A number of periarticular disorders have become increasingly common over the past two to three decades, due in part to greater participation in recreational sports by individuals of a wide range of ages. Periarticular disorders most commonly affect the knee or shoulder. With the exception of bursitis, hip pain is most often articular or is being referred from disease affecting another structure.
This document provides an overview of common injuries around the knee joint. It describes the anatomy of the knee including bones and ligaments. Common mechanisms of injury are discussed for fractures around the knee like condylar fractures of the femur, patella fractures, and tibial plateau fractures. Injuries to the ligaments including ACL, PCL, MCL and LCL are also summarized. Treatment approaches for many of these injuries including nonsurgical and surgical options are highlighted. Other topics covered include meniscal injuries, knee dislocations, and patella dislocations. Complications of various knee injuries are also mentioned.
Hemophilia is an X-linked bleeding disorder caused by deficiencies in clotting factors VIII or IX. Repeated bleeding into joints from hemophilia can lead to hemophilic arthropathy, progressing through acute, subacute, and chronic stages. In the chronic stage, joints like the knee and ankle develop deformities, restricted range of motion, and bone/cartilage damage visible on imaging. Treatment involves factor replacement for bleeds, physiotherapy, bracing, and occasionally surgery. Managing exercise and range of motion is important for joint health in hemophilia patients.
This document provides an overview of humerus shaft fractures, including:
- Epidemiology showing they are most common in young males from high-energy trauma and elderly females from low-energy mechanisms.
- Classification systems including the AO classification system.
- Treatment options of non-operative management with splinting or bracing for most fractures, and operative options including plating or intramedullary nailing for displaced or unstable fractures.
- Surgical approaches and techniques for plating and nailing are also described.
This document provides information on tibial plateau fractures, including:
- The tibial plateau is the proximal end of the tibia including the articular surfaces.
- Tibial plateau fractures most often involve the lateral plateau and are commonly associated with soft tissue injuries.
- Surgical treatment aims to restore the joint surface and provide stability to allow early mobilization.
- Surgical approaches include anterolateral, posteromedial, and anterior. Fixation methods include plates, screws, and external fixators.
- Arthroscopic techniques are increasingly used to directly visualize and treat the articular surface with minimal soft tissue disruption.
Foot drop is the inability to lift the front part of the foot. It can be caused by injuries or conditions that damage the common peroneal nerve. Symptoms include difficulty lifting the foot and dragging the toes. Treatment depends on the underlying cause but may include bracing, nerve stimulation, tendon transfers, or joint fusions. The goal is to improve mobility and gait.
This document discusses various types of non-inflammatory arthritis including osteoarthritis, neuropathic arthritis, acute rheumatic fever, and ochronosis. It focuses on osteoarthritis, describing it as a non-inflammatory degenerative joint disease characterized by cartilage loss, new bone formation, and fibrosis. Symptoms include pain, swelling, stiffness and deformity. X-ray findings include joint space narrowing, sclerosis, and osteophyte formation. Treatment involves protecting joints, exercises, analgesics, and occasionally surgery such as arthroscopy or joint replacement. Neuropathic arthritis and other types are also briefly summarized.
This document provides an overview of common injuries around the knee joint. It describes the anatomy of the knee including bones and ligaments. Common mechanisms of injury are discussed for fractures around the knee like condylar fractures of the femur, patella fractures, and tibial plateau fractures. Injuries to the ligaments including ACL, PCL, MCL and LCL are also summarized. Treatment approaches for many of these injuries including nonsurgical and surgical options are highlighted. Other topics covered include meniscal injuries, knee dislocations, and patella dislocations. Complications of various knee injuries are also mentioned.
Hemophilia is an X-linked bleeding disorder caused by deficiencies in clotting factors VIII or IX. Repeated bleeding into joints from hemophilia can lead to hemophilic arthropathy, progressing through acute, subacute, and chronic stages. In the chronic stage, joints like the knee and ankle develop deformities, restricted range of motion, and bone/cartilage damage visible on imaging. Treatment involves factor replacement for bleeds, physiotherapy, bracing, and occasionally surgery. Managing exercise and range of motion is important for joint health in hemophilia patients.
This document provides an overview of humerus shaft fractures, including:
- Epidemiology showing they are most common in young males from high-energy trauma and elderly females from low-energy mechanisms.
- Classification systems including the AO classification system.
- Treatment options of non-operative management with splinting or bracing for most fractures, and operative options including plating or intramedullary nailing for displaced or unstable fractures.
- Surgical approaches and techniques for plating and nailing are also described.
This document provides information on tibial plateau fractures, including:
- The tibial plateau is the proximal end of the tibia including the articular surfaces.
- Tibial plateau fractures most often involve the lateral plateau and are commonly associated with soft tissue injuries.
- Surgical treatment aims to restore the joint surface and provide stability to allow early mobilization.
- Surgical approaches include anterolateral, posteromedial, and anterior. Fixation methods include plates, screws, and external fixators.
- Arthroscopic techniques are increasingly used to directly visualize and treat the articular surface with minimal soft tissue disruption.
Foot drop is the inability to lift the front part of the foot. It can be caused by injuries or conditions that damage the common peroneal nerve. Symptoms include difficulty lifting the foot and dragging the toes. Treatment depends on the underlying cause but may include bracing, nerve stimulation, tendon transfers, or joint fusions. The goal is to improve mobility and gait.
This document discusses various types of non-inflammatory arthritis including osteoarthritis, neuropathic arthritis, acute rheumatic fever, and ochronosis. It focuses on osteoarthritis, describing it as a non-inflammatory degenerative joint disease characterized by cartilage loss, new bone formation, and fibrosis. Symptoms include pain, swelling, stiffness and deformity. X-ray findings include joint space narrowing, sclerosis, and osteophyte formation. Treatment involves protecting joints, exercises, analgesics, and occasionally surgery such as arthroscopy or joint replacement. Neuropathic arthritis and other types are also briefly summarized.
Gout is a chronic disorder of urate metabolism that causes recurrent attacks of inflammatory arthritis. It is most common in men over 40 years of age. Risk factors include purine-rich foods, alcohol, caffeine, trauma, and certain genetic mutations. An acute gout attack causes sudden severe pain, swelling, and tenderness in joints like the toe. Chronic gout results in deposits of urate crystals that form chalk-like tophi under the skin. Treatment involves medications to prevent attacks like NSAIDs, colchicine, allopurinol, and febuxostat or uricosurics. Surgery may be needed in advanced cases with joint destruction.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints and causes pain, stiffness, and swelling. It impacts around 1% of the adult population worldwide. While conventional disease-modifying antirheumatic drugs (DMARDs) like methotrexate are usually the first line of treatment, biological DMARDs or biologics targeting molecules like tumor necrosis factor (TNF) are used for cases that are resistant to conventional DMARDs. Biologics have revolutionized RA treatment by providing rapid relief and preventing long-term joint damage. The monoclonal antibody rituximab depletes B cells and is effective for RA by reducing inflammation and rheumatoid factor levels. It is administered as two 1000 mg intravenous
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Fractures of the upper extremity are described, including the clavicle, scapula, humerus, radius, ulna, carpals and metacarpals. Treatment depends on the specific bone and location of the fracture. Most common fractures like clavicle and humerus can be treated conservatively with slings or plates/screws for displaced fractures. More complex fractures involving joints often require open reduction and internal fixation to restore anatomy. Complications include nonunion, malunion, nerve palsies and joint stiffness.
The document discusses various deposition arthropathies including gout, calcium pyrophosphate crystal associated arthropathy, and basic calcium phosphate crystal deposition disease. It describes the pathogenesis, risk factors, clinical features, investigations, and treatment of these conditions. Gout is caused by deposition of monosodium urate crystals and is associated with hyperuricemia. It commonly affects the first metatarsophalangeal joint. Calcium pyrophosphate crystal deposition can cause acute arthritis, be seen in osteoarthritis, or cause chronic inflammatory arthritis. Basic calcium phosphate deposition is usually asymptomatic but can cause acute or chronic destructive arthritis, most commonly in the shoulder.
Tarsal tunnel syndrome involves compression of the tibial nerve as it passes beneath the flexor retinaculum in the ankle. It causes pain, numbness and tingling in the foot. Non-surgical treatments include orthotics, stretching, weight loss and activity modification. Surgery to release the flexor retinaculum may be considered if non-surgical options fail. Anterior tarsal tunnel syndrome is a similar condition affecting the deep peroneal nerve. Risk factors include ankle injuries and activities that put repetitive stress on the ankle.
Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
The document discusses the anatomy and examination of the elbow joint. It describes the elbow as a compound synovial joint made up of three joints: the ulnohumeral joint, radiohumeral joint, and superior radio ulnar joint. It provides details on the ligaments, muscles, movements, and common conditions that can be examined at the elbow. Specific tests for conditions like tennis elbow and golfer's elbow are also outlined.
Cubitus varus, or gunstock deformity, is caused by malunion of supracondylar fractures and results in the forearm being deviated inward at the elbow with loss of the carrying angle. It is a triplanar deformity involving varus, hyperextension, and internal rotation. Treatment options include observation for young children, hemiepiphysiodesis to alter growth, and corrective osteotomy. The lateral closing wedge osteotomy is commonly used to safely correct the varus deformity through removal of a lateral wedge. Other techniques include medial opening wedge, oblique, dome, and step-cut osteotomies. Postoperative management focuses on immobilizing the arm in extension
Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
Examination of case of long bone nonunion lldFadzlina Zabri
This document discusses the examination of patients presenting with long bone nonunions or limb length discrepancies. It outlines the key components of history taking including chief complaints, history of presenting illness, and relevant medical history. The physical examination is described in detail, including inspection of the bone and surrounding soft tissues, palpation of the bone focusing on sites of tenderness, irregularity and mobility, assessment of range of motion, measurements, and deformity. Relevant investigations including laboratory tests, x-rays and potential special investigations like MRI are also mentioned. The document provides guidance on documenting anatomical location of involvement and pathological diagnosis.
This document discusses shoulder dislocations, including the types, risk factors, signs and symptoms, treatment, and prognosis. It defines a shoulder dislocation as the separation of the humeral head from the scapula. The most common type is an anterior dislocation, accounting for 95% of cases. Risk factors include age and previous trauma. Signs and symptoms include loss of normal shoulder contour, pain, and decreased range of motion. Treatment involves reduction, immobilization, and physical therapy, while prognosis depends on age, with younger patients having a higher risk of recurrence.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
1) Fractures of the humeral shaft can result from a fall on an outstretched hand or direct blow to the arm.
2) Treatment involves either hanging casts or surgery depending on the severity of the fracture and any complications.
3) Complications can include injury to the radial nerve and non-union of the bone fragments, so careful assessment of nerve function is important both before and after treatment.
Thomas Test is used to evaluate hip flexion contracture and psoas syndrome (Iliopsoas Tightness), which is more common in runners, dancers, and gymnasts with symptoms of hip “stiffness” and “clicking” feeling when flexing at the waist.
Thomas Test is used to evaluate hip flexion contracture and psoas syndrome (Iliopsoas Tightness), which is more common in runners, dancers, and gymnasts with symptoms of hip “stiffness” and “clicking” feeling when flexing at the waist.
This document discusses various peri-articular disorders including crystal deposition diseases like gout and pseudogout. It defines these conditions, describes their signs and symptoms, risk factors, diagnosis, and treatment options. It also covers non-crystal peri-articular disorders like bursitis, tendinitis, and rotator cuff injuries of the shoulder, explaining their causes, presentations, and management approaches.
The document provides information on performing a differential diagnosis examination for the hip. It discusses evaluating the hip for common conditions like osteoarthritis, fractures, bursitis, labral tears, and referred pain from the low back. Physical examination tests are outlined to help determine the likely cause of hip pain, including assessing range of motion, special tests, and risk factors. The goal is to systematically examine the hip to form an evidence-based diagnosis and guide appropriate treatment.
Gout is a chronic disorder of urate metabolism that causes recurrent attacks of inflammatory arthritis. It is most common in men over 40 years of age. Risk factors include purine-rich foods, alcohol, caffeine, trauma, and certain genetic mutations. An acute gout attack causes sudden severe pain, swelling, and tenderness in joints like the toe. Chronic gout results in deposits of urate crystals that form chalk-like tophi under the skin. Treatment involves medications to prevent attacks like NSAIDs, colchicine, allopurinol, and febuxostat or uricosurics. Surgery may be needed in advanced cases with joint destruction.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints and causes pain, stiffness, and swelling. It impacts around 1% of the adult population worldwide. While conventional disease-modifying antirheumatic drugs (DMARDs) like methotrexate are usually the first line of treatment, biological DMARDs or biologics targeting molecules like tumor necrosis factor (TNF) are used for cases that are resistant to conventional DMARDs. Biologics have revolutionized RA treatment by providing rapid relief and preventing long-term joint damage. The monoclonal antibody rituximab depletes B cells and is effective for RA by reducing inflammation and rheumatoid factor levels. It is administered as two 1000 mg intravenous
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Fractures of the upper extremity are described, including the clavicle, scapula, humerus, radius, ulna, carpals and metacarpals. Treatment depends on the specific bone and location of the fracture. Most common fractures like clavicle and humerus can be treated conservatively with slings or plates/screws for displaced fractures. More complex fractures involving joints often require open reduction and internal fixation to restore anatomy. Complications include nonunion, malunion, nerve palsies and joint stiffness.
The document discusses various deposition arthropathies including gout, calcium pyrophosphate crystal associated arthropathy, and basic calcium phosphate crystal deposition disease. It describes the pathogenesis, risk factors, clinical features, investigations, and treatment of these conditions. Gout is caused by deposition of monosodium urate crystals and is associated with hyperuricemia. It commonly affects the first metatarsophalangeal joint. Calcium pyrophosphate crystal deposition can cause acute arthritis, be seen in osteoarthritis, or cause chronic inflammatory arthritis. Basic calcium phosphate deposition is usually asymptomatic but can cause acute or chronic destructive arthritis, most commonly in the shoulder.
Tarsal tunnel syndrome involves compression of the tibial nerve as it passes beneath the flexor retinaculum in the ankle. It causes pain, numbness and tingling in the foot. Non-surgical treatments include orthotics, stretching, weight loss and activity modification. Surgery to release the flexor retinaculum may be considered if non-surgical options fail. Anterior tarsal tunnel syndrome is a similar condition affecting the deep peroneal nerve. Risk factors include ankle injuries and activities that put repetitive stress on the ankle.
Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
The document discusses the anatomy and examination of the elbow joint. It describes the elbow as a compound synovial joint made up of three joints: the ulnohumeral joint, radiohumeral joint, and superior radio ulnar joint. It provides details on the ligaments, muscles, movements, and common conditions that can be examined at the elbow. Specific tests for conditions like tennis elbow and golfer's elbow are also outlined.
Cubitus varus, or gunstock deformity, is caused by malunion of supracondylar fractures and results in the forearm being deviated inward at the elbow with loss of the carrying angle. It is a triplanar deformity involving varus, hyperextension, and internal rotation. Treatment options include observation for young children, hemiepiphysiodesis to alter growth, and corrective osteotomy. The lateral closing wedge osteotomy is commonly used to safely correct the varus deformity through removal of a lateral wedge. Other techniques include medial opening wedge, oblique, dome, and step-cut osteotomies. Postoperative management focuses on immobilizing the arm in extension
Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
Examination of case of long bone nonunion lldFadzlina Zabri
This document discusses the examination of patients presenting with long bone nonunions or limb length discrepancies. It outlines the key components of history taking including chief complaints, history of presenting illness, and relevant medical history. The physical examination is described in detail, including inspection of the bone and surrounding soft tissues, palpation of the bone focusing on sites of tenderness, irregularity and mobility, assessment of range of motion, measurements, and deformity. Relevant investigations including laboratory tests, x-rays and potential special investigations like MRI are also mentioned. The document provides guidance on documenting anatomical location of involvement and pathological diagnosis.
This document discusses shoulder dislocations, including the types, risk factors, signs and symptoms, treatment, and prognosis. It defines a shoulder dislocation as the separation of the humeral head from the scapula. The most common type is an anterior dislocation, accounting for 95% of cases. Risk factors include age and previous trauma. Signs and symptoms include loss of normal shoulder contour, pain, and decreased range of motion. Treatment involves reduction, immobilization, and physical therapy, while prognosis depends on age, with younger patients having a higher risk of recurrence.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
1) Fractures of the humeral shaft can result from a fall on an outstretched hand or direct blow to the arm.
2) Treatment involves either hanging casts or surgery depending on the severity of the fracture and any complications.
3) Complications can include injury to the radial nerve and non-union of the bone fragments, so careful assessment of nerve function is important both before and after treatment.
Thomas Test is used to evaluate hip flexion contracture and psoas syndrome (Iliopsoas Tightness), which is more common in runners, dancers, and gymnasts with symptoms of hip “stiffness” and “clicking” feeling when flexing at the waist.
Thomas Test is used to evaluate hip flexion contracture and psoas syndrome (Iliopsoas Tightness), which is more common in runners, dancers, and gymnasts with symptoms of hip “stiffness” and “clicking” feeling when flexing at the waist.
This document discusses various peri-articular disorders including crystal deposition diseases like gout and pseudogout. It defines these conditions, describes their signs and symptoms, risk factors, diagnosis, and treatment options. It also covers non-crystal peri-articular disorders like bursitis, tendinitis, and rotator cuff injuries of the shoulder, explaining their causes, presentations, and management approaches.
The document provides information on performing a differential diagnosis examination for the hip. It discusses evaluating the hip for common conditions like osteoarthritis, fractures, bursitis, labral tears, and referred pain from the low back. Physical examination tests are outlined to help determine the likely cause of hip pain, including assessing range of motion, special tests, and risk factors. The goal is to systematically examine the hip to form an evidence-based diagnosis and guide appropriate treatment.
Sacrum is an IT services company headquartered in California that provides managed services for enterprise business transformation. They have over four years of experience delivering IT services, business transformation services, and software projects. Their services include application development and management, infrastructure management, consulting services, and more. They take an end-to-end approach and leverage offshore resources to deliver cost-effective solutions while ensuring quality and flexibility for customers.
This document provides an overview of the biomechanics of the sacroiliac (SI) joints. It discusses the osteology, articulating surfaces, ligaments, blood supply, nerve supply, factors promoting stability, kinematics, and functional considerations of the SI joints. It also covers clinical anatomy and causes of SI joint dysfunction. Key points include that the SI joints are plane synovial joints that connect the sacrum to the iliac bones and allow for slight rotational motion. Stability is provided by the interlocking articular surfaces and strong ligaments. During activities like walking and childbirth, the joints undergo nutation and counternutation movements.
VIMG's Condition of the Week - Ilio-Tibial Band Syndrome.
Learn more about ilio-tibial band syndrome including ideas for treatment and prevention.
www.markjpitcher.com
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1. Slipped capital femoral epiphysis (SCFE) is a slippage of the femoral head through the growth plate that commonly occurs in obese adolescent males.
2. Traumatic hip dislocation can occur from direct trauma and results in the femoral head being displaced from the acetabulum, causing pain and inability to walk. Posterior dislocations are most common.
3. Osteoarthritis is a degenerative joint disease involving cartilage breakdown and new bone formation. It commonly affects the hip in older adults and results in pain and stiffness that can be relieved by medications or treated with hip replacement surgery.
Iliotibial Band Syndrome (ITBS) is an overuse injury of the iliotibial band, a thick fascia that runs down the outside of the thigh. ITBS is caused by training errors like increasing mileage too quickly, running on uneven surfaces, or having poor form. Anatomical factors like tight muscles or leg length differences can also contribute. Diagnosis involves pain tests like the Renne Test or Noble Compression Test. Treatment starts with rest, ice, stretching, and anti-inflammatories. Later stages may include corticosteroid injections, surgery for refractory cases. Prevention focuses on gradual mileage increases, proper footwear, stretching, and avoiding uneven terrain.
This document discusses common hip conditions presenting in the emergency department and the use of ultrasound for evaluating hip pain. It reviews posterior hip dislocation, trochanteric bursitis, septic hip, and their presentations, relevant imaging findings on ultrasound and x-rays, complications, and management strategies. Ultrasound can help identify effusions and collections associated with these conditions to help guide diagnostic injections and treatment. Timely reduction, orthopedic consultation, antibiotics, and drainage when indicated are important aspects of management.
Evidence-based Interventional Pain Medicine
according to Clinical Diagnoses
13. Sacroiliac Joint Pain
Pascal Vanelderen, MD, FIPP*,†; Karolina Szadek, MD‡; Steven P. Cohen, MD§;
Jan De Witte, MD¶; Arno Lataster, MSc**; Jacob Patijn, MD, PHD††;
Nagy Mekhail, MD PhD, FIPP‡‡; Maarten van Kleef, MD, PhD, FIPP††;
Jan Van Zundert, MD, PhD, FIPP*,††
This document discusses sacrum fractures, including their classification, examination, imaging, treatment, and complications. It describes Denis zones of sacrum fractures and their associated neurological injuries. Treatment involves conservative management with bed rest for stable fractures without deficits or surgery for unstable fractures and those with neurological injuries. Surgical options include percutaneous or open reduction and internal fixation.
This document summarizes musculoskeletal disorders of the lower extremity, including skeletal and muscle disorders. It describes various joint disorders of the hip, knee, ankle and foot. Specific conditions mentioned include osteoarthritis, avascular necrosis, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, hip dislocation, labral injuries, and impingement syndromes of the hip. Injuries to various muscle groups like the quadriceps, hamstrings, adductors and plantar fascia are also summarized.
The document provides information on hip anatomy and orthopedic conditions. It discusses:
1) The bones that make up the hip girdle including the hip bone, femur, and sacrum. 2) Joints such as the hip joint and sacroiliac joint. 3) Common hip injuries and conditions like femoral neck fractures, developmental dysplasia of the hip, and labral tears. 4) Imaging appearances of the hip on x-ray, MRI, and MR arthrography that can help identify abnormalities.
Piriformis syndrome is a condition where sciatica symptoms occur due to involvement of the piriformis muscle, often caused by muscle tightness or trauma. It results in entrapment of the sciatic or pudendal nerves, leading to pain, tingling, and numbness in the buttocks, thigh, and leg. Diagnosis involves physical tests like the Freiberg test and treatment focuses on stretching, strengthening, and modalities like massage to relieve tightness while surgery is rarely needed.
Musculo-skeletal injuries are commonly caused by motorbike accidents, vehicular accidents, mishandling of tools and equipment, falls, and sports. Signs and symptoms include pain with motion, deformity, swelling, discoloration, and loss of function. Types of injuries include strains, sprains, dislocations, and fractures. First aid involves protection, rest, ice application, compression, and elevation (PRICE) as well as splinting. Bandages are used to control bleeding, protect wounds from infection, absorb fluids, tie splints in place, and immobilize body parts. Different bandaging techniques include open, cravat, semi-broad cravat, and narrow cravat wraps.
The document summarizes assessment and treatment techniques for sacroiliac joint dysfunction, including muscle energy techniques. It describes tests like the prone lying, sphinx, and hypersphinx positions to assess sacral positions. Treatment involves techniques to correct unilateral sacral flexion or torsion, like medial rotation or trunk rotation against resistance. Specific protocols are outlined for addressing forward or backward sacral torsion. Rotated innominate dysfunctions are also addressed using resisted hip motions in various positions.
Este documento describe diferentes tipos de bursitis y tendinitis que afectan las articulaciones. Explica las causas, síntomas y características de bursitis en hombros, caderas, codos, talones, rodillas e isquiones. También describe la tendinitis del manguito rotador, su relación con el síndrome de atrapamiento, y las tendinitis calcificadas y del tendón del bíceps.
This is a small presentation on causes of foot and heel pain. This gives brief description of conditions like plantar fasictis, retrocalcaneal bursitis, calcaneal spur etc. This presentation provides information on causes, symptoms and management of foot and heel pain problems.
Presentation1.pptx, radiological imaging of bursae.Abdellah Nazeer
This document discusses various bursae in the body, including those around the shoulder, knee, and other joints. It provides details on the anatomy and locations of bursae and describes imaging findings of normal and pathological bursae. Key points include:
- Bursae are fluid-filled sacs that reduce friction between tissues like tendons and bones. They can communicate with joints or be separate.
- Common shoulder bursae include the subacromial-subdeltoid bursa and subcoracoid bursa. MRI is useful for identifying bursal inflammation or fluid from rotator cuff tears.
- Around the knee, the superficial and deep infrapatellar burs
This present power point presentation on soft tissue conditions, is an orthopedic topic useful for a quick glance of the conditions mostly of UL and LL. Physiotherapists and other health professionals will be benefited.
Subacromial bursitis is inflammation of the bursa between the shoulder blade and rotator cuff muscles. It is usually caused by repetitive overhead activities or trauma and presents as shoulder pain that worsens with movement between 80-120 degrees of elevation. While physical examination can suggest bursitis, imaging may be needed to diagnose and rule out other issues. Treatment involves rest, ice, anti-inflammatories, and potentially corticosteroid injections into the bursa.
Golfer elbow, also known as medial epicondylitis, is an overuse injury caused by repetitive motions that place stress on the tendons where the forearm muscles attach to the inner bump of the elbow. The condition causes pain on the inner elbow and difficulty with wrist movement. It commonly affects people over 30 years old who participate in sports like golf or tennis that involve swinging motions, or those with occupations requiring strong gripping. Conservative treatment includes rest, anti-inflammatory medications, physiotherapy, and bracing to decrease stress on the tendons.
This document provides an overview of tuberculosis of the shoulder and other bones. It discusses the pathology, clinical presentation, relevant anatomy, radiological features, and management of tuberculosis in the shoulder, elbow, wrist, and fingers. Tuberculosis can affect various bones and joints, most commonly presenting as pain, swelling, and limited range of motion. Diagnosis is made based on clinical features and radiological findings like bone erosion. Management involves antitubercular drugs, rest, splinting, and in some cases surgery. The document serves as a reference for musculoskeletal tuberculosis.
TB Shoulder and short tubular bones orthosunnysam4072
Tuberculous infection can affect the shoulder joint and short tubular bones such as the metacarpals and phalanges. For the shoulder, the disease typically originates in the humerus or scapula, causing pain and limited range of motion. Left untreated, it can lead to bone destruction and fibrous ankylosis of the shoulder. Treatment involves immobilizing the shoulder with plaster or a brace combined with antitubercular drugs. For short tubular bones, the infection causes expansion of the bone and subperiosteal new bone formation, appearing radiographically as a "honeycomb" pattern. Both locations require differentiating from other bone infections and cancers.
1. The document summarizes various conditions affecting the shoulder joint including rotator cuff lesions, adhesive capsulitis, deltoid contracture, and bursitis.
2. Rotator cuff lesions include impingement syndrome and tears. Impingement syndrome occurs when the rotator cuff gets pinched between the acromion process and humerus, causing pain.
3. Adhesive capsulitis is characterized by painful restriction of shoulder movement due to thickening of the joint capsule. It involves painful, stiff, and resolution phases.
Regional conditions of upper limb BY MIN^ED ACADEMYMINED ACADEMY
Dr. Aishwarya Rai is a physical therapist who specializes in regenerative rehabilitation and the anatomy of the shoulder, arm, forearm, and hand. The document provides detailed information about:
1. The anatomy and structure of the shoulder, elbow, wrist, and hand joints. Common conditions that affect these areas like rotator cuff injuries, adhesive capsulitis, deltoid contractures, lateral epicondylitis, and medial epicondylitis are described.
2. Treatment approaches for each condition including conservative treatments like rest, ice, anti-inflammatories, and physical therapy as well as surgical interventions if conservative treatments fail.
3. Detailed explanations of shoulder
This document summarizes common muscular strains that can occur in the shoulder region, including the deltoid, biceps, medial and lateral rotators. It describes the symptoms of strains in each of these muscles, such as pain during active movement or resisted movement. It also discusses specific injuries like rupture of the long head of the biceps, which presents with a bulbous swelling. Treatment involves surgery to repair torn muscles or reattach avulsed tendons. Bicipital tendinitis is another discussed condition affecting the biceps tendon within the shoulder joint.
Bursitis and tendinitis are conditions involving inflammation of soft tissues like bursae and tendons around joints. They are commonly caused by overuse or repetitive motions. Symptoms include pain in areas like the shoulder, elbow, wrist, hip, knee or ankle. Diagnosis involves medical history, exams, and sometimes imaging tests. Treatment focuses on rest, anti-inflammatory medications, physical therapy, and corticosteroid injections if needed. Prevention emphasizes warming up, strengthening, taking breaks, and gradually increasing activity levels.
The document discusses disorders of the upper limb, including the shoulder, elbow, wrist, and hand. It provides details on anatomy, common conditions such as frozen shoulder, lateral epicondylitis, carpal tunnel syndrome, and treatments including injections, physical therapy, and surgery. It comprehensively covers the assessment and management of various musculoskeletal issues in the upper extremity.
The document provides an overview of pertinent anatomy, pathologies, clinical examinations, and ultrasound-guided interventions for hip pain. It discusses various pain generators in the hip region including the hip joint, musculotendinous structures, and bursas. Indications for ultrasound include effusion, bursitis, trauma, and prosthesis. Physical examinations involve inspection, palpation, and special tests like FADIR, FABER, and log roll. Common pathologies discussed include osteoarthritis, bursitis, snapping hip syndrome, and impingement syndromes. Injection techniques are provided for the hip joint, iliopsoas bursa, greater trochanteric bursa, and
1. Dr. Manoj R. Kandoi founded the Institute of Arthritis Care & Prevention, an NGO involved in patient education and creating self-help groups for arthritis patients.
2. Common causes of knee pain include traumatic injuries, inflammation, vascular disorders, degeneration, and tumors. Traumatic injuries depend on the mechanism of injury such as hyperextension causing ACL tears.
3. Physical examination of the knee involves inspection for swelling, alignment, and wasting, and palpation for effusions, hypertrophy, and localized swellings. Tests like the patellar tap test help identify effusions.
This document provides information on painful arc syndrome, also known as impingement syndrome. It begins with an introduction that describes the rotator cuff muscles and how the supraspinatus tendon can impinge on the acromion bone. It then defines impingement syndrome and lists common signs and symptoms such as pain when lifting the arm overhead. Causes include bony spurs and thickening of tissues that narrow the space for the tendon. Diagnosis involves physical exams like the Neer and Hawkins-Kennedy tests. Treatment options progress from rest, medication and physical therapy to corticosteroid injections and surgery if conservative measures fail.
This document discusses various common wrist and hand injuries in athletes. It describes injuries such as De Quervain's tenosynovitis, carpal tunnel syndrome, ulnar nerve compression, sprains of the ulnar collateral ligament of the first MCP joint, mallet finger, jersey finger, and trigger finger. For each injury, it discusses symptoms, diagnostic tests, and treatment options including splinting, injections, and in some cases surgery. The goal of treatment is usually conservative management but some injuries may require surgical intervention.
This document provides an overview of common elbow injuries and disorders. It discusses the functional anatomy of the elbow and then describes various conditions such as olecranon bursitis, cubital bursitis, tendonitis, lateral and medial epicondylitis, arthritis (including rheumatoid arthritis and osteoarthritis), gout, and overuse conditions in children including traction apophysitis, Panner disease, and osteochondritis dissecans. For each condition, it outlines symptoms, causes, diagnostic imaging findings, and other relevant clinical details.
The cubital fossa is a triangular depression on the anterior surface of the elbow joint. It is bounded laterally by the brachioradialis muscle, medially by the pronator teres muscle, and superiorly by the epicondyles of the humerus. The brachial artery bifurcates in the cubital fossa into the radial and ulnar arteries. The median nerve also passes through the cubital fossa. Injuries like supracondylar fractures can damage the neurovascular structures within the fossa.
This document discusses the anatomy and clinical assessment of the rotator cuff. It describes the four muscles that make up the rotator cuff, their innervation and attachments. Common rotator cuff injuries like impingement syndrome and ruptures are explained. The physical exam involves assessing range of motion and performing special tests like Neer's, Hawkins-Kennedy, and lift-off to identify injuries.
Cumulative trauma injuries refer to musculoskeletal injuries that develop over time due to repetitive minor injuries or overuse of body parts. Examples include carpal tunnel syndrome, tennis elbow, trigger finger, and hand-arm vibration syndrome. These injuries often develop in workers who perform repetitive tasks and motions. Treatment may involve rest, splinting, anti-inflammatory medication, corticosteroid injections, physiotherapy, or surgery depending on the injury and its severity. Many cumulative trauma injuries are accepted as compensable occupational health issues.
Similar to Periarticular Disorders of the Extremities (20)
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Bursitis
function of the bursa is to facilitate movement of tendons and muscles over bony
prominences.
Excessive frictional forces from overuse, trauma, systemic disease (e.g.,
rheumatoid arthritis, gout), or infection may cause bursitis.
3. 1.Subacromial bursitis (subdeltoid bursitis)
is the most common form of
bursitis.
The subacromial bursa, which is
contiguous with the subdeltoid
bursa, is located between the
undersurface of the acromion and
the humeral head and is covered by
the deltoid muscle.
Bursitis is caused by repetitive
overhead motion and often
accompanies rotator cuff tendinitis.
4. 2.trochanteric bursitis
Involvement of the bursa around
the insertion of the gluteus
medius onto the greater
trochanter of the femur.
Patients experience pain over
the lateral aspect of the hip and
upper thigh and have tenderness
over the posterior aspect of the
greater trochanter.
External rotation and resisted
abduction of the hip elicit pain.
5. 3. Olecranon bursitis
occurs over the posterior elbow, and when the area is acutely inflamed, infection or
gout should be excluded by aspirating the bursa and performing a Gram stain and
culture on the fluid as well as examining the fluid for urate crystals.
6. 4.Achilles bursitis
involves the bursa located above the insertion of the tendon to the
calcaneus and results from overuse and wearing tight shoes.
7. 5. Retrocalcaneal bursitis
involves the bursa that is located between the calcaneus and posterior
surface of the Achilles tendon. The pain is experienced at the back of
the heel, and swelling appears on the medial and/or lateral side of the
tendon.
It occurs in association with spondyloarthropathies,rheumatoid arthritis,
gout, or trauma.
8. 6.Ischial bursitis (weaver's bottom)
affects the bursa separating the gluteus medius from the ischial
tuberosity and develops from prolonged sitting and pivoting on hard
surfaces.
9. 7. Iliopsoas bursitis
affects the bursa that lies
between the iliopsoas muscle and
hip joint and is lateral to the
femoral vessels.
Pain is experienced over this area
and is made worse by hip
extension and flexion.
10. 8.Anserine bursitis
is an inflammation of the sartorius bursa located over the medial side of the tibia
just below the knee and under the conjoint tendon and is manifested by pain on
climbing stairs.
Tenderness is present over the insertion of the conjoint tendon of the sartorius,
gracilis, and semitendinosus.
11. 9. Prepatellar bursitis
(housemaid's knee) occurs in the bursa situated between the patella and
overlying skin and is caused by kneeling on hard surfaces. Gout or
infection may also occuar at this site.
12. Treatment of bursitis consists of:
1.prevention of the aggravating situation.
2.rest of the involved part.
3.administration of a nonsteroidal anti-inflammatory drug
(NSAID) where appropriate for an individual patient, or local
glucocorticoid injection.
13. Rotator Cuff Tendinitis and Impingement Syndrome
Tendinitis of the rotator cuff is the major cause of a painful shoulder and is
currently thought to be caused by inflammation of the tendon(s).
The rotator cuff consists of the tendons of the supraspinatus, infraspinatus,
subscapularis, and teres minor muscles, and inserts on the humeral tuberosities.
The process begins with edema and hemorrhage of the rotator cuff, which
evolves to fibrotic thickening and eventually to rotator cuff degeneration with
.tendon tears and bone spurs
14. :Rotator Cuff Tendinitis and Impingement Syndrome
Subacromial bursitis also accompanies this syndrome.
Symptoms usually appear after injury or overuse, especially with activities involving
elevation of the arm with some degree of forward flexion.
Those over age 40 are particularly susceptible.
Patients complain of a dull aching in the shoulder, which may interfere with sleep.
Severe pain is experienced when the arm is actively abducted into an overhead position.
The arc between 60° and 120° is especially painful.
15. :Rotator Cuff Tendinitis and Impingement Syndrome
Patients may tear the supraspinatus tendon acutely by falling on an outstretched arm
or lifting a heavy object.
Symptoms are pain along with weakness of abduction and external rotation of the
shoulder.
Atrophy of the supraspinatus muscles develops.
The diagnosis is established by arthrogram, ultrasound, or MRI.
16.
17. :Calcific Tendinitis
This condition is characterized by deposition of calcium salts, primarily
hydroxyapatite, within a tendon.
The supraspinatus tendon is most often affected because it is frequently
impinged on and has a reduced blood supply when the arm is abducted.
The condition usually develops after age 40.
Calcification within the tendon may evoke acute inflammation, producing
sudden and severe pain in the shoulder.
18. Bicipital Tendinitis and Rupture
Bicipital tendinitis, or tenosynovitis, is produced
by friction on the tendon of the long head of
the biceps as it passes through the bicipital
groove.
When the inflammation is acute, patients
experience anterior shoulder pain that radiates down
the biceps into the forearm.
1.Abduction and external rotation of the arm are painful and limited.
2.The bicipital groove is very tender to palpation.
3.Pain may be elicited along the course of the tendon by resisting supination
of the forearm with the elbow at 90° (Yergason's supination sign).
4.Acute rupture of the tendon may occur with vigorous exercise of the arm
and is often painful.
19. De Quervain's Tenosynovitis
In this condition, inflammation involves the abductor pollicis longus and the
extensor pollicis brevis as these tendons pass through a fibrous sheath at the radial
styloid process.
1.The usual cause is repetitive twisting of the wrist.
2. Patients experience pain on grasping with their thumb, such as with pinching.
3.Swelling and tenderness are often present over the radial styloid process.
4. The Finkelstein sign is positive, which is elicited by having the patient place
the thumb in the palm and close the fingers over it. The wrist is then ulnarly
deviated, resulting in pain over the involved tendon sheath in the area of the
radial styloid.
It may occur in pregnancy, and it also occurs in mothers who hold their babies with
the thumb outstretched.
20. Patellar Tendinitis (Jumper's Knee)
Tendinitis involves the patellar
tendon at its attachment to the
lower pole of the patella.
Patients may experience pain when
jumping during basketball or
volleyball, going up stairs, or doing
deep knee squats. Tenderness is
noted on examination over the lower
pole of the patella.
Treatment consists of rest, icing,
and NSAIDs, followed by
strengthening and increasing
flexibility.
21. Iliotibial Band Syndrome
The iliotibial band is a thick connective tissue that runs from the ilium to the
fibula.
Patients with iliotibial band syndrome most cammonly present with aching or
burning pain at the site where the band courses over the lateral femoral
condyle of the knee; pain may also radiate up the thigh, toward the hip.
Predisposing factors for iliotibial band syndrome include a varus alignment of
the knee, excessive running distance, poorly fitted shoes, or continuous
running on uneven terrain.
22. Adhesive Capsulitis :
Often referred to as "frozen shoulder," adhesive capsulitis is characterized by pain
and restricted movement of the shoulder, usually in the absence of intrinsic
shoulder disease.
Adhesive capsulitis may follow bursitis or tendinitis of the shoulder or be associated
with systemic disorders such as chronic pulmonary disease, myocardial infarction,
and diabetes mellitus.
23. Adhesive Capsulitis :
Prolonged immobility of the arm contributes to the development of adhesive
capsulitis.
Pathologically, the capsule of the shoulder is thickened, and a mild chronic
inflammatory infiltrate and fibrosis may be present.
Adhesive capsulitis occurs more commonly in women after age 50.
Pain and stiffness usually develop gradually but progress rapidly in some
patients.
Night pain is often present in the affected shoulder and pain may interfere with
sleep.
24. Adhesive Capsulitis :
The shoulder is tender to palpation, and both active and passive movement are
restricted.
Radiographs of the shoulder show osteopenia.
The diagnosis is typically made by physical examination but can be confirmed if
necessary by arthrography, in that only a limited amount of contrast material,
usually <15 mL, can be injected under pressure into the shoulder joint.
25. Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, or tennis elbow, is a painful condition involving the soft tissue
over the lateral aspect of the elbow.
The pain originates at or near the site of attachment of the common extensors to the
lateral epicondyle and may radiate into the forearm and dorsum of the wrist.
The pain usually appears after work or recreational activities involving repeated
motions of wrist extension and supination against resistance. .
26. Medial Epicondylitis (golfer's elbow)
Medial epicondylitis is an overuse syndrome resulting in pain over the medial side
of the elbow with radiation into the forearm.
The cause of this syndrome is considered to be repetitive resisted motions of
wrist flexion and pronation, which lead to microtears and granulation tissue at
the origin of the pronator teres and forearm flexors, particularly the flexor
carpi radialis.
This overuse syndrome is usually seen in patients >35 years and is much less
common than lateral epicondylitis.
27. Medial Epicondylitis (golfer's elbow)
It occurs most often in work-related repetitive activities but also occurs with
recreational activities such as swinging a golf club (golfer's elbow) or throwing a
baseball.
On physical examination, there is tenderness just distal to the medial epicondyle
over the origin of the forearm flexors.
Pain can be reproduced by resisting wrist flexion and pronation with the elbow
extended.
28. Medial Epicondylitis (golfer's elbow) :
Radiographs are usually normal.
The differential diagnosis of patients with medial elbow symptoms include tears of
the pronator teres, acute medial collateral ligament tear, and medial collateral
ligament instability.
Ulnar neuritis has been found in 25–50% of patients with medial epicondylitis and
is associated with tenderness over the ulnar nerve at the elbow as well as hypesthesia
and paresthesia on the ulnar side of the hand.
29. Plantar Fasciitis
Plantar fasciitis is a common cause of foot pain in adults, with the peak incidence
occurring in people between the ages of 40 and 60 years.
Several factors that increase the risk of developing plantar fasciitis include:
obesity, pes planus (flat foot or absence of the foot arch when standing), pes cavus
(high-arched foot), limited dorsiflexion of the ankle, prolonged standing, walking on
hard surfaces, and faulty shoes. In runners, excessive running and a change to a harder
running surface may precipitate plantar fasciitis.
30. Plantar Fasciitis
The pain originates at or near the site of the plantar fascia attachment to the
medial tuberosity of the calcaneus.
Patients experience severe pain with the first steps on arising in the morning or
following inactivity during the day.
Pain is made worse on walking barefoot or up stairs.
On examination, maximal tenderness is elicited on palpation over the inferior heel
corresponding to the site of attachment of the plantar fascia.
31. Imaging studies may be indicated when the diagnosis is not clear;(Plain radiographs
may show heel spurs, which are of little diagnostic significance).
The differential diagnosis of inferior heel pain includes calcaneal stress fractures,
the spondyloarthritides, rheumatoid arthritis, gout, neoplastic or infiltrative bone
processes, and nerve compression/entrapment syndromes.