Carpel tunnel syndrome
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Carpal tunnel syndrome is caused by increased pressure on the median nerve as it passes through the carpal tunnel in the wrist. It is commonly seen in conditions that increase pressure in the tunnel such as diabetes, hypothyroidism, pregnancy, and anatomical variations. Symptoms include pain, numbness and tingling in the hand, especially at night. Diagnosis involves physical exam tests like Tinel's sign and Phalen's maneuver as well as electrodiagnostic studies. Treatment begins with splinting, lifestyle changes and medications but may require carpal tunnel release surgery to divide the transverse carpal ligament if conservative measures fail.
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Polymyositis Dermatomyositis
It is a slide show about the Inflammatory Muscle Diseases with particular focus on Polymyositis and Dermatomyositis.
Inflammatory disease of muscle
This document provides an overview of inflammatory diseases of muscle, specifically polymyositis and dermatomyositis. It discusses the pathophysiology, clinical manifestations, diagnosis, treatment and prognosis of these conditions. Key points include that they present with proximal muscle weakness, increased muscle enzymes, characteristic findings on electromyography and muscle biopsy. Diagnosis is based on criteria including skin lesions, muscle symptoms and testing. Treatment involves corticosteroids and immunosuppressive agents. Prognosis can be poorer if complications like interstitial lung disease are present.
A Case of Dermatomyositis
A 40-year-old woman presented with difficulty using her limbs over the last 7 months, discoloration of her face and hands for 6 months, and swallowing difficulties for 2 months. She was diagnosed with dermatomyositis based on her symptoms and signs of muscle weakness, characteristic rashes, and positive autoantibodies. She is being treated with steroids and immunosuppressants and is improving. Dermatomyositis is an autoimmune disease characterized by muscle inflammation and weakness along with skin rashes.
Polymyositis
Bracken, an 11-year-old English Springer Spaniel, presented with a 5-week history of paraparesis, lethargy, and decreased appetite. Clinical examination revealed weakness in all limbs, especially the hind limbs. Diagnostic testing showed an elevated creatine kinase level and abnormal electromyography results. A small bladder mass and enlarged lymph node were also found. A muscle biopsy displayed lymphocytic infiltration and necrosis consistent with polymyositis. Bracken was diagnosed with immune-mediated polymyositis and started on immunosuppressive treatment and physical therapy. His condition is slowly improving.
Dermatomyositis
Dermatomyositis is an inflammatory myopathy that affects the skin and muscles. It is characterized by progressive proximal muscle weakness, elevated muscle enzymes, abnormal electromyography and muscle biopsy findings. The cause is unknown but genetic, immunological, infectious and environmental factors may play a role. Treatment involves sun protection, immunosuppressants like hydroxychloroquine and methotrexate, and corticosteroids like prednisone to control muscle and skin symptoms.
Idiopathic inflammatory myopathy
Inflammatory myopathies are rare diseases characterized by symmetric proximal muscle weakness. The main types are polymyositis, dermatomyositis, juvenile dermatomyositis, myositis associated with other conditions, and inclusion body myositis. Diagnosis involves muscle biopsy showing inflammation, elevated muscle enzymes, EMG changes, and sometimes autoantibodies. Treatment begins with glucocorticoids and may include immunosuppressants if weak response. Prognosis depends on type, with dermatomyositis having best outlook.
Muscle weakness & rash (Dermatomyositis)
This document discusses muscle weakness and skin rash (dermatomyositis). It provides information on the clinical presentation, causes, diagnostic criteria and classification, investigations, histopathological findings, treatment and prognosis of dermatomyositis. Key points include that dermatomyositis involves proximal muscle weakness and a skin rash. Diagnosis involves elevated muscle enzymes, electromyography, muscle biopsy and the presence of a skin rash. Treatment primarily involves oral steroids. Prognosis depends on factors like age, presence of malignancy and disease recalcitrance.
Idiopathic Inflammator Myopathie Dr.Mark Boulos June5 07fin
This document discusses idiopathic inflammatory myopathies (IIMs), including polymyositis, dermatomyositis, and inclusion body myositis. It reviews the clinical features, diagnostic criteria, pathology, and treatment strategies for these conditions. It also presents a case of a patient presenting with proximal muscle weakness who is diagnosed with polymyositis based on elevated CK, myopathic EMG findings, and muscle biopsy consistent with polymyositis. Treatment options discussed for IIMs include corticosteroids, immunosuppressants, rituximab, and intravenous immunoglobulin.
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Polymyositis Dermatomyositis
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A Case of Dermatomyositis
A 40-year-old woman presented with difficulty using her limbs over the last 7 months, discoloration of her face and hands for 6 months, and swallowing difficulties for 2 months. She was diagnosed with dermatomyositis based on her symptoms and signs of muscle weakness, characteristic rashes, and positive autoantibodies. She is being treated with steroids and immunosuppressants and is improving. Dermatomyositis is an autoimmune disease characterized by muscle inflammation and weakness along with skin rashes.
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This document discusses muscle weakness and skin rash (dermatomyositis). It provides information on the clinical presentation, causes, diagnostic criteria and classification, investigations, histopathological findings, treatment and prognosis of dermatomyositis. Key points include that dermatomyositis involves proximal muscle weakness and a skin rash. Diagnosis involves elevated muscle enzymes, electromyography, muscle biopsy and the presence of a skin rash. Treatment primarily involves oral steroids. Prognosis depends on factors like age, presence of malignancy and disease recalcitrance.
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This document discusses idiopathic inflammatory myopathies (IIMs), including polymyositis, dermatomyositis, and inclusion body myositis. It reviews the clinical features, diagnostic criteria, pathology, and treatment strategies for these conditions. It also presents a case of a patient presenting with proximal muscle weakness who is diagnosed with polymyositis based on elevated CK, myopathic EMG findings, and muscle biopsy consistent with polymyositis. Treatment options discussed for IIMs include corticosteroids, immunosuppressants, rituximab, and intravenous immunoglobulin.
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1. This case presentation describes a 30-year-old female patient admitted with complaints of muscle pain for 2 months, general weakness for 1 month, and difficulty swallowing for 10 days.
2. On examination, the patient had reduced muscle strength and elevated CPK and LDH levels. EMG showed signs consistent with inflammatory myopathy.
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A middle-aged woman presented with generalized weakness, rashes, and sores. On examination, she had hyperpigmentation, edema, and rashes on her buttocks and groin. Tests found elevated muscle enzymes. She was diagnosed with dermatomyositis and admitted for IV fluids and steroids. Her symptoms worsened, and she developed difficulty raising her arms, confirming the diagnosis of dermatomyositis. She was started on immunosuppressants and referred for palliative care.
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NB: This presentation is equipped with animations, which might not work on slideshare
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This document provides an overview of the approach to diagnosing and classifying muscle disorders. It discusses taking a clinical history and performing a physical exam to identify symptoms and patterns of weakness. Key investigations include blood tests of enzymes like CK, electromyography and muscle biopsy. Major classifications of myopathies covered are immune-mediated myopathies like dermatomyositis and polymyositis, necrotizing myopathies, inclusion body myositis, and others. Treatment typically involves immunosuppressants like corticosteroids and newer targeted immunotherapies depending on antibody status and subtype.
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The document discusses various types of inflammatory myopathies (myositis):
1) Polymyositis causes symmetric proximal muscle weakness and inflammation within muscle fibers. Symptoms include fatigue and a skin rash.
2) Dermatomyositis causes similar muscle symptoms but also features a characteristic rash on the skin. It can also involve other organs.
3) Inclusion body myositis typically causes asymmetric weakness of wrist, finger, and thigh muscles. It involves degeneration in addition to immune dysfunction.
4) Overlap myositis combines myopathy with connective tissue diseases like lupus. Diagnosis involves blood tests, muscle enzyme levels, muscle biopsy and MRI or EMG. Treatment
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This document summarizes different types of inflammatory myopathy including polymyositis, dermatomyositis, and inclusion body myositis. Polymyositis causes proximal weakness, elevated CK enzyme levels, and sometimes muscle pain. Dermatomyositis has similar features to polymyositis but also includes skin lesions. Inclusion body myositis has an older age of onset, affects both proximal and distal muscles, and is typically painless. Treatment involves corticosteroids, immunosuppressants, and intravenous immunoglobulin for severe cases. Prognosis is generally good with treatment but respiratory muscle involvement can potentially be fatal.
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The document discusses three major types of inflammatory myopathies: polymyositis (PM), dermatomyositis (DM), and inclusion body myositis (IBM). PM is difficult to diagnose initially as symptoms develop gradually, while DM causes a characteristic rash that facilitates early detection. IBM primarily affects older patients and is often initially misdiagnosed as PM. DM is associated with increased risk of certain cancers but PM and IBM are not. Treatment options for inflammatory myopathies include glucocorticoids like prednisone and other immunosuppressive drugs, though IBM typically does not respond well to these therapies.
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This document discusses inflammatory myositis, including dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. It is a heterogeneous group of autoimmune disorders that predominantly affect skeletal muscles, resulting in muscle inflammation and weakness. The most common forms are DM, PM, and immune-mediated necrotizing myopathy. Treatment involves systemic glucocorticoids. Refractory cases may require steroid-sparing agents like azathioprine, methotrexate, or rituximab. There is an increased risk of associated malignancy that warrants cancer screening.
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This document discusses inflammatory myopathies and provides information on their classification, diagnosis, and presentation. Some key points include:
1) Dermatomyositis (DM) is often associated with skin lesions which are helpful for diagnosis. Polymyositis (PM) is a diagnosis of exclusion.
2) DM, PM, and inclusion body myositis (IBM) can present differently and be associated with other conditions.
3) IBM is common in the elderly and can present variably, with a characteristic but non-inflammatory muscle biopsy. Screening cancer patients with PET/CT is recommended.
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A 36-year-old Thai man presented to the hospital after a motorcycle accident where he collided with a dog and fell off his bike 3 hours prior. He complains of left shoulder and chest pain. Imaging shows a closed fracture of the mid-shaft left clavicle with a left scapula neck fracture. The patient is admitted and managed conservatively with sling immobilization.
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This document discusses extremity vascular injuries, which can result in limb loss or death if not properly treated. The most common causes are road traffic injuries. Clinical features include signs of active bleeding, ischemia, pain, pallor, and pulse absence. Imaging like duplex scans and angiography can help diagnose the injury. Early surgical repair of damaged blood vessels is needed to restore blood flow. Complications include compartment syndrome, which requires fasciotomy to reduce pressure. Close monitoring is also needed after reperfusion to watch for systemic effects. With proper emergency treatment and surgery, many extremities can be saved from amputation.
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1. This case presentation describes a 30-year-old female patient admitted with complaints of muscle pain for 2 months, general weakness for 1 month, and difficulty swallowing for 10 days.
2. On examination, the patient had reduced muscle strength and elevated CPK and LDH levels. EMG showed signs consistent with inflammatory myopathy.
3. The patient was diagnosed with polymyositis based on clinical signs, laboratory findings, and EMG results. She was started on high-dose steroids and other treatments.
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A middle-aged woman presented with generalized weakness, rashes, and sores. On examination, she had hyperpigmentation, edema, and rashes on her buttocks and groin. Tests found elevated muscle enzymes. She was diagnosed with dermatomyositis and admitted for IV fluids and steroids. Her symptoms worsened, and she developed difficulty raising her arms, confirming the diagnosis of dermatomyositis. She was started on immunosuppressants and referred for palliative care.
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This document discusses idiopathic inflammatory myopathies (IIM), which are rare diseases characterized by symmetrical proximal muscle weakness, elevated skeletal muscle enzymes, and characteristic electromyography and muscle biopsy findings. IIM includes dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and inclusion body myositis. It most commonly affects women aged 50-59 and can cause difficulty with activities like lifting arms or climbing stairs due to proximal muscle weakness. Investigations may show elevated muscle enzymes or skin rash in DM cases, while management involves immunosuppressive drugs.
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Includes classification, characteristic features of all and specific features of each of them with diagnosing and approach to management.
NB: This presentation is equipped with animations, which might not work on slideshare
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This document provides an overview of the approach to diagnosing and classifying muscle disorders. It discusses taking a clinical history and performing a physical exam to identify symptoms and patterns of weakness. Key investigations include blood tests of enzymes like CK, electromyography and muscle biopsy. Major classifications of myopathies covered are immune-mediated myopathies like dermatomyositis and polymyositis, necrotizing myopathies, inclusion body myositis, and others. Treatment typically involves immunosuppressants like corticosteroids and newer targeted immunotherapies depending on antibody status and subtype.
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The document discusses various types of inflammatory myopathies (myositis):
1) Polymyositis causes symmetric proximal muscle weakness and inflammation within muscle fibers. Symptoms include fatigue and a skin rash.
2) Dermatomyositis causes similar muscle symptoms but also features a characteristic rash on the skin. It can also involve other organs.
3) Inclusion body myositis typically causes asymmetric weakness of wrist, finger, and thigh muscles. It involves degeneration in addition to immune dysfunction.
4) Overlap myositis combines myopathy with connective tissue diseases like lupus. Diagnosis involves blood tests, muscle enzyme levels, muscle biopsy and MRI or EMG. Treatment
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Polymyositis dermatomyositis and inclusion body myositis
The document discusses three major types of inflammatory myopathies: polymyositis (PM), dermatomyositis (DM), and inclusion body myositis (IBM). PM is difficult to diagnose initially as symptoms develop gradually, while DM causes a characteristic rash that facilitates early detection. IBM primarily affects older patients and is often initially misdiagnosed as PM. DM is associated with increased risk of certain cancers but PM and IBM are not. Treatment options for inflammatory myopathies include glucocorticoids like prednisone and other immunosuppressive drugs, though IBM typically does not respond well to these therapies.
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This document discusses inflammatory myopathies, including types such as polymyositis, dermatomyositis, and immune-mediated necrotizing myopathy. It is characterized by chronic muscle inflammation that is often autoimmune in nature and causes weakness. Diagnosis involves evaluating for proximal muscle weakness, elevated muscle enzymes, EMG findings of myopathy, and muscle biopsy showing inflammation. Skin manifestations may also be present in dermatomyositis. Treatment typically involves glucocorticoids and immunosuppressants like methotrexate or mycophenolate mofetil. The document also presents four clinical cases of patients with suspected inflammatory myopathies and discusses their evaluations, diagnoses, and management considerations.
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Myositis 2019
This document discusses inflammatory myositis, including dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. It is a heterogeneous group of autoimmune disorders that predominantly affect skeletal muscles, resulting in muscle inflammation and weakness. The most common forms are DM, PM, and immune-mediated necrotizing myopathy. Treatment involves systemic glucocorticoids. Refractory cases may require steroid-sparing agents like azathioprine, methotrexate, or rituximab. There is an increased risk of associated malignancy that warrants cancer screening.
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Rheumatic diseases include rheumatoid arthritis and psoriatic arthritis. Rheumatoid arthritis is an autoimmune disease that causes inflammation and destruction of joints, tendons, and bones. It affects around 1% of the adult population and women more than men. While the cause is unknown, genetic and environmental factors are involved. Symptoms include joint stiffness, pain, swelling and decreased range of motion. Treatment involves medications like NSAIDs, DMARDs and corticosteroids to relieve symptoms and slow disease progression. Psoriatic arthritis causes joint pain and swelling in some joints and scaly skin patches, with symptoms varying between individuals.
2. miopatia inflamatoria dr grau
This document discusses inflammatory myopathies and provides information on their classification, diagnosis, and presentation. Some key points include:
1) Dermatomyositis (DM) is often associated with skin lesions which are helpful for diagnosis. Polymyositis (PM) is a diagnosis of exclusion.
2) DM, PM, and inclusion body myositis (IBM) can present differently and be associated with other conditions.
3) IBM is common in the elderly and can present variably, with a characteristic but non-inflammatory muscle biopsy. Screening cancer patients with PET/CT is recommended.
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Similar to Carpel tunnel syndrome
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A 36-year-old Thai man presented to the hospital after a motorcycle accident where he collided with a dog and fell off his bike 3 hours prior. He complains of left shoulder and chest pain. Imaging shows a closed fracture of the mid-shaft left clavicle with a left scapula neck fracture. The patient is admitted and managed conservatively with sling immobilization.
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This document discusses extremity vascular injuries, which can result in limb loss or death if not properly treated. The most common causes are road traffic injuries. Clinical features include signs of active bleeding, ischemia, pain, pallor, and pulse absence. Imaging like duplex scans and angiography can help diagnose the injury. Early surgical repair of damaged blood vessels is needed to restore blood flow. Complications include compartment syndrome, which requires fasciotomy to reduce pressure. Close monitoring is also needed after reperfusion to watch for systemic effects. With proper emergency treatment and surgery, many extremities can be saved from amputation.
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This document discusses several motor disorders - motor neuron disease, myasthenia gravis, and muscular dystrophy. Motor neuron disease includes ALS and causes progressive weakness and wasting through damage to motor neurons. Myasthenia gravis is an autoimmune disorder causing muscle weakness and fatigability through antibodies blocking acetylcholine receptors. There are several types of muscular dystrophy which are inherited disorders causing progressive muscle weakness and wasting, such as Duchenne muscular dystrophy.
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- A 40-year-old female presented with sudden onset weakness of both lower limbs, band-like sensation in the upper trunk, and diminished sensation below the umbilicus with early bladder involvement. Examination revealed decreased tone and power in both lower limbs, absent deep tendon reflexes in the lower limbs, bilateral plantar extensor response, absent abdominal reflex, and loss of all modalities of sensation below the T8 spinal segment. There was also loss of spinal prominence and tenderness at the T6 vertebral level. This suggests compressive myelopathy at the T6-T8 levels affecting motor and sensory functions bilaterally.
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This document provides an overview of the anatomy of the spinal cord including its structure, blood supply, sensory and motor systems, and approach to spinal cord diseases. Key points include:
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Compartment syndrome and VIC
I. Acute compartment syndrome (ACS) is a medical emergency caused by severe injury that can lead to permanent muscle damage, while chronic compartment syndrome (CCS) is not an emergency and is caused by athletic exertion.
II. Compartment syndrome is caused by increased pressure within the osteofascial compartments surrounding muscles. Increased pressure decreases blood flow leading to ischemia, pain, and if untreated, tissue necrosis.
III. Clinical evaluation looks for the 5 P's - pain out of proportion, pallor, paresthesia, paralysis, and pulselessness - though these signs only appear after ischemic injury has already occurred. Pressure monitoring is important for early diagnosis.
Incidence clical features, diagnosis and management of
This document discusses tuberculosis of the hip, including its pathogenesis, clinical features, diagnosis, classification, and management. Some key points:
- TB of the hip is usually secondary to a primary lung infection and spreads hematogenously. It presents with limping and referred knee pain.
- Stages include synovitis, early arthritis, and advanced arthritis with possible subluxation. Radiographs show osteopenia, erosions, and joint space narrowing.
- Treatment involves anti-tubercular drugs, bed rest, traction, and may require synovectomy, arthrodesis, or excision arthroplasty depending on stage and deformity. The goal is to preserve joint function through early diagnosis and
INTERNAL MEDICINE - Vascular Diseases of the Extremities
This document discusses peripheral arterial disease and other vascular diseases of the extremities that affect arteries. It covers the definition, risk factors, symptoms, diagnostic testing, and treatment options for conditions such as peripheral arterial disease, fibromuscular dysplasia, Buerger's disease, acute arterial occlusion, and atheroembolism.
Avascular necrosis
This document discusses avascular necrosis (AVN) of the bone, also known as osteonecrosis. It begins by explaining that AVN results from interrupted blood supply to the bone, which can lead to bone and cell death. The most common sites of AVN are the femoral head, scaphoid, and talus. Non-surgical treatments include limited weight bearing, while surgical options include core decompression, bone grafting, and osteotomies to preserve the joint. More advanced cases may require joint replacement like hip resurfacing or total hip arthroplasty. Risk factors include corticosteroid use, alcoholism, trauma, and various medical conditions.
Spinal cord injury
This document discusses spinal cord injuries, including the anatomy of the spine, mechanisms of injury, types of injury, assessment, management in the acute phase, and long term care. It notes that spinal cord injuries can cause paralysis, sensory deficits, and autonomic dysfunction depending on the level and completeness of injury. Initial management involves immobilization, minimizing secondary injury, and addressing airway, breathing and circulation problems. Definitive care includes early surgical fixation and rehabilitation to prevent complications like pressure sores, thrombosis, and psychological issues.
Brachial plexus injury diagnosis
This document discusses the anatomy, clinical evaluation, and management of brachial plexus injuries. It begins with the anatomical components of the brachial plexus including roots, trunks, divisions, cords, and branches. It then covers the clinical evaluation including history, physical exam findings, and investigations like imaging and electrodiagnostic studies. Key aspects of the physical exam are described for assessing specific nerves and muscles. The document concludes with classifications of brachial plexus injuries and considerations for non-operative versus operative management.
Compartment syndrome
This document discusses compartment syndrome, including its definition, relevant anatomy, causes, pathophysiology, diagnosis, and treatment. Compartment syndrome is an elevation of pressure within a closed muscle compartment that restricts blood flow. The most common causes are tibial and forearm fractures. Diagnosis is based on pain disproportionate to the injury that increases with stretch, and measurement of intracompartmental pressure over 30 mmHg. The only effective treatment is urgent surgical fasciotomy to release the fascial compartment and restore blood flow. Early diagnosis and treatment are important to prevent permanent muscle and nerve damage.
Peripheral Arterial Disease
Peripheral arterial disease (PAD) is the obstruction or deterioration of arteries other than those supplying the heart and brain. PAD prevalence increases with age and is more common in Black individuals compared to Whites. A study in Ghana found higher PAD prevalence in Ghanaians living in Ghana compared to migrant Ghanaians in Europe. Risk factors for PAD include smoking, hypertension, diabetes, hyperlipidemia, and renal insufficiency. Treatment involves lifestyle modifications, medications, and revascularization procedures like angioplasty, stenting, or bypass surgery depending on the severity and location of arterial blockages. Amputations may be required for gangrenous or critically ischemic limbs.
MANAGEMENT OF ACUTE SPINAL CORD INJURY.
It's a PowerPoint on the management of acute spinal cord injury
Relevant for medical doctors especially orthopaedic surgery subspecialty.
thoracic outlet syndrome
This document provides information on thoracic outlet syndrome (TOS). It begins with a brief history and defines TOS as abnormal compression of the neurovascular bundle in the thoracic outlet. It describes the relevant anatomy and compartments of the thoracic outlet. The document discusses the causes, types, symptoms, and diagnostic approaches for the neurogenic, venous, and arterial forms of TOS. It provides details on conservative and surgical treatment options.
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Incidence clical features, diagnosis and management of
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INTERNAL MEDICINE - Vascular Diseases of the Extremities
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CNS SPECT
This document discusses 6 applications of CNS SPECT imaging: 1) Evaluating collateral circulation during internal carotid balloon test occlusion, 2) Evaluating amobarbital sodium distribution during the Wada test, 3) Evaluating vasospasm associated with subarachnoid hemorrhage or cerebral angiography, 4) Evaluating cerebrovascular reserve before carotid endarterectomy, 5) Presurgically localizing seizure foci, and 6) Guiding stereotactic biopsy for evaluation of tumor recurrence.
MENINGIOMA - SIGNS
Meningiomas can be identified through several characteristic signs seen on imaging scans. These signs include the CSF cleft sign, dural tail, ginkgo leaf sign, mother in law sign, spoke wheel sign, sunburst sign, and white matter buckling sign which help doctors diagnose meningiomas.
MENINGIOMA DDs
This document lists different conditions that should be considered in the differential diagnosis of meningiomas. These include haemangiopericytoma, solitary fibrous tumour of the dura, primary dural lymphoma, Rosai-Dorfman disease, EBV-associated smooth muscle tumour, meningeal melanocytoma, primary meningeal malignant melanoma, Erdheim-Chester disease, sarcoidosis, dural metastases, and hypertrophic pachymeningitis.
second impact syndrome
This document discusses second impact syndrome and concussion grading. It defines concussion as an immediate loss of consciousness due to a blow to the head. A second, less intense impact before recovery from an initial concussion can lead to malignant cerebral edema and sudden death within minutes due to loss of the brain's autoregulatory mechanism. It presents the CANTU grading system for concussions from Grade 1 to 3 based on loss of consciousness time and post-traumatic amnesia duration. It outlines return to play protocols depending on concussion grade and whether it is a first or second concussion to prevent second impact syndrome.
IRIS IN CNS
This document discusses immune reconstitution inflammatory syndrome (IRIS), which can occur in 30% of HIV patients starting antiretroviral therapy and causes an exaggerated immune response to existing infections. It describes the two forms of IRIS - paradoxical and unmasking - and risk factors like low CD4 counts. Clinical presentations include worsening of conditions like TB, PML, or Kaposi sarcoma. Radiology may show enhancing masses or lesions. Treatment involves continuing antiretrovirals while using steroids to address the inflammatory response.
Pineal region tumors
This document provides an overview of the pineal gland and pineal region tumors. It begins with the anatomy and histology of the pineal gland, then discusses common tumor types including germinomas, teratomas, pineocytomas, pineoblastomas, and others. For each tumor type, the characteristics, imaging appearance, histology, and clinical features are described. The document also reviews the surgical anatomy of the pineal region and historical aspects of pineal tumor surgery. Overall, it serves as a comprehensive reference for the pineal gland and tumors that originate within this region.
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Carpel tunnel syndrome
- 1. CARPEL TUNNEL SYNDROME DR. GOVIND GAIKWAD
- 2. DEFINITION AN entrapment neuropathy is defined as a pressure or pressure induced injury bto to a segment of a segment of peripheral nerve secondary to anatomic or pathologic structure. prevalence- men-2% , women- 3% Earliest description - sir James Paget 1854, 1880 Putnam- 30 patients series Surgical treatment- 1993
- 3. pathophysiology Increased pressure within the canal Decreased space Increased contents Pressure @30mmhg- Impair Axonal transport @30-40mmhg- paraesthesia @50mmhg- Axonal block @60mmhg-complete intraneural block ischaemia, sensory, motor block
- 4. Anatomy of carpel tunnel Definition - A fibro-osseous tunnel in the anterior aspect of the wrist that is formed by the carpel bones and flexor retinaculum (carpel tunnel ligament) Floor -volar radiocarpel ligament and other bridging ligaments Attachments- Medial-pisiform and hook of hamet Lateral -tubercle of scaphoid Roof- transverse carpel ligament Attachments -medial-pisiform and hook of hamet Lateral- tubercle of scaphoid
- 5. Length-4-6cm Thickness-2.5-3.5cm Width- 3-4cm Contents - Median nerve and its vascular bundle 9 tendons FDS-4, FDP-4, FPL-1
- 6. MEDIAN NERVE ORIGIN- Median and lateral cord Course Arm - Medial aspect with BA and BV Cubital fossa -MBBT Forearm - between Two head of prpnater teres Deep surface of FDS Sublimusbridge @CT- Superficial to FDS Deep to PL tendon
- 7. Branches of median nerve Medial palmar cutaneous nerve- 5cm proximal to the TCL Recurrent motor branch- Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis Digital palmar branches Lateral two lumbricals Sensory to palmar surface and distal dorsal surface of index, middle n lat ½ ring finger
- 8. Entrapment sites Arm - struther’s ligament Bicipital aponeurosis Forearm - pronaters teres - sublimus bridge Hand - carpel tunnel
- 9. Conditions a/w CTS METABOLIC-DM, Pregnancy, hypothyroidism, acromegaly, B6 deficiency, renal failure AUTOIMMUNE/INFLAMMATORY-RA,Sarcoidosis, amyloidosis, tenosynovits ANATOMIC -persistent median artery, anomalous tendon or muscle,congenital stenosis, #/dislocation @wrist INFECTIONS-septic arthritis, Lymes disease, TB, Histoplasma NEOPLASM- Ganlion cyst, nerve sheath tumors
- 10. CLINICAL PRESENTATION Pain and paraesthesia Nocturnal burning pain Predisposing factors Wheel chair athletes , bicyclers, archers, bodybuilders, wrestlers, golfers,football players Alcoholism Familial CTS
- 11. EXAMINATIONS INSPECTION- Entire shoulder and limb Asymmetry and atrophy Palpation- Entire length of nerve Point of tenderness Bony abnormality
- 13. HAND MUSCLES- LOAF muscles Lumbricals 1,2 Opponans pollicis APB FPB
- 14. SENSORY EXAMINATION SW filaments Vibrations testing
- 15. Provocative maneuvers Tinels sign Phalens test Reverse phalens test Pressure provocation test Durlhan compression test Gilliat torniquet test Ultrasonic stimulations test
- 16. Electrophysiological testing NCS Palamr sensory latency Distal motor latency Sensory Nerve action potential SNAP EMG -APB Spontaneous fibrillation potential Positive sharp waves MUP
- 17. IMAGING X RAYS -#, Dislocation, SCP. USG- Nerve cross section >10mm @pisiform MRI- STIR MRN
- 18. MEDICAL MANAGEMENT WRIST SPLINTING PHYSICAL THERAPY LIFESTYLE MODIFICATIONS US THERAPY DIURETICS NSAIDS STEROIDS LASER THERAPY
- 19. SURGICAL MANAGEMENT OPEN TECHNIQUE Goal- complete division of TCL Preservation of motor and sensory branch AX Position Incision -3-4cm starting @distal skin crease to @ point intercepting a imaginary line drawn from distal bank of extended thumb to pisiform prominence Layers - skin, subcut fat, Palmar fascia DIVISION @ MIDPOINT OF TCL
- 20. ENDOSCOPIC CTR UNIPORT-Agee and Okutsu BIPORT- CHOW and BROWN