logging in or signing up Kimball Presentation with introduction tedyaz98 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 22 Category: Business & Fin.. License: All Rights Reserved Like it (0) Dislike it (0) Added: November 01, 2011 This Presentation is Public Favorites: 0 Presentation Description Dr. Hervey Kimball on Hand and Wrist Injuries in the Workplace, New England Baptist Hospital October 26, 2011 Comments Posting comment... Premium member Presentation Transcript Hand & Wrist Disorders in Workplace Injuries October 26, 2011: Hand & Wrist Disorders in Workplace Injuries October 26, 2011 Hervey L. Kimball MD, MS Hand Surgical Associates Occupational Medicine CenterHand & Wrist Disorders in Workplace Injuries October 26, 2011: Hervey L. Kimball MD, MS Hand Surgical Associates Occupational Medicine Center Hand & Wrist Disorders in Workplace Injuries October 26, 2011Outline: Outline Workplace injuries Compressive neuropathy Soft tissue disorders Tendinopathies Ganglion Fractures / Traumatic injuriesWorkplace Disorders: Workplace Disorders Different than Non-Work Related Causes Psychosocial factors Job issues TreatmentWorkplace Disorders: Workplace Disorders Surgery less successful More Pain = Less GainSlide 7: BLS year 2005Workplace Disorders: Workplace Disorders Treatments: Education Expectations Attempt work prior to surgery ? permanent job modificationCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Hand Paresthesias Median nerve distribution Night symptoms Intermittent Hand / forearm painCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Incidence 3% women, 2% men Risk Factors Female Age: older BMI Diabetes BiopsychosocialCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Non-operative treatment Intermittent symptoms No atrophy Normal or Mild abnormal NCSCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Non-operative Treatment Job modification Wrist splints Steroid injection 60-80% respond may recur 2-4 monthsCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Operative Treatment Endoscopic vs. Open Indications Failed conservative mgmt. Atrophy ≥ Moderate rating by NCSCarpal Tunnel Release: Carpal Tunnel ReleaseCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Return to work May depend on job Agee ASSH 2 weeks average endoscopic 4 weeks average open Early Outcome and Cost-Effectiveness of Endoscopic Versus Open Carpal Tunnel Release: A Randomized Prospective Trial J Hand Surg [Br] October 2003 28: 444-449Carpal Tunnel Release: Carpal Tunnel Release Non Work Related Work Related Numbness Resolves Persists Discomfort Resolves 3-8 weeks Persists Scar Tenderness 3-6 months Persists Strength Returns 6 month Persists Return to work* 2-4 weeks 6 weeksdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis First extensor compartment Radial side wrist Pain SwellingdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Finkelstein’s TestdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Incidence Women > Men 8:1 in some reports Risk Factors Combination of factors : some evidence Post partumdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Splinting NSAIDs Ultrasound Cortisone injectiondeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Surgical ReleasedeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Post op 1 to 3 weeks splinting Tendon gliding, avoid maximal flexion Return to workTrigger Finger: Trigger Finger Inflammation at tendon sheath Digit Pain Swelling LockingTrigger Finger: Trigger Finger Incidence 2-3% population Risk Factors Female Diabetes 10% incidence Combination of factorsTrigger Finger: Trigger Finger Splinting NSAIDs Cortisone Injection Surgical ReleaseTrigger Finger: Trigger Finger Post op Early ROM Return to work Job dependent days to 3 weeks Complications recurrence stiffnessWrist Ganglion: Wrist Ganglion Cyst from joint or tendon sheath Joint stress Capsular tear Mucoid degenerationWrist Ganglion: Wrist Ganglion 1-2 cm mass Most painless Size may changeWrist Ganglion: Wrist Ganglion Firm mass May be tender Mild decrease in ROM Grip strength Trans illuminationWrist Ganglion: Wrist Ganglion Occult Ganglia Dorsal wrist pain MRI Associated with scapholunate lig. dorsal tearWrist Ganglion: Wrist Ganglion Splinting Aspiration Sheath 60 to 70% Dorsal 30 to 50% Volar < 30%Wrist Ganglion Excision: Wrist Ganglion Excision Gold standard 1 to 10% recur Short term post-op splintWrist Ganglion Excision: Wrist Ganglion Excision Return to work 2 to 8 weeks Complications scar stiffness neurovascular injury carpal instabilityArthroscopic Ganglion Excision: Arthroscopic Ganglion ExcisionArthroscopic Ganglion Excision: Arthroscopic Ganglion ExcisionTFCC Injuries: TFCC Injuries Traumatic Fall in pronation Twisting Peripheral locationTFCC Injuries: TFCC Injuries Degenerative Ulnar positive Central locationTFCC Anatomy: TFCC Anatomy T riangular F ibro c artilage C omplexTFCC Injuries: TFCC Injuries Ulnar wrist pain + / - clicking Point tenderness Fovea sign Pain with rotation Pronated gripTFCC Injuries: TFCC Injuries Diagnosis MRI ArthrogramTFCC Injuries: TFCC Injuries Acute Tears Cast 4- 6 weeks Chronic Splint / cast Cortisone injectionTFCC Injuries: TFCC Injuries Surgery Acute instability DRUJ Fracture of styloid Failed conservative tx.TFCC surgery: TFCC surgeryTFCC surgery: TFCC surgeryTFCC Injuries: TFCC Injuries Peripheral tear repair 4 weeks cast without rotation Splint and therapy Chronic tear debrided Splint / cast 3 weeks Therapy Wrist Fractures: Wrist Fractures 1/6 th of all fractures treated in ED 15% of all fractures in adults Workplace incidence 25% female 75% male Fall most common Labor / transportation / handler USDL 1995Distal Radius Fractures: Distal Radius Fractures Most common wrist fracture Fall on outstretched armDistal Radius Fractures: Distal Radius Fractures Deformity Pain, swelling, paresthesiasDistal Radius Fractures: Distal Radius FracturesDistal Radius Fractures: Distal Radius FracturesDistal Radius Fractures: Distal Radius Fractures Nonoperative Cast 4-6 weeks Closed Reduction Long arm cast Monitor for displacementDistal Radius Fractures: Distal Radius Fractures Surgery Displaced Unstable pattern Neurovascular injuryDistal Radius Fractures: Distal Radius FracturesDistal Radius Fractures: Distal Radius Fractures Post op: Splint / cast ≤ 4 weeks Therapy ROM / Strengthening Return to work 2 to 4 months if laborerSlide 57: younger age higher education higher income strong social support employment not physically demanding Receipt of disability compensation had a strong negative effect on RTWWork Related Disorders: Work Related Disorders Primary muscloskeletal disorders with…. Secondary psychosocial & economic issuesWork Related Disorders: Work Related Disorders Multi-specialty involvement Physicians Therapists Case managers Improved outcomes Facilitate return to work Manage conflicts You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Kimball Presentation with introduction tedyaz98 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 22 Category: Business & Fin.. License: All Rights Reserved Like it (0) Dislike it (0) Added: November 01, 2011 This Presentation is Public Favorites: 0 Presentation Description Dr. Hervey Kimball on Hand and Wrist Injuries in the Workplace, New England Baptist Hospital October 26, 2011 Comments Posting comment... Premium member Presentation Transcript Hand & Wrist Disorders in Workplace Injuries October 26, 2011: Hand & Wrist Disorders in Workplace Injuries October 26, 2011 Hervey L. Kimball MD, MS Hand Surgical Associates Occupational Medicine CenterHand & Wrist Disorders in Workplace Injuries October 26, 2011: Hervey L. Kimball MD, MS Hand Surgical Associates Occupational Medicine Center Hand & Wrist Disorders in Workplace Injuries October 26, 2011Outline: Outline Workplace injuries Compressive neuropathy Soft tissue disorders Tendinopathies Ganglion Fractures / Traumatic injuriesWorkplace Disorders: Workplace Disorders Different than Non-Work Related Causes Psychosocial factors Job issues TreatmentWorkplace Disorders: Workplace Disorders Surgery less successful More Pain = Less GainSlide 7: BLS year 2005Workplace Disorders: Workplace Disorders Treatments: Education Expectations Attempt work prior to surgery ? permanent job modificationCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Hand Paresthesias Median nerve distribution Night symptoms Intermittent Hand / forearm painCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Incidence 3% women, 2% men Risk Factors Female Age: older BMI Diabetes BiopsychosocialCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Non-operative treatment Intermittent symptoms No atrophy Normal or Mild abnormal NCSCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Non-operative Treatment Job modification Wrist splints Steroid injection 60-80% respond may recur 2-4 monthsCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Operative Treatment Endoscopic vs. Open Indications Failed conservative mgmt. Atrophy ≥ Moderate rating by NCSCarpal Tunnel Release: Carpal Tunnel ReleaseCarpal Tunnel Syndrome: Carpal Tunnel Syndrome Return to work May depend on job Agee ASSH 2 weeks average endoscopic 4 weeks average open Early Outcome and Cost-Effectiveness of Endoscopic Versus Open Carpal Tunnel Release: A Randomized Prospective Trial J Hand Surg [Br] October 2003 28: 444-449Carpal Tunnel Release: Carpal Tunnel Release Non Work Related Work Related Numbness Resolves Persists Discomfort Resolves 3-8 weeks Persists Scar Tenderness 3-6 months Persists Strength Returns 6 month Persists Return to work* 2-4 weeks 6 weeksdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis First extensor compartment Radial side wrist Pain SwellingdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Finkelstein’s TestdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Incidence Women > Men 8:1 in some reports Risk Factors Combination of factors : some evidence Post partumdeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Splinting NSAIDs Ultrasound Cortisone injectiondeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Surgical ReleasedeQuervain’s Tenosynovitis: deQuervain’s Tenosynovitis Post op 1 to 3 weeks splinting Tendon gliding, avoid maximal flexion Return to workTrigger Finger: Trigger Finger Inflammation at tendon sheath Digit Pain Swelling LockingTrigger Finger: Trigger Finger Incidence 2-3% population Risk Factors Female Diabetes 10% incidence Combination of factorsTrigger Finger: Trigger Finger Splinting NSAIDs Cortisone Injection Surgical ReleaseTrigger Finger: Trigger Finger Post op Early ROM Return to work Job dependent days to 3 weeks Complications recurrence stiffnessWrist Ganglion: Wrist Ganglion Cyst from joint or tendon sheath Joint stress Capsular tear Mucoid degenerationWrist Ganglion: Wrist Ganglion 1-2 cm mass Most painless Size may changeWrist Ganglion: Wrist Ganglion Firm mass May be tender Mild decrease in ROM Grip strength Trans illuminationWrist Ganglion: Wrist Ganglion Occult Ganglia Dorsal wrist pain MRI Associated with scapholunate lig. dorsal tearWrist Ganglion: Wrist Ganglion Splinting Aspiration Sheath 60 to 70% Dorsal 30 to 50% Volar < 30%Wrist Ganglion Excision: Wrist Ganglion Excision Gold standard 1 to 10% recur Short term post-op splintWrist Ganglion Excision: Wrist Ganglion Excision Return to work 2 to 8 weeks Complications scar stiffness neurovascular injury carpal instabilityArthroscopic Ganglion Excision: Arthroscopic Ganglion ExcisionArthroscopic Ganglion Excision: Arthroscopic Ganglion ExcisionTFCC Injuries: TFCC Injuries Traumatic Fall in pronation Twisting Peripheral locationTFCC Injuries: TFCC Injuries Degenerative Ulnar positive Central locationTFCC Anatomy: TFCC Anatomy T riangular F ibro c artilage C omplexTFCC Injuries: TFCC Injuries Ulnar wrist pain + / - clicking Point tenderness Fovea sign Pain with rotation Pronated gripTFCC Injuries: TFCC Injuries Diagnosis MRI ArthrogramTFCC Injuries: TFCC Injuries Acute Tears Cast 4- 6 weeks Chronic Splint / cast Cortisone injectionTFCC Injuries: TFCC Injuries Surgery Acute instability DRUJ Fracture of styloid Failed conservative tx.TFCC surgery: TFCC surgeryTFCC surgery: TFCC surgeryTFCC Injuries: TFCC Injuries Peripheral tear repair 4 weeks cast without rotation Splint and therapy Chronic tear debrided Splint / cast 3 weeks Therapy Wrist Fractures: Wrist Fractures 1/6 th of all fractures treated in ED 15% of all fractures in adults Workplace incidence 25% female 75% male Fall most common Labor / transportation / handler USDL 1995Distal Radius Fractures: Distal Radius Fractures Most common wrist fracture Fall on outstretched armDistal Radius Fractures: Distal Radius Fractures Deformity Pain, swelling, paresthesiasDistal Radius Fractures: Distal Radius FracturesDistal Radius Fractures: Distal Radius FracturesDistal Radius Fractures: Distal Radius Fractures Nonoperative Cast 4-6 weeks Closed Reduction Long arm cast Monitor for displacementDistal Radius Fractures: Distal Radius Fractures Surgery Displaced Unstable pattern Neurovascular injuryDistal Radius Fractures: Distal Radius FracturesDistal Radius Fractures: Distal Radius Fractures Post op: Splint / cast ≤ 4 weeks Therapy ROM / Strengthening Return to work 2 to 4 months if laborerSlide 57: younger age higher education higher income strong social support employment not physically demanding Receipt of disability compensation had a strong negative effect on RTWWork Related Disorders: Work Related Disorders Primary muscloskeletal disorders with…. Secondary psychosocial & economic issuesWork Related Disorders: Work Related Disorders Multi-specialty involvement Physicians Therapists Case managers Improved outcomes Facilitate return to work Manage conflicts