The document provides information about examining the median nerve, including:
- It describes examining muscles supplied by the median nerve like the flexor pollicis longus and flexor digitorum profundus.
- Local examination involves inspection for signs like claw hand or ape thumb deformity, and palpation for signs like temperature, muscle wasting, and Tinel's sign which indicates nerve regeneration.
- Carpal tunnel syndrome is examined where the median nerve is compressed in the wrist tunnel, causing pain and weakness of the thenar muscles.
4th year medical student's seminar presentation under supervision of orthopedic lecturer. Reference is from Dr. Sameh Doss Textbook of upper and lower limb, and also other multiple websites.
Compiled by Dr S Selvaganesh
Hand Surgery Fellow KTPH
Triceps to axillary nerve transfer is used in partial plexus injuries where the C5/6 component is damaged and the C7/8 and T1 are intact. The typical indication is in the C5 or C5/6 avulsion injury but it may also be used in cases of C5/6 rupture where presentation is delayed, grafting of the upper trunk has not been successful or in continuity lesions of the upper trunk that failed to reinnervate. It may also be used to salvage the axillary nerve rupture at the quadrilateral space associated with high energy shoulder dislocation or the rare non-recovering isolated lesion in continuity of the axillary nerve following a low energy shoulder dislocation.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
4th year medical student's seminar presentation under supervision of orthopedic lecturer. Reference is from Dr. Sameh Doss Textbook of upper and lower limb, and also other multiple websites.
Compiled by Dr S Selvaganesh
Hand Surgery Fellow KTPH
Triceps to axillary nerve transfer is used in partial plexus injuries where the C5/6 component is damaged and the C7/8 and T1 are intact. The typical indication is in the C5 or C5/6 avulsion injury but it may also be used in cases of C5/6 rupture where presentation is delayed, grafting of the upper trunk has not been successful or in continuity lesions of the upper trunk that failed to reinnervate. It may also be used to salvage the axillary nerve rupture at the quadrilateral space associated with high energy shoulder dislocation or the rare non-recovering isolated lesion in continuity of the axillary nerve following a low energy shoulder dislocation.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Peripheral nerve damage affecting the upper extremities can vary widely in cause and extent.
Many disorders, ranging from mild carpal tunnel syndrome to severe brachial plexopathy, need to be considered in a patient presenting with pain, sensory loss, or weakness involving the shoulder, arm, or hand.
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
Similar to EXAMINATION OF MEDIAN NERVE FOR MBBS UNDERGRADUATES ORTHO (20)
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.
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
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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.
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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
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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
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
4. HISTORY
History of trauma (incisional wound, penetrating wound, fracture,
dislocation) .Supracondylar fracture of humerus- median nerve can be
injured.
History of malignant growth.
History of injecting drugs (direct injury or irritant drugs).
History of diabetes/leprosy (can cause peripheral neuropathy)
Wound infection may lead to fibrosis and will not allow proper regeneration of
the nerve
5. LOCAL EXAMINATION
INSPECTION
Attitude:
Complete claw hand seen in combined lesion of median and
ulnar nerve(median nerve supplies the first 2 lumbricals) . Also
seen in Klumpke’s paralysis.
Ape thumb deformity (paralysis of opponens pollicis) and
pointing index(paralysis of lateral half of flexor digitorum
profundus)
Wasting of muscles obvious only in long term paralysis.
Skin: Becomes dry, glossy and smooth with loss of cutaneous fold
and subcutaneous fat, sometimes trophic ulcers may be seen.
Look for scar or wound.
6. LOCAL EXAMINATION
PALPATION
Temperature is cold in paralysis.
Muscles wasted and their functions are lost. Injuries in the arm cause
paralysis of all muscles innervated by the median nerve, including those
arising from the medial epicondyle (flexor carpi radialis, pronator teres,
palmaris longus, and part of flexor digitorum superficialis), as well as those
innervated by the anterior interosseous nerve (flexor pollicis longus, flexor
digitorum profundus to index finger)
If sensory supply is lost, skin is anaesthetized. Involvement of the palmar
cutaneous nerve is useful in localizing a lesion at the wrist. Anterior
interosseous palsy is distinguished from high median injury by the absence
of any loss of skin sensation.
Hyper aesthesia at the site of nerve regeneration.
Palpate the scar for tenderness, indicates of adhesion of nerve to the scar.
7. Tinel’s sign
In closed injuries, percussion of the skin over a nerve in which axons have
been ruptured evokes sensations usually described as a wave or surge of pins
and needles into the cutaneous distribution of the nerve. This is Tinel’s sign
and it is a most useful aid to diagnosis
Importance of Tinel’S SIGN
Whether nerve interrupted
Whether in process of regeneration
Rate of regeneration
Success of nerve repair
8.
9. EXAMINATION
FLEXOR POLLICIS LONGUS
The patient is asked to bend the terminal phalanx of the thumb against resistance
while the proximal phalax is steadied by the physician.
10. Flexor digitorum superficialis and profundus(lateral half):
Ochsner’s clasping test- the patient is asked to clasp the hand. The index finger of the
affected hand fails to flex and remains as a pointed finger
11. Abductor pollicis brevis
ask the patient to keep the hand on the table and ask
the patient to touch a pen which is kept at a slight
higher level than the palm of the hand with the
thumb-pen test
Opponens pollicis
Ask the patient to touch the tips of other fingers with
the thumb against resistance
12. Flexor Carpi Radialis
Normally, palmar flexion at the wrist occurs in the
long axis of the forearm. In a patient with
paralysed flexor carpi radialis………….?
13. Causes of peripheral nerve lesions
1.Traumatic- closed injury; open injury
2.inflammatory – eg.herpes zoster
3.neoplastic – neurofibroma,neurofibrosarcoma
4.miscellaneous – tunnel syndrome , lead
poisoning, leprosy
5.metabolic disordes – B complex deficiency
14. Carpel tunnel syndrome
The median nerve is injured in the carpal tunnel due to its compression and
produces a clinical condition called carpal tunnel syndrome. The carpal
tunnel is formed by anterior concavity of carpus and flexor retinaculum. The
tunnel is tightly packed with nine long flexor tendons of fingers and thumb
with their surrounding synovial sheaths and median nerve. The median nerve
gets compressed in the tunnel due to its narrowing following a number of
pathological conditions such as
(a) tenosynovitis of flexor tendons (idiopathic),
(b) myxedema (deficiency of thyroxine),
(c) retention of fluid in pregnancy,
(d) fracture dislocation of lunate bone, and
(e) osteoarthritis of the wrist.
15.
16. Characteristic clinical features of the carpal tunnel syndrome are as follows:
• Feeling of burning pain or ‘pins and needles’ along the sensory distribution of median nerve (i.e.,
lateral 3½ digits) especially at night.
• There is no sensory loss over the thenar eminence because skin over thenar eminence is supplied by
the palmar cutaneous branch of the median nerve, which passes superficial to flexor retinaculum.
• Weakness of thenar muscles.
• ‘Ape-thumb deformity’ may occur, if left untreated, due to paralysis of the thenar muscles.
• Positive Tinel’s sign and Phalen’s test
• Reduced conduction velocity in the median nerve (<30 m/s) is diagnosis.
17.
18. Management
Splinting- prevents wrist flexion
Corticosteroid/anesthetic injection
Surgical decompression- Division of
the transverse carpal ligament
19. Anterior Interosseous Syndrome
Damage to the anterior interosseous nerve
Pain in the forearm
Weakness of the gripping movement of the thumb and index finger (unable to make ok
sign)
Causes
-Injury to elbow
Injury during open / closed reduction
Okay or circle sign
A Quick way to assess flexor digitorum profundus and flexor policis longus
With weakness in these muscles, the distal phalanges cannot flex and instead of fingertips touching,
the volar surfaces of each distal phalanx make contact.