Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
The menisci are crescents, roughly triangular in cross section, that cover one half to two thirds of the articular surface of the corresponding tibial plateau. They are composed of dense, tightly woven collagen fibers arranged in a pattern providing great elasticity and ability to withstand compression.
Meniscus surgery is either to repair meniscus or to ressect it.
Earlier menissectomy was the regular surgery done by arhroscopic surgeon for meniscus injury,but now meniscus repair is on increasing trends in the arthroscopic surgeon for meniscus injury.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
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A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
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It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
4. Superior view of tibial condyles after
removal of femur
MENISCI
MM
LM
5. • During flexion-extension movts- Prevent capsular & synovial
impingement
• Joint lubrication fn, helping to distribute synovial fluid throughout
the joint & aiding nutrition of articular cartilage
• Contribute to stability in all planes but are especially important rotary
stabilizers
11. • Miller, Warner, and Harner categorized meniscal tears according to
their location in three zones of vascularity
12. MENISCAL TEAR
• Mech - by a rotational force incurred while the joint is partially flexed.
• Medial meniscus, being far less mobile on the tibia, can become
impaled b/n the condyles & injury can result.
• M/C location for injury - posterior horn of meniscus
• M/C type of injury - longitudinal tears.
• Length, depth & position of tear depends on posterior horn position
in relation to femoral & tibial condyles at the T.O.I.
13. Classification
- based on the type of tear found at surgery.
(1) longitudinal tears (M/C)
(2) transverse and oblique tears,
(3) a combination of longitudinal and transverse tears,
(4) tears associated with cystic menisci, and
(5) tears associated with discoid menisci.
14. O’Connor classification
(1) longitudinal tears;
(2) horizontal tears;
(3) oblique tears;
(4) radial tears and
(5) variations, which include
flap tears, complex tears, and degenerative meniscal tears.
19. • Locking usually occurs with longitudinal tears and is much more
common with bucket-handle tears, usually of the medial meniscus.
• A sensation of “giving way” or snaps, clicks, catches in the knee may
be described
Or
• the history may be even more indefinite, with recurrent episodes of
pain & mild effusion in the knee and tenderness in the anterior joint
space after excessive activity.
30. NON OP -
• An incomplete meniscal tear or a small (5 mm) stable peripheral tear
with no other pathologic condition, such as a torn anterior cruciate
ligament, can be treated nonoperatively with predictably good
results.
• Many incomplete tears will not progress to complete tears if the knee
is stable.
• Small stable peripheral tears have been observed to heal after 3 to 6
weeks of protection.
33. MENISCAL AUTOGRAFTS & ALLOGRAFTS
• ALLOGRAFTS are preserved in one of four ways:
• fresh,
• fresh frozen (deepfreezing),
• freeze-dried (lyophilization), &
• cryopreserved.
• Of these four methods, only cryopreservation has been shown to
reproducibly maintain a substantially viable cell population (10% to
40%)
• Ideal candidate is a patient younger than 40 years with an absent or
nonfunctioning meniscus
35. • Partial meniscectomy is always preferable to subtotal or total
meniscectomy.
• Leaving an intact, balanced, peripheral rim of meniscus aids in the
stability of the joint and protects the articular surfaces by its load-
bearing functions.
46. All-inside repair techniques have been simplified by the development
of suture fixators, which have pre-tied knots.
These devices provide secure fixation and decrease the potential for
chondral injury present in earlier devices.
joint filler,b/n femoral & tibial articulating surfaces
.mm- c shaped, larger diameter, thinner periphery, Post horn wider than ant horn
Lm- more circular, smal dia, more mobile; more mobile than mm Post horn receive anchorage to femur by lig of wrisberg & humbrey[AMFL] & from fascia covering popliteus, arcuate complex at post.lat corner of knee
mmis firmly attached to tibial collateral ligament. In contrast, the lm is not attached
to the FCL
collagen fibers arranged in a pattern providing great elasticity and ability to withstand compression.
TENSILE STRENGTH
Cross section of meniscus showing horizontal cleavage split.
Perforating
compression of the menisci by tibia & femur generates outward forces that push the menisci out from between the bones. The circumferential tension in the menisci counteracts this outward or radial force. These hoop forces are transmitted to the tibia through the strong anterior and posterior attachments of the menisci. Hoop tension is lost when a single radial cut or tear extends to the capsular margin;
vascular supply to the medial and lateral menisci originates predominantly from lateral & medial geniculate vessels (both inferior and superior). Branches from these vessels give rise to a perimeniscal capillary plexus within the synovial and capsular tissue
Branching radial vessels from perimeniscal capillary plexus (PCP) can be seen penetrating peripheral border of medial meniscus. F, Femur; T, tibia. Three zones of meniscal vascularity are shown: 1 RR, red-red is fully within vascular area; 2 RW, red-white is at border of vascular area; and 3 WW, white-white is within avascular area.
Good healing in RR zone
tears of the medial meniscus in were approximately five to seven times more common than LM
Meniscial cyst are freq. asso. with tears & are 9 times more common on lateral than on medial side.
: incomplete radial tear part of width of meniscus (A);
complete radial tear extends to periphery (B); and
incomplete tear extending posteriorly or anteriorly is called “parrot beak” tear (C)
f posterior oblique (A) and anterior oblique (B) tears.
). Most anterior zone of medial meniscus is labeled C, whereas most anterior zone of lateral meniscus is labeled D.
0 is meniscosynovial junction; I is outer third, II is middle third, and III is inner third of each meniscus.
Classification of meniscal root tears based on tear morphology: partial stable root tear (type 1), complete radial tear within 9 mm from the bony root attachment (type 2), bucket-handle tear with complete root detachment (type 3), complex oblique or longitudinal tear with complete root detachment (type 4), and bony avulsion fracture of the root attachment (type 5)
Knee – full extension , femur slightly rotates on tibia to lock the knee jt in place
Popliteus –key to unlocking knee as it begins knee flexion by laterally rotating femur on tibia
supine MM ER + VALGUS,,LM – IR + VARUS
knee acutely & forcibly flexed
medial meniscus - palpating posteromedial margin of jt one hand while grasping the foot with other hand.
Keeping knee completely flexed, leg is ERknee is slowly extended.
As the femur passes over a tear in the meniscus, a click may be heard or felt.
A click produced by the McMurray test usually is caused by a posterior peripheral tear of the meniscus and occurs between complete flexion of the knee and 90 degrees. Popping, which occurs with greater degrees of extension when it is definitely localized to the joint line, suggests a tear of the middle and anterior portions of the meniscus. The position of the knee when the click occurs thus may help locate the lesion.
With the patient prone, the knee is flexed to 90 degrees and the anterior thigh is fixed against the examining table. The foot and leg are then pulled upward to distract the joint and rotated to place rotational strain on the ligaments (Fig. 45-40A); when ligaments have been torn, this part of the test usually is painful. Next, with the knee in the same position, the foot and leg are pressed downward and rotated as the joint is slowly flexed and extended (Fig. 45-40B); when a meniscus has been torn, popping and pain localized to the joint line may be noted
Examiner – holds pt outstretched hands while pt stands flatfooted on floor. Pt rotates knee & body, internally & externally, 3 times with knee in slight flexion (20 degrees). The same procedure is carried out with the knee flexed 20 degrees
Compared with arthroscopy, MRI has been shown to have 98% accuracy for medial meniscal tears and 90% for lateral meniscal tears. Others have reported that MRI had a positive predictive value of 75%, a negative predictive value of 90%, a sensitivity of 83%, and a specificity of 84% for pathological changes in the menisci.
knee immobilizer worn for 4 to 6 weeks- a progressive isometric exercise program- m/s around Knee & hip
At 4 to 6 weeks, the immobilization is discontinued and the rehabilitative exercise program for the muscles around the hip and knee is intensified
Systematically examine knee arthroscopically to rule out pathologic conditions KF – 60
vertical posteromedial arthrotomy incision from medial femoral epicondylar distally towards semimembranosus tendon in line with the fibers of posterior oblique ligament.
retract the posterior capsul
Debride tear edges
■ Place interrupted sutures of Mersilene or other nonabsorbable surgical suture material every 3 to 4 mm. Beginning outside the posterior capsule, pass the sutures through the capsule, then vertically from inferior to superior through the meniscus, and then back out through the capsule, but do not tie them
posterior horn of the lateral meniscus is exposed through a posterolateral capsular incision above the popliteal tendon, coursing of the popliteal tendon through a hiatus in the periphery of the lateral meniscus adds to the difficulty
. skeletally mature but too young for total knee arthroplasty and have significant knee pain and limited function. All other options for medical management of pain, including a thorough trial of conservative therapy and bracing techniques, should be exhausted. The cause of meniscal damage must be mechanical, not degenerative,
Contraindications include knee instability
depending on the amount of meniscal tissue to be removed
partial meniscectomy (A); subtotal meniscectomy (B); and total meniscectomy (C).
PM- only the loose, unstable meniscal fragments are excised
ST- excision of a portion of the peripheral rim of the meniscus. This is most commonly required in complex or degenerative tears of the posterior horn of either meniscus.
Displaced bucket-handle tear of lateral meniscus probed. B, After reduction of displaced bucket-handle tear, posterior attachment is partially released with scissors. C, Anterior attachment is released with scissors. D, Tenuous remaining posterior attachment is avulsed with grasper and extracted
Technique for longitudinal incomplete intrameniscal tears. A, Probing longitudinal intrameniscal incomplete inferior surface tear. B, Fragment is removed bit by bit with basket forceps. C, Rim is smoothed and contoured with motorized trimmer
. A, With radial tear. B, With longitudinal tear. C, With flap tear.
Radial tears can be divided into partial and complete. A partial-depth tear of the meniscus is treated with saucerization, balancing, and contouring of the edges
TREATMENT OF PARTIAL DEPTH MENISCAL TEARS
Discoid meniscus is an uncommon meniscal anomaly that occurs more frequently l
Type I • Complete Type II • Incomplete
subtotal meniscectomy or a so-called saucerization of the mobile fragment. Type III • Wrisberg (lack of posterior meniscotibial attachment to tibia lacks an adequate posterior tibial attachment, the treatment generally is total meniscectomy, either open or arthroscopic.
Anterior portion of discoid lateral meniscus is removed with rotary basket forceps. B, Further contouring of anterior rim with 90-degree rotary basket forceps. C, Posterior discoid fragment is removed with basket forceps.
T2- associated oblique tear (small white arrow) in the body of the lateral meniscus.
Cysts of LM-3 to 10 time cmon than mm
Cyst can occur following trauma or degenerative c hanges
ARTHROSCOPIC PARTIAL MENISCECTOMY AND DECOMPRESSION OF MENISCAL CYST
A and B, Excision of tears associated with meniscal cysts (see text). C, Decompression of meniscal cyst with basketpunch forceps.
Inside out - Pass the needle through the cannula to enter the meni
