This PPT includes information about the disease and conditions related to lumbosacral plexus.The PPT is made from the trusted books of neurology and google is the source for the great images.
Conus Medullaris syndrome (CMS) majorly arises from a spectrum of clinico-pathologic entities representing dysfunction of the lowest level of the spinal cord termed the Conus Medullaris, which consists of the sacral segments. There is a subset of spinal cord injuries clinically referred to as spinal cord injury syndromes, to which Conus Medullaris syndrome belongs, that are grouped by their respective symptomatology, encompassing central cord syndrome [2].
Conus Medullaris syndrome (CMS) majorly arises from a spectrum of clinico-pathologic entities representing dysfunction of the lowest level of the spinal cord termed the Conus Medullaris, which consists of the sacral segments. There is a subset of spinal cord injuries clinically referred to as spinal cord injury syndromes, to which Conus Medullaris syndrome belongs, that are grouped by their respective symptomatology, encompassing central cord syndrome [2].
Cns case-extramedullary compressive myelopathy, Q&AKurian Joseph
Tracts involved-corticospinal tract
anterior and lat spinothalamic
posterior coloumn
Mostly extramedullary compressive myelopathy at T10 level
Etiology –to consider both intra and extradural causes like neurofibroma/meningioma/av malformation.
extradural-potts spine,ivdp
Cns case-extramedullary compressive myelopathy, Q&AKurian Joseph
Tracts involved-corticospinal tract
anterior and lat spinothalamic
posterior coloumn
Mostly extramedullary compressive myelopathy at T10 level
Etiology –to consider both intra and extradural causes like neurofibroma/meningioma/av malformation.
extradural-potts spine,ivdp
Tibial nerve Nerve roots: L4-S3
Sensory: Innervates the skin of the posterolateral leg, lateral foot and the sole of the foot.
Motor: Innervates the posterior compartment of the leg and the majority of the intrinsic foot muscles.
Clinical Relevance
Injury to the tibial nerve can cause motor loss and altered sensation and pain to any of the areas it supplies, depending on site of involvement.
Popliteal Fossa region. Injury may occur due to:
Space occupying lesion
Laceration injury
Posterior dislocation of knee.
Fractures of the tibia and fibula
Local trauma to the posterior lower leg.
Medial malleolus level:
Compression of the tibial nerve in the osseofibrous tunnel below the flexor retinaculum of the ankle causes tarsal tunnel syndrome. On examination it presents as pain and paresthesia in the sole of the foot.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve.
The tunnel lies posterior to the medial malleolus of the ankle, beneath the flexor retinaculum.
Symptoms include pain radiating into the foot, usually, this pain is worsened by walking (or weight-bearing activities).
Etiology
Tarsal tunnel syndrome is divided into intrinsic and extrinsic etiologies.
Extrinsic causes include poorly fitting shoes, trauma, anatomic-biomechanical abnormalities (tarsal coalition, valgus or varus hindfoot), post-surgical scarring, systemic diseases, generalized lower extremity edema, diabetes, and post-surgical scarring.
Intrinsic causes include tendinopathy, tenosynovitis,osteophytes, hypertrophic retinaculum, and space-occupying or mass effect lesions (enlarged or varicose veins, ganglion cyst, lipoma, neoplasm, and neuroma).
Pathophysiology
Up to 43% of patients have a history of trauma including events such as ankle sprains. Abnormal biomechanics can contribute to disease progression. Risk factors include systemic diseases such as diabetes mellitus, hypothyroidism, gout, mucopolysaccharidosis, and hyperlipidemia
History and Physical
There is no specific test for the diagnosis of tarsal tunnel syndrome, and diagnosis is made with a detailed history and clinical examination.
Sharp shooting pain in the foot, numbness on the plantar surface, radiation of pain and paresthesias along the distribution of the posterior tibial nerve, pain with extremes of dorsiflexion and eversion, and a tingling or burning sensation.
The symptoms may worsen at night, with walking or standing, or after physical activity, and typically get better with rest.
On exam, the provider may observe pes planus, pronated foot, or talipes equinovarus.
In chronic cases, atrophy, weakness of the intrinsic foot muscles, and contractures of the toes may be appreciated. They are typically tender on deep palpation of the tarsal tunnel.
The gait should be analyzed for abnormalities including excessive pronation or supination, toe eversion, excessive foot inversion or eversion, and antalgic gait.
Light touch and two-point discrimination
Low back pain is one of the most common musculoskeletal complaints encountered in clinical practice. It is the leading cause of disability in the developed world and accounts for billions of dollars in healthcare costs annually. Although epidemiological studies vary, the incidence of low back pain is estimated to be anywhere between 5% to more than 30% with a lifetime prevalence of 60% to 90%. Most occurrences of low back pain are self-limited and resolve without intervention. Approximately 50% of cases will resolve within one to two weeks. 90% of cases will resolve in six to 12 weeks. The differential for low back pain is broad, and amongst other diagnoses, should include lumbosacral radiculopathy. Lumbosacral radiculopathy is a term used to describe a pain syndrome caused by compression or irritation of nerve roots in the lower back. It can be caused by lumbar disc herniation, degeneration of the spinal vertebra, and narrowing of the foramen from which the nerves exit the spinal canal. Symptoms include low back pain that radiates into the lower extremities in a dermatomal pattern. Other accompanying symptoms can include numbness, weakness, and loss of reflexes, although the absence of these symptoms does not exclude a diagnosis of lumbosacral radiculopathy.
This PPT contains the information about the pneumothorax lung condition,This PPT is made up from the well known book named essentials of cardiopulmonary physical therapy by ellen hillegass.
This PPT includes the information about the interstital lung disease.This PPT is made up from the essentials of cardiopulmonary physical therapy by ellen hillegass.
This PPT is contains the valuable information related to the tone of the muscle.This PPT is made up from the book physical rehabilitation by o sullivan.
This PPT includes the valuable information about the extrapyramydal tract ot the nervous system. The PPT is made up from the well known book named essentials of medical physiology by k.sembulingam.
This PPT includes an absolute knowledge about the scalenus syndrome,with causes,clinical features and management of the same,which is taken from the known books such as orthopaedics physical assessment by David J.Magee &etc.
This PPT includes an absolute knowledge about the torticollis,with causes&management of same,which is taken from the various known books such as essential of orthopaedics by J.maheshwari and orthopadics physical assessment by David J. Magee.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
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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).
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3. INTRODUCTION:-
• Radiculopathy:-Radiculopathy describes a range of symptoms
produced by the pinching of a nerve root in the spinal column.
• Neuropathy:- Disease or dysfunction of one or more peripheral
nerves, typically causing numbness or weakness.
• Mononeuropathy:-Damage to a single nerve.
• Polyneuropathy:-Damage to many nerves.
• Plexus syndrome:-Damage to the whole plexus due to injuries,
tumors or autoimmune reactions leads to plexus syndrome.
4. DIABETIC NEUROPATHY:-
• This condition is uncommon in childhood and increases with age.
• Peripheral nerve damage is related to poor control of diabetes. This is more
common in insulin-dependent patients.
• Damage results from either metabolic disturbance with sorbitol and
fructose accumulation in axons and Schwann cells or an occlusion of the
nutrient vessels supplying nerves (vasa vasorum).
5. • The frequent occurrence of neuropathy with other vascular
complications – retinopathy and nephropathy – suggests that
the latter is the more usual mechanism.
• Neurological complications correlate with levels of glycosylated
haemoglobin A1C, an indicator of the long-term control of
hyperglycaemia.
7. • 1) Polyneuropathy:-
• Present in 30% of all diabetics, but only 10% are symptomatic.
• Distal weakness and sensory loss is usual.
• Two forms of sensory neuropathy occur – large fibre, causing ataxia and
small fibre causing a painful anaesthesia.
• 2) Autonomic neuropathy:-
• In most patients with peripheral neuropathy, some degree of
autonomic disturbance is present.
• Occasionally this predominates:
8. • pupil abnormalities
• loss of sweating
• orthostatic hypotension
• resting tachycardia
• gastroparesis and diarrhoea
• hypotonic dilated bladder
• impotence.
9. • 3)Cranial nerve palsy:-
• An oculomotor palsy, usually without pain, may occur with pupillary
sparing, which helps to differentiate from an aneurysmal cause.
• The 6th and 7th cranial nerves may also be involved in diabetes.
10. • 4) Asymmetrical neuropathy:-
• Much less common than polyneuropathy.
• Pain and weakness rapidly develop.
• The anterior thigh is preferentially affected with wasting of the
quadriceps, loss of the knee jerk and minimal sensory loss.
• The condition is due to anterior spinal root or plexus disease.
• Imaging the lumbar roots and plexus excludes other causes.
• Functional recovery is good.
11. • Treatment:-
• Improved control of diabetes is essential.
• Carbamazepine, gabapentin, pregabalin, tricyclic antidepressants or α-
adrenergic blockers, e.g. phenoxybenzene, help control pain.
• Drugs which reduce aldose reductase and halt accumulation of sorbitol
and fructose in nerves are being evaluated.
• Management of autonomic neuropathy – Improve diabetic control and
treat symptoms e.g. fludrocortisone for BP control.
• Asymmetrical neuropathies usually spontaneously recover, whereas
prognosis for symmetric neuropathies is less certain.
12. LUMBOSACRAL PLEXUS SYNDROME:-
The proximity of the plexus to important abdominal and
pelvic structures renders it liable to damage from
disease of these structures.
Trauma following surgery, e.g. hysterectomy, lumbar
sympathectomy or during labour. Compression from an
abdominal mass, e.g. aortic aneurysm. Infiltration from
pelvic tumour,Radiotherapy.
13. • Symptoms:-
• It may be unilateral or bilateral, depending upon causation.
• Weakness, sensory loss and reflex changes are dictated by the location
and extent of plexus damage.
• Pain of a severe burning quality may be present; it may be worsened by
coughing, sneezing, etc.
• In general:
• Lower plexus lesions produce:Weakness of posterior thigh (hamstring) and
foot muscles with posterior leg sensory loss.
• Upper plexus lesions produce:Weakness of hip flexion and adduction with
anterior leg sensory loss.
14. Lumbosacral neuritis:-
• Inflammation of the lumbosacral spinal nerves is called lumbosacral
neuritis.
• Causes of Lumbosacral neuritis:-
• It can occur due to a variety of different causes.
• Essentially, there is irritation of the nerve fibers that lie within the spinal
canal.
• This irritation can occur from infection, inflammation, compression by a
small bone spur, compression from a small spinal tumor and even
endocrine causes such as diabetes.
• A herniated lumbar disc is also a well recognised cause.
15. • Symptoms:-
• low back pain and shooting pains down the leg.
• some alteration in the sensation of the skin on the leg
• weakness of the muscles
• On examination, patients may find that certain movements
exacerbate their pain.
• Diagnosis:-
• Many a times, a clear-cut diagnosis can be made from history and
clinical examination alone.
• However, in some cases this may not be sufficient and patients may
require additional investigations of the spine.
16. • A simple x-ray of the spine will demonstrate any irregularities within the
alignment of the spinal column.
• In addition, any narrowing of the disc spaces, bone spur formation,
osteoporosis, fractures and tumors may become visible through an x-ray
alone.
• In some cases there is a requirement of CT scan and MRI or nerve
conduction study to determine the involvement of specific nerve fibers.
17. • Treatment:-
• The choice of treatment depends upon the cause of Lumbosacral
Neuritis.
• For example patients with diabetic neuropathy may benefit from
simple physical therapy along with multivitamin supplementation and
good diabetic control.
• Patients who have a tumor may benefit from some form of surgery
along with radiotherapy.
• Patients who have a protruded lumbar intervertebral disc may find
relief through physical therapy along with conservative treatment
options and a possible surgical correction of the defect.
18. LOWER LIMB MONONEUROPATHIES:-
• 1) Femoral nerve(L2,L3,L4):-
• Damaged by:
• Fractures of the upper femur
• Congenital dislocation of the hip, hip surgery
• Neoplastic infiltration
• Psoas muscle abscess
• Haematoma into iliopsoas muscle(haemophilia, anticoagulants)
• Systemic causes of mononeuropathy, e.g. diabetes
19. • Results in:
• Weakness of hip flexion
• Weakness of knee extension with wasting of thigh muscles
• Sensory loss over the anterior and medial aspects of the thigh
• The knee jerk is lost
20. • 2) Obturator nerve (L2,L3,L4):
• Damaged by:-
• Fractures of the upper femur
• Congenital dislocation of the hip, hip surgery
• Neoplastic infiltration
• Psoas muscle abscess
• Haematoma into iliopsoas muscle(haemophilia, anticoagulants)
• Systemic causes of mononeuropathy, e.g. diabetes
• During labour and occasionally as a consequence of compression by
hernia in the obturator canal.
21.
22. • Results in: –
• Weakness of hip external rotation and adduction.
• The patient may complain of inability to cross the affected leg on the
other.
• Sensory loss is confined to the innermost aspect of the thigh.
• The adductor reflex is absent (adductor response to striking the
medial epicondyle).
23. • 3) Lateral cutaneous nerve of thigh(L2,L3):-
• Compression (entrapment) may occur at the point where it passes
between the two prongs of attachment of the inguinal ligament.
• Compression of the nerve results in uncomfortable paresthesias and
sensory impairment in its cutaneous distribution, a common
condition known as meralgia paresthetica (meros, “thigh”).
• Usually numbness and mild sensitivity of the skin are the only
symptoms, but occasionally there is a persistent distressing burning
pain.
24.
25. Perception of touch and pinprick are reduced in the
territory of the nerve; there is no weakness of the
quadriceps or diminution of the knee jerk.
The symptoms are characteristically worsened in certain
positions and after prolonged standing or walking.
Occasionally, for an obese person, sitting is the most
uncomfortable position.
Obesity, pregnancy, and diabetes mellitus may be
contributory factors.
26. • Most of the patients with meralgia paresthetica request no treatment
once they learn of its benign character.
• Weight loss and adjustment of restrictive clothing or correction of
habitual postures that might compress the nerve are sometimes helpful.
• A few with the most painful symptoms have demanded a neurectomy or
section of the nerve, but it is always wise to perform a lidocaine block
first, so that the patient can decide whether the persistent numbness is
preferable.
• Hydrocortisone injections at the point of entrapment may have helped in
a few cases.
27. • 4) Sciatic nerve(L4,L5,S1,S2,S3):-
• The nerve descends between the ischial tuberosity and the greater
trochanter of the femur. In the thigh it innervates the hamstring
muscles (semitendinosus, semimembranosus and biceps).
• Damaged by:-
• Congenital or traumatic hip dislocation.
• Penetrating injuries.
• Accidental damage from ‘misplaced’ intramuscular injection.
• Entrapment at sciatic notch.
• Systemic causes of mononeuropathy
• Total hip arthroplasty
• Tumors of the pelvis (sarcomas, lipomas)
28.
29. Sitting for a long period with legs
flexed and abducted (lotus
position) under the influence of
narcotics or barbiturates or lying
flat on a hard surface in a
sustained stupor may severely
injure one or both sciatic nerves or
branches thereof.
30. • Results in:-
• Weakness of hamstring muscles with loss of knee flexion.
• Distal foot and leg muscles are also affected.
• Sensory loss involves the outer aspect of the leg.
• The ankle reflex is absent.
31. Sciatica:-
• Sciatica refers to pain that radiates along the path of the sciatic nerve,
which branches from your lower back through your hips and buttocks
and down each leg.
• Typically, sciatica affects only one side of your body.
• Sciatica most commonly occurs when a herniated disk, bone spur on
the spine or narrowing of the spine (spinal stenosis) compresses part
of the nerve.
32.
33. • Symptoms:-
• Radiating pain down to leg
• Numbness
• Tingling sensation
• Weakness of muscle
• Treatment:-
• Anti-inflammatory drugs
• Narcotics
• Muscle relaxants
• Steroid injections
34. • 5)Common peroneal nerve(L4,L5,S1,S2):-
• The nerve arises from the division of the sciatic nerve in the popliteal
fossa. It bears a close relationship with the head of the fibula as it
winds anteriorly.
• Damaged by:-
• Trauma to the head of the fibula; pressure here from kneeling,
crossing legs.
• Systemic causes of mononeuropathy, e.g. diabetes
35. • Results in:-
• Weakness of dorsiflexion and eversion of the foot. The patient walks
with a ‘foot drop’.
• Sensory loss involves the dorsum and outer aspect of the foot.
• Partial common peroneal nerve palsies are common with very
selective muscle weakness.
36.
37. • 6) Posterior tibial nerve (L4,L5,S1,S2,S3):-
• This nerve also arises from the division of the sciatic nerve in the
popliteal fossa and descends behind the tibia, terminating in the
medial and lateral plantar nerves which innervate the small muscles
of the foot.
• The sensory branch contributes to the sural nerve.
38. • Damaged by:-
• Trauma in the popliteal fossa.
• Fracture of the tibia.
• Systemic causes of mononeuropathy.
• Results in:-
• Weakness of plantar flexion and inversion of the foot.
• The patient cannot stand on toes.
• Sensory loss involves the sole of the foot.
• The ankle reflex is lost.
39. • Tarsal tunnel syndrome:-
• The posterior tibial nerve may be entrapped below the medial
malleolus due to thickening of the tendon sheaths or the adjacent
connective tissues or by osteoarthritic changes.
• This produces a burning pain in the sole of the foot. Weakness of toe
flexion and atrophy of small muscles of the foot occur in advanced
cases.
• A prolonged sensory conduction velocity confirms the diagnosis.
• Surgical decompression is often required.
40.
41. • Plantar and small digital nerves:-
• Compression of these nerves at the sole of the foot produces
localised burning pain.
• Involvement of interdigital nerves produces pain and analgesia
in adjacent halves of neighbouring toes.