Charcot joint or neuropathic joint are destructed joint occurs in Diabetes, syphilis, syringomyelia , leprosy, AMLS, Peripheral neuropathy and any condition leads to impair sensation of peripheral part of body
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Lumbar spinal canal stenosis is one of the difficult topic of spine. All the information are taken from Campbell's operative orthopedics Thirteen edition and from internet. I also took help from the lectures of renowned orthopedics professors of Bangladesh.
Hi ! Med Students . In this slide, you will learn a summary definition of elbow dislocation and subluxation their causes, symptoms and treatments. I hope this will help to make your notes. Good luck with your studies.
Peripheral nerve damage affecting the upper extremities can vary widely in cause and extent.
Many disorders, ranging from mild carpal tunnel syndrome to severe brachial plexopathy, need to be considered in a patient presenting with pain, sensory loss, or weakness involving the shoulder, arm, or hand.
Charcot joint or neuropathic joint are destructed joint occurs in Diabetes, syphilis, syringomyelia , leprosy, AMLS, Peripheral neuropathy and any condition leads to impair sensation of peripheral part of body
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Lumbar spinal canal stenosis is one of the difficult topic of spine. All the information are taken from Campbell's operative orthopedics Thirteen edition and from internet. I also took help from the lectures of renowned orthopedics professors of Bangladesh.
Hi ! Med Students . In this slide, you will learn a summary definition of elbow dislocation and subluxation their causes, symptoms and treatments. I hope this will help to make your notes. Good luck with your studies.
Peripheral nerve damage affecting the upper extremities can vary widely in cause and extent.
Many disorders, ranging from mild carpal tunnel syndrome to severe brachial plexopathy, need to be considered in a patient presenting with pain, sensory loss, or weakness involving the shoulder, arm, or hand.
this presentation explains the different sensory and motor functions of upper and lower limb peripheral nerves , in addition to the common injuries associated with them and their loss of function.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
Injuries to the nerves of the upper limb can result from trauma, compression, lacerations, or certain medical conditions. Nerve injuries may lead to various symptoms, including pain, weakness, numbness, or loss of function in specific areas of the upper limb. Nerve injuries may range from mild to severe, and appropriate medical evaluation and treatment are essential. Physical therapy, splinting, medications, or in some cases, surgical intervention may be recommended based on the type and severity of the nerve injury. Early intervention is crucial for optimal recovery.
0x01 - Newton's Third Law: Static vs. Dynamic AbusersOWASP Beja
f you offer a service on the web, odds are that someone will abuse it. Be it an API, a SaaS, a PaaS, or even a static website, someone somewhere will try to figure out a way to use it to their own needs. In this talk we'll compare measures that are effective against static attackers and how to battle a dynamic attacker who adapts to your counter-measures.
About the Speaker
===============
Diogo Sousa, Engineering Manager @ Canonical
An opinionated individual with an interest in cryptography and its intersection with secure software development.
This presentation, created by Syed Faiz ul Hassan, explores the profound influence of media on public perception and behavior. It delves into the evolution of media from oral traditions to modern digital and social media platforms. Key topics include the role of media in information propagation, socialization, crisis awareness, globalization, and education. The presentation also examines media influence through agenda setting, propaganda, and manipulative techniques used by advertisers and marketers. Furthermore, it highlights the impact of surveillance enabled by media technologies on personal behavior and preferences. Through this comprehensive overview, the presentation aims to shed light on how media shapes collective consciousness and public opinion.
This presentation by Morris Kleiner (University of Minnesota), was made during the discussion “Competition and Regulation in Professions and Occupations” held at the Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found out at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Sharpen existing tools or get a new toolbox? Contemporary cluster initiatives...Orkestra
UIIN Conference, Madrid, 27-29 May 2024
James Wilson, Orkestra and Deusto Business School
Emily Wise, Lund University
Madeline Smith, The Glasgow School of Art
Acorn Recovery: Restore IT infra within minutesIP ServerOne
Introducing Acorn Recovery as a Service, a simple, fast, and secure managed disaster recovery (DRaaS) by IP ServerOne. A DR solution that helps restore your IT infra within minutes.
Have you ever wondered how search works while visiting an e-commerce site, internal website, or searching through other types of online resources? Look no further than this informative session on the ways that taxonomies help end-users navigate the internet! Hear from taxonomists and other information professionals who have first-hand experience creating and working with taxonomies that aid in navigation, search, and discovery across a range of disciplines.
2. Introduction
• Peripheral nerve damage affecting the upper and lower extremities can vary widely
in cause and extent. E.g. stretching, compression and transection.
• Many disorders, ranging from mild carpal tunnel syndrome to severe brachial
plexopathy, need to be considered in a patient presenting with pain, sensory loss, or
weakness involving the shoulder, arm, or hand.
10. Primary injury
– Results from same trauma that injures a bone or joint
– Radial nerve is the most commonly injured. Of humeral
shaft fractures, 14 % is complicated by radial nerve injuries
– Displaced osseous fragments
– Stretching
– Manipulation
Secondary injury
– Results from involvement of nerve by infection, scar, callous or
vascular complications which may be hematoma, AVfistula,
Ischemia or aneurysm
11. Diagnosis of Peripheral nerve injuries
• History
– Which nerve ?
– What level ?
– What is the cause ?
– What degree of injury ?
– Old or fresh injury ?
12. Diagnosis of Peripheral nerve inuries
1. Motor:
– All muscles distal to the injury – paralyzed &
atonic
–
–
Atrophy : 50 -70 % in 1sttwomonths
Striations & motor end plate configurations
retained for 12 – 18 months (critical limit of
delay)
13. 2. Sensory :
• Sensory loss usually follows a definite
anatomical pattern, although factor of
overlap from adjacent nerves may be
present
• Autonomous zone
• Tinel’s sign
14. (3) Reflex
• Abolishes all reflexes transmitted by that
nerve, either afferent or efferent arc.
• Complete & incomplete lesion. So , not a
reliable guide to injury severity.
(4) Autonomic:
• Loss of sweating
• Loss of pilomotor response and
• Vasomotor paralysis in autonomous zone
15. (5) Others:
• Trophic Changes
•
•
Esp. hand and feet
Skin – thin, glistening, breaks easily to form
ulcers that heal slowly
• Fingernails
• Ridged, distorted and brittle
• Osteoporosis (Reflex sympathetic dystrophy)
16. Classification of nerve injuries
Seddon Classification
1. Neuropraxia:
1. Minor contusion or compression with preservation of axis – cylinder of
myelin sheath.
2. Impulse transmission physiologically interrupted.
3. Complete recovery in a few days toweeks
17. 2. Axonotemesis :
1.More significant injury
2.Breakdown of axon and distal Wallerian degeneration butwith
preservation of schwann cell & endoneurial tubes
3.Spontaneous regeneration with good functional recovery canbe
expected
18. 3.Neurotmesis
1.More severe injury
2.Complete anatomical severance, avulsion or crushing of nerve
3.Axon, Schwann cell & endoneurial tubes are
completely disrupted
4.Spontaneous recovery cannot be expected unlessexplored
19. Sunderland
Classification
Each degree of injury suggesting a greater anatomical
disruption with its correspondingly altered prognosis
Anatomically various degrees (1st – 5th) representinjury
to
Myelin
Axon
Endoneurial tube & it’scontent
Perineurium
Entire nerve trunk
Sixth degree (Mackinson) or mixed injuries occur in
which a nerve trunk is partially severed and
remaining part of trunk sustains 1st to 4thdegree
injury.
Mixed recovery pattern depending on degree of
injury to each portion of nerve.
20. Test for peripheral nerves of upper limb
• Radial nerve injury
– very high / high / low injury
– Wrist drop / finger drop / thumb drop
– Test for triceps/ /Brachioradialis/ wrist extensors /
extensor digitorum / EPL
• Median nerve
– High / low injury
– Test for FPL / FDS / FDP (lat. half) / FCR /Abd. Pollicis brevis
( pen test) / Oppenenspollicis
– See for pointing index / complete claw hand
• Ulnar nerve
– High / low palsy –ulnar paradox
– Test for FCU / Abd. digiti minimi / Interossei (dorsal - Egawa’s test ; palmar –
card test ) / lumbricals /Add. Pollicis (Froment’s sign / book test )
– Ulnar claw hand
22. Brachial plexus
Erbs – C 5 6 with or without c7 dysfunction
Extended elbow, adducted internally rotated
If serratus ant, levator scapulae, rombiods gone indicating lesion
medial to dorsal scapular and long thorasic
Denervation potention in segmental paraspinous muscles inervated by
post rami.
Myelography- pseudo meningocele
Klumpke-C8 T1 with or without C 7 dysfunction
Intrinsic of hand / flexors of wrist and finger
Horner syndrome -ptosis /anhydrosis /miosis enopthalmos / loss of
cilio spinal reflex
23. Axillary nerve injury
• Sensory function:
sensation of an oval shaped
area over the lateral
shoulder “ sergeant's patch
“
• Motor function: it
innervates the deltoid
(shoulder abduction) and
teres minor (shoulder
external rotation) muscles.
• Common causes of injury:
Trauma, usually with
shoulder dislocation or
humeral fracture, iatrogenic
24. Axillary nerve injury manifestations
• Sensory loss: sharply-
defined region of sensory
loss over the lateral shoulder
“sergeant's patch “
• Motor loss: The patient
complains of shoulder
‘weakness’. Although
abduction can be initiated
(by supraspinatus), it cannot
be maintained.
• Deformity: wasting of the
deltoid
25. Radial nerve injury
• Sensory function: posterior
arm and forearm , lateral ⅔
of dorsum of hand and
proximal dorsal aspect of
lateral 3½ fingers
• Motor function: posterior
compartment of the arm and
forearm
• Common causes of injury:
fractures of proximal
humerus, shaft of humerus
or radius, stab wounds to
antecubital fossa, forearm or
wrist
26. Radial nerve injury manifestations
• Sensory loss: numbness of
skin over posterior
posterior forearm and
arm,
radial
distribution of dorsum of hand
• Motor loss: weak elbow ,
wrist , thump and MCPJ
extension, absent triceps
and supinator reflexes
• Deformity: “WRIST DROP”
deformity
27. Radial nerve
In closed humeral fracture normal function may return
in 3-6 months
In absence of nerve recovery and advancing tinel
exploration can be done after 3 months
Tendon transfer can be done after 6 months
28. Median nerve injury
• Sensory function: Skin over
thenar eminence, lateral ⅔
palm of hand and palmar
aspect of lateral 3½ fingers
• Motor function: all muscles of
anterior compartment of
forearm except flexor carpi
ulnaris and the medial two
parts of flexor digitorum
profundus
• Common causes of injury:
supracondylar fractures of
humerus , compression by
carpal tunnel syndrome
29. Median nerve injury manifestations
• Sensory loss: numbness of
skin over thenar eminence
and median distribution of
hand
• Motor loss: weak forearm
pronation, wrist flexion
and abduction, and weak
finger flexion, weak pincer
grip
• Deformity: ape hand
deformity, wasting of thenar
m.
30. Median nerve
Flexion of index and middle finger- side to side suture
with ulnar inervated fdp
Fpl – brachioradilis / ECRL / ECU
Thumb opposition- EIP
31. Ulnar nerve injury
• Sensory function: skin over
hypothenar eminence,
medial ⅓ palm of hand
,palmar aspect of lateral 1½
fingers
• Motor function: two
muscles of anterior
compartment of forearm ,
and most of the intrinsic
muscles of the hand
• Common causes of injury:
supracondylar fractures of
humerus , compression
cubital tunnel in the elbow.
32. Ulnar nerve injury manifestations
• Sensory loss: numbness of
skin over hypothenar
eminence and ulnar
distribution of hand
• Motor
flexion
loss: weak wrist
and adduction,
flexion of ring and little finger
DIPJs
HAND”• Deformity: “CLAW
deformity and wasting of
hypothenar m.
33. Ulnar nerve
restoration of intrinsic
If wrist extensors are strong to prevent flexion of wrist
and intrinsics are weak not paralyzed – bunnell transfer ( 4
fds, modified 1 ring finger fds split)
If wrist flexion is chronic habit- Riordan
Brand- ECRB/ 4 tailed free graft - volar to deep tansverse
metacarpal lig – lumbrical canal- radial side of extensor
apponeurosis except index finger difficult to re-educate
if wirst ext stronger than flex – brand – ECRL volarward 4
tail free graft
34.
35. If fds /wrist flex /ext not available- fowlers – EIP or
riordan modification of fowler- EIP + PL free plantaris
If n0 muscle/ joint supple – zancolli capsulodeisis
Bouvier test- if ext at ip present then static procedure
if ext not present dynamic procedure required
Thumb adduction- omer- ring fds split brown- EIP in
palm near 3rd metacarpal
37. Femoral nerve injury
• The femoral nerve may be injured by a gunshot
wound, hip or pelvic fractures, by pressure or
traction during an operation or by bleeding into the
thigh.
• Clinical manifestations: Quadriceps action is
lacking (week knee extension). There is
numbness of the anterior thigh and medial aspect
of the leg. The knee reflex is depressed. Severe
neurogenic pain is common
38. Sciatic nerve injury
• Division of the main sciatic nerve is rare except in
gunshot wounds. Traction lesions may occur with
traumatic hip dislocations and with pelvic
fractures.
• Clinical manifestations: In a complete lesion the
hamstrings and all muscles below the knee are
paralyzed; the ankle jerk is absent. Sensation is
lost below the knee, The patient walks with a drop
foot and a high-stepping gait to avoid dragging the
insensitive foot on the ground.
39. Common peroneal nerve injury
• The most frequent site of injury is just below the
knee as the nerve wraps around the lateral aspect
of the fibula, immediately before dividing into its
deep and superficial branches
• Common causes include: Trauma or injury to the
knee , Fracture of the fibula , Crossing the legs,
protracted squatting, and leg casts.
40. Common peroneal nerve injury
• Clinical manifestations:
• Drop foot deformity, the
patient can neither dorsiflex
nor evert the foot.
• He or she walks with a high-
stepping gait to avoid
catching the toes.
• Sensation is lost over the
front and outer half of the
leg and the dorsum of the
foot.
• Pain may be significant.
41. Time of Surgery
• Primary repair : First 24 hours
• Delayed primary repair : First 1 – 18 days
• Secondary repair : 18 days- 3months
42. Indications for surgery
1. When a sharp injury has obviously divided a nerve.
2. When abrading, avulsing or blast wounds have rendered
the condition of nerve unknown
3. When a nerve deficit follows a blunt or closed trauma & no
clinical or electrical evidence of regeneration has occurred
after an appropriate time
4. When a nerve deficit follows a penetrating wound as stab or
low velocity gunshot wound, part observed for evidence of
nerve regeneration for appropriate time.
48. Method of closing gap between nerve ends
1. Nerve grafting
2. Transposition
3. Bone resection
1. Mobilization ( critical nerve gap distance – value of
Grantham)
2. Positioning of extremity
–
–
Flex knee and elbow < 90°
Flex wrist < 40°
50. Prognostic Factors of Outcomes
Patient
factor
•Age
• Level of injury (distal vs
proximal)
• Type of nerve (pure vs mixed
functions)
• Condition of nerve ends
Injury
factors
• Delay to repair
• Length of gap
Surgical
factors
51. History
• The diagnostic processbeginswith the physician obtaininga careful history.
• The family, social, and occupational histories are important for identifying familial occurrences
or toxicexposures.
Evaluation of patient with neuropathy
KeyQuestions:
•Isthe onsetsuddenorgradual?
• Isthe progressionrapidorslow?
• Isthe predominant manifestationsensory,motor,orboth?
•Isthe distribution focalor generalized,distalorproximal,
symmetric orasymmetric?
• Is there autonomicinvolvement?
• Doesthe patient haveanyassociateddiseases?
52. Relative predisposition to injury to peroneal
component than tibial
More superficial
Greater disability because of over stretched muscles
Poorer blood supply single funiculus with major nutrient
Artery exposed on surface
Large and tighty packed funiculi with less connective tissue
Oblique course ,fixed at sciatic notch and neck of fibula
53. Can distinguish a recent from old injury in medico –
legal cases
At initial post injury- normal or recruitment at this
point depends on injury pattern
10 to 14 day- abnormal spontaneous rest potential ,
positive sharp waves in denervated myotome
14 to 18 days- fibrillations appear
3 months – polyphasic potentials / motor unit
potential increase progressively
EMG
