Entesopathy Z. Rozkydal •Entezopathy •Patological changes of insertions •of tendons, ligaments and •joint capsules into the bone • •Dystrophia, microruptures •of Sharpey´s filaments from bone •inflammation, periostitis •ossifications, metaplasia Entesopatie- schéma •Acute and chronic overloading • •Microtraumatisation • •Repetitive movements and activities • •Cause •Tennis elbow •Epicondylitis radialis humeri Ruka- epikondylitis •Pain with activity of extensors •Tenderness •Painfull supination •Painful resisted dorsiflexion of the wrist •and of the third finger •Chair test •Tennis elbow- the cause •Entesopathy •Bursitis •Ossifications of insertion of extensors •Painfull annular ligament •Painful synovial plica •Osteochondrosis dissecans •Pressure od radial nerve •Referred pain from cervical spine and shoulder •Tennis elbow •Conservative treatment •Rest, NSAID •Stretching, sling •Corticosteroids locally •Physiotherapy •Orthesis or immobilisation •Operative treatment •Op. sec. Hohman •Op. sec. Boyd- Mc Leod Entezopatie - tenis loket 2 •Golf elbow - •Epicondylitis ulnaris humeri •Entesopathy of insertions of flexors •on the ulnar epicondyle •Pain, tendernes •Resisted movements • •Treatment: •Conservative • •Operative •Distalisation of flexor´s insertion Entezopatie Loket •Bursitis of olecranon Entezopatie- bursa lokte •Swelling and fluid •Tenderness • •Treatment: •Aspiration, NSAID •Bandage, immobilisation •Corticoids locally • •Risk of pyogenic inflammation •M. de Quervain • •Stenosing tenosynovitis of •long abductor and short extensor •of the thunb • • •Tenderness over styloid process •Finkelstein test • •Treatment •Rest, orthesis, plaster •NSAID, corticoids •Surgery Ruka- de Quervain Ruka- de Quervain •M. de Quervain •Dissection of the tendon •sheat Trigger thumb - pollex saltans •Snapping of the tumb •In childhood, in adults •Narrowing of flexor sheath •Entlargement of the tendon • •Therapy: surgery Ruka-pollex saltans op •Trigger digit- digitus saltans Ruka- dig saltans op •Th: corticoids, rest, surgery •Carpal tunnel syndrom •Compression neuropathy of median nerve •Pain, diminished muscle power •Hypotrophy of thenar muscles •Paresthesia and numbness •Limited function of fingers • •Tenderness •Tinnel sign •Phalen test Ruka-karp • •Therapy • •Conservative • •Surgery •Carpal tunnel syndrom •Guyon channel syndrom •Compression neuropathy of ulnar nerve •in hand • •Paresthesia and numbness on •ulnar side •Hypotrophy of hypothenar •Limited function of 4.5. finger • • •Therapy •Conservative •Surgery Ruka- anatomie2 •Bursitis and entesopathies in hip region •Greater trochanter •Ischial tubercle •Bursa ileopectinea •Gracilis syndrom •Spina iliaca ant. sup. •Spina iliaca ant inf. •Adductor entesopathy •Snaping hip- coxa saltans •Femoroacetabular impingement O entes Kyčel-cévy,burzy1 •Prepatellar bursitis • •Bursitis of pes anserinus Entezopathie- bursitis kolena •Bursitis in the knee region •Therapy: •Rest, aspiration, corticoids •NSAID, surgery •Baker´s cyst •Bursa gastrocnemio- semimembranacea •Is connected with joint space •Swelling, soft mass in popliteal region •Limited movements •Pressure onto large veins in •popliteal region. • •Secondary to pathology in the knee • •Therapy: •Conservative – aspiration, local corticoids, • NSAID •Surgery Entezo- Baker cysta1 Entezo- Baker 2 •Jumper´s knee •- distal pole of the patella • •m. Osgood- Schlatter • •Entesopathy in ligaments insertion • •Entesopathy at Gerdy´s tubercle •Entesopathies in knee region Entezo •Bursitis and entesopathies in the foot •Achillodynia •Calcaneal spur •Haglund´s exostosis •Osteophytes – dorsal •Os tibiale externum Entezopatie - noha Noha •Achillodynia Noha- ŠA2 •Painful Achillis tendon •and it´s insertion • • •Degeneration •Haemorhage, ruptures •Peritenonitis • •The risk of rupture •Achillodynia Noha- ŠA3 •Conservative treatment: • •Rest, taping, NSAID •Physiotherapy •Orthesis •Hyaluronic acid •No corticoids ! • •Surgery: •Peritenonectomy •Excision of necrotic tissue •Entesopathy at the spine Entezopatie- záda •Painfull insertions of ligaments and tendons • •Transverse or spinal processes •Scapula •Pelvis • • •Painful shoulder •Tenosynovitis of tendon of long head of biceps •Rupture of tendon of long head of biceps •Subacromial bursitis •Supraspinatus tendinitis •Rotator cuff rupture •Impimgement syndrom •Frozen shoulder syndrom •Osteoarthritis of glenohumeral joint •Disorders of acromioclavicular joint •Inflammations •Tumors •Referred pain from cervical spine •Tenosynovitis of long head of biceps •Tenderness •Resisted flexion and supination •of the elbow • •Therapy: •Corticosteroids locally •Rest, sling •NSAID Entezo- biceps •Rupture of long head of biceps Rameno- rpt •Tenderness • •Distalisation of •muscle belly • •Diminished strength •Rupture of long head of biceps Rameno- rpt bicepsu •Therapy: • •Rest, sling •NSAID •Surgery – up to 40 years •Conservative- over 40 years • • •Surgery: •key hole fixation to the humerus •Suture to the short head •of biceps •Subacromialis bursitis •Inflammation •White fluid •Severe, burning pain •Restricted movements •Tenderness •Calcifications Rameno- bursitis subac Rameno-kalcifikace v burze •Conservative treatment: •Rest, sling •Lavage with 2 needles •Corticosteroids locally •NSAID •Physiotherapy • •Surgery: •Removal of bursa • •Subacromial bursitis Rameno- bursitis •Supraspinatus tendinitis •Tenderness over greater •tuberosity •Limited movements • •Therapy: •Rest, NSAID •Corticosteroids •Physiotherapy • Rameno-rpt •Rotator cuff •Rotator cuff: •m. supraspinatus •m. infraspinatus •m. teres minor •m. subscapularis • •Function: •First 30 ° of abduction •Pressure of the humeral head •into glenoid cavity •Depressor of the humeral •head Entezo- RM Rameno- anatomie 2 •Anatomy of the shoulder Entezo- rameno ze zadu •Anatomy of the shoulder Rameno •Rupture of rotator cuff Rameno- rpt •Partial rupture: • •Severe pain •Painful arc •Painful abduction •Keeps the arm in position •of adjusted abduction • •Ultrasonography • •Management: conservative •Rupture of rotator cuff Rameno- rpt •Complete rupture: •No active abduction •Lifting of the shoulder • •Managemet: •suture: ASC, open surgery •- attachment to greater •tuberosity Completed rotator cuff repair •Impingement syndrom •Greater tuberosity impinges •to distal surface •of acromion and •coracoacromial ligament • •Narrowing of subacromial •space • • Imping •Impingement syndrom •The cause: • •Spure of acromion •Change of contours •of acromion •Distal osteophytes of AC joint •Prominence of gr. tuberosity Imping •Impingement syndrom •Stages: 1.Swelling, hemorhage of • supraspinatus • •2. Fibrosis, tendinitis, • bursitis • degenerative changes of cuff • •3. Rupture od rotator cuff • and long biceps tendon • Entezo- GH kloub •Impingement syndrom Rameno-bolestivý oblouk •Symptoms: •Painful arc •Impingement sign •Impingement test •Jobe test • •X-ray: •Narrowed subacromial space •Y view- outlet view •Arthrography •Ultrasonography •Impingement syndrom •Therapy: 1.stage: conservative •Rest, NSAID, •Physiotherapy, •Local corticosteroids • •2. stage: the same •+ bursectomy, ASAD • •3. stage: ASAD •Subacromial decompression Burr acromioplasty •Frozen shoulder- capsulitis adhesiva Rameno- sy zmrzlého ramene •Progressive limitation •of movements •Pain •No motivation for movement • •Shrinkage of capsule •Adhesions in distal recesus •Tightening of soft tissue •Muscle spasm •Low capacity of joint space •The cause •All conditions limiting •joint movements: •Impingement syndrom •Arthrosis of AC joint •Posttraumatic conditions •Inflammations •Thoralic outlet syndrom •Tumors of the lungs •Disorders of pleura •Cardiac disorders Rameno- frozen shoulder •Frozen shoulder •Management: •Long lasting period •Heat •Passive movements •Positioning •Active movements •Physioterapy •NSAID •Local corticosteroids •ASC- decompression •Redressement force •Removal of adhesions Rameno- frozen shoulder •Glenohumeral osteoarthritis •- omarthrosis Rameno- artróza •Disorders of acromioclavicular joint •Synovitis •O.A. •Sprain •Subluxation •Dislocations Rameno- luxace AC • • • • • • • •Disorders of sternoclavicular joint rameno-sternoklav •Synovitis •O.A. •Sprain •Subluxation •Dislocations •Chronic subluxation •Referred pain to the shoulder •Cervical spine •Thoracic outlet syndrom •Cardiac diseases •Lung and pleura disorders •Herpes zoster neuralgia