Compression neuropathy: pathophysiology, history, diagnosis, and treatment (including the management of carpal tunnel syndrome, and cubital tunnel syndrome).
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
A brief topic presentation I made about Cubital Tunnel Syndrome, its definition, anatomy, causes, clinical features, risk factors, diagnosis, differential diagnosis and treatment. This presentation was done at the HSA staff in Cayman Islands
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
A brief topic presentation I made about Cubital Tunnel Syndrome, its definition, anatomy, causes, clinical features, risk factors, diagnosis, differential diagnosis and treatment. This presentation was done at the HSA staff in Cayman Islands
What is trigger finger or Stenosing tenosynovitis? How to diagnose trigger finger? what are Annular pulleys? What are causes of it? How to treat trigger finger through physical therapy?
anatomy of median nerve,course in arm and struthers ligament, branches in the forearm, carpal tunnel and course in hand, high and low median nerve injuries, principles of surgical management, pronator teres syndrome, anterior interosseous nerve syndrome, open and endoscopic carpal tunnel release
This is a short presentation on one of the most common entrapment neuropathy carpal tunnel syndrome. This presentation also provides information on its causes, epidemiology,diagnosis and management of carpal tunnel syndrome.
Scoliosis is not a disease, but rather it is a term used to describe any abnormal, sideways curvature of the spine. Scoliosis is usually mild and needs no treatment. The curve can bend to the left or to the right.
What is trigger finger or Stenosing tenosynovitis? How to diagnose trigger finger? what are Annular pulleys? What are causes of it? How to treat trigger finger through physical therapy?
anatomy of median nerve,course in arm and struthers ligament, branches in the forearm, carpal tunnel and course in hand, high and low median nerve injuries, principles of surgical management, pronator teres syndrome, anterior interosseous nerve syndrome, open and endoscopic carpal tunnel release
This is a short presentation on one of the most common entrapment neuropathy carpal tunnel syndrome. This presentation also provides information on its causes, epidemiology,diagnosis and management of carpal tunnel syndrome.
Scoliosis is not a disease, but rather it is a term used to describe any abnormal, sideways curvature of the spine. Scoliosis is usually mild and needs no treatment. The curve can bend to the left or to the right.
Instrumental TenseActive Release of Median Nerve. Poland 2014. The professor David Lopez PT, DC teach how to release the median nerve and increases the affected circulation to recover the neural mobility and function using the KineticXer approach. The presentation expose the most common points where the median nerve suffer entrapment and during the workshop those techniques to produce the release according the anatomy and pathological attachments. In addition teach the traces to increaseand normalize the nerve irrigation affected by the compression and chronic dysfunction.
Neuropathy of the foot has more to do with mechanical trauma than secondary condition such as diabetes, alcoholism, etc.
Learn more at www.GraMedica.com.
Entrapment Neuropathies in Upper Limb.pptxNeurologyKota
This presentation is about the entrapment syndrome of upper limb giving an insight regarding diagnosis clinically as well as electrophysiologically and
its management.
Axons of the peripheral nervous system have the potential for regeneration, after they are severed.
Axons of the peripheral nervous system have the potential for regeneration, after they are severed.
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
WALANT: wide awake local anaesthetic no tourniquet hand surgeryIan Grant
Hand surgery, Wide awake local anaesthetic no tourniquet. Avoiding general anaesthetic, cheaper, and avoids waste, better for the patient and environment. Dupuytren's, trigger finger, carpal tunnel, cubital tunnel, finger fractures, tendon and ligament repair.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Compression neuropathy:
Chronic Nerve Compression: acquired neuro-degenerative
condition – demyelination
Axon loss – only in later stages of the disease
Pathophysiology – Schwann cell
Genetics
History of surgical intervention
Diagnosis / tests – decision making
chronic nerve compression
3. Central nervous
system
- not subject to compression or stretch
Peripheral nervous system
- vulnerable to compression or stretch
• Chronic nerve compression
Syndromes
Carpal tunnel syndrome
Cubital tunnel syndrome
Supraspinatus syndrome
Anterior interosseous syndrome
Posterior interosseous syndrome
Thoracic outlet syndrome
Meralgia parasethetica
Tarsal Tunnel syndrome
Peroneal syndrome
Peripheral entrapment neuropathy
Symptoms - Tingling,
numbness, pain,
Pathophysiology - Reduced conduction
Abnormal excitability
7. AGE
1039 pt’s neurophysiological carpal tunnel syndrome.
Nora et al 2004 Mean Age 48
PREVALENCE
CTS European Prevalence: estimate 2.7-5.8 %
AGE & PREVALENCE OF CARPAL TUNNEL SYNDROM
12. ANATOMY – NERVE FIBRES
With thanks to Caitlin Monney: illustrator
13. Denny-Brown, and Bremmer
1944 –
rodent sciatic nerve
compression
Investigation of compression neuropathy
Oedema – is evident within 4 hours of constriction
20. The double crush in nerve entrapment syndromes
Adrian Upton, Alan McComas, Lancet 1973
• 115 patients with entrapment
• 70% had cervical lesion
A sick nerve or proximal compression:
predisposes to entrapment neuropathy at a peripheral site
This is explained through interruption of axoplasmic transport
21. Nerve pain: mechanically sensitive
as consequence of compression or
entrapment
• Ectopic electrogenesis
• Nervi-nervorum on outside of nerve –
increased sensitivity to stretch
STRAIN
Connective tissue
thickening
Restricted neural
mobility
22. Dilley and Bove 2008
Failure of axoplasmic transport results in accumulation of
mechanosensitive components proximal to the blockage
25. Ramsay Hunt: The thenar and hypothenar types of neural atrophy of the
Hand American Journal of Medical Sciences 1911
Gessler:Die motorische Endplatte und ihre Bedeutung für die peripherische Lähmung,
Habitations Schrift, München, 1885
Treatment: Surgery for CTS
Marie and Foix 1913: Atrophie isolé de l’éminence thénar d’origine néevritique.
Rôle du ligament annulaire antérieur du carpe dans la patholgénie de la lésion.
Rev Neurol., 26: 647-649, 1913
Severe bilateral atrophy of the thenar muscles, at autopsy a neuroma of the median nerv
just proximal to the transverse carpal ligament
26. Lancet 1946: Spontaneous compression of both median nerve in the carpal tunnel
Russell Brian DM Oxfd, FRCP A Dickson Wright MS Lond., FRCS
Marcia Wilkinson BM Oxfd, MRCP
6 cases – middle aged or elderly women
Treated by surgical division of the carpal ligament at the wrist
27. Marcia Wilkinson DM Oxfd FRCP 4th February 2013
Arthur Dickson-Wright MS Lond FRCS
Father to the chef:
Clarissa Dickson-Wright
28. Phalen 1950: Neuropathy of the median nerve due to compression
beneath the transverse carpal ligament
4 cases = three of which were treated by surgical division of the transverse carpal
Ligament, with excellent results
Linked disease to occupation ?
29. Ulnar nerve compression – cubital tunnel syndrome
Panas, J 1878: Sur une cause peu connue de pralysie du nerf cubital
Archivee Générales de Médecine, 2 (VII Serie)
Repeated trauma – hyperaemia – oedema, - infiltration of fibrous tissue
Geoffrey Osbourne 1957: “tardy ulnar neuritis” –
band of fibrous tissue bridging the two heads of flexor carpi ulnaris –
Sir W.R Gowers 1866 – Manual of diseases of the nervous system
Alan Apley remarked : that he had “difficulty accepting this analogy, -
pain was a prominent factor in carpal tunnel syndrome”
30.
31. The patient has severe neurological symptoms at
presentation for example altered sensation,
muscle wasting or weakness of thenar abduction.
OR
The patient has moderate symptoms has not
responded to a minimum of 3 months of
conservative management, including local
corticosteroid injections and a compliant trial of
nocturnal neutral wrist splints.
Surgery funded if :
32. • Mild – intermittent paraesthesia
• Moderate – paraesthesia that interferes
with ADL – constant waking
• Severe – constant numbness, wasting,
weakness of thumb muscles
33. Clinical tests – questionable value
CTS
• Tinel’s
• Phalen’s
• Reverse Phalen’s
• Carpal compression
Cubital tunnel syndrome
• Elbow flexion
• Froment’s
Catch me if you can 2002
34. Sensibility testing
LIGHT MOVING TOUCH
Ten-test1 – compare two sides(1.Strauch et al 1997 PRS)
Reliable in unilateral / early disease
2-point discrimination – late disease
35. Neurophysiological tests
Images: Dr Andrew Michell,
Consultant Neurophysiologist
• Scored questionnaire
• 80-85% sensitivity, 90%
positive predictive value
• Nerve Conduction
studies
• 92-96% sensitive, 92-
94% positive predictive
38. Ian Grant
Consultant in plastic & reconstructive surgery
Cambridge
Addenbrooke’s Hospital
The Spire Lea Hospital
Hand surgery: including children’s hands
& peripheral nerve surgery
With thanks to Caitlin Monney, Dr Rhys Russel, Mr Adrain Choznowski, Mr Harry Belcher,
Dr Andrew Michell