Calcific tendinitis
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This document provides information about calcific tendinitis, which is a self-limiting disorder where calcium deposits form in the rotator cuff tendons, most commonly the supraspinatus tendon. It affects those over 30 years old and women more than men. The deposits go through phases of precalcification, calcification, and postcalcification. Conservative treatment includes exercises and anti-inflammatories, while corticosteroid injections and surgery are options if conservative measures fail. The surgical techniques discussed are ultrasound-guided needle removal, extracorporeal shockwave therapy, and arthroscopic shaver removal.
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Hypospadias
This document discusses hypospadias, a congenital abnormality where the opening of the urethra is on the underside of the penis instead of at the tip. It begins with definitions and classifications of hypospadias. It then discusses the incidence, associated anomalies like cryptorchidism and inguinal hernia, role of imaging, timing of repair, anesthesia techniques, hemostasis methods, suture techniques, and dressings used postoperatively. It outlines indications for repair and the use of preoperative hormonal stimulation. It provides an intraoperative algorithm and details techniques for repair of distal, middle, and proximal hypospadias. Finally, it discusses potential complications like bleeding, meatal stenosis
Endovenous Ablation of Varicose Veins. Treat painful varicose veins by Laser ...
Varicose Veins is a very common medical condition affecting more than 30 % of the population. If left untreated, this can cause painful skin ulceration and a significant loss of quality of life.
Treatment is an office procedure, a small needle prick is all that is needed to position the Laser / RFA fiber within the vein and treat this disease once and for all.
Find out more and contact Dr.Joshi for details.
shaharukh ahamd
Tuberculosis can infect the vertebrae and bones, usually spreading from the lungs via blood. It causes osteomyelitis and arthritis, often affecting the lower thoracic and upper lumbar vertebrae. Symptoms include localized back pain, fever, weight loss, and sometimes neurological signs. Diagnosis involves tests showing elevated ESR, positive Mantoux test, and MRI identifying bone changes. Treatment involves antibiotics and sometimes surgery to correct spinal instability or decompress the spinal cord.
Cystic hygroma.pptx
This document provides tips for using a PowerPoint presentation on lymphangioma and cystic hygroma. It recommends freely editing and modifying the slides. It suggests showing blank slides first to elicit student responses before presenting content. Repeating this process of blank slide then content slide three times promotes active learning. The presentation can also be used for self-study. The final slides provide links to access the full presentation on mobile devices or download the collection.
Complications of gall stone disease
Gallstone disease can cause several serious complications if left untreated. The most common complication is cholecystitis, which occurs when a gallstone becomes lodged in the cystic duct, causing inflammation of the gallbladder. If not treated, cholecystitis can progress to gangrenous cholecystitis, empyema, or gallbladder perforation in some cases. Other complications include cholangitis, Mirrizi's syndrome, gallstone ileus, emphysematous cholecystitis, and gallstone pancreatitis. Most complications require urgent or emergent surgical treatment to remove the gallbladder and any gallstones causing blockages or infections.
Management of Necrotising Fasciitis of the Breast
A brief revision of the management of necrotising fascitis of the breast; a common problem among lactating mothers in the developing world. This is a copy of a presentation I made at the Breast and Endocrine Surgery Unit of the Division of Genera Surgery, Ahmadu Bello University Teaching Hospital Zaria.
AMPUTATIONS-PRESENTATION.pptx
This document discusses amputations, including definitions, incidence rates, indications, levels, procedures, complications, and prognosis. Some key points:
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- Most amputations are due to vascular/diabetes issues (83%) or trauma (10%). Lower limbs are more commonly affected than upper limbs.
- Indications are often related to issues of ischemia, infection, or non-functionality of the limb.
- Level and length of the amputation are based on tests of blood flow and functionality. Proper preparation, technique, and post-
Sympathectomy
This document discusses the surgical anatomy and history of surgical sympathectomy. It begins with the anatomy of the sympathetic nervous system and sympathetic trunks. It then discusses the historical approaches to thoracic sympathectomy including open and minimally invasive techniques. The key points are:
- Thoracoscopic sympathectomy has high success rates for treating hyperhidrosis with low complication rates.
- It involves clipping or cutting the sympathetic chain and rami between T2-T3 to denervate the hands. Care must be taken to preserve T1 to avoid Horner's syndrome.
- Compensatory hyperhidrosis is a common complication but most others are rare if T1 is preserved.
CSF RHINORRHOEA
This document discusses CSF rhinorrhea (leakage of cerebrospinal fluid from the nose). It classifies CSF fistulas as either traumatic (often post-procedure) or non-traumatic. It describes the routes of CSF egress from different skull fracture patterns and surgical sites. Clinical features, investigations for locating the fistula, and management approaches including conservative care, timing of surgery, types of repair, and endoscopic techniques are outlined. The goal of treatment is to prevent serious complications like meningitis by achieving definitive repair of the CSF leak.
abc hdat.pdf
The document discusses hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It summarizes the life cycle, pathology, clinical features, investigations including imaging techniques, and treatment options for hydatid cyst. Treatment options include medical treatment with albendazole, percutaneous drainage using the PAIR technique, endoscopic management for biliary involvement, and surgical options. PAIR involves puncturing the cyst under imaging guidance, injecting a scolicidal agent, and reaspirating the contents.
Postoperative care.pptx
Comprehensive presentation on Postoperative care including its phases as well as common complications after surgeries.
THERAPEUTIC ENDOSCOPY IN GI SURGERY
Endoscopy involves examining the interior of hollow organs using an endoscope. It has become an important tool for both diagnostic and therapeutic purposes in GI surgery. Key developments include the first endoscopes in the early 1800s, and the modern fiberoptic endoscope in the 1950s. Common endoscopic procedures today include upper and lower GI endoscopy, ERCP, EUS, and PEG/PEG-J placement. Endoscopy is used to diagnose and treat conditions like GI bleeding, varices, strictures, cancers, and stones. Procedures include biopsy, polypectomy, dilation, ablation, ligation, and stent/drain placement.
Venous ulcer for MBBS
1) Venous ulcers are caused by venous insufficiency and often occur on the lower medial aspect of the leg.
2) Compression therapy is the standard treatment to reduce edema and enhance healing. Elastic compression stockings are recommended.
3) Debriding and dressing the wound along with treating underlying causes such as varicose veins or eczema also aids healing.
4) Surgery to remove incompetent veins may be considered if conservative measures fail to heal the ulcer. Lifelong compression is still needed after healing to prevent recurrence.
varicose veins.pptx
This document provides an overview of varicose veins, including their anatomy, pathophysiology, symptoms, signs, investigations, and management. It discusses the prevalence of varicose veins, affecting up to 40% of adults. The anatomy of the lower limb venous system is described, including the deep and superficial venous systems. Signs and symptoms include enlarged, twisted veins near the surface of the leg as well as heaviness, aching, and fatigue. Investigations include physical exams, ultrasound scans, and other imaging tests. Management options are covered, such as compression therapy, ablation techniques like laser and radiofrequency ablation, sclerotherapy, and open surgery. Recurrence rates and complications are also summarized.
Leg ulcers
This document discusses different types of leg ulcers including venous, arterial, diabetic neuropathic, and hypertensive ulcers. It provides information on:
1. The causes, risk factors, signs and symptoms, investigations and management for each type of ulcer.
2. Venous ulcers are the most common type, caused by venous insufficiency and reflux, and are typically treated with compression therapy and dressings.
3. Arterial ulcers are caused by peripheral arterial disease and present with dry necrotic wounds, often over bony prominences of the feet. Revascularization may be required for healing.
4. Diabetic and neuropathic ulcers occur due to loss of sensation from
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Wrist drop
The radial nerve innervates the extensor muscles of the forearm and hand. Damage to the radial nerve causes wrist drop where the patient is unable to extend the wrist and fingers, impairing grasping. Symptoms include pain, numbness, weakness of hand grip and drooping of the wrist and fingers. Diagnosis involves assessing range of motion, imaging tests and electrodiagnostic tests. Treatment depends on the underlying cause but may include medications, injections, bracing and physical therapy.
Tourniquets
Tourniquets are devices used to control blood flow to an extremity during surgery. Various types of tourniquets have been developed throughout history including the Esmarch bandage and modern pneumatic tourniquets. Proper tourniquet placement and pressure are important to minimize complications like nerve injury, muscle injury, and bleeding. Tourniquet time should be limited to 1.5-2 hours to avoid local and systemic effects. Complications can be further reduced by following precautions during tourniquet application and use.
Torticollis
Torticollis is a twisting of the neck that can have several causes. In newborns, it is often due to injuries during birth or fetal positioning, while in older children it may result from neck injuries, infections, or other conditions. The document discusses the main types and causes of torticollis, including congenital muscular torticollis in newborns, self-limiting torticollis, trauma, infections, tumors, and certain drugs. Ultrasound is often used to diagnose congenital cases in newborns, while CT and MRI are used to diagnose other causes like trauma, infections, or tumors in older children. Treatment depends on the underlying cause but may include stretching, physical therapy
Thoracic outlet syndrome
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the lower neck and upper chest - become compressed. This can cause pain and numbness in the shoulders and neck as well as reduced pulse. It is commonly caused by anatomical variations like cervical ribs or muscle abnormalities that reduce the space available to the neurovascular structures passing through. Diagnosis involves clinical tests like Adson's maneuver and imaging like MRI. Treatment ranges from physiotherapy and analgesics for mild cases to surgical removal of the first rib and scalene muscles for more severe or progressive cases.
Tennis elbow
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
Tendo achilles
The Achilles tendon connects the calf muscles to the heel bone and is active during walking, running, and jumping. It is vulnerable to rupture, which commonly occurs in the watershed area 2-6cm above the heel in males ages 25-50 during sports. Diagnosis involves physical exam findings like inability to raise the toes and a gap or defect being felt. Treatment options include immobilization in a cast or surgical repair, with the goal of restoring proper tension and length. Post-operative care focuses on protecting the repair during healing over 6 months using casts, braces, and physical therapy.
Surgical site infections
Surgical site infections occur when bacteria enter through an incision made during surgery. They are classified as superficial, deep, or organ/space infections. Common causative agents include Staphylococcus aureus and Streptococcus pneumoniae. Factors that increase risk include patient health issues like malnutrition or diabetes as well as surgical factors like poor technique, inadequate prophylactic antibiotics, or an unclean operating environment. Diagnosis involves clinical signs plus lab and imaging tests. Treatment consists of antibiotics, wound debridement, and drainage. Prevention strategies focus on proper patient preparation, strict sterile techniques in the operating room, and careful post-operative wound care.
Spinal cord tractography
Diffusion tensor imaging (DTI) and fiber tractography are MRI techniques that can be used together to non-invasively visualize spinal cord tracts. DTI measures the anisotropic diffusion of water in tissue to infer the orientation of white matter tracts. Fiber tractography then generates 3D reconstructions of the tracts. This technique provides information about spinal cord injuries or other pathologies. However, it faces challenges from motion artifacts and has limitations when tracts converge or cross or are non-homogeneous. Despite this, DTI tractography can be used to prognosticate outcomes from spinal cord deformities, injuries, tumors, or myelopathies. Two case studies are described, one with a C6 burst fracture
Spina ventosa
Spina ventosa is a form of tuberculous dactylitis that affects the short tubular bones of the hands and feet in children. It occurs secondary to tuberculosis infection and presents as swelling and tenderness of the affected bone. Investigations may show leukocytosis and elevated inflammatory markers. Chest x-rays and bone x-rays can identify periosteal reaction, lytic lesions, or sclerosis. Biopsy is needed to confirm the diagnosis. A case report described a 13-year-old girl with left index finger pain, weight loss, and loss of appetite who was found to have spina ventosa on biopsy along with a tuberculoma seen on brain MRI. She was started on antitub
Snapping hip syndrome
There are three main types of snapping hip: external, internal, and intra-articular. External snapping hip is caused by increased tension in the iliotibial band over the greater trochanter with repeated flexion and extension. Internal snapping hip involves snapping of the iliopsoas tendon over the femoral head. Intra-articular snapping hip is caused by labral tears or loose bodies in the hip joint. Conservative treatments include rest, stretching, strengthening, and therapies like cold compression, while operative options involve procedures like Z-plasty of the iliotibial band or arthroscopic surgery to address intra-articular issues.
Scurvy
- Scurvy is a disease caused by vitamin C deficiency that results from a lack of vitamin C in the diet for several weeks. It impairs collagen formation and causes hemorrhaging in tissues.
- Symptoms include bleeding gums, loose teeth, bruising of the skin, and bone fractures. In infants, scurvy can cause pseudoparalysis and swelling over bones from subperiosteal hemorrhaging.
- Diagnosis is based on low vitamin C blood levels and x-ray findings of bone changes like the white line of Fraenkel. Treatment involves vitamin C supplementation in doses of at least 200mg daily until recovery is complete.
Screws in orthopedics
This document provides an overview of screws in orthopedic surgery. It discusses the history of screw development from ancient times through modern innovations in materials. The anatomy of a screw is described in detail, including the head, shaft, thread, tip, and special features like pitch, diameter, and cannulation. Different types of screws are compared based on their properties and intended uses in cortical versus cancellous bone. Special screw designs like Herbert screws, lag screws, and dynamic hip screws are also briefly mentioned.
Sacral chordoma
Sacral chordoma is a rare, slowly growing malignant tumor that arises from remnants of the notochord, usually occurring in the sacrum. It accounts for 1-4% of all malignancies and is the most common primary malignancy of the sacrum. Patients typically experience lower back pain worsening with sitting in their 5th-7th decade. Imaging shows a destructive lytic lesion in the sacrum. Complete surgical resection is the primary treatment, but recurrence is common due to the locally aggressive nature, leading to poor long-term survival rates.
Robotics in orthopedics
This document discusses the use of robots in orthopaedic surgery. It describes how robotic systems can improve accuracy of bone cuts and component placement compared to manual surgery. Both autonomous and haptic robotic systems are presented. Applications discussed include unicondylar knee replacement using the Mako robotic arm and spinal pedicle screw placement using the Renaissance system. While robotic surgery may provide benefits like increased accuracy, it also has drawbacks such as high costs and long-term outcomes have not proven superiority over manual techniques.
Reverse shoulder arthroplasty
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
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Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
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Chapter 5
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Calcific tendinitis
- 2. INTRODUCTION ■ It is largely a self limiting disorder of rotator cuff in which the tendons are infiltrated with calcium deposits. ■ Most common age group is usually above 30. ■ Female are affected more than males. ■ Around 10 percent cases are bilateral. ■ The most common site of occurrence is within the supraspinatus tendon and at a location 1.5 to 2 cm away from the tendon insertion on greater tuberosity. ■ Most patients with calcific deposits are asymptomatic ,but pain can be intense in symptomatic patients.
- 3. ETIOLOGY ■ The correct etiology still remain unknown. ■ Suggested causes have included a vascular etiology, with degeneration of tendon fibres preceding the calcification and aging of tendon with a general diminishing of vascularity to supraspinatus as a normal course of events. ■ Microangiographic studies showed an area of hypovascularity near codman’s critical zone just proximal to supraspinatus insertion into greater tuberosity.
- 4. CHRONOLOGICAL PROGRESSION (by Sarkar and Uthoff) ■ PHASE 1 – Precalcification stage – Possibly a site of diminished blood supply undergoes fibrocartilaginous metaplasia.No symptoms. ■ PHASE 2 — Calcification stage — Calcium is deposited into matrix vesicles. — smaller vesicles coalesce to form larger vesicles. — Fibrocartilage is gradually replaces and eroded but pain is minimal. — X-rays show well marginated deposits called as resting phase. —Resorptive phase starts when vascular channels appear at periphery of deposits and calcium resorption starts.This is extremely painful and patient seeks help. — Calcium gets replaced with granulation tissue.
- 5. Contd.. ■ PHASE 3 — Postcalcification phase —During this phase , the granulation tissue matures into collagen and pain subsides.
- 7. LOCATION ■ Supraspinatus- 80% ■ Infraspinatus – 15% ■ Subscapularis – 5% ■ Ligaments, capsule,bursae
- 8. Investigations ■ X-rays – most practical and feasible. ■ USG – hyperechoic focus,can’t classify the stages ■ CT – best for assessing bony erosions and consistency. ■ MRI –T1- hypointense homogenous T2-hypointense calcium deposits with hyperintense edema.
- 11. TREATMENT ■ Essentially almost all patients eventually recover from calcific tendinitis . ■ Non operative – Exercises — Anti inflammatory medications —Corticosteroid injections- can cause recurrence as they abort the resorptive phase returning the lesion to dormancy. ■ Operative – Gschwend et al. listed following indications (1)symptoms progression (2)pain affecting activities of daily life even after a long time. (3)absence of improvement after conservative therapy.
- 12. Techniques 1. Ultrasound guided percutaneous needling with corticosteroid injection showed 70 percent improvement in a 2 year follow up study. 2. Extracorporeal shoch wave therapy -10 to 30 mins with >0.28mj/mm square 3. Currently the best technique being arthroscopic removal with shaver.Acromioplasty is needed in patients with subacromial stenosis.
- 13. Thank you