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Prof. Dr. Şansın Tüzün.  Chronic musculoskeletal syndrome characterized by diffuse pain and tender points  No evidence that synovitis or myositis are.

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Presentation on theme: "Prof. Dr. Şansın Tüzün.  Chronic musculoskeletal syndrome characterized by diffuse pain and tender points  No evidence that synovitis or myositis are."— Presentation transcript:

1 Prof. Dr. Şansın Tüzün

2  Chronic musculoskeletal syndrome characterized by diffuse pain and tender points  No evidence that synovitis or myositis are causes  Occurs in the context of unrevealing physical examination, labaratory and radiologic examination  % of patients are women, peak age is years

3  Generalized chronic musculoskeletal pain  Diffuse tenderness at discrete anatomic locations termed tender points  Other features, diagnostic utility but not essential for classification of fibromyalgia are; fatique, sleep disturbances, headaches, irritable bowel syndrome, paresthesias, Raynaud’s-like syndromes, depression and anxiety

4  For classification criteria, patients must have pain for at least 3 months involving the upper and lower body, right and left sides, as well as axial skeleton, and pain at least 11 of 18 tender points on digital examination

5 Syndrome Relationship with Fibromyalgia Depression Irritable bowel Migraine Chronic fatiqe Syndrome Myofascial pain % of FM cases % of FM cases 50 % of FM cases 70 % of CFS cases meet FM May be localized form of FM

6  Classify as CFS or idiopathic Chronic Fatique if; Fatique persists or relapse for > 6 months History, physical examination and appropriate laboratory tests exclude any other cause for the chronic fatique

7  Classify as CFS if along with fatique, four or more of the following are present for >6 months; Impaired memory of concentration, sore throat, tender cervical or axillary lymph nodes,muscle pain, multijoint pain, new headaches,unrefreshing sleep, postexertion malaise

8  Presence of trigger points, which include a localized area of deep muscle tenderness, located in a taut band in the muscle, and a characteristic reference zone of the perceived pain that is aggravated by the palpation of the trigger point

9 VariableFibromyalgia Myofascial pain Examination Tender points Trigger points LocationGeneralized Regional Regional Response to local therapy Not sustained Curative Curative SexFemales;males 10:1 10:1 Equal Equal Systemic features characteristic characteristic ?

10  NSAID  Tricyclic antidepresants ( i.e. amitriptyline, desipramine 1-3h before bedtime)  Cardiovasculer fitness training  Biofeedback  Hypnotherapy  Cognitive behavioral therapy  Educating patient

11  Results from incresed pressure on a nerve as it passes through an enclosed space  Knowledge of anatomy is essential for understanding of the clinical manifestations of these syndromes  Splinting, NSAIDs and local corticosteroid injections usually suffice when symptoms are mild and of short time.  Surgical procedures to decompress the nerve are indicated in more severe cases

12  Results from compression of one or more of the neurovasculer elements that pass through the superior thoracic aperture  Anatomic abnormalities and trauma to the shoulder girdle region play a far more pivotal role

13  Between the scalenius anterior and scalenius medius  Costoclavicular space  Under the coracoid process and beneath the pectoralis minor tendon

14  Paresthesias  Aching pain, radiating to the neck, shoulder and arm  Motor weakness  Atrophy of thenar, hypotenar and intrinsic muscles of the hand  Vasomotor disturbances

15  Neurologic examination  Certain clinical stress tests (Adson and hyperabduction maneuvers)  A radiograph of cervicothoracic region (cervical rib, elongated transverse process of C7)

16  Exercise designed to improve posture by strengthening the rhomboid and trapezius muscles  Avoidance of hyperabduction  Surgical intervention if; muscle wasting, intermittent fleeting paresthesias replaced by continous sensory loss, incapacitating pain,worsening of circulatory impairment

17  Compression neuropathy of the ulnar nerve as it transverses the elbow  Causes are; history of a trauma, chronic pressure by occupational stress or from unusual elbow positioning  Arthritic conditions that results in synovitis  Osteophyte production

18  Paresthesias in the distribution of the ulnar nerve  Aggrevated by prolonged use of the elbow in flexed position  (+) Tinel’s sign  Atrophy of intrinsic muscles and weakness in pinch and grasp  Wasting of the hypothenar muscles and slight clawing of the 4th and 5th fingers  Weakness in adduction of the 5th finger

19  Physical examination (Tinel’s sign, Wartenberg’s sign i.e.)  Radiographs  Electrodiagnosis

20  Avoidance of prolonged elbow flexion  Local steroid injection along the ulnar groove  Surgical procedures to decompress the nerve

21  Entrapment of the ulnar nerve in Guyon’s canal at the wrist  Compression is due to ganglia  Causes are; Aberrant muscles, Dupuytren’s disease, RA, OA  Chronic trauma due to certain tools and occupations

22  Combined sensory and motor deficits  Hypoesthesia in the hypothenar region and 4th and 5th fingers  Weakness of the intrinsic muscles of the hand

23  Pyhsical examination  Electrodiagnosis is helpful in determining the site of the entrapmant Treatment  Avoidance of trauma  Physical therapy  Surgical decompression

24  Most common entrapment neuroropathy  Compression of the median nerve at the wrist  Causes are; occupation, crystal-induced rheumatic disorders  Complication of connective tissue disorders  Uremia, metabolic and endocrine diseases, infections, familial occurrance, during pregnancy

25  Sensory loss in the radial three finger and one- half of the ring finger  Burning, pins-and-needles sensations, numbness and tingling in the fingers  Pain may radiate to the antecubital region or to the lateral shoulder area  Awaken at night by abnormal sensation

26  (+)Tinel’s sign  (+) Phalen’s sign (wrist flexion)  Thenar atrophy

27  History and physical examination  Radiographs  Electrodiagnosis

28  Splints  Local corticosteroid injection  NSAIDs  Physical therapy  Surgery ; patients with progressive increases in distal motor latency times


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