bimm talk may2011

8/6/2019 Bimm Talk May2011

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AIMSAND OBJECTIVESAim ² to understand the pract ice of common hand cond itions in pr imary care

Object ives

1. To list the common hand cond itions in pr imary care

2. Diagnoses and assess these cond itions

3. Descr ibe the management of these

4. Able to perform s imple hand procedures in pr imary care

5. Develop a personal profess ional de velopment plan in hand surgery for your pract ice



COMMON CONDITIONSChronic tenosyno vitisTr igger f inger De Quer vain`s tenosyno vitisGanglia

Tenn is elbowOlecranon burs itisCarpal & Cubital Tunnel SyndromeOA Hand jointsRotator cuff tend initis

Subacrom ial impingementFrozen shoulder AC joint d isease



RESOLUTIONFIBROSISCHRONICITYSPREADEXUDATE



PATHOLOGY



PARAESTHESIACTS video 2

Cubital tunnel video

Thorac ic outlet syndrome

Rad ial Tunnel syndrome

Cer vical Disc degenerat ive disease



TOS



DIAGNOSIS



MANAGEMENT



RADIAL TUNNEL SYNDROME



CUBITAL TUNNEL SYNDROME



INJECTION VIDEO



CARPAL TUNNEL SYNDROME



DIFFERENTIAL DIAGNOSIS



RADIAL SIDED WRIST PAIN



OA HANDS



ULNAR SIDEDW RIST PAINECU TENDINITIS



DRUJ OA



TRAUMATIC SYNOVITIS PIP J



TRIGGER DIGITS



TRIGGER FINGER T

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D

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GANGLION



THANK YOU

WWW .HANDSURGERYMANUAL.COM

USER NAME : GUESTPASSW ORD: HANDS

[email protected]



INJECTIONS

W HY?Very useful modal ity and immensely apprec iated by pat ients

Minimal system ic effect

Maximal Local effects



PREPARATIONS

soluble - l ittle role in inf iltration

(e.g., hydrocort isone)depot - crystall ine, bulky, and relat ively imper vious to degrad ing enzymes(methylpredn isolone acetate, tr iamc inolone aceton ide, tr iamc inolone hexaceton ide)



POTENCIES

methylpredn isolone acetate has a shorter durat ion of act ion (isrelatively more soluble) than tr iamc inolone hexaceton ide.

cost of tr iamc inolone hexaceton ide, however, is 3-4 times that of methylpredn isolone

Methylprednisolone ² reser ved for superf icial structures such assubcutaneous bursae and flexor tendon sheaths, and when there isconcern about tendon rupture, e.g., rotator cuff tend initis andretrocalcaneal ( Ach illes) bursa inject ions.

Tr iamc inolone hexaceton ide - more effect ive in reduc ing stubborn

syno vitis in a rheumato id knee, wr ist, elbow, or shoulder .



GUIDELINES FOR DOSAGE/VOLUME OFINFILTRATION

Knee 40-80 mg 3-10ml

Glenohumeral jo int 40-80 mg 3-10 ml

Subacrom ial bursa 20-40 mg 3-5 mlAcrom ioclavicular jo int 10 mg 1-2 ml

Olecranon bursa 20 mg 2 ml

Trochanter ic bursa 20-40 mg 2-5 mlTr igger f inger 10 mg 1 ml

Region Dosage (methylprednisolone acetate or triamcinolone acetonide)Region Dosage (methylprednisolone acetate or triamcinolone acetonide) Volume (corticosteroid + lidocaine) Volume (corticosteroid + lidocaine)



TECHNIQUEEffective ster ilizat ion - 70-92% ethyl alcohol or povidone- iod ine solut ion (Betad ine)

local anesthet ic, e.g., lidoca ine 1% or 2%, can be used concom itantly

Rest ing an injected jo int for 24-48 hours follow ing inf iltration helps to conf ine thecort icostero id to the injected s ite and enhances local act ion



GANGLIONAsp irate

Surgery

Digital Block

Digital Tourn iquet



DIGITSTr igger Digits video

OA PIP and DIP video

Synovitis ² R A, gout



ADVERSE EFFECTS

Post- inject ion flare

5% of articular inf iltrations and a much larger proport ion of soft t issueinf iltrations .

Rx - single dose of a nonstero idal ant i-inflammatory drug or w ith the use of cold packs



ADVERSE EFFECTS -CONT.

Skin atrophy,

hypop igmentat ion,

fat pad atrophy, and

tendon ruptureAll above genera ll y due to poor techn ique.

Infection ² rare

Vasovaga l Anaphy l axis ² rare Rx - ep inephr ine



GENERAL SIDE EFFECTSDiabet ics - trans ient hyperglycem ia,

Arter ial hypertens ion,

Chronic adrenal suppress ion,

Iatrogen ic Cush ing's syndrome,

Menstrual irregular ities,Osteoporos is,

Avascular necros is of bone ² femoral head, K ienboch·s etc

bimm talk may2011

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