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Extern conference - Tendon injury
- 1. Extern conference By : Wannida Nipakakul
- 2. Patient pro鍖les : 犖犖項犖犢犖о権犖犖迦権犢犖犖∇賢犖迦権犖 38 犖犖 犖犖項検犖巌献犖橿犖犖迦犖園犖犖о険犖犖犖犖犖犖迦犖犖朽検犖
- 3. Chief complaint : 犢犖犢犖о犖迦犖犢犖犖÷厳犖犖犖о顕 1 犖犖 犖犢犖犖犖÷顕 犖犖.
- 4. Present illness : 1 hr PTA 犢犖犖犢犖犢犖о犖迦犖犖朽犖犢犖 犖÷厳犖犖犢犖迦犖犖о顕 犢犖犢犖犢犖犖ム犖犖巌 犖犖ム険犖犖犖迦犖犖園犖犖犖∇険犖犖÷厳犖犖犖о顕犢犖犢 犖犢犖犖∇献犖 犖÷元犖犖迦犖迦牽犖犖迦検犖劇賢犖犖о顕 犖犖園犖犖÷厳犖 犖犖謹犖÷顕 犖犖.
- 5. Past history : No U/D Hx. 犖犢犖迦犖園 herniorrhaphy 3 yr PTA
- 6. Family history : Personal history : None - 犖犖劇犖÷肩犖伍牽犖迦硯犖園犖ム鍵 2 犢犖犢犖 3-4 犖о険犖犖犢犖犖犖園犖犖迦見犢 - 犖犖項犖∇顕犢犖犢犖 犖犖犖萎検犖迦 20 犖÷硯犖犖犢犖犖о険犖犖÷顕犖犖犖萎検犖迦 20 犖犖 - 犖犖蹩巌犖犖犖犖犖萎硯犖園犖巌権犖迦犖伍 犖∇顕犖犖÷犖 犖∇顕犖ム弦犖犖犖ム賢犖 - 犖犖蹩巌犖犖犖犖犖萎硯犖園犖巌犖犢犖∇顕
- 7. Physical examination : V/S : Temp 36.7 C, BP106/68 mmHg, HR 78 bpm, RR 20/ min HEENT : not pale conjunctivae, anicteric sclerae Heart : full regular pulse, normalS1S2, no murmur Lung : clear both lung
- 8. Physical examination : 犖犖 : - Hand position - 鍖ex 4th and 5th 鍖nger - Cut wound 6x3 cm at right wrist, deep to subcutaneous tissue with tear nerve seen 犖犖ム験 : - Decrease pinprick sensation at median nerve distribution - Palpated radial pulse 2+ - Capillary re鍖ll < 2 sec Right forearm:
- 9. Physical examination : 犖犖∇険犖 : - cannot 鍖ex MCP, PIP, DIP joint of 2nd-3th 鍖nger - intact MCP, PIP, DIP joint 鍖exion - cannot opponen thumb - intact extension all 鍖ngers - cannot fully 鍖ex/extend wrist (+/- due to pain) - intact wrist adduction/abduction Right forearm:
- 13. Investigation : - Film right wrist AP, lateral
- 15. Problem lists : Cut wound right wrist with tear 鍖exor tendon , with tear nerve
- 16. Plan of management : Debridement wound with repair tendon with repair nerve
- 17. WRIST INJURY
- 18. Anatomy of Wrist
- 20. Anatomy of Wrist (palmar view) 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Lateral -> Medial
- 22. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Flexor carpi radialis
- 23. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Flexor carpi radialis Origin - medial epicondyle of humerus Insertion - bases of second and third metacarpals Action - 鍖exor and radial abductor of wrist
- 26. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Palmaris longus Origin - medial epicondyle of humerus Insertion - 鍖exor retinaculum and the palmar aponeurosis Action - weak 鍖exor of wrist
- 27. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Flexor digitorum 壊顎沿艶姻鍖c庄温鉛庄壊
- 28. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Flexor digitorum 壊顎沿艶姻鍖c庄温鉛庄壊 Origin - medial epicondyle of humerus Insertion - middle phalanges of digits 2nd - 5th Action - 鍖exor of PIP, MCP and wrist joint
- 30. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Flexor carpi ulnaris
- 31. 犖犖 犢犖 犖÷顕 犖犖 犖犖迦硯 犢犖犖 犖犖犢犖 犖犖迦 Flexor carpi ulnaris Origin - medial epicondyle of humerus Insertion - pisiform bone, hook of hamate bone, 5th metacarpal bone Action - 鍖exor and ulnar deviates of wrist
- 32. Deep 鍖exor group
- 33. Flexor digitalis profundus Origin - medial epicondyle of humerus, proximal 3/4 of ulna Insertion - bases of the distal phalanges of the medial 4 鍖ngers Action - 鍖exor of DIP joints of the medial 4 鍖ngers, helps of 鍖exion of PIP, MCP and wrist joints
- 34. Flexor pollicis longus Origin - anterior surface of radius and adjacent interosseous membrane Insertion - bases of distal phalanx of thumb Action - 鍖exes phalanges of thumb
- 35. Pronator Quadratus Origin - lower 1/4 of the anterior surface of the shaft of ulna Insertion - lower 1/4 of the anterior surface of the shaft of radius Action - pronation of the forearm at the radio- ulnar joint
- 36. Post-op Note (21/8/60) : Findings : Complete tear Median nerve Complete tear FPL, PL, FDS 2nd-5th 鍖nger, FDP 2nd-3rd Partial tear FDP 4th 鍖nger, FCU Intact ulnar nerve and artery, radial artery
- 39. Tendon repair Core-suture Locking technique
- 40. Post-op >>> 犢犖犢犢犖犖劇賢犖 Extension block splint 犖犖迦犖犢犖迦犖犖ム険犖犖犖犖犖犖巌犖о検犖劇賢犖犖 犖犖謹犢犖犖 犢犖犖劇犖犢犖犢犢犖犢犖犖犖朽犢犖∇犖犖犢犖犖÷犖÷犖犖謹 犖犢犖犖犖犖園 re-rupture
- 41. 犖犖犖犢犖犖÷厳犖 20 犖犖犖犖 犖犖犖犢犖 Metacarpophalangeal joint (MCP) 50 犖犖犖犖 犖犢犖о犖犢犖 DIP 犢犖ム鍵 PIP 犢犖犖劇賢犖犖犖萎犖÷犖犖
- 42. 犢犖犢犖犢犖犢犖犖犖朽犢犖∇犖犖犢犖犖÷検犖園犖犖萎検犖朽犖о顕犖÷賢犢犖犖犢犖犖÷顕犖犖犖朽犖犖伍犢犖 犖犢犖о 10 犖犖謹 14 犖о険犖犖犖ム険犖犢犖∇犖犖犢犖犖
- 43. Reference : 犢犖犢犖犢犖犢犖犖犖迦犢犖犢犖 Tendon injury 犢犖犖 犖犖.犖犖. 犖犖犖巌犖犢 犖犖犖園犖犖犖 犖犖巌