- The conus medullaris syndrome involves compression of the lower end of the spinal cord known as the conus medullaris, located around the L1-L2 vertebrae. This can result in saddle anesthesia, absent bulbocavernous and anal reflexes, and both upper and lower motor neuron signs and symptoms below the level of compression.
- The cauda equina syndrome involves compression of the bundle of spinal nerve roots in the lower back called the cauda equina. It can cause radicular pain, urinary retention, and asymmetric sensory loss. MRI is key for diagnosis and treatment involves decompression through procedures like discectomy, laminectomy, or corpectomy.
-
Claw Hand,Definition,Causes,Types,Symptoms and ManagementDr.Md.Monsur Rahman
Dr.Md.Monsur Rahman, Bachelor of Physiotherapy (BPT), Master of Physiotherapy (MPT) in Musculoskeletal Disorders, ABC-Spine in Osteopathic Approach,
Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
Claw Hand,Definition,Causes,Types,Symptoms and ManagementDr.Md.Monsur Rahman
Dr.Md.Monsur Rahman, Bachelor of Physiotherapy (BPT), Master of Physiotherapy (MPT) in Musculoskeletal Disorders, ABC-Spine in Osteopathic Approach,
Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
Tibial nerve Nerve roots: L4-S3
Sensory: Innervates the skin of the posterolateral leg, lateral foot and the sole of the foot.
Motor: Innervates the posterior compartment of the leg and the majority of the intrinsic foot muscles.
Clinical Relevance
Injury to the tibial nerve can cause motor loss and altered sensation and pain to any of the areas it supplies, depending on site of involvement.
Popliteal Fossa region. Injury may occur due to:
Space occupying lesion
Laceration injury
Posterior dislocation of knee.
Fractures of the tibia and fibula
Local trauma to the posterior lower leg.
Medial malleolus level:
Compression of the tibial nerve in the osseofibrous tunnel below the flexor retinaculum of the ankle causes tarsal tunnel syndrome. On examination it presents as pain and paresthesia in the sole of the foot.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve.
The tunnel lies posterior to the medial malleolus of the ankle, beneath the flexor retinaculum.
Symptoms include pain radiating into the foot, usually, this pain is worsened by walking (or weight-bearing activities).
Etiology
Tarsal tunnel syndrome is divided into intrinsic and extrinsic etiologies.
Extrinsic causes include poorly fitting shoes, trauma, anatomic-biomechanical abnormalities (tarsal coalition, valgus or varus hindfoot), post-surgical scarring, systemic diseases, generalized lower extremity edema, diabetes, and post-surgical scarring.
Intrinsic causes include tendinopathy, tenosynovitis,osteophytes, hypertrophic retinaculum, and space-occupying or mass effect lesions (enlarged or varicose veins, ganglion cyst, lipoma, neoplasm, and neuroma).
Pathophysiology
Up to 43% of patients have a history of trauma including events such as ankle sprains. Abnormal biomechanics can contribute to disease progression. Risk factors include systemic diseases such as diabetes mellitus, hypothyroidism, gout, mucopolysaccharidosis, and hyperlipidemia
History and Physical
There is no specific test for the diagnosis of tarsal tunnel syndrome, and diagnosis is made with a detailed history and clinical examination.
Sharp shooting pain in the foot, numbness on the plantar surface, radiation of pain and paresthesias along the distribution of the posterior tibial nerve, pain with extremes of dorsiflexion and eversion, and a tingling or burning sensation.
The symptoms may worsen at night, with walking or standing, or after physical activity, and typically get better with rest.
On exam, the provider may observe pes planus, pronated foot, or talipes equinovarus.
In chronic cases, atrophy, weakness of the intrinsic foot muscles, and contractures of the toes may be appreciated. They are typically tender on deep palpation of the tarsal tunnel.
The gait should be analyzed for abnormalities including excessive pronation or supination, toe eversion, excessive foot inversion or eversion, and antalgic gait.
Light touch and two-point discrimination
Compression neuropathy: pathophysiology, history, diagnosis, and treatment (including the management of carpal tunnel syndrome, and cubital tunnel syndrome).
Shoulder pain is one of the most prevalent musculoskeletal pain syndromes with a prevalence of 18%–26% . This presentation depict the various forms of neuromodulation in treating pain generators at shoulder joint
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. 24/11/2016 3
Source: Walter B. Greene. Netter's Orthopaedics 1st ed. 2006
Source:
Keith L. Moore and Anne Agur. Essential Clinical Anatomy, 3rd Edition
9. CONUS MEDULLARIS SYNDROME
• Most distal bulbous part of spinal cord
situated at level of L1-L2 vertebral
bodies and comprises of sacral
segments S1-S5.
• Signs shows involvement of:-
1. Saddle anesthesia ( S3-S5)
2. Absent Bulbocavernous reflexes (
S2-S4)
3. Absent anal reflexes ( S4-S5)
• Symptoms include both upper and
lower motor neuron lesions.:
• LMN- at the level
• UMN- below the level
10. CONUS MEDULLARIS SYNDROME
• Symptoms
• Back pain
• Unilateral or bilateral leg pain
• Bladder dysfunction
• Bowel dysfunction
• Sexual dysfunction
• Diminished rectal tone
• Perianal sensory loss
• Lower extremity spasticity: specifically in muscles supplied by
myotomes S1-S5
11.
12. CAUDA EQUINA SYNDROME
Cauda equina is the collection of nerve
containing nerve roots from L1-L5 and S1-S5.
Most centrally located nerve roots are from
most caudal segments.
Lesions give rise to lower motor neurons
symptoms.
Radicular pain is prominent and symptoms are
usually unilateral.
Bladder dysfunction with a decrease in
perianal sensation
13.
14. • Early radicular pain in the distribution of the lumbosacral roots due to the compression of the lumbar and sacral roots
below the L3 vertebral level.
• With extensive lesions, patients develop flaccid, hypotonic, areflexic paralysis that affects the glutei, posterior
thigh muscles, and anterolateral muscles of the leg and foot, resulting in a true peripheral type of paraplegia.
• Sensory testing usually reveals an asymmetric sensory loss in the saddle region, involving the anal, perineal, and
genital regions extending to the dorsal aspect of the thigh, the anterolateral aspect of the leg, and the outer aspect
of the foot.
18. CONUS MEDULLARIS
SYNDROME
CAUDA EQUINA
SYNDROME
Presentation Sudden and bilateral Gradual and unilateral
Reflexes Diminished- at the level
Brisk- below the level
Diminished
Radicular pain - +
Low back pain More Less
Impotence Frequent Absent
Numbness Symmetrical Asymmetrical
Motor strength Symmetric
Hyperreflexic
Distal paresis of lower limbs
Asymmetric
Areflexia
Paraplegia
Sphincter dysfunction Present early
Both urinary and fecal
incontinence
Present later
Only urinary retention
21. 24/11/2016 21
Sagittal and axial CT scans of
thoracolumbar spine
demonstrating an L4 burst
fracture with retropulsion of
bone into the spinal canal
Source: Harrop, J. S., G. E. Hunt Jr, et al. (2004). "Conus medullaris and
cauda equina syndrome as a result of traumatic injuries: management
principles." Neurosurgical Focus 16(6): 1-23.
22. 24/11/2016 22
Sagittal MRI images
demonstrating large
central disc
extrusion at L5-S1
(arrows) with
compression on the
cauda equina.
Source: Levis, J. T. (2009). "Cauda
equina syndrome." Western
Journal of Emergency Medicine
10(1): 20.
23. METHOD TO RELIEVE CORD
COMPRESSION• Discectomy - A discectomy (also called open discectomy) is the
surgical removal of herniated disc material that presses on a nerve
root or the spinal cord. The procedure involves removing the central
portion of an intervertebral disc, the nucleus pulposus, which
causes pain by stressing the spinal cord or radiating nerves.
• Laminectomy - a surgical operation to remove the lamina- , usually
to give access to the spinal cord or to relieve pressure on nerves.
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