Common Conditions occurring due to
Desk jobs
Dr. Deepthi Nandan Adla
MS(Orth)osm, MSc (Orth eng.) UK, FRCS, FRCS(Tr&Orth), CCT UK
Consultant Orthopaedic Surgeon (Upper limb)
Apollo Hospitals, Hyderabad
Repetitive strain
Conditions occurring due to repeated use of a certain movement
Forceful exertions
Repetition
Awkward postures
Mostly affects office workers
Sedentary jobs
Conditions Musculoskeletal
Cervical spondylosis
Shoulder impingement
Tennis elbow/Golfers elbow
Trigger finger/ DeQuervain’s tenosynovitis
Nerve related
Carpal tunnel syndrome
Cubital Tunnel syndrome
Nerve root compression
Symptoms
Muscle/tendon problems
Pain
Swelling
Weakness
Nerve related
Tingling/altered sensation
Weakness
Tendon problems:Dequervain’s History
New, repetitive activity
Pain over thumb side of the wrist
Pain on making a fist, grasping or holding objects
Examination
Swelling
Thickening
Tenderness
Treatment Activity modification NSAID Splintage – thumb widely abducted
Some reports of low success rates Most reports suggest ineffective
Steroid Injection 60 – 80% improved
Soluble steroid
One or two injections
depigmentation
fat atrophy
Surgical Release Day case procedure
Local anaesthesia
Transverse incision
Release tendon
Tennis/Golfers elbow
First described by Runge in 1873
‘Schreibers Krampfes’ (writers cramps)
Incidence
General population: 0.6% Tennis players: 9%
Age:
35 and 50 years, with an equal distribution between males and
females Associated Rotator cuff problems: 20-40%
Etiology
Multiple microtraumatic events
Disruption of the internal structure of the tendon and degeneration of the cells and matrix JBJS 81:259-278 (1999)
Hypovascular zones
Eccentric tendon stresses
Microscopic degenerative response
Presentation Pain
outer aspect (Tennis elbow )of elbow/ inner aspect (Golfers)
Increases with activity Lifting objects Sometimes pain at rest
Palapation
Tenderness
Special test
Resisted wrist extension Elbow flexion Elbow Extension
Investigation
X ray
Bony spur Calcification Arthritis
Ultrasound
Tendon integrity Synovitis of Elbow
Non- Operative Treatment options
Topical NSAIDs
Oral NSAIDs
Orthotic devices
Physiotherapy
Autologous blood injection-79% had improvement of Nirschl scores
J Hand Surg [Am]. 2003 Mar;28(2):272-8
Literature: Steroid/Physio/wait
RCT
6 weeks Pain/function improved in:
92% (57) of steroid group 47% (30) for physiotherapy 32% (19) for wait-and-see
One year:
69% (43) for injections 91% (58) for physiotherapy 83% (49) for a wait-and-see policy Lancet 2002
Operative treatment Surgery to repair the tendon
Conclusion
Confirm diagnosis
Need assessment by surgeon to confirm diagnosis
NSAIDs
Physio
Surgey if:
Unresolved after non op treatment
H/O trauma and pain after injury
Tear in the tendon
Carpal Tunnel Syndrome
Incidence: 1-3 cases per 1000 persons per year
Prevalence: 50 cases per 1000 persons
aged in their 30s and 50s
Women are affected 2-3 times more often
Association of CTS in computer workers
BMC Musculoskeletal Disorders 2008, 9:134
Symptoms Pins and needles
Pain
The pain may travel up the forearm.
Numbness of finger
Dryness of the skin
Weakness of muscles
AnatomyContents:Nine flexor tendons
Tendons
Median Nerve
Cause of carpal tunnel syndrome
Nerve function v/s pressure in tunnel (healthy people)
Tingling @ 40mmhg
Complete motor and sensory block at 50 mmHg
Carpal tunnel pressure:
5.3 mmHg during rest
16.8–18.7 mmHg static on the mouse
28.8–33.1 mmHg while dragging mouse
Examination
Dry pulps
Wasting of Thenar muscles
Tinels
Investigations Nerve conduction test
Confirm Diagnosis
Assess nerve function
Double crush/Polyneuropathy
Prognosis
Base line, if recurrence
Non-operative Night splint
(good for patients with nocturnal symptoms)
Activity modification (avoid aggravating activity)
NSAIDs
Treatment NSAIDS
Physiotherapy
Activity modification
Surgery
Operative treatment
Indications:
Failed non-operative treatment
Motor weakness
Procedure:
Local anesthesia.
Shoulder Impingement syndrome
Pain in shoulder
Increases with activity
Clicking sensation in shoulder
Pain with overhead activities/ reaching for seat belt, changing gears/wearing cloths
Assessment
Shoulder surgeon to assess to confirm diagnosis
Complex joint
Needs thorough knowledge
Understanding poor among general orthopedic surgeons
Newer techniques available to help improve pain
Treatment
Pain medication
Activity modification
Physio
To improve scapular position
Strengthen a specific group of muscles
Injection into shoulder
To be done by shoulder specialist
If not treated
Continued rubbing of tendon in shoulder
Tear of tendon
Arthritis
Procedure
General anaesthetic
Key hole/arthroscopic surgery
2-3 small cuts around shoulder
Assess shoulder and the tendons
Shaving of the boney spur
Results
90-95% good results
Pain (sharp catching pain) improves
If wear/tear changes in tendon some residual pain is possible
Conclusion
Prevention better than cure
Regular exercises
Try activity modification
Physiotherapy
If still not better: Surgery
Exceptions: Nerve compressions: carpal/ cubital tunnel
Tendon tear in shoulder (Rotator cuff tear)
Thank youContact:[email protected] 7893844800
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