اختلالات اسکلتی عضلانی شایع در مشاغل اداری دکتر پورحسین پائیز 1390

Carpal tunnel syndrome entrapment idiopathic median neuropathy

Causes Most cases of CTS are of unknown causes, or idiopathic obesity oral contraceptives hypothyroidism, arthritis diabetes Trauma lipoma ganglion vascular malformation

Work related Occupational risk factors of repetitive tasks force posture vibration

Associated with other diseases heredity size of the carpal tunnel associated local and systematic diseases Rheumatoid arthritis pregnancy and hypothyroidism pregnancyhypothyroidism Previous injuries including fractures of the wrist Colles' fracture Amyloidosis hypothyroidism diabetes mellitus Acromegaly use of corticosteroids and estrogens Obesity BMI (> 29) BMI Double-crush syndrome

Diagnosis The reference standard for the diagnosis of carpal tunnel syndrome is electrophysiological testingelectrophysiological Phalen's maneuver Tinel's sign Durkan test The role of MRI or ultrasound imaging in the diagnosis of carpal tunnel syndrome is unclearMRIultrasound imaging

Treatment splinting or bracing steroid injection activity modification physiotherapy regular massage therapy treatments chiropractic medications surgical release of the transverse carpal ligament

De Quervain’s Tenosynovitis

ANATOMICAL REVIEW The tendons of the abductor pollicis longus and extensor pollicis brevis

Etiology regular biomechanical strain intense or unusual biomechanical strain local trauma metabolic diseases (diabetes mellitus, hypothyroidism,gout, ankylosing spondylitis, various collagenoses) infection such tuberculosis or a bacterial infection specific conditions such as pregnancy factors such as the use of gloves and exposure to cold or vibration increase the risk of developing this condition.

Tenosynovitis affecting the dorsal tendons of the wrist may be of two types: Tenosynovitisis with effusion is of infectious or rheumatoid origin. stenosing tenosynovitises

De Quervain’s tenosynovitis may coexist with carpal tunnel syndrome and “trigger finger”

WORK-RELATEDNESS OF MUSCULOSKELETAL STRAIN Biomechanical strain actions that are highly repetitive or forceful or both Grasping objects with the fingers spread, rotation of the wrist, and pronation-supination of the forearm

Differential Diagnosis carpometacarpal osteoarthrosis of the thumb intersection syndrome Wartenberg’s syndrome brachioradialis insertion tendinitis tenosynovitis of the extensor digitorum communis

Treatment Modification of activities NSAIDs Rest for 3-6 weeks Hydrocortisone injection Consider surgery

Trigger finger, trigger thumb, or trigger digit

catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain most commonly at the level of the first annular (A1) pulley when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun.

Cause The cause of trigger finger is usually unknown. Trigger fingers are more common in women than men. They occur most frequently in people who are between the ages of 40 and 60 years of age. Trigger fingers are more common in people with certain medical problems, such as diabetes and rheumatoid arthritis. Trigger fingers may occur after activities that strain the hand.

Symptoms usually start without any injury, although they may follow a period of heavy hand use. A tender lump in your palm Swelling Catching or popping sensation in finger or thumb joints Pain when bending or straightening your finger

Diagnosis history and physical examination More than one finger may be affected at a time The triggering is usually more pronounced in the morning, or while gripping an object firmly. No other testing or x-rays are usually needed to diagnose trigger finger.

Treatment corticosteroid Injection corticosteroid surgical

Prognosis idiopathic trigger finger behaves differently in people with diabetes. [diabetes [ More often they are part of a compound injury due to overuse, repetitive stresses, workplace vibration, which when combined in particular, are particularly harmful and accelerate the progression of the injuries. Recurrent triggering is unusual after successful injection and rare after successful surgery

Complications Incomplete extension — due to persistent tightness of the tendon sheath beyond the part that was released Persistent triggering — due to incomplete release of the first part of the sheath Bowstringing — due to excessive release of the sheath Infection

Recovery Most people are able to move their fingers immediately after surgery. It is common to have some soreness in palm. Frequently raising your hand above your heart can help reduce swelling and pain. Recovery is usually complete within a few weeks, but it may take up to 6 months for all swelling and stiffness to go away. If your finger was quite stiff before surgery, physical therapy and finger exercises may help loosen it up.