Enthesopathy

Dr. Jainal Arifin, Mkes , SpOT

Bagian Ortopedi & Traumatologi

Fakultas Kedokteran Universitas Hasanuddin
Makassar, 2011
What is Enthesopathy?

Enthesopathy is a condition that

affects the entheses (e.g.
inflammation of the entheses).
The entheses are sites of
tendinous or ligamentous
attachment to the bone
 Lateral Epicondylitis
(Tennis Elbow)
 Tennis elbow is a painful inflammation of the tendon on
the lateral aspect of the elbow, caused by the pull of the
muscles which extend the wrist and fingers.
Signs and symptoms
 Pain that radiates from the outside of the elbow into
the forearm and the wrist
 Pain when you touch or bump the outside of the elbow
 Pain when extend the wrist joint
 A weak grip
 A painful grip during certain activities, such as shaking
hands or turning a doorknob
Area pada lengan yg nyeri apabila ditekan
 Risk factors
 Repetitive stresses the wrists. Tennis
players, carpenters, gardeners, dentists
and musicians may be at particular risk.
 Complications
 Left untreated, can result in chronic pain
Treatment
Non operative
• (NSAIDs)
• Rest, ice, and physical therapy.
• Steroid injection
Operative
 Medial Epicondylitis
(Golfer's Elbow)
 is pain and inflammation on the inner side of the elbow,
where the tendons of the forearm muscles attach to the
bony bump on the inside of the elbow
Signs and symptoms
 Pain and tenderness on the inner side of the
elbow. Sometimes the pain extends along the
inner side of the forearm. Your elbow may feel
stiff, and it may hurt to make a fist. You may
have weakness in your hands and wrists.
 Risk factors
 Repetitive stresses the wrists or fingers.
 Complications
 Left untreated, golfer's elbow can cause
persistent elbow pain.
 Treatment
Non operative
• (NSAIDs)
• Rest, ice, and physical therapy.
• Steroid injection
Operative
STENOSING TENOSYNOVITIS

 Inflammation of a synovial tendon

sheath which severely narrows the space
normally required for a tendon to pass
freely through its tunnel and beneath the
pulleys and ligaments
 Risk Factors
 More common in womenover age 30.
 Diabetics.
 Repetitive bending of the fingers, thumb
and wrist, gripping and grasping
STENOSING TENOSYNOVITIS
 De Quervains Disease
 Trigger Fingers
 De Quervains Disease

• Stenosing tenovaginitis of the first dorsal extensor

compartment
• (extensor pollicis brevis & abductor pollicis longus)
Daerah yg berwarna merah merupakan
refleksi dari tendo M Adduktor Policis
Longus dan tendo M Ekstensor Policis
Brevis
 DIAGNOSIS
 Local tenderness, pain and swelling
involve thumb
 radiation of pain to the thumb and
forearm are frequent.
 Positive Finklestein test
De Quervain’s
Treatment
Non operative
• Rest
• steroid injection
• anti-inflamatory
operative
Trigger Fingers
stenosing tenovaginitis of the flexor
tendon sheath(A1 pulley)
ANATOMY
 etiology
 congenital (thumb)
• often not recognised until toddlers
• 30% resolve spontaneously
 acquired (middle aged)
• idiopathic
• traumatic
• diabetes
• rheumatoid
PATHOPHYSIOLOGY
Repetitive flexion → irritation
sheath inflamation
Trauma → infection ↓
constriction/stenosis
↓
tendon swelling → nodule
↓
mismatch between the size of
flexor tendon & the pulley
↓
TRIGGER FINGER/THUMB
 Signs and symptoms
 Affected finger may stiff and may click when move.
 A bump (nodule) or tenderness at the base of the affected
finger
 Eventually, the finger may not fully straighten.
 Treatment
non operative
• Rest.
• Splinting.
• Finger exercises.
• Avoiding repetitive gripping.
• Nonsteroidal anti-inflammatory drugs
operative
Achilles tendinitis
 Achilles tendinitis is inflammation,
irritation, and swelling of the Achilles
tendon (the tendon that connects the
muscles of the calf to the heel).
Causes
 overuse
 arthritis
Symptoms
 Pain in the heel
 Swollen and warm.
Physical examination
 Tenderness along the tendon
 Pain in the area of the tendon when the
patient stands on their toes.
Treatment
Non operative
• (NSAIDs)
• Rest, ice, and physical therapy.
• Steroid injection
Operative
Dupuytren’s Contracture

nodular hypertrophy and contracture of the palmar fascia

 Dupuytren’s Contracture
aetiology
 genetic
 geographical
 smoking
 alcohol
 epilepsy
Dupuytren’s Contracture
clinical
 middle aged
 male 10 x female
 nodular thickening in the palm
 contracture of the ring and little finger
 MCPJ and/or IPJ not DIPJ
Dupuytren’s Contracture
treatment
Surgery if :
 rapidly progressive contracture
 inconvenience