Imaging Detects Scaphoid Fracture <40

Scaphoid Bone Essay
Hi everyone, For this week 's post is regarding the imaging of wrist and hand. First, diagnostic
imaging is a fundamental element of clinical examination of the wrist and hand for possible injury
or trauma. Due to the complexity of the anatomy of the wrist and hand, it 's hard to diagnose a true
pathology of the wrist and hand. However, an individual suffers from their activities of daily living,
missed work or sports due to early restrictions of hand/wrist motion (provided and prescribed by
medical practitioners) due to the unconfirmed diagnosis of wrist pathology, such as scaphoid waist
fracture. A scaphoid bone is the largest bone at the upper portion of the carpal bones and plays a
significant role in the articulation of the ... Show more content on Helpwriting.net ...
The study performed by Ty et al. (2007) is reliable although the sample size is very small because of
the valid methods and criteria used includes (1)the proper procedures for using CT of twenty–eight
eligible participants, (2) patients with status post injury fro a fall on the outstretched hand with pain
and tenderness of the scaphoid region, (3) the X–ray image performed after six weeks or more from
injury for possible scaphoid fracture is unremarkable, (4) diagnostic traits ( sensitivity, specificity,
negative and positive predictive values (PV) and the accuracy of CT for possible fracture of the
waist of scaphoid and (5) by comparing into two different studies of using CT scan non–displaced
scaphoid fractures. After Ty et, al (2007) compared their study by performing two trials, the
outcome of the research of the CT scan of the patients with a non–displaced fracture is significant
between 89–97 percent for the sensitivity, 85 to 91 percent for the specificity and 88 to 89 percent
for the accuracy. The average PPV of the very low prevalence (5%) of scaphoid fracture of patients
with possible scaphoid fractures using CT scan of the wrist is 0.28 and 0.99 for the negative PV.
Therefore, CT scan is an important modality in detecting an actual fracture of the waist of the
scaphoid, or
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Signs And Symptoms Of Chauffeur's Fracture
Chauffeur's fracture
Another name for a Chauffeur's fracture is the Hutchinson's fracture or oblique fracture. Chauffeur's
fracture is one of the many fractures of the forearm. This kind of fracture occurs on the radial styloid
process.
The signs and symptoms
They are pain over the radial styloid process, and tenderness. Over the skin above the fracture,
swelling, deformity, and bruising will appear.
The cause of the injury is by pressure of the scaphoid bone of the hand, which firmly touches the
styloid process of the distal radius. Another cause of this fracture is that when a person is falling, all
their body weight on their arms and therefore that pressure is the result of trauma a blow to the back
of the wrist or from forced dorsiflexion

Orthopedic Case Study Essay
Orthopedic Hardware
This case study is about a 31 year old male who was rushed into the Manatee Memorial emergency
department with excruciating elbow pain. When evaluated, he broke his internal hardware that was
placed in his distal humerus. After looking through his clinical history, I retrieved different exams
from the time he first broke his lower arm up to today. The patient was originally diagnosed with an
acute displaced fracture involving the distal humeral shaft. Because I only participated in the exam
when the patient broke the internal hardware, I included a report on orthopedic hardware.
Patient History
On June 29th, 2015, a thirty–one year old male was brought into the Manatee Memorial ER with
excruciating right elbow pain. The ... Show more content on Helpwriting.net ...
Before determining a final decision for specific surgeries, prior evaluation must be done to know the
correct locations, areas, angles, and depths of the injuries. X–rays and/or CT scans should be done
prior. Hardware such as metal rods, screws, or plastic placed in the human body is an attraction for
orthopedic surgeons. "Insertion of foreign objects into the human body has been performed with
increasing frequency during the past 50 years and has received added encouragement in the
antimicrobial era" (Howard A. Medelsohnn, 1961). According to the California Medicine Journal,
there have been recordings of internal fixators made our of copper, gold, silver, lead, platinum,
brass, and many more that were implanted into bones to fix fractures as early as the 18th century
(Howard A. Medelsohnn, 1961). All hardware must be able to withhold a certain amount of strength
for specific areas of the body. For an example, a rod placed in a patient's femur must be able to hold
the patient's weight without breaking. The Wayne State University website states that the thicker a
screw or plate, the more resistant it is to bending and breaking (Jerry V. Glowniak & Peter R. Miller,

Essay On Dxa
In DXA the production of photons, based on the use of an X–ray tube (18), leads to shorter imaging
times (less than 5 min) with enhanced resolution and improved accuracy than in DPA using a
radionuclide source. Like DPA, this technique determines BMD in two dimen¬sions (from an
anterior–posterior image). A DXA scanner consists of a mobile X–ray source, an examination table
for the patient, and a de¬tection system that detects radiation emerging from the bones being
examined. The X–ray source is under the examination table and moves together with the detection
system, which is located opposite the X–ray source and over the patient's body (18).
through bones and soft tissue. The attenuation values of soft tissues are subtracted by an ... Show
more content on Helpwriting.net ...
It has been shown that the reproducibility of BMD measurements, expressed as coefficient of
variation (CV), is quite good: 1.12% for vertebrae, 2.21% for femoral neck and 1.32% for total hip
(21).
The central skeleton (spine and femur) is the most relevant measurement site, since this is the site
suffer¬ing the most severe fractures. In particular lumbar spine (for L1 to L4) and proximal femur
(total hip, femoral neck, trochanter and WARD area) (F are mea¬sured by axial DXA devices (21).
The DXA–method has also been applied for mea¬surements of peripheral locations, such as the heel
and distal radius. The choice to investigate the forearm can give an information on the possibility to
have a wrist fracture and can be performed when evaluation of other sites is unfeasible; similarly,
calcaneus measurements are particularly predictive of spine fractures (22) even if the WHO criterion
for osteoporosis diagnosis (T score ≤ –2.5) is not applicable to the calcaneus. Anyway, since there is
only a moderate correlation between the periph¬eral and axial BMD (r = 0.5–0.6), it has been
estimated that over 40% of the patients investigated at peripheral bone sites would need an
additional referral to the axial DXA measurement (23). It has been shown that the most reliable
prediction of future

Case Study: Two Bone Cattle Tufacture
CHIEF COMPLAINT: Both bone forearm fracture follow up HISTORY OF PRESENT ILLNESS:
Noah is an 11–year–old fifth grader who fell off his skateboard, resulting in a both bone forearm
fracture of the left forearm with deformity, who underwent closed reduction in the emergency room
on July 4, 2015, after his injury. He was treated with closed reduction and double sugar tong
application and returns for followup today to check his progress and his reduction in double sugar
tongs. The patient reports no complaints. No pain. No numbness or other problems. He does notice
that the left thumb continues to be somewhat swollen although significantly better with the release
of the soft tissue at his last visit on July 7, 2015. PAST MEDICAL

Broken Bone Procedure
Diagnosis is confirmed by X–ray of the wrist. This is important to understand the extent of the
injury. A posterior–anterior (PA), lateral, and oblique radiographs of the distal radius that include the
carpal bones should be obtained. All three radiographs should be examined for a loss of normal
anatomy, disruption of the articular surface, involvement of the distal radio–ulnar and radiocarpal
joints, and evidence of comminution (Villet 2011). other members of the multidisciplinary team
when its beyond their scope of
Treatment depends on many factors, such as the nature of the fracture, age and activity level of the
patient, and the surgeon's preferences. For the initial pharmacological management of pain in adults
with suspected long fracture of the arm, patient should be offered oral Paracetamol for mild pain;
oral Paracetamol and Codeine or, intravenous Paracetamol supplemented with intravenous morphine
titrated to effect for severe pain (NICE 2016). The treatment of Colles fracture significantly changes
over time. According to Cooney (1989) The basic principles of fracture treatment:
(1) To obtain accurate fracture reduction; and
(2) To use a method of immobilisation that will maintain and hold the reduction; but
French (2001) ... Show more content on Helpwriting.net ...
Many departments would use a dorsal back slab. However, the introduction of radial back slab is
impressive believing that the radial back slab will hold the reduction more effectively (Ferguson et
al 2008). There has been no evidence to determine whether a dorsal or radial back slab should be
used and that adherence to local policy should be followed. However, a retrospective analysis was
carried out on the loss of position after initial manipulation of distal radius fractures in elderly
patients concluded that dorsal slab is not adequate to maintain the position, and therefore complete
cast or radial slab is recommended (Khalid et al

Scaphoid Fractures: A Case Study
Hi everybody,
Wrist fractures are fairly common injuries that are seen in the emergency department with regular
radiograph used as the first choice of approach for diagnosis (Balci et al., 2015). According to Balci
et al. (2015), the gross sensitivity of plain radiographs is between 57.8% to 63.7% while the use of a
multidetector computerized tomography was able to expose 128 occult fractures out of 457 wrists
examined that was missed by radiography.
Scaphoid fractures account for 60% of carpal trauma due to its location, with fractures developing in
three areas mainly the distal pole, proximal pole and the mid portion or the "waist" (McKinnis,
2014). Scaphoid fractures are mainly caused by a fall on outstretched hand with ... Show more
content on Helpwriting.net ...
However, based on an article by Bergh et al. (2015), there was only a minimal difference in total
costs between patients receiving early MRI for scaphoid fracture suspicion compared to the
population that followed a typical diagnostic approach (includes radiographic assessment after 2
weeks and use of a temporary cast) which in turn reduced patients' costs by decreasing lost work
days and time spent in a cast. To summarize, in my opinion, I concur that MRI should be included in
the triage of intervention instead of CT scans for suspicion of a scaphoid fracture due to its high
accuracy for the diagnosis of occult scaphoid fractures (Unay et al., 2009) and due to the overall
reduced costs for the patients.
1.) scaphoid waist fracture with degenerative changes noted on the distal radius
2.) oblique fracture of the 3rd metacarpal shaft
3.) RA with telescoping digits, evident joint deformity (zigzag deformity), joint space narrowing of
the carpal bones
4.) avascular necrosis of the lunate
How does imaging results affect your clinical judgment and treatment for wrist fractures?
Thank you,
Mares

References
Balci, A., Basara, I., Çekdemir, E. Y., Tetik, F., Aktas, G., Acarer, A., & ... Acarer, A. (2015). Wrist
fractures: Sensitivity of radiography, prevalence, and patterns in MDCT. Emergency Radiology,
22(3), 251–256. doi:10.1007/s10140–014–1278–1
Bergh, T.

Case Study on Compartment Syndrome
A Case Study on Compartment Syndrome of the Forearm in a soccer player
Objective: To describe the evaluation, diagnosis, and current treatment of a men's soccer player with
compartment syndrome of the forearm.
Background: The forearm is the most common site for compartment syndrome in the upper
extremity. The compartments of the forearm include the volar (anterior or flexor), and the dorsal
(posterior or exterior). Both bone forearm fractures and distal radius fractures are common initial
injuries that lead to acute forearm compartment syndrome. The flexor digitorum profundus and
flexor pollicis longus are among the most severely affected muscles because of their deep location,
closest to the bone.
Differential Diagnosis: ... Show more content on Helpwriting.net ...
Acute compartment syndrome is a medical emergency. It is usually cause by a severe injury. And
without treatment, it can lead to permanent muscle damage. Chronic compartment syndrome, also
known as exertional compartment syndrome, is usually not an emergency. This is most often caused
by an athletic exertion. Because the fascia does not stretch, this can cause increase pressure on the
capillaries, nerves and muscles in the compartment. The blood flow to the muscle and nerve cells is
disrupted. Without a steady supply of oxygen and nutrients, the nerve and muscle cells can be
damaged. Compartment syndrome most often occurs in the anterior compartment of the lower leg.
But can also be present in other compartments in the leg, as well as the arms, hands, feet and
buttocks. The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes
who participant in activities with repetitive motions, such as running, biking, or swimming, are
more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the
exercise and is usually not dangerous. Acute compartment syndrome usually develops after a severe
injury such as a broken bone. Rarely does it develop after a relatively minor injury. Conditions that
may bring on acute compartment syndrome include: a fracture, badly bruised muscle, reestablished
blood flow after block circulation, or constricting bandages. The classic sign of acute

Distal Fracture And The Fracture
Distal Radius Fractures
Introduction
A distal radial fracture is also commonly known as a Colles fracture. This is a fracture of the distal
metaphysis of the radius, which often has dorsal displacement leading to deformity commonly
referred to as a dinner folk deformity. It is caused due to a fall on the outstretched hand (FOOSH).
This type of fracture was first described by an Irish surgeon, Abraham Colles in 1814 (Radiopaedia,
2014).
Epidemiology
Colles fracture becomes more recurrent with increasing age and occurs more in women with
osteoporosis. This is because osteoporosis is a progressive disease which in time drastically reduces
bone density and ' micro–architectural deterioration of bone tissue ' ... Show more content on
Helpwriting.net ...
The periosteal sleeve is also happens to be much thicker in children than in adults and acts as a
restraint to displacement. The thick periosteal sleeve is important for pediatric skeletal remodeling.
There is a strong correlation between osteoporosis and a Colles fracture. When a male patient is
diagnosed with a distal radial fracture, it is imperative that correct tests should be done to eliminate
osteoporosis as the patient 's risk of a hip fracture will also increase drastically as demonstrated in
many studies (Patient, 2014).
Classification
The radius is a long bone; this means that the bone is longer in length than it is wide; which aids in
mechanical movement of the skeleton. Most skeletal muscle attaches to bone, therefore when
muscles contract and relax, which allows flexion and extension in the sagital plane. Flexion
decreases the angle at the moving joint. Extension increases the angle at the moving joint. Synovial
joints such as the elbow hinge joint are able to efficiently carry out these motions. The wrist is a
classic example of a condyloid joint, which means it can move on two axes, side to side and back
and forth so on the sagittal and frontal plane.
A Colle 's fracture can be extra–articular; this is a fracture which does not involve the joint space
therefore it is

Left Ankle Injury Case Study
On 09/08/2017, the claimant presented with a left ankle pain which has been present for 1 week. It
was noted that the symptoms occurred on the left side. It was described as sharp and intermittent.
The claimant sustained a left ankle injury on 08/28/2017 while running. The pain was relieved with
braces and was not relieved by heat and ice. Her weight was 135 pounds and her BMI was 21.22.
The left foot/ankle examination revealed tenderness to palpation over the medial malleolus. The x–
ray of the left ankle revealed a non–displaced transverse fracture at the distal portion of the medial
malleolus. She was diagnosed with a left ankle stress fracture medial malleolus. An outside DME
bone stimulator and the use of a boot were recommended.
Questions ... Show more content on Helpwriting.net ...
There was significant bone–to–bone variation; metatarsal was "fresh" until week 7, ankle until week
9, humerus until week 10, and femur and radius until week 12. Healing was significantly impacted
by the patient's age, body mass index, and open fracture (all, P ≤ 0.02). The results suggest that
fractures of the metatarsal, femur, humerus, ankle, and radius respond to low–intensity ultrasound
treatment. https://www.ncbi.nlm.nih.gov/pubmed/28134628
As such, the request for an Osteogenic ultrasound bone growth stimulator is considered medically
necessary and appropriate to further promote healing and recovery.
2. Does an osteogenic ultrasound bone growth stimulator meet the standard of care? Yes or no;
please explain.
Yes. The requested medical service does not meet the standard of care.
3. Is an osteogenic ultrasound bone growth stimulator considered to be experimental/ investigational
for this patient with a diagnosis of left ankle stress fracture? (See attached plan language.) Yes or no;
please explain.
Yes. As per the plan language, numerous scientific studies established the health benefits of
ultrasound stimulation in promoting healing of fresh fractures. This medical treatment is considered
reasonable and necessary and not experimental or

Descriptive Essay About Tattoos
small–tattoos–01.jpg Tattoo on the outer side of the upper arm about four inches long depicting
army–like stripes approximately a quarter inch thick, with the first stripe two inch from the crook of
the arm. Four stripes of light black ink tone point upwards towards the upper arm and transform into
two dark–toned images of a bird in motion. Small–tattoos–02.jpg Tattoo design covering the entire
circumference of the wrist. Shows an ocean wave on the backside of the wrist of the right hand in
grey and accented in black ink and with the front side depicting a small island with a single coconut
tree on it. Small–tattoos–03.jpg Tattoo style on the innermost part of the forearm of the left hand
indicating an intricate image of Da Vinci's framed hand of God and Adam, about two inches thick.
This is a perfect way to represent spiritual path Small–tattoos –04.jpg Small tattoos for guys on the
lower side of the chest, one inch from mamma and on the left side a drawing that shows a simple
representation of an elephant. A great tattoo that symbolizes dignity, strength and pride. Small–
tattoos–05.jpg Small tattoo ideas can be applied to the left inner arm and turn cycling into a body
art! adorable and lovely black bicycle design pointing to the left; about two inches thick for travel
lovers. Small–tattoos–06.jpg Small tattoo for men, a classic flying bald eagle one inch from clavicle,
drawn entirely using black ink with simple white horizontal lines at the wings apart from the

Bone : Distal Radius Fracture Essay
Bone: Distal radius fracture, non–displaced, in a healthy middle–age adult.
The primary cellular components of bone tissue are osteoblasts and osteocytes, and these are
distinguished by their location and their function.1 The osteoblast is the bone–forming cell that
eventually becomes an osteocyte. During this intermediate changeover, the cells are referred to as
intermediate cells. "Bone matrix is comprised of three elements: organic, mineral, and fluid. Organic
components constitute 39% of the total bone volume, which contains 95% type I collagen and 5%
proteoglycans. Minerals include primarily calcium hydroxyapatite crystals and contribute about half
of total bone volume."1 Within the matrix, collagen fibers are responsible for providing tensile
strength. Eventually, calcification and ossification of the fibrous matrix forms individual bony
trabeculae that together constitute a primary ossification center.2 The arrangement of the
collagen/trabeculae along the length of the bone give the bone its tensile strength; the resistive
strength against bending/breaking.1,2 The density of the bone is provided by calcium salts which
are necessary to provide resistive strength against compressive forces, such as load/weight bearing
activities.1 Stresses from weight bearing and using muscles provide the necessary stimulus for the
formation and organization of collagen/trabeculae to form architecturally strong bones. Typically,
when no injury or disease is present, bone

Medical Case Study Term Paper
DOI: 06/06/2015. Patient is a 61–year–old female full time housekeeper at a hotel resort who
sustained a work–related injury when she fell and broke her wrist when taking trash out. Per claim
notes, she was initially diagnosed with right comminuted fracture radius and right wrist contusion.
Submitted medical report is handwritten and most of the notes are illegible. X–ray of right wrist 3
views dated 6/18/15 revealed persistent linear opacities distal radius consistent with incompletely
healed intra–articular fractures. Ultrasound of right carpal tunnel dated 2/17/16 revealed median
nerve measurement was 0.08CM2 (nl X<0.10 CM2) and compression/impingement showed no
evidence of compression of the median nerve. As per request for authorization,

Anne Rutter Case
A reflective analysis on a case presented via a video tape of a simulated patient with a minor injury.
This assignment will present a reflective analysis of the examination, diagnosis, treatment and
referral plan based on a simulated patient presenting with a minor injury. Potential diagnoses related
to the mechanism of injury will discussed aligning the patient presentation with the literature to
produce the most likely diagnosis. When this is established, a suggested treatment plan will be
created in line with current guidance. This essay is based upon the case of Anne Rutter. A forty six
year old lady who two days previously fell on icy path outside of her house; putting her left hand
down to break the fall. Anne reports immediately feeling ... Show more content on Helpwriting.net
...
Anne is currently taking paracetamol for the pain in her wrist, within healthcare analgesia should
always be monitored to assess whether it is achieving elimination of pain and should be adapted to
the individual patient (Vargas–Schaffer, 2010). If paracetamol were not effective in eliminating
Anne's pain then practitioners should consider a non–steroidal anti–inflammatory medication
[NSAIDS] or a mild opioid medication such as codeine as the next step (Vargas–Schaffer, 2010).
However as Anne is asthmatic NSAID medication should be used with caution due to the risk of
increased frequency of asthma attacks and breathlessness (Joint Formulary Committee, 2015); if
Anne has taken NSAIDS before with no issue then this would be the next choice of analgesia
followed by codeine if combined paracetamol and NSAID did not prove effective (Vargas–Schaffer,

Code and Modifiers Used by Orthopedic Surgeons in Medical...
Fundamental of Health: Orthopaedic is the medical specialty that focuses on injuries and diseases of
your body's musculoskeletal system. This complex system includes your bones, joints, ligaments,
tendons, muscles, and nerves and allows you to move, work, and be active. (AAOS)
Once devoted to the care of children with spine and limb deformities, orthopaedists now care for
patients of all ages, from newborns with clubfeet to young athletes requiring arthroscopic surgery to
older people with arthritis. And to anybody that can break a bone. (AAOS)
Orthopedic surgeons manage special problems of the musculoskeletal system. This involves:
Diagnosis of your injury or disorder Treatment with medication, exercise, surgery or other treatment
... Show more content on Helpwriting.net ...
The physician reports CPT code 20610 (arthrocentesis, aspiration and/or injection; major joint or
bursa [eg, shoulder, hip, knee joint, subacromial bursa]) for the right knee injection, and 20610–59
for the right shoulder injection. Modifier 59 distinct procedural service * 25605–76 – Physician
reduces a distal radius fracture in the office on May 15 and the reduction is lost so that the fracture
must be reduced a second time on May 22, the physician would report CPT code 25605 (Closed
treatment of distal radial fracture [eg, Colles or Smith type] or epiphyseal separation, includes
closed treatment of fracture of ulnar styloid, when performed; with manipulation) for the May 15
visit and 25605–76 to indicate a repeat reduction for the May 22 visit. * 27412 Autologous
chondrocyte implantation, knee J7330 Autologous cultured chondrocytes, implant S2112*
Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells) The asterisk indicates it is
not paid by medicaid (www.priorityhealth) * CPT codes 29874 (Surgical knee arthroscopy for
removal of loose body or foreign body) and 29877 (Surgical knee arthroscopy for
debridement/shaving of articular cartilage) should not be reported with other knee arthroscopy codes
(29871–29889). Report G0289 (Surgical knee arthroscopy for removal of loose body, foreign body,
debridement/shaving of

Distal End-Radius Fractures: A Case Study
Distal end radius fractures are the commonest fractures of upper limb with debatable treatment
modalities. Whereas, the dictum followed among the orthopods is to undergo operative intervention
in younger age groups, conservative treatment is usually reserved for the geriatric population.
Various studies have stressed upon the linear co–relation of anatomical restoration with better
functional outcome 10–12. Once anatomical restoration has been achieved, methods like casting,
external fixation, internal fixation should be used to maintain the same. Closed reduction and
casting can help to achieve a three–point fixation required for proper union. Albeit, cast application
alleviates the necessity for a surgical intervention, this method has limited rotational control and
maintenance of length that is required for anatomical union to occur13. There were 31 patients in
Group A in the present study, ... Show more content on Helpwriting.net ...
Treatment of unstable distal end radius fractures with volar locking plates without additional bone
graft can give good results 1,16–18. However, many are of the opinion that the surgical modality is
associated with higher morbidity and mortality especially amongst the geriatric age group with
approximately 2% of the population with sustained complications within first 30 days of
surgery19,20. Contradictory to this notion, the present study had better outcomes in patients who
underwent volar plating in terms of range of movements, grip strength, radiological parameters
which were statistically significant. Our findings were in consistent with that of Lutz et al19, who
prospectively studied 256 patients with distal end radius fractures from several databases and
concluded that patients who underwent surgery had better functional and radiological outcome and
better DASH

Case Study Osteoporosis
Case Study 1. What is meant by a "complete, comminuted, intertrochanteric fracture of the right
hip"? A. Complete – refers to a fracture completely through the bone: B. Comminuted – refers to a
fracture in which the broken bone has shattered into several smaller pieces: C. Intertrochanteric –
refers to a fracture located between the greater trochanter and lesser trochanter of the femur: 2.
Draw a picture of what you think Margaret's fracture looks like. 3. The radiologist reported signs of
osteoporosis. Describe the characteristics of an osteoporotic femur as seen on an X–ray. (How does
it differ in appearance from a normal femur?) Osteoporosis is marked by a decreased bone volume.
Loss of spongy ("cancellous") bone is greater than ... Show more content on Helpwriting.net ...
cartilage–forming cells) and lay down a fibrocartilage splint (i.e. soft tissue callus) | C. bony
callus(starting 3 to 4 weeksafter the injury) | – osteoblasts begin to replace the fibrocartilage splint
with spongy and compact bone, forming a bulge that is initially wider than the original bony shaft |
D. bone remodeling | – as the patient starts to use (or bear weight on) the bone, the bone starts to
remodel along lines of maximal stress (this remodeling process requires the activity of both
osteoblasts and osteoclasts | 7. During her long recovery, Margaret is advised by her physician to
begin weight–bearing as soon as she can. How does weight–bearing influence the process you
described in question #6? (Be specific in your answer and describe what weight–bearing does to
bone at the microscopic level.) The most popular hypothesis regarding the effect of weight–bearing
on bone remodeling is called Wolff's law . Wolff's law states that bone grows and remodels in
response to the mechanical stresses placed upon it (e.g. from muscle pull or gravitational pull).
Thus, bone is laid down along lines of maximal stress. This is presumably why: A. long bones are
the thickest midway down the diaphysis, where the stresses are the greatest. B. curved bones are the
thickest where they are most likely to buckle (e.g. note the thick greater

Procedural Skills Research Paper
Procedural skills: The assessment of procedural skills and clinical examination is an important part
in emergency department. So, Competence in these skills is extremely integral. Usually when the
case is ready for examination, the doctors call us to attend and ask us to observe what they do, if the
patient is stable, the doctors allow us to examine them under their supervision. Otherwise, they
satisfied us just to observe and write down their notes. The doctors told us not to forget the rules and
the rights of patients before touching them. These rules includes : take the permission from the
patient before you start and tell them all what you want to do and examine , wash your hands before
and after your examination, do not forget to wear our your gloves , ensure your patient privacy and
do not expose anything that will not be examine. In addition to that, they taught us the general steps
of clinical examination which are: general inspection, palpation, percussion and auscultation. They
make us able to inspect patients from the head to the toes, seeking for any abnormalities, changing
in color, distribution of hair, temperatures, scars and stretch marks. They taught us how to palpate
far from the area of pain and look at the same time on the patient's face. Also, we learnt the
difference between dullness percussion and resonance percussion. Lastly, we knew how to
differentiate between all heart sounds and ... Show more content on Helpwriting.net ...
We did for her blood test. The result was hyperglycemia, acidosis and high level of ketones body.
This girl was diagnosed with Diabetes Ketoacidosis (DKA). 2– A 45 years female suffer from
ascites five months ago, fatigue, loss of appetite, yellow skin and weight loss. We did for her many
laboratory tests to check liver and kidney function. She had high level of certain and bilirubin and
that was indicate liver

Systemic Osteoporosis
Systemic glucocorticoids are the leading cause of secondary osteoporosis. Osteoporosis is described
by the World Health Organization (WHO) as a 'progressive systemic skeletal disease characterised
by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in
bone fragility and susceptibility to fracture'. Oral glucocorticoids are the low bone mass and
microarchitectural deterioration main iatrogenic cause of fragility fracture. Relationship between
glucocorticoid use and bone loss has been studied and established since 1990. Early studies showed
that oral glucocorticoid cause a substantial loss in bone density and other bone markers. Subsequent
epidemiological research identified confirmed the link between fracture and oral glucocorticoid use.
Fragility fractures are the ultimate clinical endpoint that is targeted to prevent in osteoporosis.
Osteoporotic fractures occur in several bone locations. Most osteoporosis–resultant fractures are
hip, proximal femur, vertebral, distal radius and ulna, which are often labeled as major osteoporotic
fractures. Fracture of the tibia, fibula, patella, ribs, and sacrum are also considered fractures
attributable to osteoporosis. A substantial amount of evidence showed increased risk of mortality
post fragility fracture. A systematic analysis of epidemiological studies showed that the mortality
rate during the first year after hip fracture ranged from 8.4% to 36.0%. Post–fracture mortality rates
was associated with vertebral, humerus, and ; while . A significant morbidity ... Show more content
on Helpwriting.net ...
Oral glucocorticoids exhibit a particular mechanism on bone that rapidly leads to bone loss and
bone structure deterioration; thus, causing higher fracture risk. Glucocorticoid–induced osteoporosis
physiopathology is multifaceted and is distinct from aging and postmenopausal

Functional Elbow And Wrist Rehabilitation Prototype...
Functional Elbow and Wrist Rehabilitation Prototype Controlled by Computer
Milton Acosta Jarrín
Flavio Pineda–López
Stephanie Vásquez Gabela
Gabriela Moya Cáceres
Universidad de las Fuerzas Armadas ESPE
Sangolquí, ECUADOR
gaby.pmc@gmail.com fmpineda@espe.edu.ec vastephanie@gmail.com mgacosta.@espe.edu.ec
Abstract– In this paper, we have considered the anthropometrics of the human arm, taking into
account the movements and angles of the elbow and wrist with the goal of developing a prototype
for the first and second phases of rehabilitation for the patient in order to achieve full joints
mobility. The implementation of this prototype consists of four different adaptations, for each
movement, a sensors interface electronic board, a control board, and a graphical user interface
where the physiotherapist is able to set up a personalized rehabilitation cycle according to the
patient needs.
We have done field tests of the prototype with a patient with elbow and wrist fracture diagnosis, as
we observe a improve in mobility of the both joints through a small number of rehabilitation
session, as regards is concluded that the prototype allows to reach progressively angles nearer to
angular limits of pronation and supination of elbow movements and flexion –extension of wrist,
with a reduction of 50% of number of sessions by conventional methods.
Keywords– Arduino; anthropomorphic; servomotor;
I. INTRODUCTION
The goal of rehabilitation is to achieve the

Distal Radius Fracture Essay
Diagnosis– Fractured distal radius and ulna
Etiology:
The primary cause of a fracture is trauma from car accidents, sports injuries and falls. The trauma
may be a direct blow to the bone or an indirect force from muscle contractions or pulling on the
bone. Other factors that may contribute to fractures include: vigorous exercise, malnutrition, genetic
factors, and osteoporosis. The most common cause of a distal radius fracture is falling onto an
outstretched arm (Ignatavicius & Workman, 2013). "Wrist fractures of the distal radius are common
and may present special problems for the surgeon and therapist. There are several categories of
distal radius fractures, but the Colles fracture of the distal radius is the most common injury to the
wrist and may result in limitations in wrist flexion and extension, as well as forearm pronation and
supination, resulting from the involvement of the distal radioulnar joint" (Early, p.613).
Signs and Symptoms:
The signs and symptoms of a distal radial and ulnar fracture could include: pain, edema,
contractures, deformity, protruding bone, and decreased sensation. In addition, ... Show more
The patient has a supportive neighbor who drove him home from the hospital and a senior services
volunteer who drives him to the nursing home his son resides at. Strength in his right UE is 4/5 in
shoulder movements, 3+/5 in elbow and hand, and 3–/5 in his wrist. He has edema in his wrist and
fingers along with pain in most wrist movements. AROM in his elbow is a –25 degrees extension,
wrist has 20 degrees of flexion and 15 degrees of extension, and his fingers are –1/3 of full ROM.
The patient is right handed and also has impaired coordination during fine–motor and dexterity
movements with his right UE but is left UE is WFL. The patient has a positive prognosis with
nursing and occupational therapy interventions to return to a functional level of

Midterm Review Anatomy 1 Lab
Review: Anatomy I Lab Chapter 1: Language of Anatomy What is anatomic position? – Human
body is erect, with the feet only slightly apart, head and toes pointed forward, and arms hanging at
the sides with palms facing forward. –two major divisions of human body surface are Axial, and
Appendicular 2. Body orientation and direction. ~Superior– above ex. the nose is superior to the
mouth ~Inferior– below ex. the abdomen is inferior to the chest ~Anterior– front ex. the face and the
arms are in the anterior body surface. ~Posterior– back ex. the spine is posterior to the heart
~Medial– toward the midline ex. the heart is medial to the lungs. ex. the sternum is medial to the
ribs ... Show more content on Helpwriting.net ...
–Coccyx–formed from the fusion of 3 to 5 small irregularly shaped vertebrae. It is literally a human
tailbone, a vestige of the tail that other vertebrates have; is attached to the sacrum by ligaments. 7.
Sternum (bones of sternum and identify them in figure) 8. True ribs and false ribs *12 pairs of ribs –
True Ribs– first seven pairs; are directly connected to the sternum. –False Ribs– next five fairs; are
not directly connected to the Sternum. Chapter 5: Appendicular Skeleton How many bones are in
the appendicular skeleton –composed of 126 bones of appendages and pectoral and pelvic girdles
which attach the limbs to the axial skeleton. 2. The bones of the Clavicle and Scapulae –Clavicle
(collarbone) – sternal (medial) end– attaches to sternal manubrium –acromial (lateral) end–
articulates w/ the scapulae to form part of the shoulder joint. –Scapulae (shoulder blades) –known as
"wings of humans" –connects humerus (upper arm bone) w/ clavicle (collar bone) – two processes:
–acromion: connects clavicle –coracoid process: attachment point for upper limb muscles –has three
angles: superior, inferior, lateral 3. The Arm –consists of single bone called humerus –head fits into
glenoid cavity &

Darrach Procedure: A Case Study
TREATMENT
Conservative treatment is always the first approach and involves reduction or modification of
activity, occupational and physical therapy, splinting, and the use of NSAIDs or intraarticular steroid
injections (41).
In cases of instability due to fractures, reduction needs to be addressed first to ensure integrity of the
joint anatomy to allow soft tissue healing. In cases of distal radius fractures, reduction and
restoration of radial alignment is necessary and long term results show no difference in outcomes of
conservative or surgical approaches following adequate fixation (42). Ulnar head dislocations may
require reduction and temporary fixation with K–wires. For fractures of the ulnar styloid, fixation of
the radius alone may have the same results as ulnar styloid fixation ... Show more content on
Helpwriting.net ...
It is usually indicated for pain relief caused by distal RU disruption or RU arthritis and improves
pronation and supination. Its limitations include the possible developments of ulna impingement
syndrome, decreased grip strength and ulnar translation of carpals (44)(45). Since it leaves the
patient with low functionality, it is preferred for the elderly. It may also be combined with ECU or
FCU tendon slings to provide more ulnar support (46)(6). Various hemiresection procedures with
interposition of soft tissues between the remaining ulnar stump and radius are another option. A
more function preserving choice is the Sauvé–Kapandji procedure involving arthrodesis of DRUJ
which is more commonly preferred in young patients. Forearm pronation and supination are
maintained by creating a pseudoarthrosis of the ulna just proximal to the DRUJ arthrodesis. It
differs from the Darrach procedure in that it preserves ulnar support of the wrist, as the distal
radioulnar ligaments and ulnocarpal ligaments are maintained but painful instability of the proximal
ulna stump may persist

Growth Plate Injury Research Paper
5 of the Most Painful Growth Plate Injures Affecting Young Athletes
The Centers for Disease Control and Prevention recently reported that more than 2 million children
are treated each year for sports– and recreation–related injuries. Sports participation provides many
benefits for younger athletes, but unfortunately, injuries do occur. This means doctors have to treat
these injuries differently than they do for adults.
Why? Children and adolescents have growth plates, which are the areas of soft tissue near the ends
of the long bones in their arms and legs. Because these are the last portion of the bones that harden
(ossify), they are particularly vulnerable to injury. For instance, the same type of accident that might
cause an adult to have an ankle sprain can be a growth plate fracture in a child.
How long does this last? Girls' growth plates usually harden or ossify wen they're around ages 13 to
15 years old, while boys' growth plates harden later, at ... Show more content on Helpwriting.net ...
Your child's treatment will depend on how severe the growth plate injury is and the vast majority of
kids do recover without any long–term consequences. Many of these injuries are minor which
means that doctors will usually suggest that they limit their activities and not bear any weight on the
affected limb. Most of the time this can be accomplished by wearing a cast, splint or brace over the
area to prevent any movement. In these cases, this may be the only treatment necessary but with
fractures, immediate care is extremely important. This is so that Doctors can:
Provide immobilization using a cast or splint
Use manipulation or surgery to unite the bones into the correct position; which can depend on where
and how serious the injury is and, the patient's age
Use strengthening and range–of–motion exercises to improve movement, but only after the fracture
heals
Incorporate a long–term follow–up plan; including x–rays, to monitor your child's growth and

Synovial Joint Creation Research Assignment
Synovial Joint Creation/Research Assignment
Assignment Outline
Name: (Your name and Partners) ¬¬¬¬¬¬¬
Anatomical Term for your Joint:
Required Information:
a) Movement (and restrictions of movement) in the joint
– Planes, type of movement (eg. Adduction) (frontal and sagittal)
– The human elbow is the summation of 3 articulations. The first 2 are the ones traditionally thought
of as constituting the elbow: the humeroulnar articulation (the synovial hinge joint with articulation
between the trochlea of the humeral condyle and the trochlear notch of the ulna) and the
humeroradial articulation (the articulation between the capitulum of the humeral condyle and the
concavity on the superior aspect of the head of the radius). The third is a pivot–type synovial joint
with articulation between the head of the radius ... Show more content on Helpwriting.net ...
Triceps brachii: This muscle at the back of the upper arm extends the arm and fixes the elbow when
the hand is used for fine movements.
Brachioradialis: A forearm muscle that flexes the arm, extends it straight, and pulls it together at the
elbow.
Anconeus: This muscle helps extend the elbow joint.
Brachialis: This muscle helps flex the elbow inward toward the body.
Pronator teres: This muscle extends from the head of the humerus over the elbow to the ulna bone to
help flex the elbow.
d) Common Injuries (mechanism, resulting damage, treatment) –– 2–4 injuries!
– Only done if no model
Lateral epicondylitis (tennis elbow)
Forearm muscles extend wrists and fingers
Tendon usullly involved in tennis elbow is called the extensor carpi radialis brevis

Right Wrist Pain Case Studies
The claimant is a 27–year–old female who sustained an injury on 09/27/2017 when she fell on a wet
floor causing a fracture in her right wrist.
X–ray of the right hand/wrist dated 09/27/2017 showed an acute fracture that involved the distal
metaphysis right radius with 2mm separation. There was a dorsal angulation of the distal segment.
There was a subtle avulsion fracture involving the styloid processes of the distal ulna.
On 10/02/2017, the claimant presented with right wrist pain. She reported that the pain interferes
with daily activities. She had a weakness, joint stiffness, and joint pain. Objective findings showed
swelling, deformity, tenderness, and limited range of motion of the right wrist/hand. She was
diagnosed with a pain in the right wrist and Colles' fracture of the right radius (closed fracture). A
forearm cast and x–ray of the right wrist/hand were recommended. ... Show more content on
Helpwriting.net ...
It was indicated that the claimant was referred to PT due to right hand/wrist pain, muscle weakness,
tightness in the right wrist and fingers, and decreased functions. She was status post closed
reduction and pinning in the right wrist with the removal of the hardware on 11/17/2017. Objective
findings showed swelling in the right wrist/forearm area and tenderness in the right medial wrist
area. She rated the pain at 5/10. She had impaired mobility, right upper extremity muscle weakness,
and decreased endurance.
On 01/03/2018, the claimant presented for a follow–up for the right wrist. She complained of pain
and weakness in her right wrist/hand. The associated symptoms include joint pain, joint stiffness,
weakness, pain, and decreased strength. Objective findings showed healed pin sites. There was less
swelling, deformity, tenderness, and limited range of motion. She had a full range of motion in the
fingers with popping in the wrist. She lacked full supination and pronation. Physical therapy was

Essay On QUS Of Bone
techniques are also used in order to estimate quantitative parameters and assess tissue properties.
Advantages of US methods can be related primarily to the fact that they do not cause radiation
exposure. In addition, US devices have the advantages of small size and portabil¬ity providing
quick and simple measurements In addition, low costs and shorter investigation times compared
with both DXA and QCT (43).
QUS of bone has been applied about two decades ago as a method for evaluating bone structural
features and elastic properties of bone tissues that could not be assessed using densitometric
approaches (43), particularly in post–menopausal os¬teoporosis (44). The recent technical creations
of some of the available devices have made it ... Show more content on Helpwriting.net ...
More complex parame¬ters have been applied from combination of SoS and BUA producing
amplitude dependent speed of sound (AD–SoS), stiffness and quantitative ultrasound index (QUI)
(45). In osteoporosis diagnosis, these latter have proved to be more useful in identifying subjects
with low BMD and therefore at high risk of fracture (47).
Several studies have been prformed to evaluatethe per¬formance of US systems in terms of stability,
accuracy, and ability in the detection of patients with osteo¬porotic fractures. Most of these studies
include com¬parison of the QUS method with X–ray methods such as DXA or QCT (48).
It has been shown that ultrasonography provides useful information, such as the distribution of the
mineralized matrix within the bone (the connectiv¬ity and the thickness of the trabeculae) and the
different resistance of the bone tissue loading according to the trabecular orientation (49).
A large number of studies in the last decades, have confirmed the usefulness of QUS to predicte
osteo¬porotic fractures of the calcaneus (particularly in elderly women aged 65–70 years or older),
the distal metaphysis of the phalanx, the radius and the tibia (50).
Recently, new QUS techniques to assess the femur and the spine have been p. In vitro studies have
shown a high correlation between QUS measurements and BMD in human femur cadaver
specimens

Reinstatement Of Health Care Letter Essay
I am writting this letter today to request pardon and for your consideration of reinstatement of
Health Care Benefits recently disenrolled from Dental, Health, Drug effective 7/1/17. I was
involved in a motorcyle/car crash on 7/9/17 at around 8pm, I was traveling west bound on The
Alameda on my motorcycle when a parked vehicle pulled out of the right hand side and attempted
to make a u–turn causing the collision. According to the State Of Maryland Vehicle Crash Report
upon impact I flew into the air, over the vehicle and about 15 feet away from the point of impact
landing unconscious on the concrete, which I still have no recollection nor memeory of! Suffered
disabling damage from the crash, sustained from non–life threatening inury and ... Show more
Overwhelmed by the accident and in the midst of recovery, medication and doctor visit's and
treatment I lost track of some responsibilities. With the help of my supervisor Charles Tate, assisting
me with communication and forms needed during the process, god bless his heart, documentation
and forms were sent/received to and from my employer and the proper channels. An FMLA form
was filed and approved, please see attachments, this is the first hospitalization in my personal life,
also my first time out of work for injury/accident so this process is all new time. As a contractural
employee I receive no compensation for the time documented or excused, caused by the incident
under FMLA policy and thefore have had a financial hardship trying to keep up with all
responsibilities over these few past months. I was under the assumption, as I did not receive
Healthcare documentation, payment vouchers, nor monthly late payment reminder letters in the
mail, as I have previously each month, and making all my payments online from my work desk, that
my employer understanding that I was involved in an accident and approved for FMLA and
receiving no payroll, I assumed that Healthcare benefits had been suspended from payment and
covered under FMLA. As I come to the final weeks of recovery and getting ready to return back to
work I find myself in this situation and alot of financial disputes between my insurance and the
institution that perform my surgery as

Wrist Pain Essay
Wrist pain can be due to mechanical, neurologic or systemic causes. Wrist pain that does not resolve
after six weeks to three months is a common diagnostic challenge due to its anatomical complexity.
Two algorithms have been designed to diagnose chronic wrist pain and both emphasize the
importance of detailed history taking and examination, which include orthopedics assessment of the
joint through a series of wrist movements, palpation and provocative maneuvers. A systematic
examination helps categorize the wrist pain to radial, central, ulnar–sided or diffuse wrist pain and
also formulates an appropriate diagnosis. Provocative maneuvers use precise physical examination
techniques where the examiner introduces energy into the wrist in a manner ... Show more content
A common cause of ulna wrist pain is TFCC tear. It occurs in up to 80% of displaced distal radius
wrist fracture. Attritional tears or degenerative pathology involving the TFCC are common, with a
reported incidence of tears in greater than 50% of those over the age of 60 years which may become
symptomatic after minor wrist trauma. Even so, ulnar–sided wrist pain can't always be linked to
TFCC abnormalities as there is a high prevalence of them being asymptomatic. Clinical
examinations used to detect TFCC injury involve testing Distal Radio–Ulnar Joint (DRUJ) stability,
palpation for surrounding tendon and ligament tenderness Recent studies have shown that stress–
testing of the guiding, check–rein portions of the ligamentum subcruentum can provide excellent
diagnostic information without the need for special imaging studies. It is most effective when used
in patients who have ulnar–sided wrist pain, tenderness in the anatomic area of the TFCC after wrist
injury, but with full forearm ranges of motion, normal x–rays and without gross DRUJ

broken hip with answer 4
Chief Complaint: 72–year–old woman who fell on her right hip.
History: Margaret Donovan, a 72–year–old white female, was brought to the emergency room by
her son–in–law after falling in her bathtub. She was previously in good health, despite leading a
relatively sedentary lifestyle and having a 30–pack–year history of cigarette smoking. The only
medication she currently takes is Inderal (propranolol) for mild hypertension. She fell upon entering
the bathtub when her right leg slipped out from under her; she landed on her right hip. There was no
trauma to her head, nor does she complain of right or left wrist pain. However, she reports severe
pain in the right hip and upper thigh, and was unable to get up after her fall. An injection ... Show
more content on Helpwriting.net ...
Given the above considerations, Margaret's osteoporotic femurs are vulnerable to fracture because
of (A) the loss of spongy bone in the epiphyses and (B) the thinning of the bony collar in the
diaphysis.
6. Describe the changes that a broken bone undergoes as it is healing. The bony collar of long bones
helps them withstand compressive stress by the mechanism described in #4A above (i.e.
hydroxyapatite, weight–bearing pillars). In addition, long bones also withstand compressive forces
by virtue of the spongy ("cancellous") bone in the epiphyses. The interlocking network of bony
plates (called "trabeculae") found in spongy bone help to distribute the weight of the body out to the
tough bony collar of the diaphysis. In this way, bony plates act much like the trusses or struts in old–
time railroad bridges which distribute the weight of the train evenly over the entire bridge.
7. During her long recovery, Margaret is advised by her physician to begin weight–bearing as soon
as she can. How does weight–bearing influence the process you described in question #6? (Be
specific in your answer and describe what weight–bearing does to bone at the microscopic level.)
The most popular hypothesis regarding the effect of weight–bearing on bone remodeling is called
Wolff's law . Wolff's law states that bone grows and remodels in response to the mechanical stresses
placed upon it (e.g. from muscle pull or gravitational

Humeral Shaft Fractures
Humeral shaft fractures account for 3 to 5% of all fractures in adults and for 20% of all humeral
fractures. Fractures of the humerus can occur proximally, mid–shaft, or distally. Humeral shaft
fractures occur most commonly in the elderly and are significantly associated with impairment of
independence and quality of life. Majority of the fractures are non–displaced and can be treated
non–operatively, which is still the standard treatment of isolated humeral shaft fractures. Although
non–surgical management of humeral shaft fracture can be associated unsatisfactory results.
Surgical treatment is reserved for specific conditions and offers better outcomes. Humeral shaft
fractures those managed with internal fixation supports relative stabilization ... Show more content
It provides strength and resistance to both torsional and bending forces. The proximal humerus
articulates with the glenoid cavity of the scapula to form the shoulder joint. The muscles and
tendons of the rotator cuff, the acromion, and ligamentous attachments between the coracoid process
of the scapula and the acromion serve to both stabilize the gleno–humeral joint and provide a wide
range of motion of the shoulder joint. The distal humerus articulates with the radius and ulna at the
elbow. The greater tuberosity is located on the superior aspect of the humerus just lateral to the
humeral head and it provides attachment for three of the rotator cuff muscles supraspinatus,
infraspinatus and teres minor. The lesser tuberosity of the humerus is located on the anterior surface
of the humerus and provides attachment for the subscapularis muscle. To classify the fractures, the
lesser tuberosity marks the boundary between the proximal humerus and the mid–shaft. Humeral
shaft is enveloped in the muscles and soft tissue which provide favorable non–operative healing
mechanism in uncomplicated fractures. Muscles originating on the humeral shaft include the
brachialis, brachioradialis, and the medial and lateral heads of the triceps brachii. The deltoid,
pectoralis major, teres major, latissimus dorsi, and coracobrachialis all insert on the humeral shaft.
Different location of the fracture along the humeral shaft will have specific deforming forces acting
on the fracture fragments. Fractures near the midpoint of the shaft can have proximal fragment
pulled laterally by the deltoid, while the distal fragment pulled medially by the triceps and biceps.
Fractures near mid–shaft of the humerus are more likely to shorten than proximal or distal fractures
due to the strong pull of the biceps and triceps muscles. The blood supply to the humeral shaft

Head Trauma Case Study
Child abuse unfortunately is prevalent in society today. It is estimated that there are more than
119,000 cases of child abuse, and 600 fatalities from it each year (Lindberg, Berger, Reynolds,
Alwan & Harper, 2014). Although it is not a relatively uncommon occurrence, it can be very
difficult to diagnose (Fingarson & Pierce, 2012). Physical abuse can range from broken bones to
intracranial bleeds, but one of the most fatal types of abuse is head trauma. Another name
commonly used for abusive head trauma is shaken–baby syndrome. Many professionals have
moved away from using this term because it does not describe a specific injury, rather it defines a
particular mechanism. Studies have shown that shaking is the most often reported mechanism in
serious and ... Show more content on Helpwriting.net ...
Studies have shown that an abdominal CT is able to show trauma to many different abdominal
organs including the liver, intestines, mesentery, kidneys, spleen, and more. Though an abdominal
CT is very helpful at visualizing trauma, it is difficult to tell if an abdominal trauma is accidental or
non–accidental. Because of this it is very important that in cases of suspected abuse with abdominal
trauma the patient's story and the injuries plausibly fit together. (Hilmes, Hernanz–Schulman,
Greeley, Piercey, Yu & Kan, 2011). A thoracic CT can also be ordered in cases of suspected abuse,
but are not common. One study found after performing both a thoracic CT and rib x–rays on post–
mortem children that were victims of child abuse that a thoracic CT was better at identifying rib
fractures. Specifically, the CT was much better at identifying both anterior and posterior rib
fractures. Although the thoracic CT was better able to identify the rib fractures, it is not the standard
exam ordered when abuse or rib fractures are suspected. This is due to the increased dose to the
pediatric patient (Hong, Reyes, Moineddin, Chiasson, Berdon & Babyn,

Modified Edema Research Paper
Synopsis: Comparing the Effects of Modified Manual with Traditional Edema Technique Jovel
Duatin Samuel Merritt University Department of Occupational Therapy Knygsand–Roenhoej and
Maribo (2011) examined the effects of modified edema mobilization (MEM) treatment with MEM
pump points (MPP) stimulation technique and compared it with the traditional edema technique for
patients with subacute hand/arm edema. The effects were determined based on the outcome
measures that includes reduction in edema and pain, active range of motion (AROM), and activities
of daily living(ADL). It was hypothesized that modified MEM treatment will have better outcome
measures compared to the traditional edema technique. The study's design was single–blinded, ...
Show more content on Helpwriting.net ...
Subacute edema size was measured using a volumeter. The distance from the nail of the fingertip to
the proximal palmar crease was measured for AROM. The distance from the nail of the thumb to the
base of the fifth finger was used to measure thumb opposition. Moreover, pain was measured using
the visual analog scale. Patients' ADL levels was assessed through a questionnaire for bilateral
activities and perceived performance and satisfaction with ADL was assessed using the Canadian
Occupational Performance Measure. The study had 30 participants originally but only 29 completed
the treatments. There was a statistically significant decrease in edema, pain, and improvement in
AROM observed in both groups. There was a significant change in ADL observed in modified
MEM group that indicates that the group managed bilateral ADL activities quicker than the control
group. There was also a tendency for modified MEM group to receive fewer occupational therapy
session. However, there was no significant statistical difference found between the groups in terms
of pain during activity or at rest, AROM, and ADL at inclusion or after six and nine

Distal Radius Fracture Report
Distal Radius Fractures (DRF) are common fractures encountered in orthopedics within the elderly.
As reported by Koval and Zuckerman (1998) the elderly have an increased number of DRF for
numerous reasons including the fragility of osteopenic bone, postmenopausal osteoporosis and as a
result of low energy trauma including trips and falls. According to Tortora and Derrickson (2009)
they are more common in women than men because women's bones are smaller, and the production
of hormones in women declines dramatically at menopause, whereas only slightly in men. A study
by Sennwald (1987) reported that after the age of 50, more than 85% of DRF occur in women,
likely attributable to the impact of osteoporosis. Approximately one in seven women ... Show more
Measurements were taken at 6 weeks after cast removal and a follow up at 24 weeks. The results
illustrated that after cast removal patients require no more than a single session of advice and
exercise provided by a physiotherapist.
Randomisation was via concealed envelopes to ensure treatment and control groups are comparable.
As concealed randomisation occurred, the validity of the results is improved. Subjects were
randomly allocated to the two study groups to ensure both groups were as similar as possible in all
aspects, apart from the treatment. The two groups were similar at baseline, 6 and 24 weeks
following cast removal in relation to age, gender, wrist injured immobilisation period and K–wire
fixation. This is important for comparisons.
45 patients were deemed eligible for this study however 4 did not enter due to individual
circumstances, therefore, the trail started with 41 patients. Only 24.4% of patients were male
because DRF are more common in women than men, likely due to the fact that bone density
decreases with age and women are more likely to be affected by osteoporosis than men due to
natural hormonal changes.
.
"Differences in sex hormone production – especially the abrupt decline of estrogen in women – are
responsible for inter–gender differences in the pathophysiology of osteoporosis" (Pietschmann,
Rauner et al, 2009)
35 patients completed the innervation and testing at 6 weeks. Out

Outpatient Clinic Case Summary
Case Presentation A 45–year–old male presented to our Outpatient Clinic with history of a swelling
involving the upper part of left leg. He had noticed this swelling 6 months back, which had
gradually increased in size. There was no history of associated pain, limitation of movements of the
knee, fever or swelling involving any other part of the body. On examination, there was a solitary,
globular swelling involving the upper lateral part of left tibia measuring approximately 5cm by 6
cm. Local temperature was not raised. The surface was smooth, margins were well defined and
consistency was bony. The skin overlying the swelling was normal and there were no visible veins,
sinuses or scar marks. Examination of the knee and ankle joints was within normal limits and the
distal neurovascular status was normal. Plain radiographs of the leg revealed a well–defined,
eccentric, expansile, multiloculated radiolucent swelling involving the whole of upper tibial
epiphysis and metaphysis with extension into the ... Show more content on Helpwriting.net ...
The cortex is expanded and thinned out. New bone formation is not seen. Joint extension is rare
[ref]. On histopathology, the tumor is characterized by numerous giant cells, which vary in size from
10 µ to 100 µ and exhibit many centrally placed uniform nuclei. The other components of the tumor
are the spindle cells. These are oval, elongated and contain large nuclei with a small amount of
acidophilic cytoplasm. It is believed that the spindle cells are the malignant component of the tumor
rather than the giant cells. Therefore, the tumor aggressiveness depends on the spindle cells and not
the giant cells [ref]. Surgery is the mainstay of treatment of GCTs [ref]. It must be remembered that
recurrences are very common following surgery, the most common reason being inadequate tumor
tissue removal. The various treatment modalities are as follows

Anatomy review
Chapter 8 Test Review Multiple Choice 1. Which is not a part of the axial skeleton? A. rib B.
vertebral column C. mandible D. clavicle 2. Which is not a part of the appendicular skeleton? A.
coxal bones B. parietal bones C. radius D. clavicle 3. The axial skeleton consists of: A. 60 bones. B.
68 bones. C. 74 bones. D. 80 bones. 4. The appendicular skeleton consists of: A. 102 bones. B. 118
bones. C. 126 bones. D. 137 bones. 5. The term sinus, as it relates to bone markings, may be defined
as a: A. raised area or projection. B. cavity within a bone. C. tubelike opening or channel. D. groove
or elongated depression. 6. Which bone is a part of the axial skeleton? A. rib B. clavicle C. radius D.
... Show more content on Helpwriting.net ...
maxilla C. ethmoid D. frontal 41. Another name for the zygomatic bone is the: A. malar. B.
sphenoid. C. ethmoid. D. sesamoid. 42. Going from superior to inferior, the sequence of the
vertebral column is: A. sacral, coccyx, thoracic, lumbar, and cervical. B. coccyx, sacral lumbar,
thoracic, and cervical. C. cervical, lumbar, thoracic, sacral, and coccyx. D. cervical, thoracic,
lumbar, sacral, and coccyx. 43. The structure that furnishes the axis for the rotation of the head from
side to side is the: A. dens. B. spinous process. C. vertebral foramen. D. transverse process. 44.
Going from proximal to distal, the bones of the upper extremity would be: A. metacarpals, carpals,
ulna, and humerus. B. carpals, metacarpals, ulna, and humerus. C. humerus, radius, metacarpals, and
carpals. D. humerus, radius, carpals, and metacarpals. 45. Going from proximal to distal, the bones
of the lower extremity would be: A. femur, tibia, carpals, and metacarpals. B. metacarpals, tarsals,
femur, and tibia. C. femur, tibia, tarsals, and metatarsals. D. tarsals, metatarsals, femur, and tibia.
Matching Match the bones with their locations. A. ethmoid B. frontal C. hyoid D. mandible E.
maxillae F. occipital G. palatine H. parietal I. sphenoid J. temporal K. zygomatic 105. _____ neck
bone 106. _____ keystone of face 107. _____ keystone of cranium 108. _____ upper jaw 109.
_____ cheek bone 110. _____ lower jaw

Descriptive Essay About Tattoos
small–tattoos–01.jpg
Tattoo on the outer side of the upper arm about four inches long depicting army–like stripes
approximately a quarter inch thick, with the first stripe two inch from the crook of the arm. Four
stripes of light black ink tone point upwards towards the upper arm and transform into two dark
toned images of a bird in motion.
Small–tattoos–02.jpg
Tattoo design covering the entire circumference of the wrist. Shows of ocean wave on the backside
of the wrist of the right hand in gray and accented in black ink and with the front side depicting a
small island with a single coconut tree on it.
Tattoo style on the innermost part of the forearm of the left hand indicating an intricate image of Da
Vinci's framed hand of God and Adam, about two inches thick. This is a perfect way to represent
spiritual path
Small–tattoos –04.jpg
Small tattoos for guys on the lower side of the chest, one inch from mamma and on the left side a
drawing that shows a simple representation of an elephant. A great tattoo that symbolizes dignity,
strength and pride.
Small tattoo ideas can be applied on the left inner arm and turns cycling into body arts! adorable and
lovely black bicycle design pointing direction on the left; about two inches thick for travel lovers.
Small tattoo for men, a classic flying bald eagle one inch from clavicle, drawn entirely using black
ink with simple white horizontal lines at the wings apart from

Scaphoid Break: A Case Study
Hi Shylaja,
What do you think are the expected complications if the scaphoid fracture is not detected and treated
at the early stage?
I enjoyed reading your post. A fracture in the scaphoid is causing an insufficient blood supply to the
wrist joint, leading to possible avascular necrosis (Ramponi, 2012). Subsequently, avascular
necrosis of the carpal bone, contributing to a decline in hand grip function and wrist movement
(Waldman, 2014). Untreated or incomplete union of the scaphoid bone associated with a fracture
may lead to various compications.
Below are the list of scaphoid fracture complications
Nonunion
Non–union may contribute with a disfigured scaphoid leading to major functional impairment and
limited motion. Clinical studies of non– union of the possible scaphoid lead to osteoarthritis but it is
not clearly justified (Singh & Dias 2012). ... Show more content on Helpwriting.net ...
Malunion
Complete or faulty union of the scaphoid is causing a flexion deformity of the scaphoid but and
possibly an ulnar translocation or rotation of the distal fragment of the radius, although, the study
remain unclear (Singh & Dias 2012). In a cadaveric research, the imitated scaphoid malunion
contributing to limited wrist extension motion and this was correlative to the deviation of angulation
(Burgess, 1987).

Smith's Fracture Paper
Smith's Fracture
Introduction
An elderly female patient presented to the emergency department with obvious deformity in the
distal aspect of her forearm following a fall onto her left arm. The patient had fallen backwards onto
her left side and landed on her wrist which was in a flexed position. Due to the way the patient had
fallen, as well as her age, the primary pathology the doctor had suspected was a Smith's fracture
(also known as a reverse Colles fracture). "Smith fractures are fractures of the distal radius with
associated palmar angulation of the distal fracture fragment" (Goel & Gaillard, 2015, para. 1). An x–
ray was required to determine if it was a Smith's fracture or another type of fracture. If the fracture
turned out to be ... Show more content on Helpwriting.net ...
The distal aspect of the radius was displaced anteriorly and comminuted. The fracture would either
be fixed with closed manipulation or open reduction depending on the amount of displacement and
number of fragments. As well as three fractures needing to heal the patient was elderly which means
that the healing process would take longer than

Imaging Detects Scaphoid Fracture <40

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