Lateral epicondylitis, commonly known as tennis elbow, is a painful condition caused by overuse and microtears of the tendons that connect the forearm muscles to the lateral epicondyle of the humerus. The condition results in pain at the outside of the elbow. Conservative treatments include activity modification, bracing, stretching, strengthening exercises, and shock wave therapy. Surgical intervention is considered if conservative treatments fail to provide relief after 6 months.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
This is a short presentation on common causes of shoulder pain, its clinical features,diagnostic methods and treatment modalities. This presentation would be helpful for general paractioners, orthopedic juniour registrars.
This presentation reviews the historical and prospective studies demonstrating the causation of carpel tunnel syndrome in non-workers, workers and individuals with trauma i.e. fractures. It utilizes evidence based information for the medical causation analysis
Tendon ruptures of the biceps brachii, one of the dominant muscles of the arm, have been reported in the United States with increasing frequency. Ruptures of the proximal biceps tendon make up 90-97% of all biceps ruptures and almost exclusively involve the long head.
Orthopedic physical assessment - David j magee
Morgan WJ . Slowman Ls Acute wrist injuries in athletes
Levine W . Rehabilitation techniques for ligament injuries of the wrist
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
Tennis Elbow(lateral epicondylitis) is a degenerative condition characterized by painful wrist extension or pain on performing backhand strokes in tennis shots.
This ppt contains an overall description of this condition with proper evidence and conservative and physiotherapy management for this condition.
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.
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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.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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.
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
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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2. What is Lateral Epicondylitis (tennis
elbow)
• Lateral Epicondylitis is a common clinical entity
characterized by pain and tenderness at the common
origin of the extensor group muscles of the
forearm,usually as a result of a specific strain, overuse,
or a direct bang.It is considered a cumulative trauma
injury that occurs over time from repeated use of the
muscles of the arm and forearm, leading to small tears
of the tendons (Tendonitis).
• The condition that is commonly associated with playing
tennis and other racket sports, though the injury can
happen to almost anybody
3. Pathophysiology of Lateral
Epicondylitis
• The tendinous origin of extensor carpi radialis
brevis (ECRB) is the area of most pathologic
changes. Changes can also be found at
musculotendinous structures of the extensor
carpi radialis longus, extensor carpi
ulnaris and extensor digitorum communis.
Overuse and repetitive trauma in this area causes
fibrosis and micro tears in the involved tissues.
Nirschl referred to the micro tears and the
vascular in growth of the involved tissues
as angiofibroblastic hyperplasia.
4. • A tear occurs at the teno-muscular junction, in the
tendon, or at the teno-periosteal junction. The
resulting inflammation produces exudate in which
fibrin forms to heal the torn tissue.Repeated activity
causes microtrauma, with subsequent granulation
tissue formation on the underside of the tendon unit
and at the teno-periosteal junction. The granulation
tissue formed appears to contain large number of free
nerve endings, hence the pain of the condition. The
major problem is that the granulation tissue does not
progress quickly to a mature form, and so healing fails
to take place, almost a type oftendinous 'nonunion'.
5. • The most common cause of Lateral Epicondylitis in tennis players is
a 'late' mechanically poor backhand, that places excess force across
the extensor wad, that is, the elbow leads the arm. Other
contributing factors include incorrect grip size,string tension, poor
racket dampening, and underlying weak muscles of the
shoulder,elbow and arm.Tennis grips that are too small often
exacerbate or cause tennis elbow.
• Often a history of repetitive flexion-extension or pronation-supination
activity and overuse is obtained (eg.,twisting a screw
driver, lifting heavy luggage with the palm down). Tightly gripping a
heavy briefcase is a very common cause.Raking leaves, baseball,
golfing, gardening, and bowling can also cause Lateral Epicondylitis.
Less commonly,tendonitis is simply a result of single acute injury.
6. Clinical Presentation
• At first, the athlete may be aware of only fatigue
and spasm of dorsal forearm muscles related to
unaccustomed activity. Then they may note the
onset of aching lateral elbow pain after playing.
Eventually the pain may become so constant and
severe so as to stop the athlete from further
playing and to interfere with activities of daily
living, such as carrying a briefcase, wringing wet
clothes or even holding a cup of tea. Grip
becomes weak.Morning stiffness may be felt
7. Physical Examination
• -Point tenderness over or just distal to the lateral humeral
epicondyle (the bony attachment of the common extensor
tendon) which gives rise to burning sensation when
pressure is applied.
• -Tenderness over muscles of dorsal forearm.
• -Pain with resisted wrist extension, finger extension and
resisted radial deviation.
• -Pain with passive stretching of wrist extensors.
• -With long standing symptoms, there is likely to be
considerable atrophy and weakness of extensor muscles
and limitation of passive wrist flexion. Accessory
movements of the elbow and superior radio-ulnar joint
may be reduced in along term problem.
8. Special tests for Lateral Epicondylitis
• 1)Cozen's test- The patient's elbow is stabilized by the examiner's
thumb, which rests on the patient's lateral epicondyle. The patient
is then asked to make a fist, pronate the forearm and radially
deviate and extend the wrist while the examiner resists the motion.
A positive sign is indicated by sudden severe pain in the area of
lateral epicondyle of the humerus.
• 2)Mill's test-While palpating the lateral epicondyle, the examiner
pronates the patient's forearm, and flexes the wrist fully and
extends the elbow. A positive test is indicated by pain over the
lateral epicondyle of humerus.
• 3)Maudsley's test- The examiner resists extension of the 3rd digit
of the hand, stressing the extensor digitorum muscle and tendon. A
positive test is indicated by pain over the lateral epicondyle of the
humerus.
9. Differential Diagnosis
• -Evaluation should note possible sensory paresthesias in
the superficial radial nerve distribution to rule out Radial
tunnel syndrome.It is the most common cause of refractory
lateral pain and coexists with Lateral Epicondylitis in 10% of
the patients.
• -The cervical nerve roots should be examined to rule
out cervical radiculopathy.
• -Other conditions that should be considered include
bursitis of the bursa below the conjoined tendon, chronic
irritation of the radiohumeral joint or capsule,
radiocapitellar chondromalacia or arthritis, radial neck
fracture, panner's disease, little league elbow and
osteochondritis dissecans of the elbow.
10. Investigations
• X-rays are not necessary. Rarely, magnetic
resonance imaging (MRI) scans may be used to
show changes in the tendon at the site of
attachment onto the bone. MRI typically shows
fluid in the ECRB origin. There may also be a
defect in this tissue. The use of the word "tear" to
refer to this defect can be misleading. The word
"tear" implies injury and the need for repair--
both of which are probably inaccurate and
inappropriate for this degenerative enthesopathy.
11. Treatments currently used for tennis
elbow
•
1. Conservative bracing
2. Eccentric strengthening exercises
3. Dry needling / acupuncture
4. Nitrate patches
5. Shock wave treatment
6. Cortisone injections
7. Platelet Rich Plasma Injections
8. Surgery
12. Conservative treatment of Lateral
Epicondylitis
• Activity Modification
• -In non-athletes, elimination of activities that are painful is key to
improvement (eg., repetitive valve opening).
• -Treatment such as ice and NSAIDs may lessen the inflammation,
but continued repetition of the aggravating motion will prolong any
recovery.
• -Often repetitive pronation-supination motions and lifting heavy
weights at work can be modified or eliminated. Activity
modifications such as avoidance of grasping in pronation and
substituting controlled supination lifting instead may relieve
symptoms.
• -Lifting should be done with the palm up whenever possible, and
both upper extremities should be used in a manner that reduces
forcible elbow extension, supination and wrist extension.
13. Correction of mechanics
• If a late poor backhand causes pain, correction of
mechanics of the game is warranted.Avoidance of ball
impact that lacks a forward body weight transference is
stressed.
• -If typing with unsupported arms exacerbates the pain,
placing the elbows on stalked towels for support will
help.
• -Calculation of grip-The distance from the proximal
palmar crease to the tip of the middle finger determine
the proper grip size.The figure obtained represents the
circumference of the racket handl
14. Stretching
• ROM of exercises emphasizing end-range and passive stretching
(elbow in full extension and wrist in flexion with slight ulnar
deviation).
• Forearm extensor stretch may be performed with the athlete facing
the wall.The dorsum of the hand is placed on the wall, and the
elbow remains locked. By leaning forward the wrist is forced into 90
degree of flexion,stretching the posterior forearm tissues.
• Wrist flexion may be combined with a pronation stretch.Keeping
the elbow locked, the forearm is maximally pronated and wrist
flexed.Overpressure is applied by other hand and static stretch is
performed.
• The scar tissue is more pliable when warm. So stretching exercises
can be given after some superficial heating modality
15. Counterforce Bracing
• Brace is used only during actual play or aggravating
activity. The tension is adjusted to comfort while the
muscles are relaxed so that maximal contraction of the
finger and wrist extensors is inhibited by the band. The
band is placed 2 finger breadths distal to the painful
area of the lateral epicondyle.
• Some authors recommend 6-8 weeks use of a wrist
splint positioned at 45 degree of dorsiflexion.
• Range of Motion Exercises
• Exercises emphasize end-range and passive stretching
(elbow in full extension and wrist in flexion with slight
ulnar deviation).
16. Strengthening exercises for Lateral
Epicondylitis
• A gentle strengthening program should be used for grip strength, wrist
extensors, wrist flexors, biceps, triceps, and rotator cuff strengthening.
• However,the acute inflammatory phase must have resolved first, with
two weeks of no pain before initiation of graduated strengthening
exercises.Development of symptoms (pain) modifies the exercise
progression, with a lower level of intensity and more icing if pain recurs.
• The exercise program includes-
• -Active motion and submaximal isometrics.
• -Isotonic eccentric hand exercises with graduated weights not to exceed 5
pounds.
• -Theraband extension is performed with athlete sitting.One end of the
band is placed under the foot and the other end is gripped.
• -Wrist curls-Sit with the hand over the knee.With palm up, bend the wrist
10 times holding a 1-2 pound weight.Increase to two sets of 10 daily; then
increase the weight by 1 pound upto 5-6 pounds. Repeat this with palm
down, but progress to only 4 pounds.
17. Forearm strengthening
• Hold the arm out in front of the body, palm
down. The patient clenches the fingers, bends the
wrist up, and holds it tight for 10 seconds. Next
with the other hand, the patient attempts to
push the hand down. Hold for 10 seconds, 5
repetitions, slowly increasing to 20 repetitions 2-
3 times a day.
• -Elbow flexion and extension exercises.
• -Squeeze a sponge ball repetitively for forearm
and hand strength.
18. Mobilization with movement (MWM)
• In this a sustained mobilization is applied to a
joint. The mobilization is applied at the same
time the patient performs a painful action with
the affected joint (extension of wrist).
• -Progress strength, flexibility, and endurance in a
graduated fashion with slow-velocity exercises
involving application of gradually increasing
resistance. Later on upper limb plyometrics,
closed chain activities and sport specific activities
are done.