This document discusses various types of peripheral nerve injuries including compression neuropathies. It describes common sites of nerve compression including the carpal tunnel, cubital tunnel, and radial tunnel. Carpal tunnel syndrome is the most common upper extremity compression neuropathy and symptoms include numbness and pain in the distribution of the median nerve. Treatment involves activity modification, splinting, injections, and potentially surgical release of the transverse carpal ligament. Cubital tunnel syndrome involves compression of the ulnar nerve in the elbow and treatment may involve decompression of the nerve. Radial, anterior interosseous, and other peripheral nerve compressions are also outlined.
This document provides an overview of approaches to assessing and treating various hand conditions. It discusses:
- Taking a thorough history including pain characteristics, deformities, range of motion, weaknesses, and hobbies/job.
- Performing a physical exam of the hand including assessing the skin, vessels, nerves, muscles/tendons, and bones/joints.
- Common traumatic hand injuries like distal radius fractures, scaphoid fractures, and Bennett's thumb fractures. Peripheral nerve injuries and compressive neuropathies like carpal tunnel syndrome are also reviewed.
- Common masses found in the hand such as ganglions, giant cell tumor of tendon sheath, and epidermoid
Entrapment neuropathies occur when peripheral nerves become compressed or damaged. Carpal tunnel syndrome is the most common, caused by median nerve entrapment at the wrist. Symptoms include pain, numbness and tingling in the hand that is worsened by certain activities. Diagnosis involves physical exam maneuvers like Phalen's test and electrodiagnostic testing. Treatment starts with splinting, injections and medications, with surgery to release the transverse carpal ligament indicated for failed conservative care or severe cases. Other median nerve entrapment sites include the elbow and shoulder.
This document discusses a case of a 45-year-old female bank officer presenting with weakness and clumsiness in her right hand over the past 3-4 weeks. On examination, she showed wasting of the thenar muscle and weakness of thumb and finger movements. Nerve conduction studies showed reduced motor responses in the median and ulnar nerves without slowing. Electromyography revealed generalized reduction of motor units. The patient was diagnosed with amyotrophic lateral sclerosis based on meeting diagnostic criteria. The document then provides background information on ALS and discusses differential diagnoses considered for the patient's symptoms.
This 55-year-old diabetic man likely has carpal tunnel syndrome (CTS) involving the median nerve. He presents with sensory loss in the lateral 3 1/2 fingers and thenar wasting, indicating stage IV disease. Provocative tests like Phalen's and Tinel's signs would help diagnose CTS. Given the advanced stage, he requires surgical release of the transverse carpal ligament to decompress the median nerve.
The document summarizes brachial plexus anatomy and entrapment neuropathies of the upper limb. It describes the anatomy of the brachial plexus and its branches. It then discusses various entrapment neuropathies including carpal tunnel syndrome, anterior interosseous syndrome, pronator teres syndrome, cubital tunnel syndrome and others. For each neuropathy, it describes the anatomy, risk factors, clinical features, diagnostic tests and management approaches.
This document provides an outline for a lecture on spine pathology for final year medical students. It covers spinal anatomy, trauma, degenerative diseases, tumors, infections, congenital abnormalities, deformities, and metabolic bone diseases. For each topic, key points are outlined such as epidemiology, clinical presentation, diagnostic imaging, and management principles. Spinal anatomy includes the vertebrae, spinal cord, and blood supply. Trauma management focuses on spinal alignment and stabilization. Degenerative diseases discussed are disc herniation and spinal stenosis. Infections can be pyogenic or tuberculosis. Congenital conditions include spina bifida and syringomyelia. Metabolic bone disease highlights osteoporosis. The document concludes with an
This document provides an overview of approaches to assessing and treating various hand conditions. It discusses:
- Taking a thorough history including pain characteristics, deformities, range of motion, weaknesses, and hobbies/job.
- Performing a physical exam of the hand including assessing the skin, vessels, nerves, muscles/tendons, and bones/joints.
- Common traumatic hand injuries like distal radius fractures, scaphoid fractures, and Bennett's thumb fractures. Peripheral nerve injuries and compressive neuropathies like carpal tunnel syndrome are also reviewed.
- Common masses found in the hand such as ganglions, giant cell tumor of tendon sheath, and epidermoid
Entrapment neuropathies occur when peripheral nerves become compressed or damaged. Carpal tunnel syndrome is the most common, caused by median nerve entrapment at the wrist. Symptoms include pain, numbness and tingling in the hand that is worsened by certain activities. Diagnosis involves physical exam maneuvers like Phalen's test and electrodiagnostic testing. Treatment starts with splinting, injections and medications, with surgery to release the transverse carpal ligament indicated for failed conservative care or severe cases. Other median nerve entrapment sites include the elbow and shoulder.
This document discusses a case of a 45-year-old female bank officer presenting with weakness and clumsiness in her right hand over the past 3-4 weeks. On examination, she showed wasting of the thenar muscle and weakness of thumb and finger movements. Nerve conduction studies showed reduced motor responses in the median and ulnar nerves without slowing. Electromyography revealed generalized reduction of motor units. The patient was diagnosed with amyotrophic lateral sclerosis based on meeting diagnostic criteria. The document then provides background information on ALS and discusses differential diagnoses considered for the patient's symptoms.
This 55-year-old diabetic man likely has carpal tunnel syndrome (CTS) involving the median nerve. He presents with sensory loss in the lateral 3 1/2 fingers and thenar wasting, indicating stage IV disease. Provocative tests like Phalen's and Tinel's signs would help diagnose CTS. Given the advanced stage, he requires surgical release of the transverse carpal ligament to decompress the median nerve.
The document summarizes brachial plexus anatomy and entrapment neuropathies of the upper limb. It describes the anatomy of the brachial plexus and its branches. It then discusses various entrapment neuropathies including carpal tunnel syndrome, anterior interosseous syndrome, pronator teres syndrome, cubital tunnel syndrome and others. For each neuropathy, it describes the anatomy, risk factors, clinical features, diagnostic tests and management approaches.
This document provides an outline for a lecture on spine pathology for final year medical students. It covers spinal anatomy, trauma, degenerative diseases, tumors, infections, congenital abnormalities, deformities, and metabolic bone diseases. For each topic, key points are outlined such as epidemiology, clinical presentation, diagnostic imaging, and management principles. Spinal anatomy includes the vertebrae, spinal cord, and blood supply. Trauma management focuses on spinal alignment and stabilization. Degenerative diseases discussed are disc herniation and spinal stenosis. Infections can be pyogenic or tuberculosis. Congenital conditions include spina bifida and syringomyelia. Metabolic bone disease highlights osteoporosis. The document concludes with an
This document discusses soft tissue lesions, including tennis elbow, carpal tunnel syndrome, and trigger finger. For tennis elbow, it describes the causes as overuse or repetitive stress injuries, clinical features such as lateral epicondyle pain aggravated by certain motions, and treatments including rest, bracing, injections and surgery. Carpal tunnel syndrome is defined as median nerve entrapment at the wrist. It lists causes such as medical conditions and repetitive stress. Clinical features include numbness and tingling in the median nerve distribution. Trigger finger is caused by thickening of the tendon sheath which results in the finger getting trapped and snapping on motion. Injection of steroids or surgery to divide the pulley may treat trigger finger.
This document summarizes carpal tunnel syndrome (CTS), including its anatomy, pathogenesis, etiology, symptoms, clinical tests, treatments, and other related topics. It describes how CTS is caused by compression of the median nerve as it passes through the carpal tunnel. Common causes include repetitive hand motions, anatomical abnormalities, medical conditions like diabetes or hypothyroidism. Clinical tests for diagnosing CTS include Phalen's test and Tinel's sign. Treatments may involve splinting, corticosteroid injections, surgery such as open or endoscopic carpal tunnel release. De Quervain's tenosynovitis and tuberculous tenosynovitis are also summarized.
This document provides an overview of ulnar nerve injury, including:
- Anatomy of the ulnar nerve and the muscles it innervates
- Common causes of ulnar nerve injury such as trauma, compression neuropathies like cubital tunnel syndrome
- Clinical signs of ulnar nerve injury including clawing of the ring and little fingers
- Surgical management options like nerve repair, grafting, decompression for compression neuropathies, and tendon transfers to restore hand function
- Specific procedures for cubital tunnel syndrome and ulnar tunnel syndrome decompression
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the carpal tunnel. While open carpal tunnel release has traditionally been used to treat carpal tunnel syndrome, endoscopic carpal tunnel release is an alternative technique. Reviews of randomized controlled trials have found no clear difference in relief of symptoms between the two techniques. The evidence is conflicting on whether endoscopic carpal tunnel release results in earlier return to work compared to open release. Endoscopic release may provide superior short-term grip strength and less scar tenderness but risks more reversible median nerve injuries. Further research is still needed to make definitive conclusions.
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the carpal tunnel. While open carpal tunnel release was previously the standard treatment, endoscopic carpal tunnel release has gained popularity as an alternative. Multiple reviews have found no difference in symptom relief between the two techniques. Evidence is conflicting on whether endoscopic surgery results in earlier return to work. Endoscopic surgery is associated with a higher risk of reversible median nerve injury but results in superior grip strength and less scar tenderness in the short term. Further research is still needed to make definitive conclusions about the relative effectiveness of open versus endoscopic carpal tunnel release.
Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel. It is characterized by numbness and tingling in the hand and fingers, especially at night. While splinting and steroid injections provide short-term relief, surgical release of the transverse carpal ligament is often required for long-term symptom relief. Open carpal tunnel release has traditionally been used but endoscopic techniques have gained popularity due to potentially faster recovery times. Both open and endoscopic techniques have been shown to significantly improve symptoms and function, though endoscopic release may result in less postoperative pain.
Lateral epicondylitis, also known as tennis elbow, is a tendinosis affecting the common tendons of the forearm extensor muscles, especially the extensor carpi radialis brevis. It is caused by overuse activities involving repetitive wrist extension and pronation/supination movements. Clinically, it presents with pain during gripping movements and tenderness over the lateral epicondyle, which is exacerbated by resisted wrist and finger extension tests. Non-operative treatments include rest, bracing, physical therapy, and injections. Surgery is considered if conservative measures fail and involves procedures such as partial resection of the annular ligament or lengthening of the affected tendon.
This document provides an overview of hand surgery basics including physical exam and anatomy, common injuries and conditions such as lacerations, fractures, arthritis, and carpal tunnel syndrome. Treatment approaches are discussed for various conditions including suturing of lacerations, splinting of fractures, surgical excision of ganglions, and carpal tunnel release surgery. Emerging treatments like platelet-rich plasma injections are also mentioned.
Carpal tunnel syndrome is compression of the median nerve at the wrist, causing numbness and tingling in the hand and fingers. It is typically diagnosed based on symptoms and physical exam findings. Conservative treatment includes splinting, corticosteroid injections, and lifestyle changes. If conservative treatment fails, surgical release of the transverse carpal ligament is performed, either via open or endoscopic technique. Care must be taken during surgery to avoid injuring nearby structures like nerves and blood vessels.
This document discusses carpal tunnel syndrome (CTS), including its anatomy, causes, symptoms, diagnosis, and surgical treatments. Some key points:
- CTS is caused by compression of the median nerve as it passes through the carpal tunnel of the wrist. It commonly causes pain, numbness, and tingling in the hand and fingers.
- Diagnosis is typically made through nerve conduction studies, which can classify CTS as mild, moderate, or severe based on latency and amplitude readings.
- Surgical treatments include open carpal tunnel release and endoscopic carpal tunnel release. Mini-open carpal tunnel release is associated with superior outcomes like less scar tenderness and faster recovery compared to standard
An entrapment neuropathy is defined as a pressure or pressure-induced injury to a segment of a peripheral nerve secondary to anatomic or pathologic structures.
Lateral epicondylitis, also known as tennis elbow, is a tendinosis affecting the common tendons of the forearm extensor muscles, especially the extensor carpi radialis brevis. It is caused by overuse activities involving repetitive wrist extension and pronation/supination movements. Clinically, it presents as pain with gripping movements of the wrist and tenderness over the lateral epicondyle, which is exacerbated by resisted wrist and finger extension tests. Treatment begins conservatively with rest, NSAIDs, physical therapy, and bracing, while corticosteroid injections, shockwave therapy, or platelet-rich plasma injections may also be used. Surgery is considered if conservative measures fail and involves
This document provides information on common upper limb conditions seen by Dr. Bijayendra Singh, an orthopaedic surgeon. It discusses his background and qualifications. It then outlines the scope of his practice, which includes shoulder, elbow, wrist and hand surgery. The document lists and describes many common orthopaedic conditions involving the shoulder, elbow, wrist and hand, such as rotator cuff tears, osteoarthritis, carpal tunnel syndrome, and Dupuytren's contracture. It provides details on evaluating and managing these various conditions.
This document provides an overview of common wrist and hand disorders presented by Dr. Farouq Makkie Alyouzbaki. It discusses the anatomy of the wrist and hand, common conditions such as De Quervain's tenosynovitis, carpal tunnel syndrome, and ganglions. Treatment approaches for various disorders are presented such as splinting, corticosteroid injections, and surgical releases. The document also covers hand infections, congenital anomalies, and other tendon and joint conditions that can affect the wrist and hand.
This document provides an overview of common conditions of the hand, including relevant anatomy, physiology, clinical assessment, and management. It describes the bones, muscles, tendons, nerves, and other structures of the hand. Common conditions are discussed such as carpal tunnel syndrome, trigger finger, osteoarthritis, and burns. Evaluation involves examining range of motion, strength, sensation, and specialized tests. Management may include splinting, injections, or surgery depending on the condition.
Cervical myelopathy is a neurological impairment caused by compression of the cervical spinal cord, most commonly due to degenerative changes like spondylosis. It presents with neck stiffness, leg weakness, gait abnormalities, and clumsy hands. Physiotherapy management includes electrotherapeutic modalities to reduce pain, cervical stabilization exercises, isometric neck exercises, stretching, and progressive resistance exercises. The goals are to relieve pain, improve function, prevent further neurological deficits, and improve existing deficits. Surgery or immobilization may also be considered depending on severity.
The document discusses common entrapment neuropathies including carpal tunnel syndrome, pronator syndrome, anterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon's canal syndrome. It provides details on the anatomy, etiology, symptoms, diagnostic studies including electrodiagnostic studies, ultrasound findings, and treatments for each of these conditions. The treatment typically involves initially trying conservative measures such as splinting, steroid injections, and activity modification. Surgery is considered if conservative treatments fail or if there is evidence of nerve damage on electrodiagnostic studies.
This document provides an overview of hand surgery basics including physical exam and anatomy, common injuries and conditions such as lacerations, fractures, arthritis, and carpal tunnel syndrome. Treatment approaches are discussed for various conditions including suturing of lacerations, splinting of fractures, surgical excision of ganglion cysts and Dupuytren's contracture, and carpal tunnel release surgery. Emerging treatments using platelet-rich plasma are also mentioned.
This document provides an overview of common soft tissue conditions in orthopedics, including bursitis, tendon injuries, and nerve entrapments. It discusses the anatomy, causes, symptoms, examinations, and treatment approaches for various conditions such as tennis elbow, carpal tunnel syndrome, trigger finger, and frozen shoulder. The document is intended as an educational guide for orthopedic practitioners.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
This document discusses soft tissue lesions, including tennis elbow, carpal tunnel syndrome, and trigger finger. For tennis elbow, it describes the causes as overuse or repetitive stress injuries, clinical features such as lateral epicondyle pain aggravated by certain motions, and treatments including rest, bracing, injections and surgery. Carpal tunnel syndrome is defined as median nerve entrapment at the wrist. It lists causes such as medical conditions and repetitive stress. Clinical features include numbness and tingling in the median nerve distribution. Trigger finger is caused by thickening of the tendon sheath which results in the finger getting trapped and snapping on motion. Injection of steroids or surgery to divide the pulley may treat trigger finger.
This document summarizes carpal tunnel syndrome (CTS), including its anatomy, pathogenesis, etiology, symptoms, clinical tests, treatments, and other related topics. It describes how CTS is caused by compression of the median nerve as it passes through the carpal tunnel. Common causes include repetitive hand motions, anatomical abnormalities, medical conditions like diabetes or hypothyroidism. Clinical tests for diagnosing CTS include Phalen's test and Tinel's sign. Treatments may involve splinting, corticosteroid injections, surgery such as open or endoscopic carpal tunnel release. De Quervain's tenosynovitis and tuberculous tenosynovitis are also summarized.
This document provides an overview of ulnar nerve injury, including:
- Anatomy of the ulnar nerve and the muscles it innervates
- Common causes of ulnar nerve injury such as trauma, compression neuropathies like cubital tunnel syndrome
- Clinical signs of ulnar nerve injury including clawing of the ring and little fingers
- Surgical management options like nerve repair, grafting, decompression for compression neuropathies, and tendon transfers to restore hand function
- Specific procedures for cubital tunnel syndrome and ulnar tunnel syndrome decompression
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the carpal tunnel. While open carpal tunnel release has traditionally been used to treat carpal tunnel syndrome, endoscopic carpal tunnel release is an alternative technique. Reviews of randomized controlled trials have found no clear difference in relief of symptoms between the two techniques. The evidence is conflicting on whether endoscopic carpal tunnel release results in earlier return to work compared to open release. Endoscopic release may provide superior short-term grip strength and less scar tenderness but risks more reversible median nerve injuries. Further research is still needed to make definitive conclusions.
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the carpal tunnel. While open carpal tunnel release was previously the standard treatment, endoscopic carpal tunnel release has gained popularity as an alternative. Multiple reviews have found no difference in symptom relief between the two techniques. Evidence is conflicting on whether endoscopic surgery results in earlier return to work. Endoscopic surgery is associated with a higher risk of reversible median nerve injury but results in superior grip strength and less scar tenderness in the short term. Further research is still needed to make definitive conclusions about the relative effectiveness of open versus endoscopic carpal tunnel release.
Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel. It is characterized by numbness and tingling in the hand and fingers, especially at night. While splinting and steroid injections provide short-term relief, surgical release of the transverse carpal ligament is often required for long-term symptom relief. Open carpal tunnel release has traditionally been used but endoscopic techniques have gained popularity due to potentially faster recovery times. Both open and endoscopic techniques have been shown to significantly improve symptoms and function, though endoscopic release may result in less postoperative pain.
Lateral epicondylitis, also known as tennis elbow, is a tendinosis affecting the common tendons of the forearm extensor muscles, especially the extensor carpi radialis brevis. It is caused by overuse activities involving repetitive wrist extension and pronation/supination movements. Clinically, it presents with pain during gripping movements and tenderness over the lateral epicondyle, which is exacerbated by resisted wrist and finger extension tests. Non-operative treatments include rest, bracing, physical therapy, and injections. Surgery is considered if conservative measures fail and involves procedures such as partial resection of the annular ligament or lengthening of the affected tendon.
This document provides an overview of hand surgery basics including physical exam and anatomy, common injuries and conditions such as lacerations, fractures, arthritis, and carpal tunnel syndrome. Treatment approaches are discussed for various conditions including suturing of lacerations, splinting of fractures, surgical excision of ganglions, and carpal tunnel release surgery. Emerging treatments like platelet-rich plasma injections are also mentioned.
Carpal tunnel syndrome is compression of the median nerve at the wrist, causing numbness and tingling in the hand and fingers. It is typically diagnosed based on symptoms and physical exam findings. Conservative treatment includes splinting, corticosteroid injections, and lifestyle changes. If conservative treatment fails, surgical release of the transverse carpal ligament is performed, either via open or endoscopic technique. Care must be taken during surgery to avoid injuring nearby structures like nerves and blood vessels.
This document discusses carpal tunnel syndrome (CTS), including its anatomy, causes, symptoms, diagnosis, and surgical treatments. Some key points:
- CTS is caused by compression of the median nerve as it passes through the carpal tunnel of the wrist. It commonly causes pain, numbness, and tingling in the hand and fingers.
- Diagnosis is typically made through nerve conduction studies, which can classify CTS as mild, moderate, or severe based on latency and amplitude readings.
- Surgical treatments include open carpal tunnel release and endoscopic carpal tunnel release. Mini-open carpal tunnel release is associated with superior outcomes like less scar tenderness and faster recovery compared to standard
An entrapment neuropathy is defined as a pressure or pressure-induced injury to a segment of a peripheral nerve secondary to anatomic or pathologic structures.
Lateral epicondylitis, also known as tennis elbow, is a tendinosis affecting the common tendons of the forearm extensor muscles, especially the extensor carpi radialis brevis. It is caused by overuse activities involving repetitive wrist extension and pronation/supination movements. Clinically, it presents as pain with gripping movements of the wrist and tenderness over the lateral epicondyle, which is exacerbated by resisted wrist and finger extension tests. Treatment begins conservatively with rest, NSAIDs, physical therapy, and bracing, while corticosteroid injections, shockwave therapy, or platelet-rich plasma injections may also be used. Surgery is considered if conservative measures fail and involves
This document provides information on common upper limb conditions seen by Dr. Bijayendra Singh, an orthopaedic surgeon. It discusses his background and qualifications. It then outlines the scope of his practice, which includes shoulder, elbow, wrist and hand surgery. The document lists and describes many common orthopaedic conditions involving the shoulder, elbow, wrist and hand, such as rotator cuff tears, osteoarthritis, carpal tunnel syndrome, and Dupuytren's contracture. It provides details on evaluating and managing these various conditions.
This document provides an overview of common wrist and hand disorders presented by Dr. Farouq Makkie Alyouzbaki. It discusses the anatomy of the wrist and hand, common conditions such as De Quervain's tenosynovitis, carpal tunnel syndrome, and ganglions. Treatment approaches for various disorders are presented such as splinting, corticosteroid injections, and surgical releases. The document also covers hand infections, congenital anomalies, and other tendon and joint conditions that can affect the wrist and hand.
This document provides an overview of common conditions of the hand, including relevant anatomy, physiology, clinical assessment, and management. It describes the bones, muscles, tendons, nerves, and other structures of the hand. Common conditions are discussed such as carpal tunnel syndrome, trigger finger, osteoarthritis, and burns. Evaluation involves examining range of motion, strength, sensation, and specialized tests. Management may include splinting, injections, or surgery depending on the condition.
Cervical myelopathy is a neurological impairment caused by compression of the cervical spinal cord, most commonly due to degenerative changes like spondylosis. It presents with neck stiffness, leg weakness, gait abnormalities, and clumsy hands. Physiotherapy management includes electrotherapeutic modalities to reduce pain, cervical stabilization exercises, isometric neck exercises, stretching, and progressive resistance exercises. The goals are to relieve pain, improve function, prevent further neurological deficits, and improve existing deficits. Surgery or immobilization may also be considered depending on severity.
The document discusses common entrapment neuropathies including carpal tunnel syndrome, pronator syndrome, anterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon's canal syndrome. It provides details on the anatomy, etiology, symptoms, diagnostic studies including electrodiagnostic studies, ultrasound findings, and treatments for each of these conditions. The treatment typically involves initially trying conservative measures such as splinting, steroid injections, and activity modification. Surgery is considered if conservative treatments fail or if there is evidence of nerve damage on electrodiagnostic studies.
This document provides an overview of hand surgery basics including physical exam and anatomy, common injuries and conditions such as lacerations, fractures, arthritis, and carpal tunnel syndrome. Treatment approaches are discussed for various conditions including suturing of lacerations, splinting of fractures, surgical excision of ganglion cysts and Dupuytren's contracture, and carpal tunnel release surgery. Emerging treatments using platelet-rich plasma are also mentioned.
This document provides an overview of common soft tissue conditions in orthopedics, including bursitis, tendon injuries, and nerve entrapments. It discusses the anatomy, causes, symptoms, examinations, and treatment approaches for various conditions such as tennis elbow, carpal tunnel syndrome, trigger finger, and frozen shoulder. The document is intended as an educational guide for orthopedic practitioners.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
6. Physical Exam
• Examine individual muscle strength --> grades
0 to 5 --> pinch strength - grip strength
• Neurosensory testing -->
– dermatomal distribution
– peripheral nerve distribution
7. Special Tests
• Semmes-Weinstein monofilaments -->
– cutaneous pressure threshold --> function of large
nerve fibers --> first to be affected in compression
Neuropathy
– Sensing 2.83 monofilament is normal
• Two-point discrimination →
– performed with closed eyes
– abnormal → Inability to perceive a difference between
points > 6 mm
– late finding
8.
9. Electrodiagnostic testing
• EMG and NCS
• Sensory and motor nerve function can be
tested
• Operator dependent
• objective evidence of neuropathic condition
• helpful in localizing point of compromise
• early disease → High false-negative rate
13. CTS
• Most common compressive neuropathy in the
upper extremity
• Anatomy of the carpal tunnel
– Volar → TCL
– radial → scaphoid tubercle +trapezium
– ulnar → pisiform +hook of hamate
– Dorsal → proximal carpal row + deep extrinsic
volar carpal ligaments
14. CTS
• Carpal Tunnel Content
– median nerve + FPL + 4 FDS + 4 FDP = 10
• Normal pressure → 2.5 mm Hg
• >20 mm Hg → ↓↓ epineural blood flow +
nerve edema
• 30 mm Hg → ↓↓ nerve conduction
15.
16. Forms of CTS
• Idiopathic → most common in adults
• Mucopolysaccharidosis → most common
cause in children
• anatomic variation
– Persistent median artery
– small carpal canal
– anomalous muscles
– extrinsic mass effect
20. CTS diagnosis
• symptoms →
– Paresthesias and pain
– often at night
– volar aspect → thumb - index - long - radial half of
ring
• provocative test → carpal tunnel compression
test -Durkan test → Most sensitive
• Other provocative tests include Tinel and
Phalen
21. CTS diagnosis
• affected first → light touch + vibration
• affected later → pain and temperature
• Semmes-Weinstein monofilament testing →
early CTS diagnosis
• late findings Weakness - loss of fine motor
control - abnormal two-point discrimination
• Thenar atrophy → severe denervation
22. CTS – Electrodiagnostic testing
• not necessary for the diagnosis of CTS
• Distal sensory latencies > 3.5 msec
• motor latencies >4.5 msec
• ↓ conduction velocity and ↓ peak amplitude
→ less specific
• EMG → ↑ insertional activity - sharp waves -
fibrillation - APB fasciculation
23. CTS - Differential diagnoses
• cervical radiculopathy
• brachial plexopathy
• TOS
• pronator syndrome
• ulnar neuropathy with Martin-Gruber
anastomoses
• peripheral neuropathy of multiple etiologies
24. CTS Treatment
• Nonoperative →
– activity modification
– night splints
– NSAIDs
• Single corticosteroid injection → transient relief
– 80% after 6 weeks
– 20% by 1 year
– ineffective corticosteroid injection → poor prognosis
→ less successful surgery
25. CTS – Operative
• Can be → open - mini-open – endoscopic
• internal median neurolysis OR flexor tenosynovectomy
No benefit
• too ulnar surgical approach → Ulnar neurovascular injury
• too radial surgical approach → recurrent motor branch of
median nerve injury
• recurrent motor branch variations
– Extraligamentous → 50%
– Subligamentous → 30%
– Transligamentous → 20%
26.
27.
28. CTS – Endoscopic release
• short term:
– less early scar tenderness
– improved short-term grip/pinch strength
– better patient satisfaction scores
• Long-term →
– no significant difference
– May have slightly higher complication rate
– incomplete TCL release
35. Anterior Interosseous Nerve Syndrome
• motor loss → FPL + index +− long FDP + pronator
quadratus
• No sensory loss
• OK sign → precision pinch → Index FDP +thumb
FPL
• Pronator quadratus → resisted pronation in full
elbow flexion
• Transient AIN preceded by intense shoulder pain
→ Parsonage-Turner syndrome →viral brachial
neuritis
36.
37. AIN Syndrome
• Electrodiagnostic tests → ?
• pronator syndrome compression sites:
– Enlarged bicipital bursa
– Gantzer muscle (accessory head of the FPL)
38. AIN Syndorme Treatment
• Nonoperative →
– mostly helpful
– activity modification
– elbow splinting in 90 deg
• Surgical decompression → satisfactory if done
within 3 to 6 months symptom onset
40. Cubital Tunnel Syndrome
• Second most common compression
neuropathy of the upper extremity
• Cubital tunnel borders:
– floor →MCL and capsule
– Walls → medial epicondyle and olecranon
– Roof → FCU fascia and arcuate ligament of
Osborne
41. Etiology
• Compression sites
– Arcade of Struthers → fascial thickening at hiatus of medial
intermuscular septum as the ulnar nerve passes from anterior to
posterior compartment 8 cm proximal to the medial epicondyle
– Medial head of triceps
– Medial intermuscular septum
– Osborne ligament →cubital tunnel roof or retinaculum
– Anconeus epitrochlearis → anomalous muscle originating from medial
olecranon and inserting on medial epicondyle
– Between two heads of FCU muscle/aponeurosis
– Aponeurosis of proximal edge of FDS
• Other causes: → tumors, ganglions, osteophytes, heterotopic
ossification, and medial epicondyle nonunion, burns, cubitus varus
or valgus deformities, medial epicondylitis, and repetitive elbow
flexion/valgus stress
42.
43. Cubital Tunnel Symptoms - clinical
• Symptoms paresthesias of ulnar half of ring
finger and small finger
• Provocative tests →
– direct cubital tunnel compression
– Tinel sign
– elbow hyperflexion
44. Cubital Tunnel Syndrome – Classical
Findings
• Froment sign → thumb IP flexion - FPL during key pinch
→ weak adductor pollicis
• Jeanne sign → thumb MCP hyperextension with key
pinch → weak adductor pollicis
• Wartenberg sign → persistent abduction and extension
of small digit during attempted adduction due to weak
third volar interosseous and small finger lumbrical
• Masse sign → Flattening of palmar arch and loss of
ulnar hand elevation due to weak opponens digiti
quinti and decreased small digit MCP flexion
• Interosseous and/or first web space atrophy
• Ring and small digit clawing
46. Cubital Tunnel Syndrome - Treatment
• Surgical Release Numerous techniques
– In situ decompression
– Anterior transposition
– Subcutaneous
– Submuscular
– Intramuscular
– Medial epicondylectomy
• No significant difference in outcome between
simple decompression and transposition
47. Cubital Tunnel Syndrome - Treatment
• Higher recurrence rate after release →
compared to CTS release
• Surgery should be performed before motor
denervation
• No long-term clinical data for endoscopic
techniques
50. Ulnar Tunnel Syndrome
• Borders →
– roof → volar carpal ligament
– floor → transverse carpal ligament
– radial → hook of hamate
– ulnar → pisiform and abductor digiti minimi
• Ulnar tunnel zones
– Zone I → proximal to bifurcation of ulnar nerve →
mixed motor/sensory
– Zone II → deep motor branch → pure motor
– Zone III → distal sensory branches → pure sensory
55. Proper Radial Nerve Compression
• Rarely compressed
– lateral head of triceps
– humerus trauma
– iatrogenic during surgical approache
– Saturday night palsy → Intoxicated patient +
passes out with arm hanging over chair → wakes
up with wrist drop.
*Clinical findings
56. Proper Radial Nerve Compression
• weakness of → triceps - brachioradialis - ECRL +
PIN muscles
• Sensory deficits → distribution of superficial
radial nerve → radial forearm and dorsum of
thumb
• EMG → may be helpful
• nonoperative treatment → initially
• surgical exploration and release if no recovery by
3 months
57. PIN compression
• Symptoms →
– lateral elbow pain
– distal muscle weakness
– radial deviation with active wrist extension → ECRL
innervated by radial nerve
– weakness PIN innervates → ECRB - supinator - EIP -
ECU - EDC - EDM - APL - EPB – EPL
– dorsal wrist pain → innervation to dorsal wrist capsule
• EMG may be helpful
58. PIN compression
• compression sites →
– Fascial band at the radial head
– Recurrent leash of Henry
– Edge of the ECRB
– Arcade of Frohse (the most common site, proximal edge of the
supinator
– Distal edge of the supinator (see Figure 7-49)
• Unusual causes
– chronic radial head dislocation
– Monteggia fracture-dislocation
– radiocapitellar rheumatoid synovitis
– space-occupying elbow mass → lipoma
– PIN palsy is differentiated from extensor tendon rupture by a normal
wrist tenodesis test
59.
60.
61. PIN compression
• Nonoperative treatment
– activity modification
– splinting
– NSAIDs
• Operative → no recovery by 3 months
• Surgical decompression → anatomic sites →
good to excellent results for 85%
62. Radial tunnel syndrome
• lateral elbow and radial forearm pain
• no motor or sensory dysfunction
• Provocative tests →
– resisted long-finger extension → pain at radial tunnel
– resisted supination
– Lateral epicondylitis may coexists
• Tenderness → anterior and distal to lateral
epicondyle
• electrodiagnostic tests normal
63. Radial tunnel syndrome
• nonoperative treatment for up to 1 year
– activity modification
– splints
– NSAIDs
• surgical decompression →
– less predictable than for PIN syndrome
– good to excellent results in only 50% - 80%
64. Cheiralgia paresthetica -Wartenberg
syndrome
• Compressive neuropathy of superficial sensory branch
of the radial nerve
• Compression site → between brachioradialis and ECRL
with forearm pronation
• Symptoms →
– pain
– numbness
– paresthesias over the dorsoradial hand
• Provocative tests
– forceful forearm pronation for 60 seconds
– Tinel sign over the nerve
66. Thoracic Outlet Syndrome - Vascular
• Subclavian vessel compression or aneurysm
• diagnosis → by physical examination and
angiography
• Adson test →
– arm at the side
– neck hyperextension
– head rotation toward affected side
– diminished radial artery pulse with inhalation
• Duplex ultrasonography → >90% sensitivity and
specificity
67. Thoracic Outlet Syndrome –
Neurogenic
• Entrapment neuropathy of the lower trunk of the
brachial plexus
• Often overlooked or undetected
• Fatigue is common → in a provocative position
• Paresthesias → initial complaint → 95% of
patients → nonspecific
• Electrodiagnostic studies rarely helpful
• Roos sign → heaviness or paresthesias in hands
after holding them above the head for at least 1
minute
68. Thoracic Outlet Syndrome –
Neurogenic
• Cervical and chest radiographs → rule out
cervical rib or Pancoast tumor
• Physical therapy → shoulder girdle strengthening
+ proper posture and relaxation techniques
• Transaxillary first rib resection (thoracic surgeon)
→ good to excellent results if cervical rib is cause
• Combined approach with anterior and middle
scalenectomy also described