Entesopathy Z. Rozkydal Entesopathy Patological changes of insertions of tendons, ligaments and joint capsules into the bone Dystrophia Microruptures of Sharpey´s filaments Periostitis Ossifications, metaplasia Entesopatie- schéma Tendinopathy: disorders in tendons and tendon sheats 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 thumb •In childhood, in adults •Narrowing of flexor sheath •Entlargement of the tendon • •Therapy: conservative • surgery Ruka-pollex saltans op Trigger finger- digitus saltans Ruka- dig saltans op Th: , NSA gel, local cortisteroids, rest, surgery Differential diagnosis Carpal tunel syndrom Guyon canal syndrom 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 canal 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 the 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 Infrapatelar 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 joint 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 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 Rupture of long head of biceps Rameno- rpt Tenderness Distalisation of muscle belly Diminished strength 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 Imping Imping Causes • acromion spur •Change of acromion •Distal osteophytes of AC •Prominence of tuberculum maius 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 Therapy: Conservative Total shoulder replacement Rotator arthropathy • poperační předoperační Reverse total shoulder artroplasty 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