1. Soft tissue MSK injuries like sprains are often diagnosed as "sprains" without determining the specific injury, but a complete physical exam is important.
2. Common injuries discussed include mallet finger, boutonniere deformity, jersey finger, skier's thumb, distal biceps avulsion, and ruptured biceps tendon.
3. Management depends on the specific injury but often involves splinting, casting, or referral for further treatment or surgery depending on the severity. Compartment syndrome is a surgical emergency if not treated promptly.
A summarised guide on these often frequently carried out proceduresv - arthrocentesis & arthrotomy. Quite useful for orthopaedic residents, GPs and med students
In this presentation, we review the current evidence of scaphoid fracture non union based on a book review of the current evidence. Options such as vascularized vs traditional bone grafting are discussed
A summarised guide on these often frequently carried out proceduresv - arthrocentesis & arthrotomy. Quite useful for orthopaedic residents, GPs and med students
In this presentation, we review the current evidence of scaphoid fracture non union based on a book review of the current evidence. Options such as vascularized vs traditional bone grafting are discussed
1. Shoulder Anatomy and Function Overview
2. Exercises for Healthy Shoulders
3. Good vs. Bad Pain
4. Overview of Common Sources of Shoulder Pain and Debility
5. Cutting Edge Treatments
6. Frozen Shoulder
- Causes and Treatment options
7. Unstable Shoulder
- Advances in Treatment
8. Rotator Cuff Tears -
Best Surgical Options Today
- Surgery Not Always Best Option
9. Shoulder Arthritis
- Many types of new surgeries
more at https://www.TheShoulderCenter.com/
This is a surgeons experience in prison, living under difficult situations, treating desperate patients, who had no where else to go. The studies conducted, discoveries made and new modalities invented.
Herniated disk in the lower back agrasen hospital dr sandeep agrawal gondia v...Dr.Sandeep Agrawal Gondia
Back Pain
Back pain is often a common symptom of many disease conditions and the back pain may range from simple or dull pain to sudden and sharp pain. If the pain persists for few days, it is acute pain whereas if continues for more than 3 months, it is considered as chronic pain. In most cases, back pain may resolve without any treatment however if persists for more than 3 days, medical intervention is necessary.
Neck Pain
The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and also less protected than other parts of spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.
Spinal Deformity Surgery
The Spine or backbone provides stability to the upper part of our body. It helps to hold the body upright. It consists of several irregularly shaped bones, called vertebrae appearing in a straight line. The spine has two gentle curves, when looked from the side and appears to be straight when viewed from the front. When these curves are exaggerated, pronounced problems can occur such as back pain, breathing difficulties and fatigue and the condition will be considered as deformity. Spine deformity can be defined as abnormality in the shape, curvature and flexibility of spine.
Spine Injections
Spine injection is a nonsurgical treatment modality recommended for treatment of chronic back pain. Injection of certain medicinal agents relieves the pain by blocking the nerve signals between specific areas of the body and the brain. The treatment approach involves injections of local anaesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It may also involve complex nerve blocks and spinal cord stimulation.
Spine Trauma
Spine trauma is damage to the spine caused from a sudden traumatic injury caused by an accidental fall or any other physical injury. Spinal injuries may occur while playing, performing normal activities, operating heavy machines, lifting heavy objects, driving automobiles, or when you suffer a fall. Injury to spine may cause various conditions including fractures, dislocation, partial misalignment (subluxation), disc compression (herniated disc), hematoma (accumulation of blood) and partial or complete tears of ligaments.
Vertebral Fractures
Vertebral compression fractures occur when the normal vertebral body of the spine is squeezed or compressed. The bone collapses when too much pressure is placed on the vertebrae, resulting in pain, limited mobility, loss of height, and spinal deformities. In severe compression fractures the vertebral body is pushed into the spinal canal which will apply pressure on the spinal cord and nerves.
presentation about minimally invasive bridge plating technique usage in pediatric femoral shaft fracture , showing a prospective case series study done over thirty child
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital, Clifton, Karachi delivered lecture on DZU Webinar series Lecture 2 on Legg Calve Perthes. Declared few pics and material taken from google.
Dear all,
This ppt contains the cause, types, clinical and radiological features, treatment and complication of fracture of lateral condyle of the humerus, medial epicondyle of Humerus, and intercondylar fracture of Humerus. I hope this is useful to you.
Thank you
1. Shoulder Anatomy and Function Overview
2. Exercises for Healthy Shoulders
3. Good vs. Bad Pain
4. Overview of Common Sources of Shoulder Pain and Debility
5. Cutting Edge Treatments
6. Frozen Shoulder
- Causes and Treatment options
7. Unstable Shoulder
- Advances in Treatment
8. Rotator Cuff Tears -
Best Surgical Options Today
- Surgery Not Always Best Option
9. Shoulder Arthritis
- Many types of new surgeries
more at https://www.TheShoulderCenter.com/
This is a surgeons experience in prison, living under difficult situations, treating desperate patients, who had no where else to go. The studies conducted, discoveries made and new modalities invented.
Herniated disk in the lower back agrasen hospital dr sandeep agrawal gondia v...Dr.Sandeep Agrawal Gondia
Back Pain
Back pain is often a common symptom of many disease conditions and the back pain may range from simple or dull pain to sudden and sharp pain. If the pain persists for few days, it is acute pain whereas if continues for more than 3 months, it is considered as chronic pain. In most cases, back pain may resolve without any treatment however if persists for more than 3 days, medical intervention is necessary.
Neck Pain
The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and also less protected than other parts of spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.
Spinal Deformity Surgery
The Spine or backbone provides stability to the upper part of our body. It helps to hold the body upright. It consists of several irregularly shaped bones, called vertebrae appearing in a straight line. The spine has two gentle curves, when looked from the side and appears to be straight when viewed from the front. When these curves are exaggerated, pronounced problems can occur such as back pain, breathing difficulties and fatigue and the condition will be considered as deformity. Spine deformity can be defined as abnormality in the shape, curvature and flexibility of spine.
Spine Injections
Spine injection is a nonsurgical treatment modality recommended for treatment of chronic back pain. Injection of certain medicinal agents relieves the pain by blocking the nerve signals between specific areas of the body and the brain. The treatment approach involves injections of local anaesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It may also involve complex nerve blocks and spinal cord stimulation.
Spine Trauma
Spine trauma is damage to the spine caused from a sudden traumatic injury caused by an accidental fall or any other physical injury. Spinal injuries may occur while playing, performing normal activities, operating heavy machines, lifting heavy objects, driving automobiles, or when you suffer a fall. Injury to spine may cause various conditions including fractures, dislocation, partial misalignment (subluxation), disc compression (herniated disc), hematoma (accumulation of blood) and partial or complete tears of ligaments.
Vertebral Fractures
Vertebral compression fractures occur when the normal vertebral body of the spine is squeezed or compressed. The bone collapses when too much pressure is placed on the vertebrae, resulting in pain, limited mobility, loss of height, and spinal deformities. In severe compression fractures the vertebral body is pushed into the spinal canal which will apply pressure on the spinal cord and nerves.
presentation about minimally invasive bridge plating technique usage in pediatric femoral shaft fracture , showing a prospective case series study done over thirty child
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital, Clifton, Karachi delivered lecture on DZU Webinar series Lecture 2 on Legg Calve Perthes. Declared few pics and material taken from google.
Dear all,
This ppt contains the cause, types, clinical and radiological features, treatment and complication of fracture of lateral condyle of the humerus, medial epicondyle of Humerus, and intercondylar fracture of Humerus. I hope this is useful to you.
Thank you
This powepoint is aimed at undergraduate medical education. It gives information regarding the orhtopedic principles of management of closed and open fractures
These slides contains information regarding fractures and dislocations of spine, various classifications of fracture spine, approach to fractures of spine, criteria for surgical or conservative management of patient, various named fractures involving cervical spine and brief description of spine fracture dislocation.
Review of common fractures encountered in children and what makes them different from adult fractures. This presentation will best benefit undergraduate medical and paramedical students
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. The Sprain Brain DrainThe Sprain Brain Drain
• The diagnosis of
sprain generally
means we don’t know
exactly what is injured
BUT:
• We assume…
• The condition will get
better with or without
ancillary therapies
• And the condition
does not need any
further thought from
us
5. Injured limbInjured limb
• HISTORY
• OBSERVATION
• XRAY
• COMPLETE PHYSICAL EXAM (this is
what is forgotten)
9. An acute Boutonniere deformityAn acute Boutonniere deformity
1. Results from a tear of conjoint tendon
2. Always requires surgery
3. Can be managed with a paper clip splint
4. Results from avulsion of the central slip
5. Can be managed by a rural family doctor
10. Jersey FingerJersey Finger
1. Is a common sprain that occurs milking
Jersey cows
2. Cannot be diagnosed clinically
3. Characterized by loss of fds funtion
4. Can be managed by the rural family
doctor
5. Always requires referral to a plastic
surgeon
11. A Stener lesionA Stener lesion
• Is caused by being shot by a Sten gun
• Is characterized by loss of flexion of the
pip joint
• Can only be diagnosed at time of surgery
• Mention of this lesion can get a surgeon to
see the patient
12. Distal Biceps AvulsionDistal Biceps Avulsion
1. Cannot be diagnosed clinically
2. Can be treated non surgically
3. Can occur with minimal injury
4. Can be treated successfully by the rural
family doctor
13. The Hook signThe Hook sign
• 1. is found in compartment syndrome
• 2. is performed in pronation and flexion
• 3. is not very sensitive or reliable
• 4. can be used for clinical diagnosis of
distal biceps tear
• 5. none of the above
14. Acute Compartment SyndromeAcute Compartment Syndrome
1. Can be successfully managed by waiting
until the 5 “P”’s are noted
2. Occurs only after fractures and burns
3. Must be diagnosed by measurement of
compartment pressures
4. Can be managed by the rural family
physician
15. What is true about TAL tearsWhat is true about TAL tears
1. Surgery is always required
2. No treatment gives equal results to
surgical care
3. Physiotherapists often make the
diagnosis
4. Can be treated successfully by the rural
family doctor with surgical skills
37. Skier’s Thumb AssessmentSkier’s Thumb Assessment
• >30 degrees relative
instability is
diagnostic of
complete ulnar
collateral ligament
tear
38. Skier’s Thumb Stener LesionSkier’s Thumb Stener Lesion
• With full tear of the
ulnar collateral
ligament the proximal
ligament retracts and
lays on top of the
adductor aponeurosis
39. Skier’s thumb RXSkier’s thumb RX
• Less than 30 degrees
instability
• less than one 2 inch
roll of fibreglass
• 5 to 6 weeks
43. Biceps avulsion: Hook testBiceps avulsion: Hook test
• Patient supinates arm
at 90 degrees flexion
• Your index finger tries
to hook the tendon
from the lateral side
• Highly sensitive and
specific
45. Distal Biceps Avulsion MRIDistal Biceps Avulsion MRI
• Clinical diagnosis
very good
• Let the surgeon
decide on need for
MRI
• Partial tears need
MRI for assessment
46. Distal Biceps Tears RXDistal Biceps Tears RX
• Always surgical ?
• Bury the tendon into
its original footprint of
the radial tuberosity
47. Proximal rupture BicepsProximal rupture Biceps
• Rupture of long head
• Very common
• Usually older age
group
• Rupture of short head
rare (never seen it)
48. Rupture Long Head BicepsRupture Long Head Biceps
• Patient usually feels a
pop
49. Rupture Long head bicepsRupture Long head biceps
POPEYE muscle
What?
Medical myths?
50. Real Picture Rupture ProximalReal Picture Rupture Proximal
BicepsBiceps
• Biceps bunched up
distally a bit
• Held by short head
51. In all fairness to PopeyeIn all fairness to Popeye
• The biceps do
sometimes appear
52. Proximal rupture biceps RXProximal rupture biceps RX
• Most proximal
ruptures are
associated with
tendon degeneration
and rotator cuff
pathology
• These (mostly in older
less active patients
can be treated
conservatively
53. Rupture long head biceps RXRupture long head biceps RX
• Non operative
treatment usually
results in loss of 20 %
supination strength
• Surgical indications
for younger
individuals who need
full supination
strength
54. Take home MessageTake home Message
• Middle age and older
patients with non
labour occupations
• Younger patients with
higher energy injury
and need for full
strength (minority of
cases)
• Sling, pain control,
physiotherapy
• Refer for surgical
treatment
55. Tendo Achilles tearsTendo Achilles tears
• Occurs in sports or
activities like pushing
cars in the snow
• Patient reports being
kicked in the heel
• Often a pop heard
• Male 6 :1
56. Tendo Achilles DXTendo Achilles DX
• Up to 20 % of TAL
tears are not clinically
clear
• Swelling or partial
tear
59. Tendo Achilles tears DXTendo Achilles tears DX
• Ultrasound or MRI
can be used if clinical
exam is not
convincing
• U/S 100% sensitive
and 94% accurate
60. Tendo Achilles Tears RXTendo Achilles Tears RX
• CAST IN EQUINUS • SURGERY AND
CAST IN EQUINUS
62. Tendo Achilles RXTendo Achilles RX
• Level one studies
support cast regimen
treatment
• No surgical
complications
63. Tendo Achilles tearsTendo Achilles tears
• controversies • Increased re-rupture
tear with non
operative treatment
• tendon heals
elongated with
conserative treatment
64. Tendo Achilles tears: compromiseTendo Achilles tears: compromise
• 1. Call orthopod and
pass responsibility
• 2. Agree with
surgeon to treat
conservatively or
send for surgery
65. Tendo Achilles Cast RXTendo Achilles Cast RX
• Regimen
• Cast in equinus
• In cast for 6 or more
weeks
• Neutral position at 4
weeks
• Non weight bearing
• Heel lift for 4 weeks
• Physiotherapy
66. Tendo Achilles RXTendo Achilles RX
• Newer studies suggest that use of
functional brace and
• Functional rehab (early ROM and weight
bearing) may be acceptable
• KEEP TUNED IN
67. Tendo achilles tearsTendo achilles tears
• Take home message
• Share responsibility
with ortho
• Especially for more
active individuals
• Use cast with
acceptable protocol
for progressive ROM
and weight bearing
68. Tendo Achilles tears RXTendo Achilles tears RX
• Surgery still an
option for patients
with high activity
69. Knee extensor injuriesKnee extensor injuries
• Can be tear of the
quadriceps tendon, or
the patellar tendon
• Presents as a
SPRAINED KNEE
70. Knee extensor injuries DXKnee extensor injuries DX
• Clinical Exam may
show a soft tissue
dibit
79. Ankle sprain SurgeryAnkle sprain Surgery
• No robust evidence to
suggest surgery over
conservative care for
3rd
degree tears
(Cochrane 2007)
80. Ankle ligament TearsAnkle ligament Tears
• Take home message
• Treat all with brace,
or cast and physio
and followup
• Call surgeon for high
level patients with
marked instability
83. Compartment Syndrome PrognosisCompartment Syndrome Prognosis
• Treatment in < 6
hours gives good
result
• Treatment in 6 to 12
hours gives 68%
normal function
Treatment in > 12 hours
only 8 % normal
function
87. Compartment syndrome: causesCompartment syndrome: causes
• Any condition that
alters consciousness
• Patient lays on the
part for a prolonged
time
• Arm under body
causes pressure of
150 mm hg
88. Compartment syndrome: causesCompartment syndrome: causes
Iatrogenic causes
Should we include
Oxycontin
prescription?
• Any injection or
vascular cannulation
particularly in
anticoagulated patient
• Tight cast
• Intraosseous infusion
• ETC
97. Compartment syndrome: DXCompartment syndrome: DX
• Interesting fact
• 50 % patients with
compartment > 30
had 2 point
discrimination > 1 cm
in median nerve
distribution
101. Compartment Syndrome RXCompartment Syndrome RX
• If patient has swollen
and painful part, but
no clear signs of
compartment
syndrome, then
• REEXAMINE with any
clinical change for the
worse
102. Compartment Syndrome RXCompartment Syndrome RX
1. Swollen limb
2. Pain out of
proportion
3. Tense compartment
4. Pain with passive
motion
5. Paresthesia
6. ACT
103. What the non-surgeon can doWhat the non-surgeon can do
• DIAGNOSIS
• AWARENESS OF
DIAGNOSIS
104. What the non-surgeon can doWhat the non-surgeon can do
• Place limb at level of
heart (not higher)
• BIVALVE all casts,
splints and split
padding
105. What the non-surgeon can doWhat the non-surgeon can do
• Split cast
• Bivalve cast
• Take off cast
• Split padding
• 30 % reduction
pressure
• Further 35%
reduction pressure
• Further 15%
reduction
• 10 to 15 % reduction
pressure
106. URGENT SURGERYURGENT SURGERY
• RECOGNIZE TIME
CONSTRAINTS
• If you are a GP
surgeon or have a
general surgeon
available, this may be
the only time to save
the limb
107. SIMILAR TO C SECTIONSIMILAR TO C SECTION
• IT IS BETTER TO DO THE C SECTION
UNNECESSARILY THAN NOT TO DO
ONE THAT IS NEEDED
• IT IS BETTER TO DO A FASCIOTOMY
UNNECESSARILY THAN NOT TO DO
ONE THAT IS NEEDED
108. REVENGE ON CITY SURGEONSREVENGE ON CITY SURGEONS
• Keep the surgical
techniques book
available
• Telephone
consultation with
orthopedic surgeon
• Cut and send
111. What is true about TAL tearWhat is true about TAL tear
• 1. Surgery is always indicated
• 2. No treatment gives equal results to
surgical care
• 3. Studies comparing surgical to non
surgical care are not well done
• 4. Physiotherapists often make the DX
• 5. Can be treated by rural family docs
112. Acute Boutonniere injuryAcute Boutonniere injury
• 1. Results from a tear of the conjoint
tendon
• 2. Always requires surgery
• 3. Can be managed with a paper clip
splint
• 4. Results from the avulsion of the central
slip
• 5. Can be managed by the rural family doc
113. Distal Biceps AvulsionDistal Biceps Avulsion
• 1. Cannot be diagnosed clinically
• 2. Can be treated non surgically
• 3. Can occur with minimal injury
• 4. Can be treated by rural family doc
114. Acute compartment syndromeAcute compartment syndrome
• 1. Can be successfully managed by
waiting until the 5 ‘P’s are noted
• 2. Occurs only after fracture and burns
• 3. Must be diagnosed by measurement of
compartment pressures
• 4. Can be managed by the GP surgeon
115. Jersey FingerJersey Finger
• 1. A common sprain that occurs milking
Jersey cows
• 2. Cannot be diagnosed clinically
• 3. Characterized by loss of FDS function
• 4. Can be managed by the rural family
doc
• 5. Always requires referral to a hand
surgeon
116. A Stener lesionA Stener lesion
• 1. Caused by being shot by a sten gun
• 2. Characterized by loss of flexion of the
PIP joint
• 3. Can only be diagnosed at time of
surgery
• 4. Mention of this lesion can get a
surgeon’s attention and expedite the
referral