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ULNAR DEVIATIONSPROBLEM BASED LEARNING (PBL)

PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB

BACHELOR MEDICINE AND SURGERY (MBBS)

UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

• Also known as ulnar drift.

• Condition:

• Wrist or fingers shift in the direction of the Ulna

• Or it shift towards the little finger side of the forearm.

• Due to inflammation at metacarpophalangealjoints.

involvement in both hands with enlarged

metacarpophalangealjoints and ulnar deviation

Physiological movement of the wristMeasure by protractor goniometer.

Boggy Joint Swelling

• In trigger 2,

- The patient noticed the formation of boggy swelling on her fingers, wrist and elbows.

Causes: Synovitis

- Synovitis causes ‘boggy’ joint swelling - The skin overlying the affected joint is

warm and red due to increased in blood flow.

- On palpation, the swelling is tender (not hard but pain)

In RA,

immune system attacks the lining of the joint (synovium) Inflammation Releasing chemicals Synovium thickening and damaging the bones, cartilage, ligament and tendon

BOUTONNIERE DEFORMITY

ANATOMY OF FINGER

• PIP joint to become flexed (bent)

• DIP joint is pulled up into too much extension (hyperextension)

CAUSES • This disorder most often results from rheumatoid

arthritis

• but can also result from injury (such as deep cuts, joint dislocations, or fractures)

• People with rheumatoid arthritis can develop the disorder because they have long-standing inflammation of the middle joint of a finger.

• If the deformity is caused by an injury, the injury usually occurs at the base of a tendon (called the middle phalanx extensor tendon)

The tendons which straighten these joints are a bit complicated. They are like strings running from the the sides and the back of the finger to a sheet on the top of the finger.

When the finger is hit or bent forcefully in just the wrong way, the sheet on the top of the finger (the central slip of tendon) tears away from its attachment

As a result, the middle joint (called the proximal interphalangeal joint) becomes “buttonholed” between the outer bands of the tendon that runs to the end of the finger (that is, the bones of the joint push out through the bands of the tendon like a button through a buttonhole).

TREATMENTNON SURGICAL SURGICAL

NON SURGICAL

Protection: If you participate in sports, you may have to wear protective splinting for several weeks after the splint is removed.

Exercises: Your physician may recommend stretching exercises to improve the strength and flexibility in the fingers.

Splints: A splint will be applied to the finger at the middle joint to straighten it. This keeps the ends of the tendon from separating as it heals. It also allows the end joint

of the finger to bend. It is important to wear the splint continuously for the recommended length of time -- usually 6 weeks for a young patient and 3 weeks for

an elderly patient. Following this period of immobilization, you may still have to wear the splint at night.

SURGICAL

• The deformity results from rheumatoid arthritis.

• The tendon is severed.

• A large bone fragment is displaced from its normal position.

• The condition does not improve with splinting.

BOUTONNIERE VS SWAN NECK