Painful arc syndrome
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This document discusses painfull arc syndrome, also known as impingement syndrome of the shoulder. It describes the history and evolution of understanding of this condition. Impingement syndrome occurs when the rotator cuff tendons are pinched between the head of the humerus and the acromion process during arm elevation. There are three main types of impingement: primary, secondary, and subcoracoid. Treatment involves conservative measures like medication and physical therapy initially but may require arthroscopic or open surgery like acromioplasty in resistant cases. Complications of acromioplasty can include infection, nerve injury, or loss of shoulder function.
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This document discusses painful arc syndrome, also known as impingement syndrome. It begins with a brief history, noting early descriptions in the 1800s and contributions in the 1970s by Neer, who characterized it as impingement of the rotator cuff tendons against the acromion. It then describes the four main types of impingement and their causes. Treatment options discussed include non-operative treatments like anti-inflammatories and physiotherapy, as well as surgical options like arthroscopic acromioplasty to remove bone and relieve impingement. Potential complications of surgery are also outlined.
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This document provides information on fractures of the radius and ulna shafts (forearm fractures). It discusses the epidemiology, anatomy, classification systems, clinical evaluation, imaging, and management including both closed and open reduction techniques. Surgical indications include displaced fractures of both bones, isolated fractures with over 10 degrees of angulation or rotation, and fracture dislocations. Acceptable postoperative alignment is discussed as well as postoperative care involving splinting and rehabilitation. Specific fracture patterns like Monteggia and Galeazzi fractures are also summarized.
maxillary sinus
The document provides information about the maxillary sinus, including its development, anatomy, blood and nerve supply, functions, diagnostic evaluation, developmental anomalies, and pathologic conditions. It discusses the maxillary sinus's development beginning in the 4th month of gestation. Anatomically, it is the largest paranasal sinus and has superior, inferior, lateral, medial, and anterior walls. Common pathologies include maxillary sinusitis, odontogenic cysts impacting the sinus, and tumors. Radiographic imaging plays an important role in evaluating sinus disease.
The ticking bomb in the abdomen diverticular disease
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fracture shaft of humerus2021
This document discusses the management of humerus shaft fractures. It begins with an introduction and anatomy section. It then covers the mechanisms of injury, examination findings, imaging, classification systems, and indications for conservative versus operative management. Conservative management techniques like slings and bracing are outlined. Surgical approaches, fixation options like plating and nailing, challenges, post-operative care, complications, and prognosis are reviewed. Key points are radial nerve palsy often recovers spontaneously and plate fixation achieves good results for most humerus shaft fractures.
Infection 2
This document discusses various orofacial infections and the fascial spaces they can involve. It begins with infections of the upper lip that can cause vestibular abscesses pointing towards the apex of the lateral incisor. Infections of the canine fossa from maxillary canine or premolar teeth cause swelling of the cheek and upper lip, obliteration of the nasolabial fold, and drooping of the angle of the mouth. Palatal and buccal space infections are also discussed. Cavernous sinus thrombophlebitis, a serious complication, is noted to potentially result from head and face infections above the maxilla. Treatment involves antibiotics, anticoagulants, and surgical
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ZMC FRACTURE / zygomatico maxillary complex fracture. fracture
This document discusses clinical features and treatment of zygomatic complex fractures. Key clinical features include pain, swelling, tenderness, step deformity, flattening of the malar prominence and zygomatic arch. Other features can include circumorbital edema, ecchymosis, soft tissue emphysema, parasthesia of the infraorbital nerve, retrobulbar hemorrhage, altered globe position, subconjunctival hemorrhage, and diplopia. Treatment involves either direct open reduction using approaches like the lateral eyebrow, subciliary, midway, or infraorbital incisions, or indirect reduction using upper buccal sulcus, Gillies temporal, or percutaneous approaches.
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Tripod fracture
A tripod fracture is a fracture of the zygomatic bone that involves three main points: the zygomatic arch, zygomaticofrontal suture, and inferior orbital rim and floor. It is caused by direct trauma and results in flattening of the malar prominence and step deformity of the infraorbital margin as the lower segment of the zygoma is pushed medially and posteriorly. Diagnosis is typically made through x-rays like a Waters' view or CT scan, and displaced fractures may require open reduction and internal wire fixation through approaches like the buccal sulcus.
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Wrist drop
The radial nerve innervates the extensor muscles of the forearm and hand. Damage to the radial nerve causes wrist drop where the patient is unable to extend the wrist and fingers, impairing grasping. Symptoms include pain, numbness, weakness of hand grip and drooping of the wrist and fingers. Diagnosis involves assessing range of motion, imaging tests and electrodiagnostic tests. Treatment depends on the underlying cause but may include medications, injections, bracing and physical therapy.
Tourniquets
Tourniquets are devices used to control blood flow to an extremity during surgery. Various types of tourniquets have been developed throughout history including the Esmarch bandage and modern pneumatic tourniquets. Proper tourniquet placement and pressure are important to minimize complications like nerve injury, muscle injury, and bleeding. Tourniquet time should be limited to 1.5-2 hours to avoid local and systemic effects. Complications can be further reduced by following precautions during tourniquet application and use.
Torticollis
Torticollis is a twisting of the neck that can have several causes. In newborns, it is often due to injuries during birth or fetal positioning, while in older children it may result from neck injuries, infections, or other conditions. The document discusses the main types and causes of torticollis, including congenital muscular torticollis in newborns, self-limiting torticollis, trauma, infections, tumors, and certain drugs. Ultrasound is often used to diagnose congenital cases in newborns, while CT and MRI are used to diagnose other causes like trauma, infections, or tumors in older children. Treatment depends on the underlying cause but may include stretching, physical therapy
Thoracic outlet syndrome
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the lower neck and upper chest - become compressed. This can cause pain and numbness in the shoulders and neck as well as reduced pulse. It is commonly caused by anatomical variations like cervical ribs or muscle abnormalities that reduce the space available to the neurovascular structures passing through. Diagnosis involves clinical tests like Adson's maneuver and imaging like MRI. Treatment ranges from physiotherapy and analgesics for mild cases to surgical removal of the first rib and scalene muscles for more severe or progressive cases.
Tennis elbow
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
Tendo achilles
The Achilles tendon connects the calf muscles to the heel bone and is active during walking, running, and jumping. It is vulnerable to rupture, which commonly occurs in the watershed area 2-6cm above the heel in males ages 25-50 during sports. Diagnosis involves physical exam findings like inability to raise the toes and a gap or defect being felt. Treatment options include immobilization in a cast or surgical repair, with the goal of restoring proper tension and length. Post-operative care focuses on protecting the repair during healing over 6 months using casts, braces, and physical therapy.
Surgical site infections
Surgical site infections occur when bacteria enter through an incision made during surgery. They are classified as superficial, deep, or organ/space infections. Common causative agents include Staphylococcus aureus and Streptococcus pneumoniae. Factors that increase risk include patient health issues like malnutrition or diabetes as well as surgical factors like poor technique, inadequate prophylactic antibiotics, or an unclean operating environment. Diagnosis involves clinical signs plus lab and imaging tests. Treatment consists of antibiotics, wound debridement, and drainage. Prevention strategies focus on proper patient preparation, strict sterile techniques in the operating room, and careful post-operative wound care.
Spinal cord tractography
Diffusion tensor imaging (DTI) and fiber tractography are MRI techniques that can be used together to non-invasively visualize spinal cord tracts. DTI measures the anisotropic diffusion of water in tissue to infer the orientation of white matter tracts. Fiber tractography then generates 3D reconstructions of the tracts. This technique provides information about spinal cord injuries or other pathologies. However, it faces challenges from motion artifacts and has limitations when tracts converge or cross or are non-homogeneous. Despite this, DTI tractography can be used to prognosticate outcomes from spinal cord deformities, injuries, tumors, or myelopathies. Two case studies are described, one with a C6 burst fracture
Spina ventosa
Spina ventosa is a form of tuberculous dactylitis that affects the short tubular bones of the hands and feet in children. It occurs secondary to tuberculosis infection and presents as swelling and tenderness of the affected bone. Investigations may show leukocytosis and elevated inflammatory markers. Chest x-rays and bone x-rays can identify periosteal reaction, lytic lesions, or sclerosis. Biopsy is needed to confirm the diagnosis. A case report described a 13-year-old girl with left index finger pain, weight loss, and loss of appetite who was found to have spina ventosa on biopsy along with a tuberculoma seen on brain MRI. She was started on antitub
Snapping hip syndrome
There are three main types of snapping hip: external, internal, and intra-articular. External snapping hip is caused by increased tension in the iliotibial band over the greater trochanter with repeated flexion and extension. Internal snapping hip involves snapping of the iliopsoas tendon over the femoral head. Intra-articular snapping hip is caused by labral tears or loose bodies in the hip joint. Conservative treatments include rest, stretching, strengthening, and therapies like cold compression, while operative options involve procedures like Z-plasty of the iliotibial band or arthroscopic surgery to address intra-articular issues.
Scurvy
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- Symptoms include bleeding gums, loose teeth, bruising of the skin, and bone fractures. In infants, scurvy can cause pseudoparalysis and swelling over bones from subperiosteal hemorrhaging.
- Diagnosis is based on low vitamin C blood levels and x-ray findings of bone changes like the white line of Fraenkel. Treatment involves vitamin C supplementation in doses of at least 200mg daily until recovery is complete.
Screws in orthopedics
This document provides an overview of screws in orthopedic surgery. It discusses the history of screw development from ancient times through modern innovations in materials. The anatomy of a screw is described in detail, including the head, shaft, thread, tip, and special features like pitch, diameter, and cannulation. Different types of screws are compared based on their properties and intended uses in cortical versus cancellous bone. Special screw designs like Herbert screws, lag screws, and dynamic hip screws are also briefly mentioned.
Sacral chordoma
Sacral chordoma is a rare, slowly growing malignant tumor that arises from remnants of the notochord, usually occurring in the sacrum. It accounts for 1-4% of all malignancies and is the most common primary malignancy of the sacrum. Patients typically experience lower back pain worsening with sitting in their 5th-7th decade. Imaging shows a destructive lytic lesion in the sacrum. Complete surgical resection is the primary treatment, but recurrence is common due to the locally aggressive nature, leading to poor long-term survival rates.
Robotics in orthopedics
This document discusses the use of robots in orthopaedic surgery. It describes how robotic systems can improve accuracy of bone cuts and component placement compared to manual surgery. Both autonomous and haptic robotic systems are presented. Applications discussed include unicondylar knee replacement using the Mako robotic arm and spinal pedicle screw placement using the Renaissance system. While robotic surgery may provide benefits like increased accuracy, it also has drawbacks such as high costs and long-term outcomes have not proven superiority over manual techniques.
Reverse shoulder arthroplasty
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
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Painful arc syndrome
- 2. • 1867 FIRSTJARJA V A Y’S DESCRIBED AS SUBACROMIAL BURSITIS • 1931 CODMAN NOTED THAT PATIENTS WITH INABILITY TO ABDUCT THE ARM HAD INCOMPLETE OR COMPLETE RUPTURES OF THE SUPRASPINATUS TENDON
- 3. • LATER NEER INTRODUCED IMPINGEMENT SYNDROME THE SUPRASPINITUS INSERTION INTO GREATER TUBIROSITY THAT PASSS BENEATH THE CORACOACROMIAL ARCH DURING FORWARD FLEXION OF SHOULDER IS SUSCEPTIBLE TO IMPINGEMENT.
- 4. • NEER IMPINGEMENT SIGN WITH THE PATIENT SEATED, THE EXAMINER RAISES THE AFFECTED ARM IN FORCED FORWARD ELEVATION WHILE STABILIZING THE SCAPULA, CAUSING THE GREATER TUBEROSITY TO IMPINGE AGAINST THE ACROMION. • NEER IMPINGEMENT TEST SUBACROMIAL INJECTION OF 10 ML OF 1% XYLOCAINE. PAIN CAUSED BY IMPINGEMENT USUALLY IS SIGNIFICANTLY REDUCED OR ELIMINATED, BUT PAIN CAUSED BY OTHER CONDITIONS (WITH THE EXCEPTION PERHAPS OF CALCIFIC TENDINITIS) IS NOT RELIEVED
- 6. • Acromial morphology has been implicated as contributing to impingement.
- 8. THERE ARE THREE TYPES • PRIMARY IMPINGEMENT • SECONDARY IMPINGEMENT • SUBCOROCHOID IMPINGEMENT
- 9. • PRIMARY IT IS CLASSIC VERSION AND OCCURS WITHOUT ANY OTHER CONTRIBUTING PATHOLOGY DIVIDED INTO INTRINSIC EXTRINSIC
- 10. • INTRINSIC STRUCTURES PASSING BENEATH THE CORACOACROMIAL ARCH BECOME ENLARGED RESULTING IN ABUTMENT AGAINST THE ARCH THICKINING OF ROTATOR CUFF CALCIUMDEPOSITSWITHInROTATOR CUFF THICKENING OF SUBACROMIAL BURSA
- 11. • EXTRINSIC WHEN THE SPACE AVAILABLE FOR THE ROTATOR CUFF IS DIMINISHED SUBACROMIAL SPURRING ACROMIAL FRACTURE OSTEOPHYTESOfACROMIOCLAVICULAR JOINT EXOSTOSES OF GREATER TUBEROSITY
- 12. • SECONDARY IT OCCURS WEN THERE IS INSTABILITY OF THE GLENOHUMERAL JOINT ALLOWING TRANSLATION OF HUMERAL HEAD TYPICALLY ANTERIORLY RESULTING IN CONTACT OF ROTATORY CUFF AGAINST CORACOACROMIAL ARCH
- 13. SUBCORACOID IMPINGEMENT PAIN CAUSED BY CONTACT BETWEEN THE ROTATOR CUFF AND THE CORACOID PROCESS MAINLY DUE TO PROMINENT CORACOID WHICH MAY BE IDIOPATHIC (MOST COMMON)
- 14. DIFFERENTIAL DIAGNOSIS • ACROMIOCLAVICULAR ARTHRITIS • GLENOHUMERAL ARTHRITIS • SHOULDER INSTABILITY IN THROWING ATHLETES • ADHESIVE CAPSULITIS • FIBROMYALGIA • CERVICAL SPONDYLOSIS • SUPRASCAPULAR NERVE INJURY
- 15. TREATMENT •NON OPERATIVE REGIMEN ANTIINFLAMMATORY MEDICATION ½ SUBACROMIAL CORTISONE INJECTION PHYSIOTHERAPY ON STRENGTHNING THE ROTATORY CUFF & FULL RANGE OF MOVEMENTS
- 17. • COMPLICATIONS AFTER ACROMIOPLASTY INCLUDE, BUT ARE NOT LIMITED TO, INFECTION, SEROMA FORMATION, HEMATOMA, SYNOVIAL FISTULA, BICEPS RUPTURE, PULMONARY EMBOLUS, ACROMIAL FRACTURE, AND COMPLEX REGIONAL PAIN SYNDROME. POOR PATIENT MOTIVATION, POOR REHABILITATION COMPLIANCE, OR A POORLY DESIGNED REHABILITATION PROGRAM ALSO CAN LEAD TO FAILURE BECAUSE OF CONTINUED PAIN AND STIFFNESS. • WITHOUT QUESTION, THE WORST COMMON COMPLICATION IS LOSS OF ANTERIOR DELTOID FUNCTION, WHICH IS CAUSED BY EITHER AXILLARY NERVE INJURY OR DETACHMENT OF THE DELTOID FROM THE ACROMION
- 18. THANK YOU