Tendonitis details and it's physiotherapy management.
It is define as inflammation of the tendon, tendonitis occur due to overuse and trauma. Depending upon involvement of tendon special test are used. it is treated with PRICE protocol.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Tendonitis details and it's physiotherapy management.
It is define as inflammation of the tendon, tendonitis occur due to overuse and trauma. Depending upon involvement of tendon special test are used. it is treated with PRICE protocol.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
The upper limb consists of various joints that enable movement and provide flexibility. These joints can be classified into different types based on their structure and function.
Understanding the anatomy and function of these joints is crucial for assessing and managing conditions related to the upper limb, as well as for rehabilitation and therapeutic interventions. Joint injuries, arthritis, and other disorders may affect the functionality of these joints, and appropriate medical care may be necessary for optimal outcomes.
Groin discomfort as well as tenderness establishes from a selection of reasons including athletic and non-athletic injuries in addition to inner physiological elements.
Forgotten in the complexity of attempting to identify. Groin discomfort is tendon laxity. Damaged, torn ligaments that cause instability. Consequently, physicians experienced in ligament reference patterns should be gotten in touch with in cases of groin discomfort.
Common sports-relatedshoulder injuriesShoulder pain is.docxcargillfilberto
Common sports-related
shoulder injuries
S
houlder pain is commonly treated in general practice; its causes are often
multi-factorial. The focus of this article is on sports-related shoulder injuries
likely to be seen in the community. This article aims to overview the presen-
tation, assessment and management of these conditions in general practice.
The GP curriculum and common sports-related shoulder injuries
Clinical module 3.20: Care of people with musculoskeletal problems lists the learning objectives required
for a GP to manage common sports-related shoulder injuries in the community or refer for specialist management. In
particular, GPs are expected to be able to:
. Communicate health information effectively to promote better outcomes
. Explore the perceptions, ideas or beliefs the patient has about the condition and whether these may be acting as
barriers to recovery
. Use simple techniques and consistent advice to promote activity in the presence of pain and stiffness
. Agree treatment goals and facilitate supported self-management, particularly around pain, function and physical
activity
. Assess the importance and meaning of the following presenting features:
. pain: nature, location, severity, history of trauma
. variation of symptoms over time
. loss of function – weakness, restricted movement, deformity and disability, ability to perform usual work or
occupation
. Understand that reducing pain and disability rather than achieving a complete cure could be the goal of
treatment
. Understand indications and limitations of plain radiography, ultrasound, and magnetic resonance scans
. Diagnose common, regional soft-tissue problems that can be managed in primary care
. Understand the challenge that many musculoskeletal conditions might be better and more confidently managed
by other healthcare personnel rather than GPs, because most GPs do not gain the necessary treatment skills
during their training
. Refer those conditions which may benefit from early referral to an orthopaedic surgeon
The four most common categories of shoulder pain
seen in primary care are (Mitchell, Adebajo, Hay, &
Carr, 2005):
. Rotator cuff disorders (85% tendinopathy)
. Glenohumeral disorders
. Acromioclavicular joint disease, and
. Referred neck pain.
There are many different types of sports that can cause
acute or chronic shoulder injuries. In professional English
Rugby Union, for example, the most common match
injury is of the acromioclavicular joint (32% overall) and
the most severe injury requiring the longest time off
(mean of 81 days) is shoulder dislocation (Headey,
Brooks, & Kemp, 2007).
Shoulder injuries can also occur in non-contact sports,
such as golf, tennis, swimming and weightlifting.
Although shoulder injuries may be more common in con-
tact sports, the injury may have a larger impact on the
performance of individuals playing non-contact sports.
For example, golfers require very precise manoeuvres
of their dominant.
Common sports-relatedshoulder injuriesShoulder pain is.docxdrandy1
Common sports-related
shoulder injuries
S
houlder pain is commonly treated in general practice; its causes are often
multi-factorial. The focus of this article is on sports-related shoulder injuries
likely to be seen in the community. This article aims to overview the presen-
tation, assessment and management of these conditions in general practice.
The GP curriculum and common sports-related shoulder injuries
Clinical module 3.20: Care of people with musculoskeletal problems lists the learning objectives required
for a GP to manage common sports-related shoulder injuries in the community or refer for specialist management. In
particular, GPs are expected to be able to:
. Communicate health information effectively to promote better outcomes
. Explore the perceptions, ideas or beliefs the patient has about the condition and whether these may be acting as
barriers to recovery
. Use simple techniques and consistent advice to promote activity in the presence of pain and stiffness
. Agree treatment goals and facilitate supported self-management, particularly around pain, function and physical
activity
. Assess the importance and meaning of the following presenting features:
. pain: nature, location, severity, history of trauma
. variation of symptoms over time
. loss of function – weakness, restricted movement, deformity and disability, ability to perform usual work or
occupation
. Understand that reducing pain and disability rather than achieving a complete cure could be the goal of
treatment
. Understand indications and limitations of plain radiography, ultrasound, and magnetic resonance scans
. Diagnose common, regional soft-tissue problems that can be managed in primary care
. Understand the challenge that many musculoskeletal conditions might be better and more confidently managed
by other healthcare personnel rather than GPs, because most GPs do not gain the necessary treatment skills
during their training
. Refer those conditions which may benefit from early referral to an orthopaedic surgeon
The four most common categories of shoulder pain
seen in primary care are (Mitchell, Adebajo, Hay, &
Carr, 2005):
. Rotator cuff disorders (85% tendinopathy)
. Glenohumeral disorders
. Acromioclavicular joint disease, and
. Referred neck pain.
There are many different types of sports that can cause
acute or chronic shoulder injuries. In professional English
Rugby Union, for example, the most common match
injury is of the acromioclavicular joint (32% overall) and
the most severe injury requiring the longest time off
(mean of 81 days) is shoulder dislocation (Headey,
Brooks, & Kemp, 2007).
Shoulder injuries can also occur in non-contact sports,
such as golf, tennis, swimming and weightlifting.
Although shoulder injuries may be more common in con-
tact sports, the injury may have a larger impact on the
performance of individuals playing non-contact sports.
For example, golfers require very precise manoeuvres
of their dominant.
USMLE MSK L002 Back Ligamnets and muscles of back.pdfAHMED ASHOUR
The anatomy of the back is complex and involves a combination of bones, muscles, nerves, and other structures that provide support, protection, and mobility.
The back is generally divided into several regions, including the cervical, thoracic, lumbar, sacral, and coccygeal regions.
Understanding the anatomy of the back is essential for healthcare professionals, including orthopedic specialists, physical therapists, and chiropractors, as well as for individuals interested in maintaining back health and preventing injuries.
The upper limb consists of various joints that enable movement and provide flexibility. These joints can be classified into different types based on their structure and function.
Understanding the anatomy and function of these joints is crucial for assessing and managing conditions related to the upper limb, as well as for rehabilitation and therapeutic interventions. Joint injuries, arthritis, and other disorders may affect the functionality of these joints, and appropriate medical care may be necessary for optimal outcomes.
Groin discomfort as well as tenderness establishes from a selection of reasons including athletic and non-athletic injuries in addition to inner physiological elements.
Forgotten in the complexity of attempting to identify. Groin discomfort is tendon laxity. Damaged, torn ligaments that cause instability. Consequently, physicians experienced in ligament reference patterns should be gotten in touch with in cases of groin discomfort.
Common sports-relatedshoulder injuriesShoulder pain is.docxcargillfilberto
Common sports-related
shoulder injuries
S
houlder pain is commonly treated in general practice; its causes are often
multi-factorial. The focus of this article is on sports-related shoulder injuries
likely to be seen in the community. This article aims to overview the presen-
tation, assessment and management of these conditions in general practice.
The GP curriculum and common sports-related shoulder injuries
Clinical module 3.20: Care of people with musculoskeletal problems lists the learning objectives required
for a GP to manage common sports-related shoulder injuries in the community or refer for specialist management. In
particular, GPs are expected to be able to:
. Communicate health information effectively to promote better outcomes
. Explore the perceptions, ideas or beliefs the patient has about the condition and whether these may be acting as
barriers to recovery
. Use simple techniques and consistent advice to promote activity in the presence of pain and stiffness
. Agree treatment goals and facilitate supported self-management, particularly around pain, function and physical
activity
. Assess the importance and meaning of the following presenting features:
. pain: nature, location, severity, history of trauma
. variation of symptoms over time
. loss of function – weakness, restricted movement, deformity and disability, ability to perform usual work or
occupation
. Understand that reducing pain and disability rather than achieving a complete cure could be the goal of
treatment
. Understand indications and limitations of plain radiography, ultrasound, and magnetic resonance scans
. Diagnose common, regional soft-tissue problems that can be managed in primary care
. Understand the challenge that many musculoskeletal conditions might be better and more confidently managed
by other healthcare personnel rather than GPs, because most GPs do not gain the necessary treatment skills
during their training
. Refer those conditions which may benefit from early referral to an orthopaedic surgeon
The four most common categories of shoulder pain
seen in primary care are (Mitchell, Adebajo, Hay, &
Carr, 2005):
. Rotator cuff disorders (85% tendinopathy)
. Glenohumeral disorders
. Acromioclavicular joint disease, and
. Referred neck pain.
There are many different types of sports that can cause
acute or chronic shoulder injuries. In professional English
Rugby Union, for example, the most common match
injury is of the acromioclavicular joint (32% overall) and
the most severe injury requiring the longest time off
(mean of 81 days) is shoulder dislocation (Headey,
Brooks, & Kemp, 2007).
Shoulder injuries can also occur in non-contact sports,
such as golf, tennis, swimming and weightlifting.
Although shoulder injuries may be more common in con-
tact sports, the injury may have a larger impact on the
performance of individuals playing non-contact sports.
For example, golfers require very precise manoeuvres
of their dominant.
Common sports-relatedshoulder injuriesShoulder pain is.docxdrandy1
Common sports-related
shoulder injuries
S
houlder pain is commonly treated in general practice; its causes are often
multi-factorial. The focus of this article is on sports-related shoulder injuries
likely to be seen in the community. This article aims to overview the presen-
tation, assessment and management of these conditions in general practice.
The GP curriculum and common sports-related shoulder injuries
Clinical module 3.20: Care of people with musculoskeletal problems lists the learning objectives required
for a GP to manage common sports-related shoulder injuries in the community or refer for specialist management. In
particular, GPs are expected to be able to:
. Communicate health information effectively to promote better outcomes
. Explore the perceptions, ideas or beliefs the patient has about the condition and whether these may be acting as
barriers to recovery
. Use simple techniques and consistent advice to promote activity in the presence of pain and stiffness
. Agree treatment goals and facilitate supported self-management, particularly around pain, function and physical
activity
. Assess the importance and meaning of the following presenting features:
. pain: nature, location, severity, history of trauma
. variation of symptoms over time
. loss of function – weakness, restricted movement, deformity and disability, ability to perform usual work or
occupation
. Understand that reducing pain and disability rather than achieving a complete cure could be the goal of
treatment
. Understand indications and limitations of plain radiography, ultrasound, and magnetic resonance scans
. Diagnose common, regional soft-tissue problems that can be managed in primary care
. Understand the challenge that many musculoskeletal conditions might be better and more confidently managed
by other healthcare personnel rather than GPs, because most GPs do not gain the necessary treatment skills
during their training
. Refer those conditions which may benefit from early referral to an orthopaedic surgeon
The four most common categories of shoulder pain
seen in primary care are (Mitchell, Adebajo, Hay, &
Carr, 2005):
. Rotator cuff disorders (85% tendinopathy)
. Glenohumeral disorders
. Acromioclavicular joint disease, and
. Referred neck pain.
There are many different types of sports that can cause
acute or chronic shoulder injuries. In professional English
Rugby Union, for example, the most common match
injury is of the acromioclavicular joint (32% overall) and
the most severe injury requiring the longest time off
(mean of 81 days) is shoulder dislocation (Headey,
Brooks, & Kemp, 2007).
Shoulder injuries can also occur in non-contact sports,
such as golf, tennis, swimming and weightlifting.
Although shoulder injuries may be more common in con-
tact sports, the injury may have a larger impact on the
performance of individuals playing non-contact sports.
For example, golfers require very precise manoeuvres
of their dominant.
USMLE MSK L002 Back Ligamnets and muscles of back.pdfAHMED ASHOUR
The anatomy of the back is complex and involves a combination of bones, muscles, nerves, and other structures that provide support, protection, and mobility.
The back is generally divided into several regions, including the cervical, thoracic, lumbar, sacral, and coccygeal regions.
Understanding the anatomy of the back is essential for healthcare professionals, including orthopedic specialists, physical therapists, and chiropractors, as well as for individuals interested in maintaining back health and preventing injuries.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
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.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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
2. Groin injuries
The groin consists of the structures deep to the anterior and
medial intersection of the leg, the lower abdomen, and
includes the structures of the perineum.
The evaluation and treatment of groin pain in athletes is
challenging.
The anatomy is complex.
Multiple pathologies often coexist that may cause similar
symptoms, and
several organ systems can refer pain to the groin.
2
3. Groin structures
the groin muscles consist of three large groups of
muscles that can be injured:
The abdominal
iliopsoas and
adductor group.
3
5. Cont.…..
The abdominal group: The abdominal musculature
comprise the
rectus abdominis
the obliques internus and externs
transverse abdominis.
5
7. The iliopsoas
The iliopsoas, comprised of iliacus and psoas major muscles.
is the only muscle directly connecting the spine and the
lower limb.
Innervation:
Iliacus: femoral nerve (L2-L4)
Psoas major: anterior rami of spinal nerves (L1-L3)
Action: main hip flexor
7
8. The adductor group
The adductors of the hip joint
include 6 muscles:
the adductor (longus, magnus
and brevis)
gracilis
obturator externus, and
pectineus.
8
9. Cont.….
INNERVATION:
All 5 muscles: obturator nerve
Pectineus: femoral nerve.
primary function of this muscle group is
adduction of the thigh
stabilization of the lower extremity
9
11. Epidemiology
Groin injuries represent 5–10% of all sports injuries.
They are highly prevalent in sports requiring kicking, high-
speed direction changes and/or skating motions.
In these sports groin injuries account for 10–23% of all
injuries.
In football and ice hockey, groin injuries have an incidence
of 1.1/1000 exposure and 1.3/1000 players exposure,
respectively, during a regular season.
11
12. Cont.…
The hip adductors are the most commonly injured
muscle group in sports-related groin injuries.
This is likely due to the eccentric forces stressing
the muscle–tendinous complex during side-to-side
running, kicking and powerful skating.
12
13. Cont.…
more than 50% of groin injuries are classified as
moderate or severe at elite level, resulting in
substantial periods of absence from football play.
Recent studies showed that the prevalence of hip and
groin pain during a season can be up to 70%.
13
14. Common Types of Groin Injury
There are many types of groin injury, some of which can occur together.
In fact, as many as 90% of athletes experiencing groin pain have
multiple types of groin injuries simultaneously.
Adductor strain (groin strain or pull)
Athletic pubalgia (sports hernia)
Avulsion fracture
Stress fractures of the femoral neck and/or pubic ramus bone
Osteitis pubis
14
15. Adductor strain (groin strain or pull)
A groin strain is an injury or a tear to the muscle or tendon
unit of the adductors.
that produces pain on palpation of the adductor tendons
or its insertion on the pubic bone with or without pain
during resisted adduction.
Groin muscle strains are encountered more frequently in
ice hockey and soccer than other sport.
These sports require a strong eccentric contraction of the
adductor musculature during competition and practice. 15
16. Cont.….
Groin strains are common amongst athletes who compete
in sports that involve repetitive twisting, turning, sprinting
and kicking.
Strain injuries to the groin are among the most common
groin injuries in adult male soccer players.
Groin strain accounts for 11% to 16% of all soccer injuries.
It can happen in other sports also
Such as running, tennis, rugby, American football,
basketball
16
17. Cont.….
The adductor longus muscle is most commonly injured.
The proximal attachment of the adductor longus
contributes to an anatomical pathway across the anterior
pubic symphysis that is likely required to withstand the
transmission of large forces during multidirectional
athletic activities.
Its lack of mechanical advantage may make it more
susceptible to strain.
17
18. Cont.…..
The exact incidence of groin muscle strains in most sports is
unknown because athletes often play through minor groin
pain and the injury goes unreported.
In addition, overlapping diagnoses can skew the incidence.
Cumulative or single injury seem to be important
etiological factors.
Chronic tendinitis of the adductor muscles/tendons(
adductor longus*) is the most frequently diagnosed.
18
19. Mechanism of injury
Direct blunt trauma:
An acute injury, typically a direct injury to the soft tissues
resulting in muscle hematoma
Micro trauma by repetitive injury:
musculotendinous injuries to the groin are mainly a
consequence of cumulative micro traumas (overuse trauma,
repeated minor injuries) leading to chronic groin pain.
Forceful contraction :
Change of direction and kicking have been described as the
main actions.
19
20. Cont.….
So a rapid muscle activation during a rapid muscle lengthening
appears to be the fundamental injury mechanism for acute
adductor longus injuries.
The adductors attempt to decelerate an extending, abducting leg
by using an eccentric contraction to adduct and flex the hip was
the main cause of injury.
Change of direction and reaching injuries were categorized as
closed chain movements (59%).
Kicking and jumping injuries were categorized as an open
chain (41%).
20
21. Clinical Presentation
intense pain in the groin area
tenderness along the muscle belly, tendon or insertion.
The pain is exacerbated by adduction.
There is loss of strength or range of movement.
A popping or snapping feeling during the injury, followed by
severe pain.
21
22. Cont.…..
Tears frequently occur at the myotendinous
junction, which is the weakest part of the muscle-
tendon unit but is also commonly seen in the
muscle belly.
The same mechanism of injury that results in a
muscle tear in an adult may cause an apophyseal
avulsion in an adolescent.
22
23. chronic cases
a tendency for the pain to radiate out….
distally along the medial aspect of the thigh or
proximally toward the rectus abdominis.
symptoms are often vague and diffuse in location.
The most common symptoms are….
pain during exercise
stiffness after exercise and in the morning, as well as
pain at rest.
23
24. Grading of strain
1st degree:
Mild pain, but little loss of strength or movement.
few fibers of the muscle are damaged
2nd degree:
Moderate pain
mild to moderate strength and function loss
some tissue damage/approximately half of the fibers are torn.
3rd degree:
Severe pain
more than half of the fibers ruptured to complete rupture of the
muscle.
Both the muscle belly and the tendon can be injured
severe loss of strength and function
24
25. diagnosis
a patient history and an identification of the pain by the
examination of the physiotherapist.
On evaluation
there is tenderness to palpation with focal swelling of the
adductors and
decreased adductor strength and pain with resisted
adduction.
sonographic and radiographic investigations.
25
26. Examination
Bilateral evaluation of adductor muscle-related pain and
strength.
palpation at the adductor insertion at the pubic bone.
Adduction against resistance (squeeze tests)
passive stretching of the adductor muscles.
inspection in a standing position to evaluate the alignment of
extremities.
check the motion of the hip joint and the flexibility of the groin
and hip muscles.
26
27. squeeze tests
purpose
diagnosis of groin injuries and
adductor muscles strength.
at 0°, 45° and 90° of hip flexion.
+ve:
if the patient complains of
pain/weakness in the adductor
muscles or bone pain at the
anterior and medial pelvic ring.
27
28. cont.….
Resistive contraction tests of the knee extensors, knee
flexors, abdominal muscles, and hip rotators,
extensors and flexors, as well as hip adductors and
abductors, should be performed.
28
30. Physiotherapy Management
The primary goal of the treatment program is
Decrease pain
to minimize the effects of immobilization,
regain full range of motion, and
restore full muscle strength, endurance and
coordination.
30
31. Phase 1: acute
First 48 hours after injury: RICE
NSAID
Massage
TENS
Ultrasound
Hip passive range of motion in pain-free range
Submaximal isometric adduction with knees bent → with knees
straight progressing to maximal isometric adduction, pain Free
31
32. Cont.…
Non weight bearing hip progressive resistance
exercises without weight in antigravity position (all
except abduction):
pain free, low load, high repetition
Upper body and trunk strengthening
Flexibility program for noninvolved muscles
Bilateral balance board
Clinical milestone: Concentric adduction against
gravity without pain.
32
33. Phase II: Subacute
Bicycling/swimming
squats
Single-limb stance
Concentric adduction with weight against gravity
Standing with involved foot on sliding board moving
in frontal plane.
Adduction in standing on cable column or resistance
band.
Seated adduction machine
Bilateral adduction on sliding board moving in frontal
plane (i.e., simultaneous bilateral adduction)
33
34. Cont.…
Unilateral lunges with reciprocal arm movements
Multiplane trunk tilting
Balance board squats with throwbacks
General flexibility program
Clinical milestone :
Lower extremity passive range of motion equal to that of the
uninvolved side and
involved adductor strength at least 75% that of the Ipsilateral
abductors.
34
35. Phase 3: Sports specific training
Phase II exercises with increase in load, intensity, speed
and volume.
Standing resisted stride lengths on cable column to
simulate skating
Slide board
On ice kneeling adductor pull together
Lunges (in all planes)
Correct or modify ice skating technique
35
36. Cont.….
Clinical milestone:
Adduction strength at least 90-100% of the abduction
strength and involved muscle strength equal to that of
the contralateral side.
36
37. Hernias
A hernia occurs when an internal organ or other body part protrudes
through the wall of muscle or tissue that normally contains it.
Hernias of the abdominal wall must always be considered in athletes
with groin pain.
Hernias are frequently overlooked in the athlete.
with only 8% of patients with hernias being detectable on initial
physical examination, but 95% returning to sport after surgical repair
and rehabilitation.
37
38. Sportsman's Hernia(athletic pubalgia)
A sportsman’s hernia (or posterior inguinal wall weakness),
Athletic pubalgia, inguinal hernia, Gilmore’s groin.
is weakness in the deep layer of the abdominal muscles
just above the genitals.
A sports hernia is a strain or tear of any soft tissue (muscle,
tendon, ligament) in the lower abdomen or groin area.
38
39. Cont.….
weakening of the muscles
and/or the tendons of
rectus abdominis
pyramidalis
internal and external
oblique's
transverse abdominis.
39
40. Cont.…..
This weakness allows contents of the abdomen to press
outwards, compressing structures in the groin.
Sports activities that involve planting the feet and
twisting with maximum exertion can cause a tear.
occur mainly in vigorous sports such as ice hockey,
soccer, wrestling, and football.
This is commonly seen in kicking sports.
40
41. symptoms
severe pain in the groin area at the time of the injury.
pain during sports movements—particularly, twisting,
kicking and turning during single-limb stance.
It is not usually painful at rest; however, the pain returns
immediately if you return to normal activity.
usually radiates to the adductor muscle region and to the
testicles.
The pain is difficult to locate.
41
42. Cont.…
There may be excessive anterior pelvic tilting and/or
an internal rotation of the ilium on the symptomatic
side concomitant with the adductor pathology.
Without treatment, this injury can result in chronic,
disabling pain that prevents you from resuming sports
activities.
42
44. Could there be any long-term
effects from a sportsman’s hernia?
Sportsman’s hernia is a condition that does not get
better by itself.
The weakness in the abdominal wall must be surgically
repaired.
Following the surgical repair of a sportsman’s hernia,
recovery usually takes place in a few months and there
are usually no long-term effects.
44
45. Physical Tests
To help determine whether you have a sports hernia,
your doctor will likely ask you to do a sit-up or flex
your trunk against resistance.
If you have a sports hernia, these tests will be painful.
Imaging
ultrasound or magnetic resonance imaging (MRI)
45
46. Nonsurgical Treatment
Rest (In the first 7 to 10 days after the injury)
Ice
If you have a bulge in the groin, compression or a wrap may help
relieve painful symptoms.
non-steroidal anti-inflammatory medicines (ibuprofen or
naproxen)
Physical therapy( 2 weeks after your injury)
Conservative management for a period of between 6–12 weeks.
46
47. Cont.….
Operative management primarily involves re
enforcement of the posterior abdominal wall,
which can either be performed open or laparoscopic
ally.
47
48. Physiotherapy treatment
Physiotherapy treatment is important following the
surgical repair of a sportsman’s hernia.
Your physiotherapist will be able to provide you with a
rehabilitation plan to strengthen your lower
abdominal and pelvic floor muscles.
This can accelerate your return to participation in
sports and prevent further problems.
48
49. Physiotherapy could include:
Electrotherapy: TENS
Hydrotherapy: Hot packs
Mobilizations and ROM exercises
Core Stability Exercises
strengthening of the hip adductors and abdominal muscles, balancing,
and postural training exercises
Soft Tissue Treatment: transverse friction and massage
49
50. Stress fractures
stress fracture is a small crack in a bone, or severe bruising
within a bone
Femoral neck and the pubic ramus are the most
common stress fractures in the groin region.
Stress fractures are caused by repetitive/overuse trauma
to the bones or through muscular attachments.
These stress fractures particularly occur secondary to
running related sports.
50
51. Cont.……
additional risk factors can be intrinsic or quite diverse
and include:
osteoporotic/metabolic bone disease tendency in young
female athletes secondary to nutritional or hormonal
imbalances.
changes in footwear and mode of training, or
changes in intensity and/or duration of training.
51
52. Cont.…..
The pathophysiology involves repeated loading of the
bone with accumulated microtrauma resulting in the
development of a bony defect.
Femoral neck stress fractures are especially
troublesome because if not treated they may lead to
avascular necrosis of the femoral head which can cause
long- term disability.
52
53. Cont.…
Femoral neck stress fractures (FNSFs) account for 3% of
all sport-related stress fractures.
The commonest causative sports are marathon and long-
distance running.
The most common reported symptom is exercise-related
groin pain.
Femoral stress fractures typically present with hip, groin,
gluteal, thigh, or knee pain, depending on the location.
53
54. Signs and Symptoms
Local pain and oedema
Point tenderness on palpation
Local swelling
Antalgic gait
Painful and limited passive and active ROM of hip and/or
knee (flexion, internal rotation, extension)
Pain increases during activity improves with rest.
Groin pain
Bone marrow oedema
54
55. Cont.…
athletes may identify vague thigh pain accompanied
with diffuse tenderness, particularly for femoral neck
stress fractures.
Regardless of region, athletes typically present with
pain during activity which may be reproducible on
passive range of motion, specifically internal rotation
and when asked to hop on the affected limb.
55
56. Cont.….
Stress fractures at the pubic rami near the symphysis
are the most common pelvic stress fractures among
runner athletes.
symptoms include low back, buttock, groin, and thigh
pain during activity.
Plain radiographs are typically normal.
MRI is the best diagnostic test to depict stress
fractures of the femur.
56
57. Cont.….
Pain upon deep palpation of the pubic ramus may
assist in differentiation between affected and an
overlying soft-tissue pathology.
most pelvic stress fractures are non-displaced,
requiring an MRI for diagnosis.
Return to participation ranges from 7–12 weeks with
conservative treatment.
57
58. Treatment and rehabilitation
is dependent on the location and any displacement.
Displacement is the primary indicator for prognosis
with 60% displacement the marker for reduction of
activity level in sport with potential avascular necrosis.
The majority of femoral stress fractures that lack
displacement respond to conservative treatment
within 8–14 weeks.
58
59. The first phase of a conservative rehabilitation
Rest
maintenance of aerobic fitness
physical therapy modalities( TENS , hydrotherapy)
oral analgesics
weight-bearing as tolerated and ambulation modification if
needed, yet running should be avoided.
Likewise, minimal-impact activities to maintain cardiovascular
fitness should be initiated, such as cycling, pool running,
antigravity treadmill running, , and swimming.
59
60. Second phase
Should begin 2 weeks after the athlete is pain free.
ambulation and cross-training.
initiation of a running progression.
Focus on muscular endurance training.
Core and pelvic girdle stability.
balance/proprioception training
60
61. Cont.….
flexibility, and gait retraining
Return to sport activity should coincide with pain free
weight-bearing
Femoral neck 4–6 weeks and pelvis 7–12 weeks
61
62. Avulsion fracture
An avulsion fracture is a failure of bone in which a bone
fragment is pulled away from its main body by soft tissue
that is attached to it.
An avulsion fracture occurs when the tendons that connect
muscles to bone are torn at the connection site resulting in
pain and muscle weakness.
Avulsion fractures in the groin are most common in
adolescent athletes because the pelvic growth plates have
not yet solidified.
62
63. Cont.….
growth plates are more prone to trauma compared to the
musculotendinous units having a hormonally induced
increase in strength.
Etiology includes….
a sudden and forceful contraction or
passive lengthening of the muscles during an acceleration, a
jump or a kick.
Acute trauma is the most common
less frequently they follow an overuse situation.
63
64. Avulsion fractures involves
the main bundle of the rectus femoris insertion at the
AIIS.
the Sartorius insertion at the ASIS.
the hamstring insertion at the ischial tuberosity (IT).
the tensor fasciae latae on the iliac crest (IC) and
the rectus abdominus insertion on the superior corner
of the pubic symphysis (SCPS).
64
65. Cont.…
a simple clinical assessment and a standard AP
radiograph are enough to make a diagnosis.
these injuries are often misdiagnosed as simple muscle
strains leading to ineffective treatments and a delayed
return to sport.
65
66. Mechanism of injuries
Avulsion fractures of ASIS and AIIS
a forceful contraction of the Sartorius and the rectus femoris,
respectively, with the hip extended and the knee flexed.
AIIS avulsions can occur with a concentric or eccentric
contraction of the rectus femoris.
the most common injury mechanism is concentric
contraction during the acceleration phase of sprinting, a
jump or a kick with sudden-onset groin pain.
66
67. Cont.….
Indirect avulsion fractures of the ischial tuberosity are
the result of a vigorous flexion of the hip joint with an
extended knee and a concomitant activation of hamstring
muscles.
Fractures involving the IC apophysis are
caused by a massive contraction or repetitive actions of the
tensor fasciae latae.
a sharp pain localized on the antero-lateral side of the pelvis.
67
68. Cont.….
0lder patients are more prone to suffer injuries to the iliac
apophysis (ASIS and iliac crest), while younger are more
likely to sustain a fracture of AIIS or ischial tuberosity.
Why ?
the timing of complete ossification of the apophysis of the
pelvis is probably accountable for these differences, with
the AIIS secondary ossification center closing first and the
iliac apophyses closing last.
68
69. Osteitis pubis
The symphysis pubis is a fibrous joint between the
two halves at the front of the pelvis.
The adductor muscles attach either side and the abdominal
muscles attach along the top of the pubic bones.
It Is an inflammation of the pubic symphysis and surrounding
muscle insertions.
It is painful chronic overuse condition characterized by pelvic
pain and local tenderness over the pubic symphysis.
69
70. Cont.…..
Therefore the symphysis is subjected to significant
shearing forces, especially during alternate single leg
weight bearing with change of direction during
activities like running and kicking
The shearing forces can be increased by biomechanical
limitations, such as restriction of internal hip rotation.
70
71. Cont.….
It commonly affects athletes, especially those who participate in sports
that involve kicking, turning, twisting, cutting, pivoting, sprinting,
rapid acceleration and deceleration or sudden directional changes.
Osteitis pubis has been described in athletes who play sports such as
soccer, rugby, ice hockey, Australian Rules football and distance
running.
Soccer player, hockey player and distance runner are especially
vulnerable to this injuries.
71
72. Cont.….
The etiology is not completely clear.
Muscle imbalance between the abdominal and hip
adductor muscles is currently considered the most
important pathogenic factor.
In women can also develop after child birth.
A prolonged labor that strain the muscle of the pelvis can
cause inflammation, which will eventually subsides.
surgery or an injury to the pelvis may also result in osteitis
pubis.`
72
73. Cause/factors cont.…..
Surgical procedures (gynecological or abdominal,
hernia repairs).
Pregnancy and childbirth
Trauma/injury
Spinal malalignment
Pelvic malalignment (the pubic symphysis itself may
be out of line
73
74. cont.….
Leg length difference
Abnormal Foot biomechanics
Technique- walking and /or running
Poor flexibility
Poor muscle strength
Reduced core strength and control of the spine and pelvis
during activity
Poor glut strength and overuse of adductors
74
75. Symptoms of Osteitis Pubis
The most common symptom of osteitis pubis is pain
over the front of the pelvis.
Pain may be unilateral or bilateral.
it is exacerbated by running, kicking, hip adduction or
flexion, and eccentric loads to the rectus abdominis.
It can also radiate down into one thigh or into the
groin(anterior and medial groin pain).
75
76. Cont.…..
At clinical evaluation, tenderness on palpation of the
symphysis region is common.
oedema (swelling) forming within the pubic ramus.
Weakness
Limping gait
Pain during sport
76
77. Treatment
treatment of this condition is notoriously difficult.
A conservative approach to treatment of osteitis pubis
is considered the first choice of action, while warning
the athlete that prolonged re-stand prolonged absence
from sport is likely.
Pain will often respond well to anti-inflammatory
medication initially.
77
78. Cont.….
However, symptoms often gradually or suddenly
become more acute with pain that inhibits or stops
activity, becoming unresponsive to conservative
management.
Advice to avoid exercising on hard or uneven surfaces.
The player rests from all weight bearing rotational
activities until the squeeze test is negative.
78
79. Treatment can include
Spinal and pelvic alignment work
correct muscular imbalance around the pubic symphysis
Soft tissue work and stretching
Myofascial release
Lower limb and core muscle strengthening
Referral to podiatry if necessary for leg length assessment
and biomechanical analysis
79
80. Cont.….
Postural analysis/correction
Retraining of walking and running technique
Balance retraining
Home exercise program
Breathing retraining
Sport specific training
80