common hand problems related to work prasad g. kilaru md plastic, reconstructive & hand surgery
TRANSCRIPT
![Page 1: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/1.jpg)
COMMON HAND COMMON HAND PROBLEMS RELATED PROBLEMS RELATED
TO WORKTO WORK
Prasad G. Kilaru MD
Plastic, Reconstructive & Hand Surgery
![Page 2: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/2.jpg)
![Page 3: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/3.jpg)
AgendaAgenda
Injury typesBasic anatomy Mechanism of actionDiagnosisTreatment Prevention Education
![Page 4: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/4.jpg)
Repetitive Stress InjuryRepetitive Stress Injury Nerve:
– Carpal tunnel syndrome, cubital tunnel syndrome
Tendon: Connects muscle to bone– Repetitive injury at muscle insertion
Trigger digit, DeQuervain’s tenosynovitis
– Repetitive injury at muscle origin Lateral epicondylitis, Medial epicondylitis
Ligament: Connects bone to bone– Chronic collateral ligament injury, TFCC injury
Joint Problems– Ganglion cyst, Mucous cyst, Basal joint arthritis
![Page 5: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/5.jpg)
Traumatic InjuryTraumatic Injury
Tendon injury– Flexor, extensor, muscle belly injury– Injury to tendon insertion
Mallet finger, Flexor tendon avulsion
Bony InjuryNerve InjuryJoint Injury
– Sprain, dislocation
![Page 6: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/6.jpg)
Anatomy - NerveAnatomy - Nerve
Median nerve – Mixed nerve– Sensory – Volar aspect of palm and radial 3 ½ fingers– Motor – Major finger and wrist flexors, thenar muscles
and radial lumbricals
Ulnar nerve – Mixed nerve– Sensory – Ulnar aspect of volar and dorsal palm and
ulnar 1 ½ fingers– Motor – Ulnar wrist and finger flexors and intrinsic
muscles of the hand
![Page 7: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/7.jpg)
Anatomy - NerveAnatomy - Nerve
![Page 8: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/8.jpg)
Anatomy - NerveAnatomy - Nerve
Radial nerve – Mixed nerve– Sensory – Dorsal aspect of hand and radial 3 ½ fingers
dorsally– Motor – Extensors of the elbow, wrist and fingers
Sensory to palm and fingers– Volarly – Radial 3 ½ fingers and palm – Median nerve,
Ulnar 1 ½ fingers and palm – Ulnar nerve– Dorsally – Radial 3 ½ fingers and hand – Radial nerve,
Ulnar 1 ½ fingers and hand – Ulnar nerve
![Page 9: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/9.jpg)
Anatomy Carpal TunnelAnatomy Carpal Tunnel
![Page 10: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/10.jpg)
Anatomy of Flexor Pulley SystemAnatomy of Flexor Pulley System
![Page 11: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/11.jpg)
![Page 12: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/12.jpg)
Anatomy – Extensor Anatomy – Extensor CompartmetnsCompartmetns
![Page 13: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/13.jpg)
![Page 14: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/14.jpg)
![Page 15: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/15.jpg)
Mechanism of ActionMechanism of Action
Repeated movement/use causes swelling over affected region
Repeated movement/use despite swelling causes worsening of swelling
Feedback loop set up with worsening symptoms Depending on the structure effected – numbness,
pain, locking etc.
![Page 16: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/16.jpg)
Nerve Compression SyndromesNerve Compression Syndromes
Median nerve compression (carpal tunnel syndrome) occurs from compression of the nerve at the wrist
Ulnar nerve compression can occur at the wrist or elbow Radial nerve compression usually occurs in the forearm Pressure buildup can occur from decrease in the size of the
tunnel(bone overgrowth, fracture) or increase in the volume of the contents of the tunnel(tendinitis, fluid buildup etc.)
![Page 17: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/17.jpg)
TendinopathiesTendinopathies
Repeated movement/use of tendons causes tendons to swell up and get trapped in tunnels either over fingers or wrist (trigger finger, DeQuervain’s tenosynovitis)
Repeated movement/use at tendon origin causes microtears which cause chronic tears near common extensor (lateral epicondylitis) or common flexor (medial epicondylitis) origin
![Page 18: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/18.jpg)
Nerve Compression Signs & Nerve Compression Signs & SymptomsSymptoms
Symptoms commonly include pain, numbness, tingling and in late stages weakness in grip
Symptoms are usually felt at night and can occasionally wake patients from sleep
The numbness is usually along the distribution of the effected nerve
Severe cases can result in muscle wasting with weakness and permanent sensory loss
![Page 19: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/19.jpg)
Nerve Compression DiagnosisNerve Compression Diagnosis
History and physical examination are usually indicative of nerve compression
Tinel’s sign, nerve compression test, Phalen’s test are all positive
Nerve conduction study and EMG are often confirmatory
![Page 20: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/20.jpg)
![Page 21: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/21.jpg)
Tendinopathy DiagnosisTendinopathy Diagnosis
Usually presents with locking or snapping of the finger or thumb on flexion that holds the finger in flexion(trigger finger)
There is usually tenderness over the MP joint volarly and a nodule or thickening is usually palpable in the same region(trigger finger)
Pain over the first dorsal compartment at the anatomic snuff box (deQuervain’s tenosynovitis)
Finkelstein’s test is usually positive (deQuervain’s tenosynovitis)
![Page 22: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/22.jpg)
![Page 23: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/23.jpg)
Tendinopathy DiagnosisTendinopathy Diagnosis
Patients usually have point tenderness over the lateral or medial epicondyle (epicondylitis)
Pain can be reproduced by wrist or finger extension (lateral epicondylitis) or flexion (medial epicondylitis)
![Page 24: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/24.jpg)
Treatment OptionsTreatment Options
Noninvasive options – Initial approach– Ergonomic evaluation– Work modification, – Splints/braces that immobilize the affected area – NSAIDS or steroidal anti-inflammatories– Topical anti-inflammatory modalities, ice, – Physical therapy
![Page 25: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/25.jpg)
Treatment OptionsTreatment Options
Steroid injections– At least 3-4 months apart, no more then 2 a year– Avoid injections near nerves– Side effects
Surgical options – When conservative measures fail or cannot be
implemented– In late cases – severe compression on NCS/EMG
![Page 26: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/26.jpg)
![Page 27: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/27.jpg)
![Page 28: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/28.jpg)
Treatment OptionsTreatment Options For compressive pathology - basic principle is to
release the area of constriction– transverse carpal ligament for carpal tunnels syndrome– A1 pulley for trigger digits– First dorsal compartment release
For nerve compression, surgery reverses symptoms for early cases and prevents progression of disease in late cases
“Wont get any worse – how much better depends on extent of the damage”
Surgery usually a cure – recurrence rare
![Page 29: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/29.jpg)
![Page 30: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/30.jpg)
Treatment OptionsTreatment Options
For tendinopathies, surgery considered when conservative therapy fails
Requires debridement of the inflamed tendon and associated bone spurs and reattachment of the extensor/flexor origin
Recovery longer with surgery around elbow Therapy needed for splinting, movement etc.
![Page 31: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/31.jpg)
Preventive MeasuresPreventive Measures
Prevention of repetitive trauma – Ergonomic evaluation and implementation– Regular stretching and strengthening
“Preparation for a marathon”
– Learning to recognize early symptoms– Preventive maneuvers
![Page 32: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/32.jpg)
EducationEducation
Teaching patients to recognize early symptoms
Preventive measures– Medication– Splinting– Anti-inflammatory modalities– Stretching and strengthening exercises
![Page 33: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/33.jpg)
Ligament InjuriesLigament Injuries
Chronic collateral ligament injuries– Usually common to the MP joint of the thumb– Splinting, casting, surgery
TFCC injury– Involves ulnar aspect of wrist– Related to trauma or repetitive injury– Splinting, steroid injections, casting, surgery
![Page 34: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/34.jpg)
Basal Joint ArthritisBasal Joint Arthritis
CMC joint of the thumb most common site for degenerative arthritis in the hand
Related to chronic repetitive use or previous injuries to the thumb
Starts with pain at the base of the thumb, progressing to weakness
Treatment entails rest, NSAIDs, splinting, steroid injections and surgery
![Page 35: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/35.jpg)
Ganglion CystsGanglion Cysts
Common soft tissue mass over the hand or fingers, is a ganglion occasionally associated with repetitive or strenuous activity
Can be volar or dorsal, over the wrist or fingers Treatment
– If asymptomatic, can be left alone– Aspiration of the cyst, rupture(by over inflation) or
infiltration with steroids has a high rate of recurrence(>50%)
– If symptomatic, resection is usually recommended
![Page 36: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/36.jpg)
![Page 37: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/37.jpg)
Mallet FingerMallet Finger
“Droop” of the DIP joint of a finger with intact passive extension, but no active extension
Usually due to avulsion of the tendinous insertion of the extensor tendon or a fracture avulsion at the base of the distal phalanx
This requires splinting in extension for a prolonged period of time and if a fracture is present or is chronic may require surgical correction
![Page 38: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/38.jpg)
SummarySummary
Careful history and physical examination usually goes a long way in obtaining a diagnosis
Rest, splinting and NSAIDS a good start for most repetitive injuries
Ergonomic evaluation can resolve or prevent many cumulative trauma disorders
Early referral to a hand surgeon, can prevent delay in diagnosis or treatment of many common hand problems
![Page 39: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/39.jpg)
Take Away PointsTake Away Points
Patient and employer educationPreventionEarly interventionDiagnosis & treatment
![Page 40: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/40.jpg)
![Page 41: COMMON HAND PROBLEMS RELATED TO WORK Prasad G. Kilaru MD Plastic, Reconstructive & Hand Surgery](https://reader033.vdocuments.site/reader033/viewer/2022051017/56649cc55503460f9498ed25/html5/thumbnails/41.jpg)
THANK YOU