‫اختالالت اسکلتی عضالنی 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
Previous injuries including fractures of the wrist
Colles' fracture
Amyloidosis
hypothyroidism
diabetes mellitus
Acromegaly
use of corticosteroids and estrogens
Obesity
BMI (> 29)
Double-crush syndrome
Diagnosis
• The reference standard for the diagnosis of carpal
tunnel syndrome is electrophysiological testing
• Phalen's maneuver
• Tinel's sign
• Durkan test
The role of MRI or ultrasound imaging in the diagnosis
of carpal tunnel syndrome is unclear
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
• surgical
Prognosis
• idiopathic trigger finger behaves differently in
people with 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.