This document discusses diagnosis and treatment of hip and knee pain. It covers evaluating hip and knee pain through history, physical exam, and various imaging modalities like x-ray, CT, MRI, bone scan, and ultrasound. Specific causes of hip and knee pain are discussed like regional nerve entrapments, bursitis, and overuse syndromes. Evaluation and treatment of conditions like trochanteric bursitis, iliotibial band syndrome, and patellofemoral syndrome are summarized. Hip and knee anatomy, pediatric hip pain, and neural causes of groin pain are also outlined.
Describing some of the most important disorders of the shoulder area: frozen shoulder, biceps tenosynovitis, biceps tendon tear, rotator cuff tear, impingement syndrome, Rotator Cuff Calcified Tendonitis
Describing some of the most important disorders of the shoulder area: frozen shoulder, biceps tenosynovitis, biceps tendon tear, rotator cuff tear, impingement syndrome, Rotator Cuff Calcified Tendonitis
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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!
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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 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
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
6. HIP & KNEE RADIOLOGY
• The imaging modality used in a given patient
depends upon the differential diagnosis that
has been developed based upon the history
and physical examination
7. HIP & KNEE RADIOLOGY - XRAY
Plain film radiography of the is used in the
initial evaluation of
• any cause of pain.
• referred pain, such as sacroiliitis
8. HIP & KNEE RADIOLOGY - CT
NCCT
• trauma
• for preoperative planning,
• evaluation and guiding percutaneous biopsy
of tumors
CECT
• septic joint
• soft tissue abscess
9. HIP & KNEE RADIOLOGY - MRI
MRI of the hip accurately evaluates
• bone marrow
• joint space
• neurovascular structures
• soft tissues
10. HIP & KNEE RADIOLOGY - MRI
MRI is the modality of choice for
• suspected femoral fracture not demonstrated
radiographically
• osteochondral injuries
• muscle injuries
• joint effusion
• early diagnosis and staging of AVN
• tumour
11. HIP & KNEE RADIOLOGY – Bone SCAN
• Radionuclide Tc-99m bone scan surveys
whole-body exam.
• Radionuclide bone scan is used for evaluation
of metastatic disease and infection.
12. HIP & KNEE RADIOLOGY - USG
Advantage
• Readily available even at the bedside
• Allows dynamic evaluation of the tendons and
muscles( soft tissues )
• Does not involve ionizing radiation
13. HIP & KNEE RADIOLOGY - USG
DISADVANTAGE
• highly operator- and patient-dependent.
USES
• Hip effusions
• bursal / periarticular fluid collections are
readily identified.
26. Hip pain in children
• Evaluation – The history and examination of
the child with hip pain is focused on
distinguishing between various causes
• This distinction helps to determine the
appropriate laboratory and radiographic
evaluation.
27. Hip Pain In Children
INFECTIOUS
• Septic arthritis of the hip / the sacroiliac joint
• Osteomyelitis of femoral head
• Psoas abscess
• Spinal epidural abscess
• Appendicitis or abdominal/pelvic abscess
28. Hip Pain In Children
INFLAMMATORY
• Transient synovitis
• Systemic arthritis
• Infectious/post-infectious (eg, ARF,
poststreptococcal arthritis)
• Rheumatologic conditions (eg SLE , vasculitis,
dermatomyositis , localized scleroderma )
• Arthritis associated with gastrointestinal
conditions (eg, IBD, celiac disease)
29. Hip Pain In Children
MECHANICAL/ORTHOPEDIC
• Avascular necrosis
• Femoral stress fracture
• Muscular strain
• Trochanteric bursitis
• Acetabular labral tear
NEOPLASTIC
• Osteoid osteoma
• Leukemia
• Solid tumor
• primary or metastatic
30. Hip Pain In Children - History
• Associated systemic symptoms
• Past medical history;
• Family history
38. Lateral Femoral Cutaneous Nerve Entrapment
• Also called Meralgia paresthetica
• Is the best known of the lower extremity nerve entrapment
syndromes.
Nerve irritation can be triggered by
• tight clothing belts
• car seat belts
• pregnancy
• focal trauma
• Obesity
• INCLUDING SURGICAL INTERVENTIONS
a) such as appendectomy or
b) hysterectomy; and
39. • Symptoms include pain to the hip area, thigh,
or groin along the distribution of the nerve
(proximal anterior lateral aspect of the leg;
burning or tingling paresthesias may be
present.
• Pain may be worsened or by tapping over the
area of the anterior superior iliac spine
40. Lateral Femoral Cutaneous Nerve Entrapment
• Those affected should limit the exacerbating
activity and eliminate the source of the
irritation.
• NSAIDs
• local injections
• weight loss
• surgical excision of the nerve are other
treatment options
41. Obturator Nerve Entrapment
• Obturator nerve entrapment is typically a sequela of pelvic
fractures or abdominal/ pelvic surgery.
• Obturator nerve inflammation is generally sensed in the groin and
down the inner thigh and aggravated by movement of the hip.
• Exercise-induced medial thigh pain may be the predominant
symptom.
• Imaging studies are of limited value
• Surgery may be required for pain relief. Local injection of lidocaine
into the area of the nerve relieves the pain and associated reactive
weakness and may make the diagnosis
42. Ilioinguinal Nerve Entrapment
• The ilioinguinal nerve arises from the lumbar
plexus and passes through the psoas and then
travese near to anterior superior iliac spine, and
the abdominal oblique muscles
• Entrapment occurs due to hypertrophy of the
abdominal wall musculature or pregnancy.
• Hypoesthesia in the distribution of the nerve,
yielding groin pain
44. Piriformis Syndrome
• Irritation of the sciatic nerve from the piriformis muscle
• Pain in the area of the buttocks and hamstring muscles that
is worsened by sitting, climbing stairs, or squatting .
• The clinician may palpate a tender mass over the piriformis
muscle and elicit pain in the region of the sacroiliac joint or
gluteal musculature.
• Hip flexion will exacerbate the symptoms.
• Imaging is useful only to rule out other conditions.
• Treatment is conservative.
46. BURSAL SYNDROMES OF THE HIP AREA
• New bursae may form at any area that is subject to repeat irritation.
• Causes of bursal pain include inflammation
• with repetitive minor trauma
• infection.
• rheumatologic disorders
a) such as psoriatic arthritis
b) rheumatoid arthritis
c) ankylosing spondylitis
d) gout or pseudogout
• Arthrocentesis is required when a septic joint is suspected. The
development of a draining sinus tract favors septic bursitis
47. BURSAL SYNDROMES OF THE HIP AREA
• Trochanteric Bursitis (Posterolateral Hip Pain)
• Ischiogluteal Bursitis (Posterior/Gluteal Pain)
• Iliopectineal Bursitis (Anterior Hip,Groin Pain)
• Iliopsoas Bursitis (Groin Pain)
49. BURSAL SYNDROMES OF THE KNEE
• Pes Anserine Bursitis (Anterior Medial Knee
Pain)
• Prepatellar Bursitis (Pain Anterior to the
Patella)
50. TREATMENT OF BURSITIS
• Treatment is aimed at the suspected cause.
• For inflammatory conditions, NSAIDs, rest,
heat, and time are the basis of conservative
treatment.
• Steroids with caution..
• Do not inject steroids into tendons, because
this may weaken the tendon and lead to
rupture.
• Associated infection....antibiotics
51. TREATMENT OF BURSITIS
• Serial aspiration and surgical drainage or
removal of the afflicted bursa are indicated for
refractory conditions.
• If any patient presents with toxicity, admit for
IV antibiotics and consultation with
orthopedic surgery.
• When fibrosis or synovial thickening leads to
the development of painful nodules, surgical
excision of the bursa is indicated.
52. HIP MYOFASCIAL
SYNDROMES/OVERUSE SYNDROMES
• The diagnosis of these syndromes is clinical.
Overuse syndromes are simply the result of
repetitive stresses and microtrauma outpacing
the body’s ability to heal.
a) External Snapping Hip Syndrome
b) Fascia Lata Syndrome
53. External Snapping Hip Syndrome
• Also known as coxa saltans
• a snapping sound is heard and popping
sensation felt as the iliotibial band (an
extension of the fascia lata) slips over the
greater trochanter
• In athletes, the syndrome is usually associated
with painful inflammation of the band and the
involved bursa.
54. • The patient will be able to voluntarily cause the
snap with hip flexion and extension.
• Young women are predisposed to this syndrome,
which occurs with activities such as dancing or
stair climbing.
• MRI may identify intra-articular causes or
demonstrate inflammation of the local bursa, the
iliotibial band, or the gluteal musculature.
Dynamic sonography is also an aid for the
diagnosis of extra-articular causes
55. Fascia Lata Syndrome
• The fascia lata syndrome is a potential cause of
pain in the lateral thigh region and is associated
with pain to palpation and trigger points.
• Unilateral enlargement of the tensor fascia lata
may occur with overuse
• Athletes develop pain in the anterior groin and
point tenderness over the anterior iliac crest.
• US is a useful aid to confirm the diagnosis.
• Treatment conservative
57. Patellofemoral Syndrome/Runner’s
Knee
• This syndrome is a major cause of anterior
knee pain, with three typical causes:
• focal trauma (least common),
• overuse
• abnormal patellar movement in the patellar
groove.
• A major contributor is weakness of the
quadriceps muscle.
58. Patellofemoral Syndrome/Runner’s
Knee
• Typically unilateral & common in females
• Pain is exacerbated by prolonged flexion of
the knee, such as sitting & stair climbing.
• The patellar grind test is accomplished by
direct anterior to posterior pressure on the
patella or the quadriceps tendon while asking
the patient to contract the quadriceps muscles
59. • Radiographic studies are of limited value but
may detect arthritis.
• Treatment is usually conservative, with an
emphasis on physical therapy and
strengthening. Brace support of the knee will
also help
• If severe arthroscopic management
60. Chondromalacia Patellae
• Chondromalacia patellae refers to a softening
of the cartilage on the posterior surface of the
patella
• This diagnosis is made by direct arthroscopic
visualization of a ragged appearance of the
affected cartilage.
61. Iliotibial Band Syndrome
• Iliotibial band syndrome is most common in
distance runners or cyclists.
• The iliotibial band inserts onto the lateral
femoral and tibial condyles .
• The thickened fascia serves as a ligament and
stabilizes the joint in extension.
• With overuse, the bursa underlying the band
becomes irritated.
62. Iliotibial Band Syndrome
• Pain is reproduced consistently after reaching a
certain mileage during running or other physical
exertion
• Examination reveals localized tenderness to
palpation over the lateral epicondyles.
• Treatment involves rest, decreasing the training
distance, changing shoes to reduce stress on the
structures, stretching exercises, and steroid
injections locally
63.
64. Patellar Tendinitis/Jumper’s Knee
• The patella tendon is subject to significant wear,
with microtears and complete ruptures occurring
in athletes and nonathletes alike
• Any activity that involves jumping can result in
focal pain, typically at the inferior pole of the
patella or proximal portion of the tendon.
• Other activities that may exacerbate pain include
running (especially uphill), squatting, cutting
maneuvers, standing from a sitting position, or
even simple walking.
65. Patellar Tendinitis/Jumper’s Knee
• Treatment involves rest, NSAIDs, and
cryotherapy. Steroid injections are
contraindicated.
• Most recently, US-guided intratendinous
injection of platelet-rich plasma has been
suggested to allow rapid healing in the
patellar tendon and other major tendons.
66. Quadriceps Tendinitis
• The quadriceps muscles and tendon are
subject to significant forces in athletes
• Resulting in microtears and inflammatory
changes, localized predominantly at the
insertion of the tendon into the proximal pole
of the patella.
• Chronic recurrent injury or acute explosive
trauma can result in complete tear of the
tendon.
67. Semimembranosus Tendinitis
• Pain is elicited just distal to the joint line, where
the tendon is easily palpated in most patients.
• In younger patients, the pain is associated with
athletics and overuse.
• In older patients, it is seen secondary to
degenerative changes in the medial
compartment.
• MRI will confirm the diagnosis if conservative
therapy fails.
68. Snapping Knee Syndrome
• Similar to the same process in the hip, is a
result of the iliotibial band passing over the
lateral femoral condyle.
• The same effect may also result from the
semitendinosus muscle passing over the
medial condyle with the initiation of flexion
and termination of extension of the knee.
69. Snapping Knee Syndrome
• The snapping sensation and sound may be
accompanied by pain in the location of the
involved tendon.
• Managed conservatively
70. POPLITEAL (BAKER) CYST
• Presents with posteroinferior knee pain
• Develops posteriorly and inferiorly to the knee
as a distention of a local bursa
• The cyst frequently communicates with the
knee (especially in adults), and associated
intra-articular pathology is common.
71. POPLITEAL (BAKER) CYST
• The cyst may develop as a herniation of the
synovial membrane through the posterior
joint capsule.
• Popliteal venous thrombosis can be confused
with the pain and swelling produced by these
posterior cysts or may exist concomitantly.
• Other potential diagnoses include aneurysms,
vascular tumors, lipoma, and other tumors.
75. PSOAS ABSCESS
• The psoas muscle is susceptible to the
hematogenous spread of infection from distant
sites because of its rich blood supply and
proximity to overlying retroperitoneal lymphatic
channels.
• Mycobacterium tuberculosis & Staphylococcus
aureus is the most common pathogens
•
• Mycobacterium is more common in
immunocompromised hosts
76. PSOAS ABSCESS
• Symptoms include hip or flank pain (43%), abdominal pain (14%),
fever (41%)
• To provoke pain, instruct the patient to perform forceful contraction
of the psoas. Place your hand just proximal to the patient’s
ipsilateral knee, and have the patient raise his or her thigh against
your hand
• . The overall sensitivity of contrasted CT imaging for the diagnosis is
over 90%,
• Treatment includes antibiotics & drainage.
• Consult surgery for percutaneous or open drainage
78. AVN
• Osteonecrosis Other terms used to describe
osteonecrosis include avascular necrosis,
aseptic necrosis, and ischemic necrosis.
• Osteonecrosis is the result of bone infarction
caused by a lack of blood supply.
• CAUSES :- Major / Minor Trauma
80. AVN ..
• Plain radiographs are helpful in establishing
the diagnosis
• findings ranging from mottled densities and
lucencies to severe collapse of the femoral
head
• Joint replacement may be required.
84. Osteomyelitis
• Osteomyelitis is an infection of the bone by bacteria or
fungus, resulting in bony changes and destruction .
• It develops by spread of infection from contiguous
structures (∼80%) or by hematogenous spread (∼20%).
• Hematogenous spread is more common to the long
bones in children and to the spine in adults.
• Spinal epidural abscess is an important differential
diagnosis to consider
• Pain at the site is a universal complaint and may be
accompanied by warmth, swelling, and erythema.
85. Osteomyelitis
• Radiographs are normal early in the course,
but later will show periosteal elevation, and
lytic lesions.
• MRI is the preferred imaging modality, with
approximately 95% sensitivity
86. Risk Factors, Likely Infecting Organism, and
Recommended Initial Empiric Antibiotic Therapy
for Osteomyelitis
87. Risk Factors, Likely Infecting Organism, and
Recommended Initial Empiric Antibiotic Therapy
for Osteomyelitis
88. Osteomyelitis
• Bone biopsy confirms the diagnosis with
certainty. S. aureus is the most common
causative agent overall.
• In acutely ill patients, begin presumptive
treatment based on the clinical findings, with
high-dose, broad-spectrum, parenteral
antibiotics ensuring coverage for S. aureus.
89. Osteochondritis Dissecans (Knee Pain)
• In osteochondritis dissecans, a portion of the
joint surface cartilage separates from the
underlying bone.
• Seen most often in adolescents, and is of
unclear origin.
• The medial femoral condyle is predominantly
involved, with unilateral occurrence.
•
91. Osteochondritis Dissecans (Knee Pain)
• The patient experiences pain and swelling.
• Plain radiographs may reveal a thin rim of
calcium separated from the underlying bone),
with
• MRI is sinvestigation of choice
• conservative therapy
• If fail go for Arthroscopic repair & removal of
associated loose bodies
92. Synovial Osteochondromatosis
• Synovial osteochondromatosis is characterized by
idiopathic, nodular synovial membrane
proliferation and subsequent calcification of the
affected tissue.
• Eventually, multiple fragments of this growth (as
large as 2 cm) break off and occupy the joint
space or the area of the bursa and tendon
sheaths.
• With time, degenerative changes and secondary
osteoarthritis occur.
93. Synovial Osteochondromatosis clinical
features & investigation
• The disease is more common in males
between the ages of 20 and 50 years old.
• Patients complain of pain and joint swelling.
• There is a limitation in range of motion, and
the joint may lock. The large joints are
commonly involved. Radiographs will show
the calcification and the intra-articular bodies
and later the changes of osteoarthritis.
95. Transient Osteoporosis of the Hip
• Transient osteoporosis of the hip occurs in
middle-aged men and in pregnant women in
the third trimester.
• The disease is uncommon, idiopathic, and
characterized by sudden onset of hip pain,
with the findings of osteoporosis on plain
films.
• The disease spontaneously resolves within 6
to 12 months
96. Paget’s Disease (Osteitis deformans)
• Paget’s disease, is a chronic disorder resulting in
enlarged, deformed bones from breakdown and
reformation.
• Most commonly affects hip joint (in 50% of
patients).
• The disease is familial and is suggested by an
elevated serum alkaline phosphate level. Patients
complain of pain, and radiographs reveal joint
space narrowing with minimal hypertrophic
changes
98. Paget’s Disease (Osteitis deformans)
• Treatment is symptomatic, and medications
that slow the rate of bone turnover
(calcitonin, alendronate, others)
• Surgery is required for complications of the
disease, such as fracture and severe arthritis.
99. Osteitis Pubis (Midline Pelvis and Groin
Pain With Radiation to Hips)
• Osteitis pubis should be considered as a
possible diagnosis in athletes with pain in the
region of the pubis.
• It is an inflammatory process related to
overuse of the adductors and gracilis muscles.
• Bony changes with periostitis occur at the
sites of the origins of the involved muscles.
102. Osteitis Pubis - Treatment
• Symptoms start off gradually and progress to
severe pain with any movement of the legs.
• The symptoms may resolve completely over a
period of months with rest and NSAID use.
• Rarely, arthrodesis of the pubic symphysis is
needed.
103. Myositis ossificans or heterotrophic
calcification
• Diseases of Abnormal Calcification, is the
deposition of bone at a site where bone does not
normally occur.
• The process is related to direct trauma, with the
thigh and hip muscles frequently involved.
• Bleeding follows direct trauma to the muscle, and
calcium deposits form inside the hematoma.
• A firm, palpable, painful mass will develop within
2 weeks and may persist for up to 1 year.
105. • The appearance may be confused with a primary
neoplasm, such as osteosarcoma or periosteal
osteogenic sarcoma.
• Range of motion in the muscle or joint is limited
due to pain or physical presence of the mass.
• Operative removal of the deposition may be
required.
106.
107. HIP EXAMINATION
• INSPECTION (for asymmetry and position of
comfort)
• PALPATION
1. pain location
2. range of motion
3. assessment of ability to bear weight.
(The inability to bear weight is a sign of serious
pathology until proven otherwise. )
108. Hip Pain In Children - Laboratory
Evaluation
• complete blood count
• erythrocyte sedimentation rate(non specific)
• C-reactive protein
• blood cultures (if osteomyelitis or septic
arthritis is suspected).
117. Lateral Hip Pain
• Greater trochanteric bursitis
• Gluteus medius tendinopathy/dysfunction
• IT band syndrome
• Meralgia paresthetica
118. Posterior Hip Pain
• Referred from lumbar spine
• Piriformis syndrome
• Sacroiliac joint dysfunction
• High hamstring strain or ischial tuberosity
avulsion