Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
A summarised guide on these often frequently carried out proceduresv - arthrocentesis & arthrotomy. Quite useful for orthopaedic residents, GPs and med students
IM injections is an important skill needed for nurses to front-line in their job. this power-point gives all needed information for the students to learn about intramuscular administration of drugs.
A VERY NICE PRESENTAION CONCISE , ONE OF THE BEST PRESENTATION ON SHOULD JOINT AND APPLIED ASPECTS
ITS A PRESENTAION FOR POST GRADUATE AND ITS FELOW MEMBERS
AS HIGHLY RATED MATERAIAL, MOST ADVANCED TILL DATE
ITYS A MATERIAL FOR MAJOR UNIVERSITIES FOR WORLD CLASS STUDENTS. TO BE PRECISE IN EVERYTHING. A WORLD OF PARAMOUNT IMPORTANCE A LUGGAGE FOR THE THE BEST OF THE STUDENTS.
WORLD CLASS PRESENTAION FOR STUDENTS AND TEACHERS.
FOR GENERAL STUDENTS CAN ALSO BENEFIT FRON THE PRESENTATION
GLAD TO PRESENT OVER THIS TOPIC
A VERY MINE BLOWING TOPIC
A VERY ACCURATE DETAILS
A MUST FOR MEDICAL GRADUATE
EXPERIANCE FACULTIES
FOR MEDICAL STUDENTS
MEDICAL GRADUATE
I M IN LOVE WITH THE CONTENT
MUST FOR ALL
LOVINGB THE IMAGES
IMAFES FOR ALL. JOURNALS INCLUDED
RECENT ADVANCED INCLUDED
JBASJFKHSDJKJKSDHVJKDFHVKJDFHVJKVHSDKJVHDSJKVHJKVNSJKDVNSDJKVNDSJKVNSJKVNSJKDVNJKNVJKVNDJKNVJKVNKJVHJKHFIQOURDOIQWJDFKQWJDLKQNFLKWENNNNWJFLIOWJIOWJIWVJWKLVNWLKNVWLKGNWKLNGWKLNGWKLEFJIWEFJEWIOFJWIOEJUOWIEFJIOWEJFOIWENFLKWENFLKWEGJWEOIGJWEIOGJWIOEGJIOWEJGOIWEIFLKWEJFIOWEJGIOWEUJGFIOWEJFOIWEJFOIWEJFIOWEJFOIWEJFWLEFJWELGJLKWEFWEKLFMNWEKLGMWIOGJWIOGJWRIOGJWOIJGOPWEIR0QWFPOQIROPQWEJGLWENVLKSVNLIVJWIOBJIOWRJGOPWQHJFOIQWUJROPQWJFOPQKFPOWEJGOPWRJGOIWR LOVING IN MEMORY OF MY FATHER AND MOTHER
A COPY FOR ALL
VERY HIGHLY RATED
FOR ALLA
I M IN LOVR WITH THE CONTENTS AND TGEXT
Orthopedic physical assessment - David j magee
Morgan WJ . Slowman Ls Acute wrist injuries in athletes
Levine W . Rehabilitation techniques for ligament injuries of the wrist
Similar to Corticosteroid injections in Orthopaedics (20)
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- 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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. INTRODUCTION
● Mainstay of treatment in many cases of acute or
chronic joint or soft tissue pain conditions
● Mechanism of action
Local – Decreases inflammation in
synovial tissues – reduces edema and
inflammatory cells in joints.
Systemic – Dose related –
decrease in inflammatory markers such as CRP
and ESR
7. Side effects - Local
● Post-injection flare: Marked pain at the site of
injection/joint – needle puncture/chemical
synovitis due to crystals – treated with
analgesics, ice packs
● Facial flushing – common in women – onset
within a few hrs of injection
● Skin/fat atrophy – common with less soluble
agents
● Joint sepsis - rare
8. Side effects - Systemic
Influenced by the agent used, dose, frequency
and number of joints injected. Generally milder
● Osteoporosis
● Corticosteroid induced myopathy
● HPA axis suppression
● Worsening glucose intolerance
9. PREREQUISITES
● Sterile gloves
● Bactericidal skin preparation – Spirit and
Povidone-Iodine
● Syringes – 5mL
● 18 gauge and 21 gauge needle
● Corticosteroid preparation and 1% lidocaine or
0.5% bupivacaine
● Sterile adhesive bandage
10. Cervical strain and sprain
● Used in the management of inappropriate
inflammation causing chronic pain
● Position – Sitting on exam stool with neck
flexed and leaning forward with the arms
resting on the exam table
● Clinician stands behind the patient, locates the
cervical spinous processes of the posterior
neck. Area of maximum tenderness palpated –
mark the entry point for the needle
● Patient should not move the neck
11. Cervical strain and sprain
● After skin preparation, a syringe with 1mL of
1% lidocaine without adrenaline and 1mL of
steroid solution (20-40mg of triamcinolone
acetonide) is taken and needle positioned
perpendicular to the target point
● Needle is introduced and advanced into the
body of the muscle and solution injected.
● Instruct patient to massage area/move neck
slowly through full ROM - distribution
12.
13. Cervical Strain and Sprain -
Aftercare
● Avoid excessive use of the neck over the next 2
weeks
● Consider the use of a cervical collar
● NSAIDS, muscle relaxants, ice and/or physical
therapy as indicated
● Consider follow-up in 2 weeks
14. Subacromial space injection
● Indications – Shoulder pain, rotator cuff sprain,
Impingement syndrome and Rotator cuff
tendinitis
● Position – Sitting on the examination table,
patient's hands folded on lap with fingers
interlaced. Clinician stands lateral, finds the
lateral and posterior edge of the acromion and
marks it, after which a vertical is dropped 2cm
below the posterolateral corner and marked.
15. ● Target site is identified by placing the index
finger of non dominant hand over the superior
aspect of the acromion just posterior to the AC
joint
16. Subacromial space injection -
technique
● Preparation, placement of 5ml syringe
(containing 3ml of 1% Lignocaine and 1ml of
steroid solution) with 25 gauge-2 inches needle
at 30 degrees to the skin with direction
cephalad towards acromion
● Advance the needle till it touches the target ie,
the undersurface of the acromion.
● Inject the needle as a bolus into the
subacromial space – without resistance
● After withdrawal – move shoulder through ROM
17.
18. Subacromial space injection -
Aftercare
● Avoid excessive use of shoulder
● Consider use of arm sling
● NSAIDS, Ice compression, physical therapy as
indicated
● Follow up after 2 weeks
19. Glenohumeral joint injection
● Indications – shoulder pain, osteoarthritis,
adhesive capsulitis
● Two approaches – anterior and posterior.
20. Glenohumeral joint injection –
Posterior Approach
● Position – sitting with hands folded, fingers
interlaced. Clinician stands lateral, lateral edge
of acromion marked, posterior edge of
acromion marked, vertical dropped from 2 cm
and point marked.
● Target site – coracoid process.
21. Glenohumeral joint injection –
Posterior Approach
● Preparation, needle positioned perpendicular to
the skin and directed anterior towards the
coracoid process
22. Glenohumeral joint injection –
Anterior approach
● Position – Sitting or supine on examination
table with hands folded, fingers interlaced and
patient's head should be rotated away from the
side being injected – minimizes anxiety and
pain perception.
23. Glenohumeral joint injection –
Anterior Approach
● Clinician stands lateral and anterior to affected
shoulder. Coracoid process identified –
injection point 1cm lateral to coracoid, marked.
● Lateral edge of acromion marked, posterior
edge of acromion marked – vertical dropped
from 2cm downwards – target point.
● Needle inserted perpendicular at the insertion
point towards the target.
24.
25.
26. Glenohumeral joint injection -
Aftercare
● Shoulder ROM to ensure distribution of the
injected solution all over the joint
● NSAIDs, Ice compression and physical therapy
● Arm sling if required
● Follow up after 2 weeks
27. Acromioclavicular joint injection
● Indications – AC joint pain, sprain,
osteoarthritis, subluxation
● Patient made to sit/lie supine. Clinician stands
anterior and lateral to the patient. Clavicle
palpated from medial to lateral till a small
tender depression is encountered.
● Needle positioned perpendicular to the point –
inserted till a “drop” is felt. If not, then the
needle is made to “walk”.
28.
29. Tennis Elbow – Lateral
Epicondylitis
● Supine with head of
bed elevated 30 deg.
● Affected elbow slightly
flexed.
● Wrist in neutral to
slightly pronated
position with elbow
supported with towels
and patient's head
turned away
30. Lateral Epicondylitis
● Preparation, needle (5ml
syringe containing 1mL
of lignocaine + 1mL of
steroid solution) placed
perpendicular to the
entry point – directed
medially towards lateral
epicondyle
31. Lateral Epicondylitis
● Needle advanced
to the bone of the
lateral epicondyle
and then
withdrawn 1-2mm
● “Pinch” technique
then performed
followed by
injection of the
solution
32. Lateral Epicondylitis Injection
-Aftercare
● Immediately after injection – Elbow ROM
● Use of elastic compression bandage
● Avoid excessive elbow and wrist movement
● Follow up after 2 weeks
33. Trigger Finger – Stenosing
tenosynovitis
● Tendinosis of the
flexor tendons of the
digits with nodule
formation.
● Supine, wrist in neutral
and fully supinated.
● Mark the tender nodule
and 1cm distal to it –
entry point.
34. Trigger Finger injection
● Needle positioned 45
deg to skin, directed
proximally, advanced
till the needle tip
meets the nodule.
● Move finger through
ROM to ensure
distribution.
● Avoid excessive
handgrip activities
35. De Quervain's Tenosynovitis
● Stenosing
tenosynovitis of
the first dorsal
compartment of
the radial side
of the wrist –
APL, EPB
● Tender point
identified in
between APL
and EPB –
entry point
36. De Quervain's Tenosynovitis
● Needle inserted at
tender point, positioned
proximally 45 degrees
– advanced towards
the convergence of the
tendons and injected
● Ensure no excessive
wrist flexion or
pronation by preferably
using wrist thumb spica
splint.
37. Carpal Tunnel Syndrome –
Traditional Approach
In the traditional
approach, the distal
palmar crease is
identified, the palmaris
longus-distal crease
intersection identified
and a point 1cm
proximal and 1cm ulnar
to the intersection is
marked – the entry
point. Needle tip at 30
deg to skin directed to
base of thumb
38. Carpal Tunnel Syndrome – FCR
approach
● Needle inserted
1cm proximal to
the distal palmar
crease at the ulnar
border of the FCR
● Tip directed ulnarly
and distally
39. Sacroiliac joint injection
● Indications –
Sacroilitis,
pain, arthritis
● Patient stands
with back
flexed forward
45 deg with
hands on
examination
table. Tender
point identified
by clinician.
40. Sacroiliac joint injection
Needle placed at
a 30-degree angle
laterally, relative
to the sagittal
plane, and 15
degrees inferiorly,
relative to the
transverse plane,
with the tip of the
needle directed
toward the
sacroiliac joint.
41. Trochanteric bursitis
● Patient lies in lateral
decubitus over the
unaffected hip
● Area of maximal
tenderness over the
GT – entry point
● Needle inserted
perpendicular towards
the trochanter,
withdrawn 1-2mm and
solution injected
42. Trochanteric bursitis
● After injection –
move hip
through full
ROM or
massage to
distribute the
solution.
● Consider
fanning the
injection for
wider coverage.
43. Knee joint injections
● Indications – Knee pain, sprain, osteoarthritis
(primary, secondary, post-traumatic)
● Four approaches commonly used - the
extended-knee lateral suprapatellar, extended-
knee lateral midpatellar, flexed-knee
anteromedial, and flexed-knee anterolateral
portals.
45. Knee joint – Lateral Suprapatellar
Approach
Supine, knee extended, or slightly flexed and
supported with folded towels - clinician stands
lateral to the affected knee. Superior aspect of the
patella located – line drawn vertically 1 cm
superior to the proximal margin of the patella - line
horizontally along the posterior edge of the
patella. Position the 18-gauge, 1½ in. needle and
syringe perpendicularly to the skin, parallel to the
floor, at a right angle to the other two previously
drawn skin lines and with the tip of the needle
directed medially.
47. Knee joint – lateral midpatellar
approach
Locate the lateral aspect of the patella, then the
patient relaxes the quadriceps muscles, pressure
applied to the medial aspect of the patella in order
to displace it laterally - sulcus at the midpatella
that develops between the lateral undersurface of
the patella and the lateral femoral condyle.
Position the 18-gauge, 1½ in. needle and syringe
over the previously marked injection site in a
medial direction and with the needle tip angled up
underneath the patella and over the lateral
femoral condyle.
49. Knee joint – anteromedial and
anterolateral approaches
Palpate the anterior aspect of the knee to locate
the patellar tendon.
At the midpoint of the tendon, move about 1 cm
medially or laterally. There is usually a depression
at that spot – mark the entry point.
Position the 18-gauge, 1½ in. needle and syringe
perpendicular to the skin with the tip of the needle
directed at a 45-degree angle into the center of
the knee.
50. Knee joint – anteromedial and
anterolateral approaches
51. Knee joint – anteromedial and
anterolateral approaches
52. Morton's Neuroma
Compression of the
interdigital nerves in
the foot can result in
a painful condition
referred to as a
Morton neuroma -
repetitive
compressive injury
causing
inflammation,
perineural fibrosis,
and enlargement of
the interdigital
53. Morton's Neuroma
● Patient supine,
knees flexed, ankle
slightly plantar
flexed. Most tender
point palpated in
between heads of
metatarsals
(sometimes nodule
felt) – point of entry.
● Needle directed
directly between the
metatarsals –
injected as a bolus.
Massaged once
injected.
54. Plantar fasciitis
Repetitive motion injury with inflammation in the
origin of the plantar aponeurosis at the medial
tubercle of the calcaneus - usually caused by an
excessive pronation of the foot—especially in
persons with pes planus.
55. Plantar fasciitis
Identify the point of maximal tenderness over the
plantar aspect of the foot - usually just medial of
midline over the medial tubercle of the calcaneus.
Then draw a vertical line down the posterior
border of the tibia and a horizontal line one
fingerbreadth above the plantar surface - the point
where these two lines intersect over the medial
aspect of the foot is the entry point.