Precipitating Factors

Bursitis
Carpal Tunnel Syndrome

 Is a condition that results when there is injury to Precipitating factors:
the bursa that commonly occurs with reduced
friction between tendons, bones and ligaments • Repetitive hand and wrist movement
• Exposure to cold temperature
 Bursae - are fluid-filled sacs that are lined with • Excessive vibrations in the hand and wrist
synovium similar to the lining of the joint • Carpal Tunnel Syndrome
surfaces
Manifestations:
Bursitis versus Synovitis
• Pain especially at night
• Bursitis is inflammation of the sac between the tendon • Numbness
and an adjacent bone that the tendon glides over, the sac • Paresthesia
is lined with a membrane that produces synovial fluid. • Weakness along the median nerve
TINEL's sign indicates CTS
• Synovitis refers to inflammation that occurs in the
tendon sheath (tenosynovitis) or the inner lining of the Management:
joint capsule (synovitis)
Bursitis 1. Medical
• Is based on the cause
Signs and Symptoms: • Use of wrist splints to prevent hyperextension and
prolonged flexion
• Pain around joint - commonly the shoulder,
knee, hip and elbow Advise to avoid repetitive hand and wrist movement
• Limited ROM
• Tenderness • NSAID's and cortisone injections
• Varying degrees of redness, warmth and • Others-yoga, acupuncture, etc.
swelling
2. Surgery is advised in severe cases:
Bursitis-Management
• Open nerve release
• R.I.C.E. • Endoscopic laser surgery
• NSAID's and analgesic
• ROM exercises • Open Release for Carpal Tunnel Syndrome
• Intra articular corticosteroid injections
• Surgery - when calcified deposits or adhesions
have diminished the function of the affected part
Ganglion
Loose bodies
• A collection of gelatinous material near the
• Small pieces of bone or cartilage floating within tendon sheaths and joints
a joint capsule. • Appears as a round, firm, cystic swelling.
• may include pieces of articular cartilage.
• probably reflects a joint trauma or the wearing • Ganglia can form around any joint, but they are
away of the articular cartilage that exposes the most frequently found in the wrist and ankles.
surface of the bone beneath, causing it to die and
separate. They are usually painless and often barely visible as
localized swellings. They typically do not appear to
Loose Bodies-Manifestations be inflamed unless they are big
• painful catching or locking of the joint. Ganglion

• Limited ROM
• Abnormal gait • Common in women who are in their 50's
• Pain may or may not be present
• Loose bodies may promote osteoarthritis if they • Weakness of the fingers occur with tendon sheath
are not removed or reattached in time. involvement
Loose Bodies Management involves aspiration, corticosteroid

injection or surgical incision
• X-ray, ultrasound, CT scan, or MRI, help find a
loose body. Dupuytren's disease
• Surgery (usually by arthroscopy) to remove the
loose body or repair the kneecap may be needed • A condition characterized by progressive contracture of
if a loose body is causing symptoms the palmar fascia that causes flexion of the fourth and
fifth fingers, most frequently, the middle finger.
Carpal Tunnel Syndrome
In severe cases, the affected fingers lose function
• An entrapment neuropathy that occurs when the
nerve at the wrist is compressed by a thickened Dupuytren's disease
flexor tendon sheath, skeletal encroachment,
edema or soft tissue mass. • Is caused by inherited autosomal trait
• Tarsal Tunnel - foot
• Occurs frequently in men • Shoes with support
• Heel cups and other orthotic devices
• Occurs frequently to those >50 years • NSAID's
• Associated with arthritis, DM, Gout alcoholism.
Stars as nodule in the palmar fascia, which may or may

not progress so the fibrous thickening extends to involve
the skin in the distal palm and produces a contracture of
the fingers.
Clinical manifestations include dull aching discomfort,

morning numbness,
In the affected fingers. Starts in one hand but eventually

become bilateral cramping and stiffness
Initially, finger stretching exercises can prevent

contractures. Fasciectomies are performed of the palm
and digits to improve function. Finger exercises may
begin in 1-2 post op days.
Achilles Tendonitis/ Tendinitis
• Overuse of the Achilles tendon can cause

inflammation that can lead to pain and swelling.
• Patients tend to experience pain after first
walking in the morning and when getting up
after sitting for long periods of time.
• Patients will also experience pain while
participating in activities, such as when running
or jumping.
Tendonitis
• X-ray is not usually diagnostic but can be used

• Thompson's test helps in the diagnosis of Achilles
rupture.
Thompson's Test
• ✓Patient kneels on the chair or less prone while

examiner squeezes affected calf
• ✓Normally, the foot responds by moving
downward
Tendonitis-Management
• R.I.C.E
• Splinting or casting for up to 6 weeks in
functional position occurs
• Surgical intervention if rupture
• Physical therapy is required for rehabilitation
• Health teaching - advise not to return to full

activity until strength is equal to unaffected
extremity
Plantar Fasciitis
• is inflammation of the fascia that runs along the

bottom of the foot from the heel to the toes
• As the fascia is stretched, microscopic tears
develop at the point where the fascia attaches to
the calcaneous
Plantar Fasciitis
• Pain is localized at the anterior medial aspect of the

heel and diminishes with walking
Management includes:
• Stretching exercises

Precipitating Factors

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Bursitis

Carpal Tunnel Syndrome

• painful catching or locking of the joint. Ganglion

Loose Bodies Management involves aspiration, corticosteroid

• Associated with arthritis, DM, Gout alcoholism.

Stars as nodule in the palmar fascia, which may or may

Clinical manifestations include dull aching discomfort,

In the affected fingers. Starts in one hand but eventually

Initially, finger stretching exercises can prevent

Achilles Tendonitis/ Tendinitis

• Overuse of the Achilles tendon can cause

• X-ray is not usually diagnostic but can be used

• ✓Patient kneels on the chair or less prone while

• Health teaching - advise not to return to full

• is inflammation of the fascia that runs along the

• Pain is localized at the anterior medial aspect of the

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