8/12/2019 4 - Late Soft Tissue Complications - D3 Updated

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Done by: mmar Mansour 

Late soft tissue

complication

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Outline

Joint stiffness

heterotopic ossification

Muscle contracture

Tendon rapture Nerve entrapment

Complex regional pain syndrome

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   joint stiffness

the symptom of pain on moving a joint, andloss of range of motion.

causes: After fracture

Direct injury to the joint

Oedema and fibrosis Adhesion

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 All above conditions are made worse by

Prolonged immobilization

Position of joint, why?

Cause if they were held in which ligaments areat their shortest, no exercise will succeed in

stretching these tissue and restoring the lost

movement completely.

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Treatment Elevation. Functional bracing (orthopaedic brace) used

to immobilize a joint or body segment, restrictmovement in a given direction.

Exercise.

Splinted.

In stiff joints, prolonged and patient

physiotherapy can work wonder. Surgery.

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Clinical features.

Pain

Local swellings

X-ray will appear normal at first butBone scan shows increased activity.

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 next 2-3 weekspain gradually subside

limited joint movements.

X-ray

fluffy calcification in soft tissue

By 8 weeks

Palpable bony mass that clearly defined in x-ray

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Treatment:

*Gentle and gradual active movements

*Excise the bony mass

*Indomethacin or radiotherapy

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Muscle contracture

the muscle and its tendons shorten, resulting inreduced flexibility.

Following arterial injury or compartment

syndrome, the patient may develop ischaemic

contracture or

(volkman’s ischaemic contracture) 

Nerve injury by ischaemia sometimes recover.

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Volkmann’s ischaemic contracture. 

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  Richard von volkmann

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clinically Deformity Stiffness

Numbness (inconstant)

In severe case (like forearem)

*muscle wasting and clawing of the fingers.

Common sites

Forearm, hand, leg, foot.

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Treatment

Detachment of flexor muscle at their origin, Mayimprove the deformity.

If the sensation and active movement are not

restored, nerve graft and tendon transfers

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Tendon rupture. After fracture.  treatment is direct suture.

Tendon transfer of extensor indicis proprius todistal stump of the ruptured thumb tendon.

No treatment usually in late rupture of the longhead of biceps after fractured head of femur.

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 Achilles tendon rupture

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Nerve entrapment

Example

carpal tunnel

syndrome,entrapm

ent median nerve

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Nerve entrapment.

nerve becomes trapped or pinched due to somephysiological abnormalities.

Numbness (parasthesia)

Loss of power

Muscle wasting in distribution of the affected

nerve.

Claw hand in ulnar nerve entrapment

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Ulnar nerve and peroneal nerve entrapment

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Common sites are ulnar nerve and median nerve.

Treatment is early decompression of the nerve.

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Complex regional pain syndrome

Sudeck in 1900.

Sudeck’s atrophy. 

Reflex sympathetic dystrophy

Or (algodystrophy) Complex regional pain syndrome

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(CRPS) is a chronic progressive disease

characterized by severe pain, swelling and changes

in the skin

International Association for the Study ofPain has divided CRPS into two typesbased on the presence of nerve lesionfollowing the injury.

Type I, also known as reflex sympatheticdystrophy (RSD), Sudeck's atrophy, reflexneurovascular dystrophy (RND) oralgoneurodystrophy, does not have demonstrablenerve lesions.

Type II, also known as causalgia, has evidence ofobvious nerve damage.

The cause of this syndrome is currentlyunknown.

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severe CRPS ofright arm

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Patient complains.

Continous pain(burining in nature)

Local swelling.

Redness

Warmth. Tenderness.

Moderate stiffness of the joint(near the site of

injury).

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 After weeks.

Pale, atrophic skin.

Increased restricted movement.

May develop fixed deformity.

X-ray

Patchy rarefaction of the bone.

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Osteprosis in CRPS

.

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treatment

Elevation.

 Active exercise.

Physiotherapy.

early stage treatment:anti-inflammatory drugs and amutriptyline

(helpful)

sympathatic block or sympatholytic

drugs.(unpredictable)

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  hank you