The Johns Hopkins Hospital Baltimore, Maryland

Researchers Collaborate to Find a Cure for Rheumatoid Arthritis

Category: Research News

Wednesday, July 15, 2009 at 6:07:53 PM

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Over 50 rheumatoid arthritis investigators from across the country recently met in San Diego to share information and present data and results from their innovative RA projects and to brainstorm ways to work more closely together to find a cure for RA.

Viewed as one of the most common and disabling types of arthritis, RA affects nearly 1.3 million Americans. RA causes pain, stiffness, swelling, and limitation in the motion of multiple joints and can cause inflammation in other organs as well. Because of rapidly advancing research into the fundamentals of inflammation and immunity, the outlook for those suffering from RA has improved dramatically over the past 25 years. Recent advances in treatment have made it possible to stop, or at least slow the progression of joint damage though serious complications and premature death remain important complications of the disease. Much research remains to be done to uncover the cause and to find the cure for RA.

Establishing collaborations between scientists in different locations—in some cases on opposite ends of the country—and across disciplines can often be challenging, but have been invaluable in answering many important scientific questions. Therefore, the American College of Rheumatology Research and Education Foundation brought together the investigators funded through its Within Our Reach: Finding a Cure for Rheumatoid Arthritis campaign with REF leadership, promising young investigators, as well as representatives from the National Institutes of Health to allow for a fluid exchange of knowledge and information.

“This meeting presented cutting-edge research on the cause, diagnosis and treatment of rheumatoid arthritis,” says Leslie Crofford, MD, REF President. “As our current Within Our Reach investigators represent a variety of scientific disciplines, including biochemistry, immunology, molecular biology and genetics, the meeting featured a wide range of topics in the context of rheumatoid arthritis.”

The goal of the meeting, explains Dr. Crofford, “was to encourage these scientists to brainstorm and approach cross-disciplinary collaborations in order to accelerate RA research.”

One such collaboration has already resulted from the first Investigators’ Meeting, held last year, between Gregg J. Silverman, MD, of the University of California, San Diego, and William F.C. Rigby, MD, of Dartmouth College. Both have known each other for years, but bringing these physician-scientists together to discuss current research spurred ideas for new projects.

“Dr. Rigby and I have complementary perspectives and we are planning on future research projects,” says Dr. Silverman. He also comments, “it isn’t one scientist who works in isolation in their efforts to find a cure for RA, as we move even faster when we collaborate with our colleagues in other institutions. Bringing the right people together is what it is all about.”

Dr. Rigby echoes Dr. Silverman’s sentiment by saying, "one of the major strengths of a meeting such as this is that it allows an array of investigators with diverse talents, interests and strengths the time to discuss new ideas and strategies in RA therapeutics. Thus, it allows our interests to broaden through the generation of new collaborations. The provision of funds for research and the opportunity to discuss them by the Within our Reach program has resulted in major advances for RA research."

While their collaborative project is not yet formalized, Drs. Silverman and Rigby are thinking about how to better predict individual patient response to therapies already available. Dr. Silverman says, “As a clinician-scientist I think, how do I make my best clinical choice between the biologic agents available?” He continues, “getting together our different perspectives will hopefully be fruitful for advances in the future,” thus making it easier to prescribe the best possible therapy for their patients.

The Within Our Reach campaign, launched in 2006, is the largest private fundraising campaign in the REF’s history. It will tap a diverse donor base, and raise $30 million to accelerate the innovative research necessary to find a cure for RA. The campaign has received tremendous support from the pharmaceuticalindustry, biotech companies, physicians and patients, raising nearly $25 million to date.

Trigger finger

From Wikipedia, the free encyclopedia

Trigger finger
Classification and external resources
ICD-10	M65.3
ICD-9	727.03
eMedicine	orthoped/570

Trigger finger, or trigger thumb, is a type of stenosing tenosynovitis (specifically digital tenovaginitis stenosans) in which the sheath around a tendon in a thumb or finger becomes swollen, or a nodule forms on the tendon. Affected digits may become painful to straighten once bent, and may make a soft crackling sound when moved. The label of trigger finger is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun.

More than one finger may be affected at a time, though it usually affects the thumb, middle, or ring finger. The triggering is usually more pronounced in the morning, or while gripping an object firmly.

Trigger finger is usually idiopathic, meaning that the cause is unknown. Some speculate that repetitive forceful use of a digit leads to narrowing of the fibrous digital sheath in which it runs, but there is no data to support this theory and it may unfairly stigmatize hand use. The relationship of trigger finger to work activities is debatable and scientific evidence for^[1] and against^[2] hand use as an etiological factor are sparse and of low quality.

There is some evidence that idiopathic trigger finger behaves differently in patients with diabetes.^[3]

Contents [hide] 1 Treatment 2 Recovery 3 References 4 External links

[edit]Treatment

The natural history of disease for trigger finger remains uncertain.

Injection of the tendon sheath with a corticosteroid is effective over weeks to months in more than half of patients.^[4]

The problem is predictably resolved by a relatively simple surgical procedure (usually outpatient, under local anesthesia). The surgeon will cut the sheath that is restricting the tendon.

Investigative treatment options with limited scientific support include: non-steroidal anti-inflammatory drugs, occupational or physical therapy, steroid iontophoresis treatment, splinting, therapeutic ultrasound, phonophoresis (ultrasound with an anti-inflammatory dexamethasone cream), and Acupuncture.

[edit]Recovery

Recurrent triggering is unusual after successful injection and rare after successful surgery.

Difficulty extending the proximal interphalangeal joint may persist for months and benefits from exercises to stretch the finger straighter.

[edit]References

1. ^ Gorsche R, Wiley JP, Renger R, Brant R, Gemer TY, Sasyniuk TM. Prevalence and incidence of stenosing flexor tenosynovitis (trigger finger) in a meat-packing plant. J Occup Environ Med. 1998 Jun;40(6):556-60.
2. ^ 1: Kasdan ML, Leis VM, Lewis K, Kasdan AS. Trigger finger: not always work related. J Ky Med Assoc. 1996 Nov;94(11):498-9. PMID: 8973080
3. ^ Journal of Bone and Joint Surgery (American). 2007;89:2604-2611.
4. ^ Journal of Bone and Joint Surgery (American). 2007;89:2604-2611.

[edit]External links

• Hand World Trigger Finger Page
• American Academy of Orthopaedic Surgeons information on trigger finger
• Overview page from a UK surgeon
• Information from the Mayo Clinic
• Information from eMedicine

[hide] v • d • e Soft tissue disorders (M65-M79, 725-727) Connective tissue, articular (arthropathy) Tendinopathy Enthesopathy Enthesitis: upper limb (Adhesive capsulitis of shoulder, Rotator cuff tear, Golfer's elbow, Tennis elbow) · lower limb (Iliotibial band syndrome,Patellar tendinitis, Achilles tendinitis, Calcaneal spur, Metatarsalgia) · Bone spur Other/general Tendinitis · Tendinosis Synoviopathy Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) · Transient synovitis · Ganglion cyst osteochondromatosis (Synovial osteochondromatosis) · Plica syndrome villonodular synovitis (Giant cell tumor of the tendon sheath) Bursopathy Bursitis (Olecranon, Prepatellar, Trochanteric, Subacromial) · Baker's cyst Connective tissue, nonarticular Fasciopathy Fasciitis: Plantar · Nodular · Necrotizing · Eosinophilic Fibromatosis/contracture Dupuytren's contracture · Peyronie's disease · Plantar fibromatosis · Aggressive fibromatosis Adiposopathy Panniculitis/Erythema (Erythema induratum, Erythema nodosum) Other Neuropathy Neuralgia/Neuritis Undefined Rheumatism · Fibromyalgia see also neoplasia, systemic connective tissue disorders

Categories: Ailments of unknown etiology | Fingers | Inflammations

DeQuervain's syndrome, washerwoman's sprain, Radial styloid tenosynovitis, de Quervain disease, de Quervain'stenosynovitis,mother's wrist

DeQuervain's syndrome

From Wikipedia, the free encyclopedia

de Quervain Syndrome
Classification and external resources
Finkelstein's test for DeQuervain's tenosynovitis
ICD-10	M65.4
ICD-9	727.04
eMedicine	pmr/36

de Quervain syndrome (also known as washerwoman's sprain, Radial styloid tenosynovitis, de Quervain disease, de Quervain'stenosynovitis, de Quervain's stenosing tenosynovitis or mother's wrist), is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb. ^[1]

Contents [hide] 1 Eponym 2 Pathology 3 Cause 4 Symptoms 5 Treatment 6 References 7 External links

[edit]Eponym

It is named after the Swiss surgeon Fritz de Quervain who first identified it in 1895.^[2] It should not be confused with "de Quervain's thyroiditis", another condition named for the same person.

[edit]Pathology

The mucous sheaths of the tendons on the back of the wrist.

The two tendons concerned are the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles, which run side by side, have almost the same function: the movement of the thumb away from the hand in the plane of the hand--so called radial abduction (as opposed to movement of the thumb away from the hand, out of the plane of the hand (palmar abduction)). The tendons run, as do all of the tendons passing the wrist, in synovial sheaths, which contain them and allow them to exercise their function whatever the position of the wrist. While de Quervain syndrome is commonly believed to be an inflammatory condition or tendosynovitis, evaluation of histological specimens shows no inflammatory changes--rather a thickening and myxoid degeneration consistent with a chronic degenerative process are seen. ^[3] The pathology is identical in de Quervain seen in new mothers. ^[4]

de Quervain syndrome is more common in women. A speculative rationale for this is that women have a greater styloid process angle of the radius, but scientific support for this theory is lacking.

[edit]Cause

The cause of de Quervain's disease is not known. In medical terms, it remains idiopathic.

Some claim that this diagnosis should be included among overuse injuries and that repetitive movements of the thumb are a contributing factor. More specifically, repetitive eccentric lowering of the wrist into ulnar deviation especially with a load in the hand such as a child or even a stack of dishes. ^[5][6].

de Quervain's syndrome was also referred to as mother's wrist due to the fact that it can be caused by over-extending the wrist into the awkward positions that parents use to hold and handle infants. It was also nicknamed washerwoman's sprain as it can be caused by wringing motions, such as wringing out a washrag or similarly, removing the lid from a jar.

Recently cases have surfaced linked to the use of video game controlers with a so called "Analog-stick".

[edit]Symptoms

This article may contain original research or unverified claims. Please improve the article by adding references. See the talk pagefor details. (October 2008)

Symptoms are pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping.

Finkelstein's test is used to diagnose de Quervain syndrome in people who have wrist pain. To perform the test, the thumb is placed in the closed fist and the hand is tilted towards the little finger - ulna deviation (as in the picture) in order to test for pain at the wrist below the thumb. Pain can occur in the normal individual, but if severe, DeQuervain's syndrome is likely. Pain will be located on the thumb side of the forearm about an in inch below the wrist.

Differential diagnosis includes ruling out:

1. Osteoarthritis of the first carpo-metacarpal joint
2. Intersection syndrome - pain will be more towards the middle of the back of the forearm and about 2-3 inches below the wrist
3. Wartenberg's syndrome

[edit]Treatment

The management of De Quervain’s disease is determined more by convention than scientific data. From the original description of the illness in 1895 until the first description of corticosteroid injection by Christie in 1955^[7], it appears that the only treatment offered was surgery.^{[8] [9][10]} Since approximately 1972 the prevailing opinion has been that of McKenzie (1972) who suggested that corticosteroid injection was the first line of treatment and surgery should be reserved for unsuccessful injections.^[11] However, data regarding the efficacy of corticosteroid injection is sparse and uncontrolled (Oxford Level of Evidence 4) and it is not clear that there is a benefit over the natural history of the illness. A structured review published in 2003 identified only 35 publications that addressed De Quervain’s on Medline, only 7 of which presented data regarding corticosteroid injection, and none of which were controlled studies.^[12]

Retrospective studies all report success rates for corticosteroid injection greater than 70%, but the one prospective cohort study noted a success rate of only 58% and many of those patients took 12 to 18 months until symptom resolution.^[13] While the authors of that study ascribed the failure of corticosteroid injection to anatomical variations, it has not been clearly established that corticosteroid injection is better than placebo or that a symptom course of 12 to 18 months is any better than the natural course of the illness.

Another commonly used criterion for failure of non-operative treatment is election of operative treatment, but the decision to operate is complex and biased by the beliefs and emotions of the surgeon and the patient. Use of an elective event such as surgery to define success makes data regarding nonoperative treatment difficult to interpret. For instance, in one of the two investigations in which a substantial number of patients were treated without injection (splints and anti-inflammatory medication alone were used), a remarkable 45 of 93 (48%) of patients in all non-operative treatment groups had surgery. ^[14] This may simply reflect frustration on the part of both the patient and the surgeon with the prolonged symptom course associated with the disease. It may appear to both patient and surgeon that, after many months of symptoms, the illness will never resolve. The data of Lane and colleagues ^[15] indicating that non-operative treatment is successful only in mild cases is similarly marred by the lack of patients randomly assigned to alternative treatments and the use in many patients of a decision for surgery as a failure criterion.

Most tendinoses are self-limiting and the same is likely to be true of de Quervain's although further study is needed.

Palliative treatments include a splint that immobilized the wrist and the thumb to the interphalangeal joint and anti-inflammatory medication or acetaminophen.

Surgery (in which the sheath of the first dorsal compartment is opened longitudinally) is documented to provide relief in most patients.^[16] The most important risk is to the radial sensory nerve.

[edit]References

1. ^ Ilyas A, Ast M, Schaffer AA, Thoder J (2007). "De quervain tenosynovitis of the wrist". J Am Acad Orthop Surg 15 (12): 757–64. PMID 18063716.
2. ^ Ahuja NK, Chung KC (2004). "Fritz de Quervain, MD (1868-1940): stenosing tendovaginitis at the radial styloid process". J Hand Surg [Am] 29 (6): 1164–70. doi:10.1016/j.jhsa.2004.05.019. PMID 15576233.
3. ^ Clarke MT, Lyall HA, Grant JW, Matthewson MH (December 1998). "The histopathology of de Quervain's disease". J Hand Surg [Br] 23 (6): 732–4. PMID 9888670.
4. ^ Read HS, Hooper G, Davie R (February 2000). "Histological appearances in post-partum de Quervain's disease". J Hand Surg [Br] 25 (1): 70–2. doi:10.1054/jhsb.1999.0308. PMID 10763729.
5. ^ "Weiss Orthopaedics - Common Injuries - Wrist/Hand - de Quervain Stenosing Tenosynovitis".
6. ^ "OSH Answers: De Quervain's Disease".
7. ^ Christie BG. Local hydrocortisone in de Quervain's disease. Br Med J 1955 Jun 25;1(4929):1501-3.
8. ^ Christie BG. Local hydrocortisone in de Quervain's disease. Br Med J 1955 Jun 25;1(4929):1501-3.
9. ^ Piver JD, Raney RB. De Quervain's tendovaginitis. Am J Surg 1952 Mar;83(5):691-4.
10. ^ Lamphier TA, Long NG, Dennehy T. De Quervain's disease: an analysis of 52 cases. Ann Surg 1953 Dec;138(6):832-41.
11. ^ McKenzie JM. Conservative treatment of de Quervain's disease. Br Med J 1972 Dec 16;4(5841):659-60.
12. ^ Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract 2003 Mar-Apr;16(2):102-6.
13. ^ Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991 Feb;73(2):219-22.
14. ^ Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg [Am] 1994 Jul;19(4):595-8.
15. ^ Lane LB, Boretz RS, Stuchin SA. Treatment of de Quervain's disease:role of conservative management. J Hand Surg [Br] 2001 Jun;26(3):258-60.
16. ^ Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg [Am] 1994 Jul;19(4):595-8.

[edit]External links

• Hand University: A Patient's Guide to de Quervain Tenosynovitis
• DeQuervain's Syndrome: Medical Imagery - Medical Art and Illustration
• -1744437193 at GPnotebook
• Computer related diseases and prevention methods

[hide] v • d • e Soft tissue disorders (M65-M79, 725-727) Connective tissue, articular (arthropathy) Tendinopathy Enthesopathy Enthesitis: upper limb (Adhesive capsulitis of shoulder, Rotator cuff tear, Golfer's elbow, Tennis elbow) · lower limb (Iliotibial band syndrome,Patellar tendinitis, Achilles tendinitis, Calcaneal spur, Metatarsalgia) · Bone spur Other/general Tendinitis · Tendinosis Synoviopathy Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) · Transient synovitis · Ganglion cyst osteochondromatosis (Synovial osteochondromatosis) · Plica syndrome villonodular synovitis (Giant cell tumor of the tendon sheath) Bursopathy Bursitis (Olecranon, Prepatellar, Trochanteric, Subacromial) · Baker's cyst Connective tissue, nonarticular Fasciopathy Fasciitis: Plantar · Nodular · Necrotizing · Eosinophilic Fibromatosis/contracture Dupuytren's contracture · Peyronie's disease · Plantar fibromatosis · Aggressive fibromatosis Adiposopathy Panniculitis/Erythema (Erythema induratum, Erythema nodosum) Other Neuropathy Neuralgia/Neuritis Undefined Rheumatism · Fibromyalgia see also neoplasia, systemic connective tissue disorders

Categories: Overuse injuries | Inflammations

A Patient's Guide to de Quervain's Tenosynovitis Introduction de Quervain's tenosynovitis is a condition that causes pain on the inside of the wrist and forearm just above the thumb. It is a common problem affecting the wrist and is usually easy to diagnose. This document will help you understand • how this condition starts • how to recognize the symptoms • what can be done to stop the pain Anatomy What part of my thumb and wrist is causing problems? de Quervain's tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus(APL) and the extensor pollicis brevis (EPB). Tendons connect muscle to bone. Muscles pull on tendons for movement. The muscles connected to the APL and EPB tendons are on the back of the forearm. The muscles angle toward the thumb. View close-up of anatomy. On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole. View tunnel image. This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. In de Quervain's tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel. Causes How did this condition develop? Repeatedly performing hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis. This inflammation can lead to swelling, which hampers the smooth gliding action of the tendons within the tunnel. Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. In other cases, scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel. Symptoms What problems does this condition cause? At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn't treated, pain may spread up the forearm or further down into the wrist and thumb. As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. If the condition is especially bad, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful. Diagnosis What tests will my doctor want to do? Doctors usually diagnose de Quervain's tenosynovitis easily through a physical examination. Most of the time no fancy tests are required. The major problem can be distinguishing de Quervain's tenosynovitis from intersection syndrome, which is a very similar condition. Document Link: A Patient's Guide to Intersection Syndrome Careful attention must be paid to where the pain is located--over de Quervain's tunnel near the end of the radius bone, or over the intersection point on the wrist. The intersection point is about three inches up the forearm. The Finklestein test is one of the best ways to make the diagnosis. You can do this test yourself. Bend your thumb into the palm and grasp the thumb with your fingers making a fist with the thumb inside. Now bend your wrist away from your thumb in a side to side motion. If you feel pain over the tendons to the thumb, your problem may be de Quervain's tenosynovitis. Treatment How can I make the pain go away? Conservative Treatment If at all possible, you must change or stop all activities that cause your symptoms. Take frequent breaks when doing repeated hand and thumb actions. Avoid repetitive hand motions, such as heavy grasping, wringing, or turning and twisting movements of the wrist. Keep the wrist in a neutral alignment. In other words, keep it in a straight line with your arm, without bending it forward or backward. Your doctor may want you to wear a special forearm and thumb splint called a thumb-spica splint. This splint keeps the wrist and lower joints of the thumb from moving. The splint allows the APL and EPB tendons to rest, giving them a chance to begin to heal. Anti-inflammatory medications may also help control the swelling of the tenosynovium and ease symptoms. These medications include common over-the-counter medications such as ibuprofen and aspirin. If these simple measures fail to control your symptoms, your doctor may suggest an injection ofcortisone into the irritated tunnel. Cortisone reduces the swelling of the tenosynovium and may temporarily relieve your symptoms. Cortisone injections will usually control the inflammation in the early stages of the problem. Your doctor may have you work with a physical or occupational therapist. The main focus of therapy is to reduce or eliminate the cause of irritation of the thumb tendons. Your therapist may check your workstation and the way you do your work tasks. Suggestions may be given about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems. Surgical Treatment If all else fails, your doctor may recommend surgery. The goal of surgery is to give the tendons more space so they no longer rub on the inside of the tunnel. To do this, the surgeon performs a surgical release of the roof of the tunnel. This surgery can usually be done as an outpatient, which means that you won't have to spend the night in the hospital. It can be done using a general anesthetic, which puts you to sleep, or a regional anesthetic. A regional anesthetic blocks the nerves going to only a certain part of the body. Injection of medications similar to novocaine can block the nerves for several hours. In surgery for de Quervain's tenosynovitis, you may get an axillary block, which puts the arm to sleep, or a wrist block, which puts only the hand to sleep. It is even possible to perform the surgery by simply injecting novocaine around the area of the incision. Once you have anesthesia, your surgeon will make sure the skin of your forearm and wrist is free of infection by cleaning the skin with a germ-killing solution. The first step in the surgical release is to make a small incision along the thumb side of the wrist. View steps of surgery: 1. Incision site. The surgeon moves aside other tissues and locates the tendons and the tunnel. An incision is made to split the roof, or top, of the tunnel. This allows the tunnel to open up, creating more space for the tendons. The tunnel will eventually heal closed, but it will be larger than before. Scar tissue will fill the gap where the tunnel was cut. 2. Tunnel opened The skin is then stitched together, and your hand is wrapped in a bulky dressing. Rehabilitation What can I expect after treatment? If conservative treatment is successful, you may see improvement in four to six weeks. You may need to continue wearing your thumb splint to control symptoms. Try to do your activities using healthy body and wrist alignment. Limit activities that require repeated motions of the wrist and thumb. View splint. Rehabilitation is more involved after surgery. Full recovery could take several months. Pain and symptoms generally begin to improve after surgery, but you may have tenderness in the area of the incision for several months. Take time during the day to support your arm with your hand elevated above the level of your heart. You should move your fingers and thumb occasionally during the day. Keep the dressing on your hand until you return to the doctor. Avoid getting the stitches wet. Your stitches will be removed ten to fourteen days after surgery. You will probably need to attend occupational or physical therapy sessions for six to eight weeks. You'll begin doing active hand movements and range-of-motion exercises. Therapists also use ice packs, soft-tissue massage, and hands-on stretching to help with the range of motion. When the stitches are removed, you may start carefully strengthening your hand and thumb by squeezing and stretching putty. Therapists also use a series of gentle stretches to encourage the thumb tendons to glide easily within tunnel. As you progress, your therapist will give you exercises to help strengthen and stabilize the muscles and joints in the hand and thumb. Other exercises are used to improve fine motor control and dexterity. Some of the exercises you'll do are designed get your hand working in ways that are similar to your work tasks and sport activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your thumb and wrist. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.
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Carpometacarpal bossing

From Wikipedia, the free encyclopedia

Carpometacarpal bossing is a condition in the small, immovable mass of bone called the carpometacarpal joint^[1] and occurs when this joint becomes swollen or bossed. The carpometacarpal joint is usually found at the base of the second and third metacarpal bones at the point where they meet the small bones of the wrist.^[2] This condition can result in sensitivity in the immediate area and/or an unsightly bulge on the back of the hand. In most cases, the boss does not result in any injury or further problems, but in some cases, the patient may feel pain, aching, or even possibly a slight lack of mobility in the wrist joint.^[3] Often, this condition will be mistaken for a ganglion cyst due to its location and external appearance.

A carpometacarpal boss may exist from birth or may be the result of a trauma or injury in the affected area. There are also indications that those with careers involving repetitive movements in the hands and fingers may develop this condition. Typically, this condition will begin to show itself in the 3rd or 4th decade.

Second metacarpal bone

Third metacarpal bone

[edit]Footnotes

1. ^ "The Carpal Boss: An Overview of Radiographic Evaluation". radiology.rsnajnls.org. Retrieved on 2008-06-15.
2. ^ Walker, M.D., Lorenzo G.. "CARPOMETACARPAL BOSS". www.handoc.net. Retrieved on 2008-06-15.
3. ^ B. Jagannath Kamath &, Praveen Bhardwaj. "Carpal Bossing With Trapezium-Trapezoid Fusion". www.ispub.com. Retrieved on 2008-06-15.

[edit]External links

• Carpometacarpal Boss (includes diagrams)
• Carpal Boss: An Overview of Radiographic Evaluation
• Electronic Doctor^[dead link]
• eMedicine from WebMD

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Categories: Upper limb anatomy | Medical sign stubs

Ganglion cyst

From Wikipedia, the free encyclopedia

Ganglion cyst
Classification and external resources
Cyst on right wrist
ICD-10	M67.4
ICD-9	727.4
DiseasesDB	31229
eMedicine	orthoped/493

A ganglion cyst (also known as a bible bump) is a swelling that often appears on or around joints and tendons in the hand or foot. The size of the cyst can vary over time. It is most frequently located around the wrist and on the fingers. The term "Bible Bump" comes from a commonurban legend that treatment by pounding on the cyst with a Bible or another large book occurred in the past.^[1]

Contents [hide] 1 Cause 2 Treatment 3 Epidemiology 4 Image gallery 5 See also 6 References 7 External links

[edit]Cause

Ganglion cysts are idiopathic, but presumably reflect a variation in normal joint or tendon sheath function. Cysts near joints are connected to the joint and the leading theory is that a type of check valve forms that allows fluid out of the joint, but not back in. The cyst contains clear fluid similar to, but thicker than normal synovial fluid. They are most often found around the wrist joint, especially at the scapho-lunate joint, which accounts for 80% of all ganglion cysts.

As with many other hand conditions, some speculate that arm use can increase the risk of ganglion formation ^[2] but there is no scientific evidence to support this claim, and it may unfairly stigmatize arm use.

[edit]Treatment

If a ganglion cyst is symptomatic, it can be managed by aspiration or excision. Aspiration of the cyst is the simpler of the two procedures, but cysts recur in more than 50% of cases. With surgery, the recurrence rate is reduced to only 5 to 10% if the check valve at the joint capsule is removed.

- Arthroscopy of the wrist is becoming available as an alternative to open excision of ganglion cysts. During arthroscopy, the origin of the cyst can be seen within the joint.

- An urban legend states that the traditional method of treating a ganglion cyst was to strike the lump with a large, heavy book, causing the cyst to rupture and drain into the surrounding tissues.^[3] Since even the poorest households often possessed a Bible (referring to the large family Bibles), this was commonly used, which led to the nicknaming of ganglion cysts as "Bible Bumps" or "Gideon's Disease."

[edit]Epidemiology

The epidemiology is not well studied, but some have stated that they occur most often in the 20–60 age group and are three times more common in women.^[4] They can also occur in teenagers.

[edit]Image gallery

[edit]See also

• Ganglion
• Carpometacarpal bossing

[edit]References

1. ^ http://www.eatonhand.com/hw/hw013.htm
2. ^ Browse NL (1997) Symptoms and Signs of Surgical Disease. 3rd ed. London: Arnold.
3. ^ http://www.eatonhand.com/hw/hw013.htm
4. ^ eMedicine - Ganglion Cyst : Article by George J Kouris

[edit]External links

• Ganglions (cysts) of the wrist - American Academy of Orthopaedic Surgeons
• A Patient's Guide to Ganglions of the Wrist
• Ganglion cyst - Canadian Centre for Occupational Health and Safety
• Ganglion cyst - eMedicine.com
• Ganglion Cyst - medscape.com

[hide] v • d • e Soft tissue disorders (M65-M79, 725-727) Connective tissue, articular (arthropathy) Tendinopathy Enthesopathy Enthesitis: upper limb (Adhesive capsulitis of shoulder, Rotator cuff tear, Golfer's elbow, Tennis elbow) · lower limb (Iliotibial band syndrome,Patellar tendinitis, Achilles tendinitis, Calcaneal spur, Metatarsalgia) · Bone spur Other/general Tendinitis · Tendinosis Synoviopathy Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) · Transient synovitis · Ganglion cyst osteochondromatosis (Synovial osteochondromatosis) · Plica syndrome villonodular synovitis (Giant cell tumor of the tendon sheath) Bursopathy Bursitis (Olecranon, Prepatellar, Trochanteric, Subacromial) · Baker's cyst Connective tissue, nonarticular Fasciopathy Fasciitis: Plantar · Nodular · Necrotizing · Eosinophilic Fibromatosis/contracture Dupuytren's contracture · Peyronie's disease · Plantar fibromatosis · Aggressive fibromatosis Adiposopathy Panniculitis/Erythema (Erythema induratum, Erythema nodosum) Other Neuropathy Neuralgia/Neuritis Undefined Rheumatism · Fibromyalgia see also neoplasia, systemic connective tissue disorders

Categories: Musculoskeletal disorders

Baker's cyst

From Wikipedia, the free encyclopedia

Baker's cyst
Classification and external resources
ICD-10	M71.2
ICD-9	727.51
DiseasesDB	1224
MedlinePlus	001222
eMedicine	radio/72

A Baker's cyst, otherwise known as a popliteal cyst, is a benign swelling of the semimembranous bursa found behind the knee joint. It is named after the surgeon who first described it, Dr. William Morrant Baker (1838-1896).^[1]

Contents [hide] 1 Etiology 2 Treatment 2.1 Cryotherapy 2.2 Medication 2.3 Heat 2.4 Bracing 2.5 Rest and specific exercise 3 References 4 Footnotes 5 External links

[edit]Etiology

In adults, Baker's cysts usually arise from almost any form of knee arthritis and cartilage (particularly the meniscus) tear. Baker's cysts can be associated with Lyme disease. Baker's cysts in children do not point to underlying joint disease. Baker's cysts arise between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles. They are posterior to the medial femoral condyle.

The synovial sack of the knee joint can, under certain circumstances, produce a posterior bulge, into the popliteal space, the space behind the knee. When this bulge becomes large enough, it becomes palpable and cystic. Most Baker's cysts maintain this direct communication with the synovial cavity of the knee, but sometimes, the new cyst pinches off. A Baker's cyst can rupture and produce acute pain behind the knee and in the calf and swelling of the calf muscles.

Diagnosis is by examination. They are easier to see from behind with the patient standing with knees fully extended and then most easily felt with the knee partially flexed. Diagnosis is that may mimic thrombophlebitis or a potentially life-threatening deep vein thrombosis (DVT) which may need to be excluded by urgent blood tests and ultrasonography. Although an infrequent occurrence, a Baker's cyst can compress vascular structures and cause leg edema and a true DVT.

[edit]Treatment

Baker's cysts usually require no treatment unless they are symptomatic. Often rest and leg elevation are all that is needed. If necessary, the cyst can be aspirated to reduce its size, then injected with a corticosteroid to reduce inflammation. Surgical excision is reserved for cysts that cause a great amount of discomfort to the patient. A ruptured cyst is treated with rest, leg elevation, and injection of a corticosteroid into the knee. Recently, prolotherapy (in use at the Mayo Clinic since 2005) has shown encouraging results as an effective way to treat Baker's cysts and other types of musculoskeletal conditions.^[2][3]

Baker's cysts in children, unlike in older people, nearly always disappear with time, and rarely require excision.

[edit]Cryotherapy

Ice pack therapy is believed to be an effective way of controlling the pain caused by Baker's cyst.^{[citation needed]} Ice must not be applied directly onto the skin but be separated by a thin cloth. Alternatively, cooling packs may be used, but the total application time for any product is for no more than 15 minutes at a time.

[edit]Medication

Medications bought at pharmacies may be used to help soothe pain. Painkillers with paracetamol, a.k.a. tylenol (acetaminophen), or with the additional anti-inflammatory action (such asibuprofen or naproxen), may be used. Stronger non-steroidal anti-inflammatory drugs may be required by prescription from one's general practitioner.

[edit]Heat

Heat is also a recognised treatment.^{[citation needed]} The application of a heating pad on a low setting for 10-20 minutes may relieve some pain, but only if instructions are followed carefully.

[edit]Bracing

A knee brace can offer support, but relieve pain by stimulating nerve fibre,^{[citation needed]} giving the feel of stability in the joint. If only support is necessary, a simple elastic bandage is recommended; however, braces compress the back of the knee, where it is most tender, and can cause pain.

[edit]Rest and specific exercise

Many activities can put strain on the knee, and cause pain in the case of Baker's cyst. Avoiding activities such as squatting, kneeling, heavy lifting, climbing, and even running can help prevent pain. Despite this, some exercises can help relieve pain, and a physiotherapist may instruct on stretching and strengthening the quadriceps and/or the patellar ligament.