um the most common tendon injury um that we see is the um the deaven the deaven syndrome is the the uh information of the first extensor compartment because uh the APL and AP kind of travel together and they're at the first they're they form the first extensor compartment it it it's mainly uh overuse here you can imagine that um in the uh in the 70s and 80s uh this Dean syndrome it's quite common within housewife because they do a lot of housework they cook they clean um and they feel pain over U the first compartment and this is called uh decent so you can kind of know that this is tendon information so the best way for this person to do or cure or treat this um thing is to immobilize so that you know the information will go away but that's not possible because people needs to do things every day with their hand so that's how we all going to have a role here to either um uh make a splint to stabilize the first compartment uh which is the APL and N EPB so that this person can still function but have some protections uh for the compartment or we can simplify the task or other things okay but that's beyond the scope of this course so I can talk Non-Stop about this um typically um this that we can easily um test on this or diagnose this we just um as this person to hold um the thumb in Palm and then do an oral deviation of the wrist if this person feel pain that's a positive sign that it is very likely that this person have that decans okay so that's the ligament in addition to flexor and extensor tendon ruptures and ligaments um the most common ligament injury of the hand is the gamekeeper thumb or the skier thumb is the medial um collateral lament of the mCP joint got rupture or spring that uh that this person lose uh the the force of stability for the thumb okay if it's rupture uh it has to be like surgically uh uh doct um if it's Sprint or um typically uh we will make a splint to um stabilize uh the thumb mCP joint and because you know that this is just U the liament right so we want to uh promote more U motion so IP is not involved typically uh we will free the IP joint um dupon um dupon contracture is interesting because I honestly uh honestly I've never treated a client um with a dup contracture um because it's it's uh it's more uh in the uh northern European um design uh person so in in Asia I never seen one um and it's it's the uh um connective tissue in the Palm um got um um uh how to say uh um a thinking uh so it get get thicker or bulky and it kind of pull the typically is the ring finger and the little finger so I pull the finger kind of down because of the thickening of the connective tissue right right here um I'm I met a gentleman in it that has this dupon contracture and he got U this contracture for both hands and uh he has more than 10 surgeries on each hand and none of the surgery is successful so that means you know uh the recurrence rate is high with this one um so yeah that's that's the downside about it and then when I met with him um and um he said he's considering U for amputation because his job he he in it uh for U the university so his job doesn't require him to do a lot of power grip instead he need to have a lot of precision U grasp or grip so he's uh seriously considered to have amputation for the ring finger and the little finger for both hands because he he doesn't need it another uh famous or popular one is called trigger finger trigger finger it's it's interesting because it's it it looks like you're uh we pulling the trigger so what we see here is U the PIP got stuck like this okay but what really caused it is really the flex attendant got uh developed a nodule and got stuck by uh at the A1 pulley A1 pulley is really at the uh mCP joint okay so uh if you're not familiar with this go back to uh slide from last week and look at the pulley for the A1 so but from the outside we all see that the pp got start but um the reason cause it is really at the A1 pulley right here there's a nodu on the flexor tended okay um so treatment typically we have the splint to uh hyperextend the mCP joint and allow the PIP and dip to to function um and or we can have the stoy injection that would release that nacho immediately uh not immediately about within 30 minutes and this person will uh be free for that but it'll come back every six month so if this person have the injection you need to do it again or um if this person choose to have surgery typically they just you know um release that pulley but we know that when p is not function uh we lose that moment arm um so um this person may have difficulty have full um finger movement but because it's A1 py is so close to the mCP joint so it's not really um too hard for this person to move okay but again this person may feel like weaker you know compared to before the surgery okay so now um let's switch attention to the extensor tendons okay here um this one's called mod finger mon finger is really the dip inflection so uh it can be the terminal tend got rupture which is the L band got ruptured and this person may not be able to extend the dip anymore so what we typically treat is we make a splint to keep the dip in hyper extension so that uh this person can still use the hand for function okay and or we can have a surgical repair and again that would require time to be to heal and all other um tissues that condenses that we need to deal with and stuff like that okay but it's worth a shot [Music] um um here I kind of jump to athritis because uh um the deformity that I'm about to uh introduce is often times related to arthritis and arthritis is more like a joint problem and um uh we know typically we have Osteo arthritis it's a degenerative U it's more like a cartilage got wear down and uh another one called rheumatoid arthritis is it's uh autoimmune system got um got got involved and uh it require a lot of medical I'm sorry medical attention and we will uh talk more about that in the spren so but here just so you know that for joints uh there there are rator auers and osto auers and um they mean different things okay so uh because of the arthritis especially the uh rheumatory uh arthritis uh people often times develop swamp neck deformity or uh buter deformity so the swamp neck deformity is the dip inflection in PIP in hyper extension it looks like a swamp net okay so what's the mechanism uh mechanism behind that um is um the L band kind of subl Loops dorsally so when this person pull or extend um the L band kind of pull um dorsally so that the uh the PIP is in more hyper extension okay so another thing that U you may see is for extension tender rupture at the level band so let me go back here if uh this if the Le bin got ruptur okay which is Zone one right so got rupture so this person lose uh control of the L band and this person may rely a lot on the central sleeve that can also cause the swamp neck but uh but for people with arthritis they have all that I mean the leg um the letter band and censor sleeve are okay it's just the letter band kind of shift dorsally so that when this person use the finger that will cause um the PIP into more hyperextension and dip inflection okay I talk too much about this uh okay and then the opposite side from the small neck is p deformity is the dip in hyper extension and pip inflection again um uh if we look at the little band um it kind of sub volum kind of go pmer more to the Palmer side and when this tenden pull U the PIP is in more flexion and dip is in more uh hyperextension okay but if you look at uh if you think about the tendon side when the central s got rupture this person has no control for the PIP joint and that would rely solely on the L band and that would easily cause this um putterer deformity as well so these are the tendons and then um the bones the most common the most common uh fracture at the RIS is called C fracture that's when we do have the um um out stretch fall and then we try to protect ourself and um the bone going to um going to um display dorsally you see here this this is the U the patient's hand and then the radio I'm sorry the radio bone going to go dors and the fracture size right here okay so this is called colus fracture what if the radi P going to go volly um that's called Smith fracture so um in the referral you you'll see uh The Physician uh just write con fracture or smth fracture and then you need to know um what that means um and this is one example of metal Cobble bone fracture of the thumb right here it's typically at the base right here and it's this is um the Ben fracture that's for specifically for thumb and for boxers fracture is more like a fourth and fifth met fracture because uh it involve power grip right um and then for digit uh fractures it just um just show um different type of U fractures and but just so you know that finger fractures is not just the bone problem when we learn the structure of the hand we know that the tendon sheath the tendon of the extensors and the flexors and intrinsic muscles are you know all the complex stuff kind of going on and they all have a role to the heating of the bone so it's it's more complex than we uh think and than it look