This document summarizes a presentation on thoracic outlet syndrome (TOS). TOS is caused by compression of the neurovascular structures between the clavicle and first rib. It discusses the history, anatomy, types of TOS including neurogenic, venous, and arterial, causes such as cervical ribs and soft tissue abnormalities, symptoms, diagnosis through history, exam and provocative tests, and imaging tools like x-rays, CT/MRI, and vascular studies. Physical exam focuses on pulse, edema and provocative maneuvers like Adson's test and Roos test. Accurate diagnosis relies on history and thorough physical exam as no single test is definitive.
Claw Hand,Definition,Causes,Types,Symptoms and ManagementDr.Md.Monsur Rahman
Dr.Md.Monsur Rahman, Bachelor of Physiotherapy (BPT), Master of Physiotherapy (MPT) in Musculoskeletal Disorders, ABC-Spine in Osteopathic Approach,
Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
This document describes a case of thoracic outlet syndrome caused by a cervical rib in a 22-year old male patient who presented with numbness, pain, discoloration, and swelling in his right arm. Imaging revealed a cervical rib compressing the brachial plexus. The patient underwent surgery to remove the cervical rib, which relieved his symptoms. The document then provides an overview of thoracic outlet syndrome, including its causes, types, symptoms, diagnostic techniques like physical exams and imaging, and treatment options like physical therapy, medications, and surgical decompression.
This document provides an overview of median nerve injuries, including anatomy, types of injuries, clinical examination findings, and management principles. It describes the anatomy of the median nerve from its origins in the brachial plexus through the arm, forearm, and hand. It discusses high and low median nerve injuries. Key examination techniques are outlined, including tests for specific muscle function. Surgical management principles include nerve repair, decompression, and tendon transfers. Common compression neuropathies like carpal tunnel syndrome and pronator teres syndrome are also summarized, including their symptoms, diagnosis, and treatment.
The document describes claw hand, which is a deformity of the hand where the fingers are flexed into the palm at the middle knuckle. It discusses the anatomy, etiology, types, clinical signs, classification, and surgical techniques for correction. The main techniques discussed are static procedures like flexor pulley advancement and dynamic procedures using tendon transfers to restore muscle function. The goal of surgery is to maintain the middle knuckle in slight flexion to allow the extensors to straighten the fingers.
This document provides information about nerve injuries of the upper limb. It discusses the anatomy of the brachial plexus and the nerves it forms. Common sites of injury for specific nerves are outlined, along with the clinical manifestations and treatments. Injuries can occur to individual nerves or to the nerve trunks. Clinical diagnosis involves sensory testing and electrodiagnostic studies. Non-operative treatments include immobilization and physical therapy. Surgery may be used for nerve repair, grafting, or tendon transfers to improve function.
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
This document provides information on claw hand deformities, including definitions, anatomy, classifications, evaluation, and surgical reconstruction techniques. It begins with defining claw hand as a flattening of the transverse metacarpal arch with hyperextension of the MCP joints and flexion of the PIP and DIP joints. It then discusses the anatomy and biomechanics involved in normal versus paralytic claw hands. Various classification systems for claw hands are presented based on etiology, pattern of nerve injury, degree of involvement, and physical characteristics. Evaluation techniques such as specific tests and angle measurements are outlined. Both static and dynamic surgical reconstruction methods are then described in detail, including tendon transfers, capsulotomies, and tenode
This document discusses median nerve injuries, including:
- The anatomy and functions of the median nerve in the forearm and hand.
- Clinical assessment of median nerve function through specific muscle tests.
- Common median nerve compression syndromes like carpal tunnel syndrome.
- Classification of nerve injuries and management options for median nerve injuries.
Claw Hand,Definition,Causes,Types,Symptoms and ManagementDr.Md.Monsur Rahman
Dr.Md.Monsur Rahman, Bachelor of Physiotherapy (BPT), Master of Physiotherapy (MPT) in Musculoskeletal Disorders, ABC-Spine in Osteopathic Approach,
Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
This document describes a case of thoracic outlet syndrome caused by a cervical rib in a 22-year old male patient who presented with numbness, pain, discoloration, and swelling in his right arm. Imaging revealed a cervical rib compressing the brachial plexus. The patient underwent surgery to remove the cervical rib, which relieved his symptoms. The document then provides an overview of thoracic outlet syndrome, including its causes, types, symptoms, diagnostic techniques like physical exams and imaging, and treatment options like physical therapy, medications, and surgical decompression.
This document provides an overview of median nerve injuries, including anatomy, types of injuries, clinical examination findings, and management principles. It describes the anatomy of the median nerve from its origins in the brachial plexus through the arm, forearm, and hand. It discusses high and low median nerve injuries. Key examination techniques are outlined, including tests for specific muscle function. Surgical management principles include nerve repair, decompression, and tendon transfers. Common compression neuropathies like carpal tunnel syndrome and pronator teres syndrome are also summarized, including their symptoms, diagnosis, and treatment.
The document describes claw hand, which is a deformity of the hand where the fingers are flexed into the palm at the middle knuckle. It discusses the anatomy, etiology, types, clinical signs, classification, and surgical techniques for correction. The main techniques discussed are static procedures like flexor pulley advancement and dynamic procedures using tendon transfers to restore muscle function. The goal of surgery is to maintain the middle knuckle in slight flexion to allow the extensors to straighten the fingers.
This document provides information about nerve injuries of the upper limb. It discusses the anatomy of the brachial plexus and the nerves it forms. Common sites of injury for specific nerves are outlined, along with the clinical manifestations and treatments. Injuries can occur to individual nerves or to the nerve trunks. Clinical diagnosis involves sensory testing and electrodiagnostic studies. Non-operative treatments include immobilization and physical therapy. Surgery may be used for nerve repair, grafting, or tendon transfers to improve function.
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
This document provides information on claw hand deformities, including definitions, anatomy, classifications, evaluation, and surgical reconstruction techniques. It begins with defining claw hand as a flattening of the transverse metacarpal arch with hyperextension of the MCP joints and flexion of the PIP and DIP joints. It then discusses the anatomy and biomechanics involved in normal versus paralytic claw hands. Various classification systems for claw hands are presented based on etiology, pattern of nerve injury, degree of involvement, and physical characteristics. Evaluation techniques such as specific tests and angle measurements are outlined. Both static and dynamic surgical reconstruction methods are then described in detail, including tendon transfers, capsulotomies, and tenode
This document discusses median nerve injuries, including:
- The anatomy and functions of the median nerve in the forearm and hand.
- Clinical assessment of median nerve function through specific muscle tests.
- Common median nerve compression syndromes like carpal tunnel syndrome.
- Classification of nerve injuries and management options for median nerve injuries.
This document discusses brachial plexus injuries, including anatomy, classification, risk factors, diagnosis, and treatment approaches. It covers both pediatric obstetric brachial plexus injuries as well as adult traumatic injuries. Key points include the Narakas classification system for pediatric injuries, signs and symptoms of preganglionic versus postganglionic injuries, imaging and electrodiagnostic testing, conservative treatment protocols, surgical reconstruction options like nerve grafting and nerve transfers, and secondary reconstruction procedures.
The document discusses thoracic outlet syndrome (TOS), which occurs when there is neurovascular compression in the thoracic outlet area leading to symptoms in the upper extremities. It notes that TOS can be predominantly neurogenic (95% of cases), arterial (1%), or venous (4%). The symptoms vary depending on the structure compressed but can include pain, paresthesias, weakness, and changes in pulse. The document outlines various clinical tests to evaluate for TOS and notes that imaging studies like MRI, ultrasound, and angiography can help identify anatomical abnormalities and assess vascular involvement. Precise diagnosis is important to guide appropriate treatment, which may include physical therapy, medications, or surgery.
1. This document discusses hip fractures, specifically subtrochanteric fractures. It notes that 10-30% of hip fractures are subtrochanteric and they have a bimodal age distribution in those 20-40 years old from high-energy injuries and those over 60 from low-energy falls.
2. It reviews treatment options for subtrochanteric fractures including traction, extramedullary fixation with plates, and intramedullary fixation with nails. Intramedullary nails are preferred as they better resist axial loads and torsion compared to plates.
3. Complications of treatment include infection, malunion, nonunion, and implant failure. Proper reduction and fixation are important to
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
1. The document describes the anatomy of the shoulder joint and common injuries to the labrum such as SLAP and Bankart lesions.
2. It outlines the signs, symptoms, and surgical procedure for repairing a SLAP tear as well as a 5 phase post-operative rehabilitation program focusing on range of motion, strengthening, and return to activity.
3. The rehabilitation program progresses from passive range of motion and stretching in the initial weeks to active range of motion, strengthening, sport specific drills, and eventual return to full activity over 4-5 months.
This document defines peripheral vascular disease and describes the differences between peripheral arterial and venous disorders. It lists various risk factors for PVD like age, smoking, hypertension, and diabetes. Tests for assessing arterial insufficiency include ankle brachial index, treadmill testing, and skin perfusion pressure measurement. Tests for venous insufficiency include venous filling time, Homan's sign, and Trendelenburg test. Signs and symptoms of arterial disease include pale skin, absent pulses, and painful ulcers. Venous disease presents with warm skin, edema, and less painful ulcers. Grading scales assess severity of venous disease based on symptoms and ulcer characteristics.
The median nerve forms in the axilla from the lateral and medial cords of the brachial plexus. It descends along the arm and passes through the cubital fossa into the forearm. It supplies branches throughout the arm and forearm and then passes through the carpal tunnel into the hand, where it divides into lateral and medial branches. It is responsible for sensation and motor function in parts of the arm, forearm, and hand. Injuries to the median nerve at different points along its course can result in deformities and loss of function such as ape thumb or pointing index finger.
This document discusses radial nerve palsy, which is an injury to the radial nerve resulting in impaired nerve function and causing wrist drop. Wrist drop is the characteristic clinical sign where the wrist hangs flaccidly and cannot be extended. Causes of radial nerve palsy include sleeping with one's arm compressed (e.g. Saturday night palsy from falling asleep with one's arm on a chair or bar), compression from walking with a crutch (crutch palsy), or from another person sleeping on one's arm (honeymoon palsy). Radial nerve palsy results in weakness of wrist and finger extension and grip. Treatment involves reducing pain, increasing range of motion, and restoring
This document provides information on nerve injuries, specifically those involving the brachial plexus. It describes the anatomy of the brachial plexus and its branches, then discusses various types of nerve injuries including locations, causes, affected muscles and functions, sensory loss, and resulting deformities. Key injuries summarized are Erb's palsy from upper trunk injury, Klumpke's palsy from lower trunk injury, injuries to specific nerves like the radial and ulnar nerves, and common sites of median nerve injury.
This document discusses fracture diseases that can result from prolonged immobilization following fracture treatment. The principal fracture diseases include musculoskeletal issues like muscle weakness, atrophy, soft tissue contractures, osteoporosis, and joint stiffness. Prolonged immobilization can also lead to cardiovascular complications such as increased heart rate, circulatory dysfunction, orthostatic hypotension, and venous thromboembolism. Prevention of these fracture diseases focuses on proper fixation, early and frequent mobilization, muscle stretching and contraction, range of motion exercises, use of leg stockings, anticoagulant drugs, and changing patient positioning regularly.
This document discusses diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease. It most commonly affects the elderly, especially between the ages of 60-70. Key features include bone proliferation at sites of tendon and ligament insertion, especially along the spine. Pathology involves calcification and ossification of spinal ligaments. Extra spinal features can include enthesopathy of bones like the iliac crest and greater trochanters. DISH is characterized by flowing ossification along at least four contiguous vertebrae that preserves disc spaces and can result in ankylosis.
This document discusses several types of hand injuries including Bennett's fracture, Rolando's fracture, and tendon injuries. Bennett's fracture is a fracture of the base of the first metacarpal bone that extends into the carpometacarpal joint, often accompanied by subluxation or dislocation. Rolando's fracture is an intra-articular fracture of the base of the first metacarpal bone that extends into the carpometacarpal joint. Tendon injuries can involve the flexor or extensor tendons and are classified based on the zone of injury. Treatment depends on the specific injury but may involve closed or open reduction, internal fixation, splinting, or surgery.
A cervical rib is an extra rib that arises from the seventh cervical vertebra. It occurs in 0.6-0.8% of the population. Cervical ribs usually do not cause symptoms but can potentially lead to thoracic outlet syndrome by compressing nerves. This occurs when the cervical rib and scalene muscles compress the lower trunk of the brachial plexus or subclavian artery. Symptoms include pain, numbness, and weakness in the arm and hand. Diagnosis involves identifying nerve compression during physical exam maneuvers. Surgery to remove the cervical rib and divide scalene muscles may be required if neurological symptoms develop. Physiotherapy focuses on reducing pain, maintaining range of motion and muscle strength, and
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.
This document discusses spondylolisthesis, including its anatomy, classification, natural history, and management. Some key points include:
- Spondylolisthesis is the forward translation of one vertebra on another, often caused by a defect in the pars interarticularis. It is classified by its cause and severity.
- Symptoms range from low back pain to neurological deficits depending on grade. Imaging helps assess severity and complications.
- Conservative care focuses on symptom relief but surgery may be needed for progressive slippage, deformity, or neurological problems.
- Surgical options include decompression with or without fusion to improve stability. Fusion techniques include posterolateral, anterior, or circumferential
Describe about the chief complaints , gait assessment, special test and local examination of hip joint.
includes the special tests like thomas test, tredenlenberg test, DDH test etc..
Jean-Martin Charcot first described neuropathic arthropathy in 1868. It is a progressive joint condition characterized by dislocations, fractures, and deformities that results from sensory or autonomic neuropathy from various conditions like diabetes, MS, alcoholism, etc. The pathophysiology involves both repetitive microtrauma from loss of sensation and an inflammatory process induced by neurovascular changes. It commonly affects the foot, knee, and hip. Diagnosis is made clinically and radiographically, showing features like joint destruction and deformity. Treatment involves casting, bracing, and surgery like fusion for advanced cases.
This document provides information on thoracic outlet syndrome (TOS). It begins with a brief history and defines TOS as abnormal compression of the neurovascular bundle in the thoracic outlet. It describes the relevant anatomy and compartments of the thoracic outlet. The document discusses the causes, types, symptoms, and diagnostic approaches for the neurogenic, venous, and arterial forms of TOS. It provides details on conservative and surgical treatment options.
Diaphragm and chest wall anatomy with some clinical correlatesAdugna Dagne
This document provides an overview of the anatomy seminar on the chest wall and diaphragm with clinical correlations. It begins with an outline and then discusses the anatomy of the chest wall including bones like the sternum and ribs, muscles, blood vessels, and nerves. It then covers the anatomy of the diaphragm including its origin, insertion, openings, blood supply and innervation. Finally, it discusses some normal anatomical variants and imaging abnormalities that can be seen involving the chest wall and diaphragm.
This document discusses brachial plexus injuries, including anatomy, classification, risk factors, diagnosis, and treatment approaches. It covers both pediatric obstetric brachial plexus injuries as well as adult traumatic injuries. Key points include the Narakas classification system for pediatric injuries, signs and symptoms of preganglionic versus postganglionic injuries, imaging and electrodiagnostic testing, conservative treatment protocols, surgical reconstruction options like nerve grafting and nerve transfers, and secondary reconstruction procedures.
The document discusses thoracic outlet syndrome (TOS), which occurs when there is neurovascular compression in the thoracic outlet area leading to symptoms in the upper extremities. It notes that TOS can be predominantly neurogenic (95% of cases), arterial (1%), or venous (4%). The symptoms vary depending on the structure compressed but can include pain, paresthesias, weakness, and changes in pulse. The document outlines various clinical tests to evaluate for TOS and notes that imaging studies like MRI, ultrasound, and angiography can help identify anatomical abnormalities and assess vascular involvement. Precise diagnosis is important to guide appropriate treatment, which may include physical therapy, medications, or surgery.
1. This document discusses hip fractures, specifically subtrochanteric fractures. It notes that 10-30% of hip fractures are subtrochanteric and they have a bimodal age distribution in those 20-40 years old from high-energy injuries and those over 60 from low-energy falls.
2. It reviews treatment options for subtrochanteric fractures including traction, extramedullary fixation with plates, and intramedullary fixation with nails. Intramedullary nails are preferred as they better resist axial loads and torsion compared to plates.
3. Complications of treatment include infection, malunion, nonunion, and implant failure. Proper reduction and fixation are important to
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
1. The document describes the anatomy of the shoulder joint and common injuries to the labrum such as SLAP and Bankart lesions.
2. It outlines the signs, symptoms, and surgical procedure for repairing a SLAP tear as well as a 5 phase post-operative rehabilitation program focusing on range of motion, strengthening, and return to activity.
3. The rehabilitation program progresses from passive range of motion and stretching in the initial weeks to active range of motion, strengthening, sport specific drills, and eventual return to full activity over 4-5 months.
This document defines peripheral vascular disease and describes the differences between peripheral arterial and venous disorders. It lists various risk factors for PVD like age, smoking, hypertension, and diabetes. Tests for assessing arterial insufficiency include ankle brachial index, treadmill testing, and skin perfusion pressure measurement. Tests for venous insufficiency include venous filling time, Homan's sign, and Trendelenburg test. Signs and symptoms of arterial disease include pale skin, absent pulses, and painful ulcers. Venous disease presents with warm skin, edema, and less painful ulcers. Grading scales assess severity of venous disease based on symptoms and ulcer characteristics.
The median nerve forms in the axilla from the lateral and medial cords of the brachial plexus. It descends along the arm and passes through the cubital fossa into the forearm. It supplies branches throughout the arm and forearm and then passes through the carpal tunnel into the hand, where it divides into lateral and medial branches. It is responsible for sensation and motor function in parts of the arm, forearm, and hand. Injuries to the median nerve at different points along its course can result in deformities and loss of function such as ape thumb or pointing index finger.
This document discusses radial nerve palsy, which is an injury to the radial nerve resulting in impaired nerve function and causing wrist drop. Wrist drop is the characteristic clinical sign where the wrist hangs flaccidly and cannot be extended. Causes of radial nerve palsy include sleeping with one's arm compressed (e.g. Saturday night palsy from falling asleep with one's arm on a chair or bar), compression from walking with a crutch (crutch palsy), or from another person sleeping on one's arm (honeymoon palsy). Radial nerve palsy results in weakness of wrist and finger extension and grip. Treatment involves reducing pain, increasing range of motion, and restoring
This document provides information on nerve injuries, specifically those involving the brachial plexus. It describes the anatomy of the brachial plexus and its branches, then discusses various types of nerve injuries including locations, causes, affected muscles and functions, sensory loss, and resulting deformities. Key injuries summarized are Erb's palsy from upper trunk injury, Klumpke's palsy from lower trunk injury, injuries to specific nerves like the radial and ulnar nerves, and common sites of median nerve injury.
This document discusses fracture diseases that can result from prolonged immobilization following fracture treatment. The principal fracture diseases include musculoskeletal issues like muscle weakness, atrophy, soft tissue contractures, osteoporosis, and joint stiffness. Prolonged immobilization can also lead to cardiovascular complications such as increased heart rate, circulatory dysfunction, orthostatic hypotension, and venous thromboembolism. Prevention of these fracture diseases focuses on proper fixation, early and frequent mobilization, muscle stretching and contraction, range of motion exercises, use of leg stockings, anticoagulant drugs, and changing patient positioning regularly.
This document discusses diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease. It most commonly affects the elderly, especially between the ages of 60-70. Key features include bone proliferation at sites of tendon and ligament insertion, especially along the spine. Pathology involves calcification and ossification of spinal ligaments. Extra spinal features can include enthesopathy of bones like the iliac crest and greater trochanters. DISH is characterized by flowing ossification along at least four contiguous vertebrae that preserves disc spaces and can result in ankylosis.
This document discusses several types of hand injuries including Bennett's fracture, Rolando's fracture, and tendon injuries. Bennett's fracture is a fracture of the base of the first metacarpal bone that extends into the carpometacarpal joint, often accompanied by subluxation or dislocation. Rolando's fracture is an intra-articular fracture of the base of the first metacarpal bone that extends into the carpometacarpal joint. Tendon injuries can involve the flexor or extensor tendons and are classified based on the zone of injury. Treatment depends on the specific injury but may involve closed or open reduction, internal fixation, splinting, or surgery.
A cervical rib is an extra rib that arises from the seventh cervical vertebra. It occurs in 0.6-0.8% of the population. Cervical ribs usually do not cause symptoms but can potentially lead to thoracic outlet syndrome by compressing nerves. This occurs when the cervical rib and scalene muscles compress the lower trunk of the brachial plexus or subclavian artery. Symptoms include pain, numbness, and weakness in the arm and hand. Diagnosis involves identifying nerve compression during physical exam maneuvers. Surgery to remove the cervical rib and divide scalene muscles may be required if neurological symptoms develop. Physiotherapy focuses on reducing pain, maintaining range of motion and muscle strength, and
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.
This document discusses spondylolisthesis, including its anatomy, classification, natural history, and management. Some key points include:
- Spondylolisthesis is the forward translation of one vertebra on another, often caused by a defect in the pars interarticularis. It is classified by its cause and severity.
- Symptoms range from low back pain to neurological deficits depending on grade. Imaging helps assess severity and complications.
- Conservative care focuses on symptom relief but surgery may be needed for progressive slippage, deformity, or neurological problems.
- Surgical options include decompression with or without fusion to improve stability. Fusion techniques include posterolateral, anterior, or circumferential
Describe about the chief complaints , gait assessment, special test and local examination of hip joint.
includes the special tests like thomas test, tredenlenberg test, DDH test etc..
Jean-Martin Charcot first described neuropathic arthropathy in 1868. It is a progressive joint condition characterized by dislocations, fractures, and deformities that results from sensory or autonomic neuropathy from various conditions like diabetes, MS, alcoholism, etc. The pathophysiology involves both repetitive microtrauma from loss of sensation and an inflammatory process induced by neurovascular changes. It commonly affects the foot, knee, and hip. Diagnosis is made clinically and radiographically, showing features like joint destruction and deformity. Treatment involves casting, bracing, and surgery like fusion for advanced cases.
This document provides information on thoracic outlet syndrome (TOS). It begins with a brief history and defines TOS as abnormal compression of the neurovascular bundle in the thoracic outlet. It describes the relevant anatomy and compartments of the thoracic outlet. The document discusses the causes, types, symptoms, and diagnostic approaches for the neurogenic, venous, and arterial forms of TOS. It provides details on conservative and surgical treatment options.
Diaphragm and chest wall anatomy with some clinical correlatesAdugna Dagne
This document provides an overview of the anatomy seminar on the chest wall and diaphragm with clinical correlations. It begins with an outline and then discusses the anatomy of the chest wall including bones like the sternum and ribs, muscles, blood vessels, and nerves. It then covers the anatomy of the diaphragm including its origin, insertion, openings, blood supply and innervation. Finally, it discusses some normal anatomical variants and imaging abnormalities that can be seen involving the chest wall and diaphragm.
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Thoracic outlet syndrome
Neurovascular symptoms in the upper extremities due to pressure on the nerves and vessels in the thoracic outlet area
The specific structures compressed are usually the nerves of the branchial plexus and occasionally the subclavian artery or subclavian vein
Anatomy
Thoracic outlet
Entrance/ Exit region of the upper limb
The thoracic outlet is defined as the interval from the supraclavicular fossa to the axilla that passes between the clavicle and the first rib
Anatomy - Scalane triangle
Anatomy of the costoclavicular space
Pectoralis minor space
Located inferior to the coracoid process
anterior to the second through fourth ribs
posterior to the pectoralis minor muscle
The cords of the brachial plexus
Axillary artery
Axillary vein.
Soft-tissue Causes (70%)
Scalene muscle
Variations in insertion
Hypertrophy
Accessory scalenus minimus muscle
Anomalous ligaments or bands
Soft-tissue tumors
Osseous Causes
Cervical rib
Prominent C7 transverse process
Displacement or callus from first rib fracture
Malunited clavicle or first rib fracture
AC or SC joint injury or dislocation
Osseous tumor
Poor posture
Drooping the shoulders
Holding the head in a forward position
Repetitive activity
Athletes and swimmers
Neurogenic TOS
Compression – scalene triangle and costoclavicular space
May be associated with normal anatomy
Traction of the lowest trunk of the brachial plexus
Often in association with arterial TOS
Features of Lower brachial plexus compression - Common
Female predominance
Appearance of Amedio Modigliani painting
Complains of pain and paresthesia extending from the shoulder /down the ulnar aspect of the arm into the medial two fingers
Neurogenic TOS
Upper brachial plexus compression C5,C6 and C7
Less common
Compression mainly occurs in scalene triangle
Symptoms
Unilateral occipito-frontal headache
Facial or jaw pain
The Gilliatt-Sumner hand
A characteristic finding of neurogenic TOS, is described as atrophy of the abductor pollicis brevis and, to a lesser degree, the hypothenar musculature and the interossei.
Venous TOS
Causes
Hypertrophy of the subclavius muscle,
Chondroma formation
Clinical presentation
Most patients are sportsmen, musicians or manual workers undertaking repetitive arm movements.
The condition occurs more commonly in the dominant limb
Male predominance
Clinical presentation
Acute presentation -
Swollen and tensed upper limb
Upper limb aching pain
blueish- purple arm due to venous engorgement
Collateral veins may be visible
Feeling of heaviness that is worse after activity
Symptoms are precipitated by working with the arms elevated and are relieved by dependency, a pathognomonic feature of vTOS.
Arterial TOS
Rare but has more devastating consequences
Caused by
Intermittent subclavian arterial compression - Costoclavicular compression with normal anatomy.
The document discusses osteotomies around the hip, including pelvic and proximal femoral osteotomies. It covers indications, classifications, principles, techniques for various osteotomies like Salter, Steel, Ganz, Pemberton, Dega, Chiari, Schanz, Lorenz, and femoral osteotomies for conditions like slipped capital femoral epiphysis, Perthes disease, congenital coxa vara and non-unions. Post-operative principles and complications of osteotomies are also discussed.
This document discusses fractures of the pelvis and acetabulum in pediatric patients. It begins by describing the anatomy of the pediatric pelvis, which differs from adults in having more malleable bones, more elastic joints, and growth plates. Common injuries include avulsion fractures at sites of muscle attachment and fractures through the triradiate cartilage of the acetabulum. Treatment depends on the fracture type and stability but may include bed rest, casting, traction, external fixation, or open reduction and internal fixation while avoiding growth plates when possible.
Tuberculosis of Hip joint and Management-30-06-2021.pptxSaurabh Agrawal
This document provides an overview of tuberculosis of the hip joint and its management. It discusses the historical aspects and epidemiology of TB. It describes the characteristics, pathogenesis, clinical features and stages of TB of the hip joint. It outlines the investigations, general treatment principles, and local management options for different stages of the disease, including chemotherapy, traction, synovectomy, arthrodesis, excision arthroplasty, and total hip arthroplasty. Surgical treatments aim to control infection, relieve pain, restore function and mobility, and correct deformities.
In this presentation I’m going to inform you briefly about a novel arthroscopic technique for athletic pubalgia. You may have heard it as “sports hernia or groin injury………” but in fact is a groin pain syndrome, particularly common in sports that require athletes to perform repetitive kicking..
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the neck and upper chest - become compressed. There are three potential spaces where compression can occur as these structures travel from the neck to the arm. Symptoms depend on whether the artery, vein, or nerves are compressed, and may include pain, numbness, coldness, or weakness in the arm. Physical exams like the Roos test, Adson's test, and costoclavicular test aim to reproduce the patient's symptoms and help diagnose thoracic outlet syndrome.
The 41-year-old patient should be informed of an increased risk for polyethylene wear and osteolysis compared to his father. Younger, more active patients are at higher risk for wear particle generation and subsequent osteolysis after total hip arthroplasty due to longer prosthetic exposure over their lifetime.
The document discusses various compartment syndromes that can occur in different parts of the body including the extremities, abdomen, and head. It covers the causes, clinical presentation, diagnosis, and treatment of these conditions with a focus on rapid fasciotomy to release pressure in the affected compartments. Extremity compartment syndromes require urgent recognition and management to prevent permanent muscle and nerve damage.
This document outlines the steps for performing an abdominal examination, including inspection, auscultation, percussion, and palpation. It describes presenting complaints to assess for, such as gastrointestinal issues, urinary problems, and abdominal or flank pain. The preparation of the patient and approach of the examiner are explained. Assessment techniques for specific organs like the spleen, kidneys, and detection of appendicitis are also covered. The document serves as a guide for performing a thorough abdominal exam.
Bill Bose, M.D. is an orthopaedic surgeon who specializes in hip injuries and arthroscopic treatment of femoroacetabular impingement (FAI). The document discusses hip anatomy, types of hip injuries including fractures and overuse injuries, and FAI which is caused by abnormal contact between the femoral head and acetabulum. Hip arthroscopy is presented as a minimally invasive alternative to open surgery for treating FAI that offers benefits like shorter recovery time and less pain compared to traditional open procedures. The goal of FAI treatment is to relieve pain and delay the onset of osteoarthritis.
This document provides an overview of the anatomy, clinical examination, and key tests for examining the hip joint. It describes the ball and socket anatomy of the hip joint and surrounding ligaments. Clinical examination involves taking a history of pain characteristics and functional limitations. Physical examination includes inspecting gait patterns, palpating bony landmarks for tenderness, and measuring range of motion. Special tests evaluate muscles like the Trendelenburg test for abductors or assess for deformities like the Thomas test for flexion contracture. Understanding hip anatomy and the focused examination of the hip is important for orthopedic evaluation.
This document discusses thoracic outlet syndrome (TOS), defined as abnormal compression of the neurovascular bundle in the narrow space between the clavicle and first rib. It describes the anatomy of the thoracic outlet and classifications of TOS (neurologic, venous, arterial). Common causes include anatomical defects, muscle anomalies, trauma, and repetitive activity. Symptoms vary depending on type but can include pain, numbness, and weakness in the neck, shoulder, arm and hand. Diagnosis involves clinical exams and imaging tests. Treatment begins with conservative options like physical therapy, injections, and exercises, while surgery is considered if symptoms persist.
This document provides clinical materials for self-learning in clinical medicine. It includes 12 clinical cases with descriptions, examination findings, imaging results, and summaries. The objective is to examine each case carefully and analyze the findings to aid in learning. Suggestions and feedback can be provided to the author via email. The author acknowledges and thanks the patients, teachers, and colleagues who contributed to developing this resource.
The document provides an overview of chest radiography procedures, including indications for chest x-rays, patient preparation, basic views and positioning, anatomy of the chest, and technical evaluation of chest radiographs to ensure diagnostic quality images. Key points covered include common indications for chest x-rays, patient positioning and preparation, basic posterior-anterior and alternative views, and technical factors radiographers should evaluate such as correct exposure, positioning, and demonstration of pertinent anatomy.
Arthroscopy: Management of chronic septic arthritisChrystal Lynch
The patient presented with septic arthritis of the knee following arthroscopy. Septic arthritis is a painful infection of the joint that can cause significant damage if left untreated. The patient underwent arthroscopic lavage and debridement to clear the infected materials from the joint, along with a regimen of antibiotics and rest for the knee. Physical therapy was prescribed to regain knee function and range of motion.
This document discusses the Bernese periacetabular osteotomy (BPO) procedure for treating hip dysplasia. The BPO was developed in 1984 to reorient the acetabulum and increase hip contact area and stability through a minimally invasive technique. Studies have shown good functional outcomes following BPO, with 18 out of 24 patients in one study showing a high functional level at a mean 3.5 years post-op. Another study found that 14 out of 26 patients who underwent unilateral BPOs had no or mild arthritis at 7-15 years post-op. The BPO allows for appropriate correction of hip coverage while maintaining version and causes less damage than other procedures.
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The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
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Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
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3. HISTORICAL REVIEW
•Galen –was the first who described the
presence of Cervical rib in medical
literature 150 years AD
•Vesalius – 1543 – A Belgian anatomist
described Cervical ribs
3/18/2018Physio-Ortho meeting
4. SIR ASTLEY COOPER (1768- 1841)
• “Prince of surgery”
• Guy’s hospital in London
• Many contribution in vascular surgery
• President of the royal collage of
surgeons
• In 1821 he described a case of a
woman with pulseless, cold arm and
gangrenous changes to the fingers due
to compression and thrombosis of the
3/18/2018Physio-Ortho meeting
6. WILLIAM HALSTED
In 1916 - described how
cervical ribs cause subclavian
artery post-stenotic dilatation
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7. • Law – 1920 – described congenital bands and
ligaments that compressed the lower brachial
plexus
• Adson and coffey – 1927 – division of anterior
scalene muscle without cervical rib resection
• Ochsner, gage, debakey – 1935 – scalene anticus
syndrome (naffziger’s syndrome) – scalenotomy
in the absence of cervical rib
3/18/2018Physio-Ortho meeting
8. •PEET – 1956 – Introduced the term
“Thoracic outlet syndrome”
•Clagett – 1962 – posterior approach to first
rib resection
•Roos – 1966 – trans-axillary first rib
resection
•Gol – 1968 – infraclavicular approach3/18/2018Physio-Ortho meeting
9. DEFINITION
Thoracic outlet syndrome (TOS)- is a collection of
symptoms brought about by abnormal compression
of the neurovascular bundle by
• bony,
• Ligamentous,
• or muscular obstacles
in the narrow space between clavicle and 1st rib.3/18/2018Physio-Ortho meeting
11. ANATOMY
BOUNDARIES OF T.O.
• Posteriorly: T1
vertebral body
• Laterally: first rib
and costal cartilage
• Anteriorly:
manubrium sterni
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12. Thoracic outlet is
subdivided to three
spaces where the
obstruction always
occur
1. Inter-Scalene
triangle
2. Costoclavicular
space
3. Pectoralis minor
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14. 2- Costoclavicular Space
• Med : 1st rib
• - Ant : clavicle
• - Post : scaleneus
Anterior
• - Lat : costoclavicular
Ligament, subclavius
Muscle
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15. 3- Pectoralis Minor Space (Subcoracoid
Space)
Compressed by
•pectoralis minor
tendon,
•head of humerus,
•or coracoid process. 3/18/2018Physio-Ortho meeting
17. PRINCIPA
L CAUSES
OF TOS
Skeletal and bone
abnormalities
•Cervical rib 0.74%,
•Anomalous 1st rib 0.76%
•Elongated C 7 transverse
process
•Exostosis or tumor of the
first rib or clavicle
3/18/2018 Physio-Ortho meeting
18. Soft tissue abnormalities
• Fibous band
• Congenital variations
• Insertion variation
• Supernumery muscle
• Hypertrophied muscle
• Acquierd soft tissue abnormalities
• Post traumatic fibrous scarring
• Postoperative scarring
3/18/2018 Physio-Ortho meeting
PRINCIPAL
CAUSES
OF TOS
19. •Poor Posture And Weak Muscular Support In Thin
Women
Posture and predisposing morphotype
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PRINCIPA
L CAUSES
OF TOS
20. CERVICAL RIB
• It is a superneumary
rib that arises from
seventh cervical
vertebra or rarely
from sixth or fifth
cervical vertebrae.
• Incidence 0.5-0.6%
• Bilateral in 60-80 %
• Symptomatic in 10 -
3/18/2018Physio-Ortho meeting
29. Pectoralis minor syndrome
• Compression of
neurovascular bundle
under the pec minor
• Pain over anterior chest
and axilla
• Fewer head/neck
symptoms
• Consider pec minor
tenotomy with thoracic
outlet decompression
3/18/2018Physio-Ortho meeting
31. VENOUS TOS
Etiology
• Developmental anomalies of costoclavicular
space
• Repetitive arm activities
• Throwing
• Swimming
• Overhead Activities
3/18/2018Physio-Ortho meeting
32. Predisposing factors
• Relationship of vein to subclavius tendon and
costoclavicular ligament
• Dimensions of costoclavicular space
• Repetitive trauma to vein causing fibrosis,
stenosis, thrombosis
3/18/2018Physio-Ortho meeting
33. Acute occlusion
• Pain
• Tightness
• Discomfort during exercise
• Edema
• Cyanosis
• Increased venous pattern
• Tenderness over the
axillary vein
• Gangrene rarely
3/18/2018
34. PHYSICAL ACTIVITIES
• Lifting or heavy objects, basketball,
baseball, painting, tennis, racquet ball,
football, golf, Up to 40% had residual
symptoms after treatment
3/18/2018Physio-Ortho meeting
35. PAGET-SCHROETTER SYNDROME
“EFFORT THROMBOSIS”
"Effort" Axillary-subclavian Vein Thrombosis
(Paget-schroetter Syndrome) Is An
Uncommon Deep Venous Thrombosis Due To
Repetitive Activity Of The Upper Limbs.
3/18/2018Physio-Ortho meeting
41. •“The most accurate diagnosis of
TOS…must rely on A careful history
and thorough, appropriate physical
examination”
David B roos, MD
•No single diagnostic test has sufficient
specificity to prove or exclude the
diagnosis 3/18/2018Physio-Ortho meeting
42. HISTORY
Neck trauma preceding onset of
symptoms
Repetitive stress injury
Occipital headaches
Pain over trapezius, neck, shoulder,
chest
Specific disabilities regarding work
and daily activities
Exertional arm pain
Other special tests/procedures
performed
3/18/2018 Physio-Ortho meeting
43. PHYSICAL EXAMINATION
Pulse Exam
Listen For Bruits
Edema/Cyanosis/Collateral Veins
Tenderness Over Scalene Muscles (Trigger Points) Or Pectoralis Minor
Reduced Sensation To Very Light Touch In Fingers
3/18/2018Physio-Ortho meeting
45. ADSON'S TEST
• The examiner palpates the radial
pulse on the side to be tested. The
examiner extends, abducts and
externally rotate the patient’s arm.
The patient is asked to take a deep
breath and hold it.
• Positive if the examiner detects a
significant decrease in strength, or
complete disappearance of the radial
pulse.
• Up to 50% of healthy volunteers have
3/18/2018
46. ROOS TEST (EAST)
• Elevated arm stress
test
• Most accurate clinical
test (roos)
• Hold “surrender”
position for 3 minutes
while opening/closing
hands
3/18/2018Physio-Ortho meeting
47. ROOS TEST (EAST)
•nTOS
• Heaviness, progressive weakness, numbness
• Tingling in fingers, progressing up arm
•vTOS
• Cyanotic arm with distended forearm veins
•aTOS
• Ischemic, cramping pain 3/18/2018Physio-Ortho meeting
48. HALSTED'S COSTOCLAVICULAR
COMPRESSION TEST
• 45° abduction and
extension of arm with
downward pressure on
shoulders
• Neck turned to opposite
side will reproduce
symptoms
3/18/2018Physio-Ortho meeting
49. EXAGGERATED MILITARY POSITION
• Patient shrugs
shoulders with deep
inhalation While drawing
the shoulders backward
in an Exaggerated
military position – radial
pulse Diminishes. 3/18/2018Physio-Ortho meeting
50. WRIGHT'S HYPERABDUCTION TEST
•Arm hyper-abducted to
180- diminishing radial
pulse.
• Neurovascular structures
compressed in
subcoracoid region by
pectoralis minor tendon,
head of humerus or
3/18/2018Physio-Ortho meeting
51. IMAGING
• X-rays
• Cervical rib
• Elongated C7 transverse process
• Hypoplastic 1st rib
• Callous formation from clavicle or 1st rib fracture
• Pseudoarthrosis of 1st rib
• Unable to image soft tissue anomalies and
fibromuscular bands – seen only at time of surgery
3/18/2018Physio-Ortho meeting
52. IMAGING
•CT/MRI
usually negative but can rule out other
pathologies
•MR neuro-graphy
newer technology to detect localized
nerve function abnormality
3/18/2018Physio-Ortho meeting
53. IMAGING
• aTOS
• Segmental arterial pressures
• Angiography
• vTOS
• Duplex U/S
• Venography
• Use positional maneuvers during the studies
• Consider bilateral studies
3/18/2018Physio-Ortho meeting
54. EMG/NCS
• Reduction in NCV to <85m/s
• Positive results
• Aid in evaluation of other conditions
• Poor prognostic factor if truly nTOS – indicate
advanced neural damage
• Negative results
• Exclude other conditions
• May still be nTOS
3/18/2018Physio-Ortho meeting
55. Electrophysiology Testing
•Medial antebrachial cutaneous nerve (MAC)
• Lowest branch of inferior trunk of brachial
plexus
• More sensitive to compression than other
branches
•Higher sensitivity and specificity than
EMG/NCS
3/18/2018Physio-Ortho meeting
56. Scalene muscle block
•Most useful when diagnosis is
unclear
•Correlation between relief of
symptoms after block and successful
outcome after surgical
decompression
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60. PHYSICA
L
THEREBY
postural changes
and correct faulty
postures.
• Step 2 manipulate
and mobilize and
relax 1st rib and
clavicular,
scapular, pectoral
muscles.
• Step 3 strengthen
the shoulder
girdle muscles
and stretch
Aims to
increase the
space in the
thoracic
outlet area
and to
relieve
compression
on the
neurovascul
ar
structures.
3/18/2018Physio-Ortho meeting
63. ERGONOMIC
S
Work posture related changes
Relative adjustment of chair height
so that forearm rests comfortably
and without shoulders being
elevated or depressed.Avoid carrying heavy weights on
effected side
Avoid hyperextension of neck and
hyper-abducting postures
3/18/2018Physio-Ortho meeting
64. EXERCIS
ES
Involves relaxing shoulder
girdle and stretching the
scalene and pectoral
muscles.
•neck side bending exercises
•Neck rotation exercises
•Neck flexion exercises
Neck :
•Shrugging of shoulders
•Pendulum exercises
Shoulder :
3/18/2018Physio-Ortho meeting
65. SURGICA
L
TREATME
NT
•Symptoms persists beyond
2 months of conservative
management.
•Associated vascular
compression with
poststenotic dialatation.
•Complete occlusion of a
large vessel.
•Progression of neurological
symptoms.
Indications
3/18/2018Physio-Ortho meeting
66. PROCEDURES
1st rib resection and scalenectomy are standard
procedures for TOS
• 1st rib resection is recommended for lower type TOS
• Scalenectomy is recommended for upper type TOS
Best results and less chance of recurrence with
combined 1st rib resection and scalenectomy.
3/18/2018Physio-Ortho meeting
67. SCALENECTO
MY
Incision : 8cms incision, 1.5cm above
middle third of clavicle.
80-90% of scalenus anterior muscle and
40-50% of scalenus medius muscle
removed.
Protect long thoracic nerve and
phrenic nerve.
Complications :
• neck hematoma,
• chylus drainge,
•Dyspnea due to phrenic nerve
irritation
3/18/2018Physio-Ortho meeting
69. TRANSAXILL
ARY
APPROACH
• Limited field of operative dissection
• Cosmetically placed incision
• Sufficient exposure (for 1 person)
• Achieve 1st rib resection and anterior
scalenectomy
• Removal of anomalous ligaments and
fibrous bands
Advantages
• Incomplete exposure of entire scalene
triangle
• Difficulty achieving brachial plexus
neurolysis
• Limited if vascular reconstruction is
needed
Disadvantages
3/18/2018Physio-Ortho meeting
70. • Advantages
• Wide exposure of all anatomic
structures
• Permits complete resection of
anterior and middle scalene as
well as brachial plexus
neurolysis
• Allows resection of cervical ribs
and anomalous 1st ribs
• Vascular reconstruction is
possible
3/18/2018Physio-Ortho meeting
SUPRACLAVICUL
AR APPROACH
75. RECURRE
NT N.TOS
Postoperative scarring is
the most common cause.
Recurrence usually is
seen within 3months.
To minimize scar
tissue formation
•patient is instructed to
perform active range of
motion
•exercises beginning the day
after surgery.
•Performed every 3-4 hrs for
at least 6 months
3/18/2018 Physio-Ortho meeting
76. Conclusio
ns
nTOS most common
nTOS most difficult to diagnose
Treatment
•Physical therapy
•Anterior scalene block
•Informed consent prior to surgery
3/18/2018 Physio-Ortho meeting
77. Conclusions
• “A surgeon recognizing nTOS should not be
dissuaded by the impression that these
problems are frequently associated with
psychiatric overtones, dependency on pain
medications, and ongoing litigation”
RUTHERFORD’S VASCULAR SURGERY 7TH EDITION 3/18/2018Physio-Ortho meeting