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Orthopaedics
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Painful locking of the thumb or finger which is functionally limiting. Thought to be due to focal degeneration within the flexor tendon sheath, leading to localised inflammation and limiting movement of the tendon within its sheath. 1:4 male to female ratio.
Introduction and Review of Biological Background
Published in Luke R. Bucci, Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Tendon sheaths are discontinuous sheets of collagen fibers wrapped around tendons, especially those with large ranges of motion. Tendon sheaths are lined by mesenchymal cells resembling vascular synovium, which secrete hyaluronate to aid in lubrication of tendons. Tendon sheaths protect tendons from friction in their movements. Fibrous adhesions often form between tendons and tendon sheaths after inflammation or surgical repair, especially upon immobilization.
Mechanically Induced Periarticular and Neuromuscular Problems
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Tendons are surrounded by sheaths mat contain lubricants to allow free sliding of the tendons (11). Again, repetitive impulsive loading causing cumulative microdamage is the likely culprit. Tendonitis is chronic inflammation of the tendon sheath. One must take care in injecting steroids into inflamed tendon sheaths: the stereoid causes matrix deterioration within the tendon substance (12). Steroid injections of tendons have been followed by tendon rupture.
Conservative management of De Quervain’s tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series
Published in Physiotherapy Theory and Practice, 2022
Scott W. Young, Thomas W. Young, Cameron W. MacDonald
Therefore, a DQT screening tool devised by Batteson, Hammond, Bruke, and Sinha (2008) was chosen before commencing patient management to confirm the diagnoses of DQT in each patient. The criteria includes seven tests: 1) pain over the radial styloid; 2) tenderness over the dorsal thumb; 3) pain with active thumb flexion; 4) localized swelling over the thumb; 5) positive Finkelstein’s test; 6) thickening of the tendon sheath of the first dorsal extensor compartment; and 7) pain with resisted thumb extension. Confirmation of DQT is made if a patient has five or more items present and the authors have reported a sensitivity and specificity of 100% (Batteson, Hammond, Bruke, and Sinha, 2008). It should be noted that we did not appreciate a difference in first dorsal extensor compartment thickness between each patients’ involved and uninvolved UE. This could be a potential variable that may limit the applicability of our case series.
A rare cause of unilateral hypoglossal nerve palsy: case report of intraneural ganglion cyst of the hypoglossal nerve and review of the literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Jeremie D. Oliver, Antonio J. Forte
Ganglion cysts causing hypoglossal compression are rare. They are typically found in peripheral nerves near tendon sheaths, often near the carpal tunnel, or in the knee region near the fibular head [1–3]. Cranial nerves are rarely affected by intraneural ganglion cysts [3]. These cysts can present clinically by causing compression of the adjacent nerve fascicles, resulting in pain, paresthaesia, weakness, muscle denervation, and atrophy [1]. Significant clinical findings to be expected from an intraneural ganglion cyst of the hypoglossal nerve include unilateral tongue deviation and atrophy on the affected side, as well as potentially slurred speech or compression of nerves of the jugular foramen [4–7]. The present literature documents only four cases being reported [4–7]. We report an extremely rare case of a patient with a hypoglossal cystic lesion. The aim of this report is to present our surgical approach to treatment and to compare our findings with previous reported cases of unilateral hypoglossal nerve palsy, highlighting the importance of an intraneural (or extraneural) ganglion cyst in the differential diagnosis of such.
Tumour necrosis factor inhibitors in enthesitis related arthritis and juvenile spondylarthropathies
Published in Expert Opinion on Orphan Drugs, 2018
The disease usually begins after the age of 6 years, typically with arthritis of the knee, hip or hip joint, or in the mid-foot (tarsitis) (Figure 1). Diagnosed mon- or oligoarthritis in children is mainly asymmetrical. Less frequently, arthritis involves the small joints of the foot or presents as sacroiliitis. In addition to arthritis, enthesitis, inflammation of tendons, tendon sheaths, and tendon attachments on the bone can be present. The enthesitis in the case of ERA is often symmetrical and predominant on the lower extremities. Insertion enthesopathies, especially at the achilles tendon (Figure 2), the plantar aponeurosis, or around the knee at the patella or the tibial tuberosity are typical. Further enthesitides are found on the greater trochanter, the epicondyles on the humerus, the pelvic crest, along the spines of the vertebral column, and on the sternum. A total of 45–80% of children with ERA-JIA exhibit at least one enthesitis [10]. Chronic inflammation of the entheses may lead to erosions, calcifications, osteopenia, and bone regeneration up to bony overgrowth [11,12].