This document discusses the anatomy, biomechanics, causes of stiffness, classification, and surgical and non-surgical treatment options for elbow contractures. It covers the relevant bones and joints, range of motion, causes of stiffness like trauma and arthritis, physical therapy approaches like splinting and motion, and surgical procedures for releasing soft tissues and reconstructing the joint surface.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Many people suffer from Elbow Arthritis that cause pain and swelling in their elbows. It causes pain in the elbow not only when they bend their elbow but also when they stretch out their hand.
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
Cervical Hybrid Arthroplasty by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Arthroplasty in combination with a fusion. When people have more than one cervical disc which has degenerated or which has sustained a traumatic rupture they may need a procedure to address both levels. These herniations may begin to affect the surrounding nerves and/or spinal cord. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniations/ Radiculopathy at multiple levels feel free to look us up online www.beverlyspine.com or call toll free 1-8SPINECAL-1
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Anatomy
Comprises of
Humero-ulnar joint:
Hinge joint
Determinant of osseous stability
Humero-radial joint
Pivot joint
Radial head acts as secondary stabilizer to
valgus stress
More stable in extreme flexion and extension
rather than mid-range
9. Functional Range of Motion
Range of motion necessary for a individual
to perform 90% of normal daily activity.
Arc of elbow flexion of 100o
, ranging from 30o
to 130o
.
Arc of forearm rotation of 100o
, ranging from
50o
pronation to 50o
supination.
Morrey et al . A biomechanical study of normal function elbow motion.
J Bone joint Surg 63 A: 872 – 877, 1981.
12. Classification
Intrinsic Contractures :
usually associated with intraarticular
fractures
Intraarticular adhesions from healed congruous
joint fracture
Loss of articular cartilage due to avascular
necrosis
Gross distortion resulting from inadequate or failed
reduction
13. Pathogenesis
Predisposing factors for posttraumatic
elbow stiffness
High degree of articular congruity & conformity
of joint predispose to limited motion after
articular injury
Brachialis muscle covers anterior capsule
predisposing it to posttraumatic ectopic
ossification
Delayed mobilization after elbow injury usually
because of inability to achieve rigid fixation
18. Management
Operative :
Considerations before Planning Surgery
Patients expectations and limitations
Patients functional needs
Likelihood that procedure will satisfy these
needs.
19. Management
Operative:
Risk associated with surgery
Postoperative pain
Instability: as release of collateral ligament
required for
Adequate soft tissue release
Removal of Ectopic Bone
Adequate exposure if Intraarticular pathology
Weakness
20. Anterior Contracture Release
Indications:
Loss of extension > 45o
Minimal changes in articular surface
Contraindications:
Significant alteration of the articular
contour
loss of joint cartilage > 50%
pathology requiring release of one or
both collateral ligaments
Motor deficiency or spasticity
21. Anterior Contracture Release
Technique: (Column procedure)
Posterolateral incision
Dissection between Extensor Carpi
ulnaris and Anconeus
Separate extensor tendon from joint
capsule and LCL
Anterior capsule exposed and incision made
over anterior capsule anterior and parallel to
LCL
As wide a capsular excision is done as
possible
23. Posterior Contracture Release
If flexion limited:
Interval between Triceps and ECRL
exposed
Triceps elevated from posterior aspect of
humerus
Posterior capsule excised
26. Anterior Contracture Release
Postoperative Management
Adequate analgesia
Continuous passive motion:
started immediately
for 3 weeks
Reassessed at 3 weeks and static splints
given
Splintage primarily in extension for 3
months
Gradual weaning from splints
28. Arthrolysis (Bhattacharya
Procedure)
Removal of capsular contracture
Mobilizing Brachialis & Triceps from lower humerus ,
Restoration of trochlear pulley
Minimal removal of Bone block without excising
articular surface
Postoperative Management:
After closure of wound 25 mg inj. Hydrocortisone
acetate injected in joint with 2 – 5 cc of Hyalase.
Compression bandage with splint in full extension
Second dose of Hydrocortisone is given with 2 – 4
cc lignocaine (2%) on 7th
or 10th
day.
29. Distraction Arthroplasty
Simultaneous joint motion while ensuring stability by
protecting collateral lig.
Indications:
Reconstructive
Adjuvant to capsule release if ligaments
damaged
Significant dissection making intraoperative
motion difficult
> 50% joint surface void of cartilage
Modified joint contour
32. Distraction Arthroplasty
Goals
Separate joint surfaces
Reorient joint surface
Protect ligament healing
Allow motion
Contraindications
Inexperience
Local sepsis
# distal humerus or proximal ulna
33. Distraction Arthroplasty
If as adjuvant to capsular release
Caution
Identification of Ulnar Nerve important at
three steps
Reflecting Triceps
Capsular Dissection
Pin Placement
34. Distraction Arthroplasty
Technique: Pin Placement
Tubercle of capitellum (Lat) to just anterior
and inferior to medial epicondyle
Two Ulnar pins anterior and posterior to
center of articulation
Pins should be placed parallel
3 – 5 mm distraction
35. Distraction Arthroplasty
Postoperative management
Adequate analgesia
Continuous passive motion for 3 weeks
Distraction device removed at 3 weeks
Flexion – Extension splints till 6 – 12 weeks
Morrey B F . Master techniques in orthopaedic surgery – The Elbow
36. Fascial Interposition Arthroplasty
Indications:
Young adults with posttraumatic ankylosis
of elbow with intact broad contour of distal
humerus
Young adult Stage I & II Rheumatoid
arthritis,with intact bone
Contraindications:
Active infection
Grossly unstable elbow
Congenital ankylosis (lacks soft ts support)
37. Fascial Interposition Arthroplasty
Preoperative planning:
Selection of donor site
Avoid hairy donor site (risk of inclusion cysts)
Cutis – preferred material
Cutis – thick dermal layer of skin remaining
after superficial epidermis has been peeled
off.
38. Fascial Interposition Arthroplasty
Technique:
Extended Kocher’s lateral approach
Extensor mass,periosteum and LCL dissected off
the lateral condyle
Medial collateral lig sectioned from within
Elbow dislocated and distal end of humerus is
prepared – removal of osteophytes,articular
cartilage, bone fragments
Smooth rounded surface obtained ~ 4 cm wide &
~ 2 cm anterior to posterior
Radial head removed only if necessary to restore
pronation & supination
39. Fascial Interposition Arthroplasty
Technique: (contd…..)
Split thickness graft taken from donor site
Deep dermal layer is excised from
subcutaneous fat (Cutis)
Cutis graft draped over distal humerus with
superficial cut surface of dermis applied to bone
Dermal graft sutured with drill holes in medial
and lateral ridges
42. Fascial Interposition Arthroplasty
Postoperative Management:
Posterior plaster splint in 90o
flexion for 2 weeks
Hinged cast brace for 4 weeks
Resistive flexion exercises started at 1 month
Extension strengthening exercises started at
6 weeks
Complications:
Medial-lateral laxity
43. Elbow Arthroscopy
Applications in Stiff elbow:
Removal of loose bodies
Debridement of joint surface or
adhesions
Release of Capsular contractures
Excision of osteophytes causing
impingement (as in early osteoarthritis
of ulnohumeral joint)
46. Elbow Arthroscopy
Advantages:
Complete examination & treatment options
Debridement of intraarticular adhesions
improve ROM as well as relieve pain
Relatively less soft ts trauma & post op
scarring reduce risk of recurrent
contractures.
47. Elbow Arthroscopy
Complications:
Permanent nerve injuries
Vicinity of Radial & median nerves to
anterior portals
Restricted Capsular Distension (Capsular
distension achieved with 15 – 25 ml saline,
intracapsular capacity ~ 6 ml in contractures)
51. Ectopic Ossification
Presentation:
Usually at 2 weeks after insult
Localized swelling, bone pain, Hyperemia,
local tenderness
Elbow stiffness after 1 – 4 months
Nerve entrapment syndromes – ulnar
nerve most common
53. Ectopic Ossification
ZONE phenomenon
Myositis Ossificans matures from inside to
Outside , i.e. Core is composed of immature
osseous tissue , while the most superficial
region is composed of most mature osseous
tissue.
55. Ectopic Ossification
Classification:
Randal W V et al
Type I : ossification of Proximal radio-ulnar
joint
Type II : ossification of proximal RUJ with distal
extension involving the bicipital tuberosity
Type III : ossification of radius & ulna distal to proximal
RUJ
Subtype A – Anterior involvement
Subtype B – Posterior involvement
Subtype C – intraarticular involvement of PRUJ
56. Ectopic Ossification
Classification:
Functional classification
Class I : Radiologically evident elbow ectopic ossification
without clinical limitation
Class II : Subtotal, functional, limitation of motion
A: in flexion & extension plane
B: in pronation & supination plane
C: in both planes
Class III : Ankylosis that eliminates motion
A:, B:, C:.
Hastings H, Graham TJ : The classification and treatment of heterotopic
ossification about elbow and forearm. Hand Clin 10:417-437, 1994.
59. Ectopic Ossification
Operative Treatment:
Indications / Criteria
Functionally limiting elbow stiffness
Radiographic union of fracture
Radiographic evidence of intact ulno-humeral
articular surface
Stage of maturation
Stabilization of traumatic brain injury & motivation
to complete therapy
Soft tissue stability
60. Ectopic Ossification
Operative Treatment:
Timing of surgery
Advantages of Delayed intervention
Metabolic quiescent ectopic bone
Maximal neurological recovery
Problems with delayed Intervention
Progressive soft tissue contracture
Potential articular cartilage destruction
Prolonged infirmity
61. Ectopic Ossification
Essentials
Select incision allowing resection of all ectopic
ossification
Decompression of compressed nerve
Resection of anterior and posterior capsule
Clearing of coronoid fossa
Debridement of coronoid process
Clearing of Olecranon fossa
Excision of terminal 1 – 1.5 cm of olecranon
Correction of elbow instability
Transposition of ulnar nerve
Preserve anterior band of MCL & LCL & Orbicular
cartilage even in presence of periarticular
calcification
63. Indications:
Age > 60
Advanced arthritis or posttraumatic destruction
of joints
Total Elbow Arthroplasty
Types
Semi constrained or linked prosthesis
Unconstrained or unlinked prosthesis
64. Total Elbow Arthroplasty
Unconstrained / Unlinked prosthesis
Prerequisite
Good Bone Stock
Little Deformity
Stable Capsulo-ligamentous support
Uncommon in a Posttraumatic elbow
Indications
Elderly patients with primary Rheumatoid
joint
Painless ankylosed elbow at 90o
in young
patient with Juvenile Rheumatoid Arthritis
Kudo Elbow
IBP Elbow
66. Total Elbow Arthroplasty
Unconstrained / Unlinked prosthesis
Extended Kocher’s Approach
Post operative Management
Elbow placed in 60o
flexion & full pronation
ROM exercises started usually by 2nd
day
Active Assisted elbow flexion & passive
gravity extension
Forearm placed in pronation to protect LCL for 6 wks
Resting splint in 90o
flexion
Extension beyond 30o
avoided for first 3 - 4 weeks
67. Total Elbow Arthroplasty
Semi constrained / linked prosthesis
Predominant role in reconstruction of posttraumatic
elbow
Indication
Elderly patient with post traumatic / arthritic
joint destruction with
Deficit Bone Stock
Unstable Capsulo-ligamentous support
Deformity
69. Total Elbow Arthroplasty
Semi constrained / linked prosthesis
Posterior / Bryan-Morrey Approach
Post operative Management
Postoperative splintage in full extension
Assisted flexion & forearm rotation started 2nd
day
with gravity assisted extension
Daytime resting splint in 90o
flexion for 6 weeks
Night time extension splint for 12 weeks
GSB III
70. Total Elbow Arthroplasty
Baksi’s Sloppy Hinge prosthesis
79 ( 69 Ankylosed ) elbows replaced with
sloppy hinge prosthesis ,followed over 10 years.
Painless stable motion in 59 ( 86.8 % )
ankylosed elbows with average arc 88.8o
.
Aseptic loosening in 4 patients
Bakshi : Sloppy Hinge prosthetic elbow replacement for posttraumatic
ankylosis or instability. J Bone Joint Surg 80 (B):614-619,1998.
71. Total Elbow Arthroplasty
Life Time Restrictions
Lifting weight not more than 5 kg
Avoid upper limb impact sports
Morrey BF:Master Techniques in Orthopaedics – The Elbow
Moro JK, King GJ: Total Elbow Arthroplasty in the Treatment of
Posttraumatic Conditions of the Elbow. CORR 370:102-114,2000.
72. Total Elbow Arthroplasty
Expected to improve valgus and
rotational stability#
? Increased incidence of loosening of
humeral component*
Proper position & orientation of
prosthesis ????
#
O’Driscoll, King GJW: Treatment of instability after total elbow
arthroplasty. Orthop Clin North Am 2001,32:679-695
* Ewald FC et al.: Capitellocondylar total elbow arthroplasty. J Bone Joint
Surg 62(A) :1259,1980.
??#!!/??
Role of Radial Head Replacement
76. References
Reconstructive Surgery of joints. Bernard F. Morrey.
Master Techniques in Orthopaedic Surgery- The
Elbow. Bernard F. Morrey.
The Athletes Elbow. David W. Altchek
Green’s Operative hand Surgery
Textbook of orthopaedics & Trauma . Kulkarni.
Clin Orthop 370,2000.
J Bone Joint Surg 83-B,1998
Current Opinion in Orthopaedics:Vol.1(4),2002.