Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It commonly affects the lungs but can also affect bones and joints. Tuberculosis of the hip joint, also known as Pott's disease of the hip, is a form of extra-pulmonary tuberculosis that constitutes 1-3% of all bone and joint tuberculosis cases. It is characterized by insidious onset of pain in the hip with limping and can progress to destruction of the femoral head and acetabulum if left untreated. Treatment involves a combination of anti-tubercular chemotherapy for a minimum of 6 months along with surgical intervention if needed to correct deformities and obtain a painless mobile joint.
This document provides information about total hip replacement surgery. It discusses the history, principles, indications, contraindications, implants, surgical techniques, postoperative nursing management, health education, exercise guidelines, and potential complications. Total hip replacement involves replacing both the acetabulum and femoral head to relieve pain and restore joint function. Postoperative care focuses on preventing dislocation, thromboembolism, and infection while promoting early ambulation and exercise.
This document provides an overview of hemiarthroplasty, which involves replacing the femoral head with a prosthesis while retaining the natural acetabulum. It discusses the history and types of prostheses used in hemiarthroplasty. The indications, surgical procedure, postoperative care, and possible complications of hemiarthroplasty are described. A case example of a 78-year-old female undergoing cemented bipolar hemiarthroplasty for a fractured neck of femur is presented.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
The radial nerve originates from the brachial plexus and provides motor and sensory innervation to parts of the arm and forearm. It has three main types of injury - very high (in the axilla), high (in the radial groove), and low (below the elbow). Clinical features depend on the level and include weakness of extension, supination, wrist drop and sensory loss over the back of the forearm and hand. Treatment involves nerve exploration, primary repair, delayed repair using grafts if needed, and tendon transfers if recovery is delayed. Prognosis depends on factors like age, nature of injury, level of lesion and surgical technique.
This document provides information on tuberculosis of the skeletal system (Potts disease). It discusses the history, epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, microbiological studies, treatment including medical management and surgical options, as well as outcomes of skeletal tuberculosis. Key points include that India accounts for a large portion of global tuberculosis cases, it most commonly involves the thoracic spine, and treatment involves a combination of anti-tubercular medications and surgery in some cases to address complications or deformities.
The document discusses different types of prostheses used to replace missing limbs. It describes exoskeletal and endoskeletal prosthetic designs, and covers the basic components and classifications of prostheses. Myoelectric prostheses that use muscle signals and various types of feet - including SACH, Jaipur and dynamic response feet - are explained. The document provides details on prostheses for transtibial and transfemoral amputations, including PTB and quadrilateral socket designs and considerations for bilateral transfemoral amputees.
contracture ppt for physiotherapy..
definition of contracture
types of contracture
why contracture occurs
therapy of contracture
YouTube link- https://youtu.be/JU1zyft7w9c
Dr. Ramkrishna Dahal presented on common musculoskeletal tuberculosis infections. He discussed the historical aspects and epidemiology of tuberculosis, identifying Potts spine as the most frequent musculoskeletal manifestation. Case illustrations were presented, showing imaging and histopathological findings. Key diagnostic features and treatment approaches for tuberculosis infections of the spine, joints, and bones were summarized.
This document provides information about total hip replacement surgery. It discusses the history, principles, indications, contraindications, implants, surgical techniques, postoperative nursing management, health education, exercise guidelines, and potential complications. Total hip replacement involves replacing both the acetabulum and femoral head to relieve pain and restore joint function. Postoperative care focuses on preventing dislocation, thromboembolism, and infection while promoting early ambulation and exercise.
This document provides an overview of hemiarthroplasty, which involves replacing the femoral head with a prosthesis while retaining the natural acetabulum. It discusses the history and types of prostheses used in hemiarthroplasty. The indications, surgical procedure, postoperative care, and possible complications of hemiarthroplasty are described. A case example of a 78-year-old female undergoing cemented bipolar hemiarthroplasty for a fractured neck of femur is presented.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
The radial nerve originates from the brachial plexus and provides motor and sensory innervation to parts of the arm and forearm. It has three main types of injury - very high (in the axilla), high (in the radial groove), and low (below the elbow). Clinical features depend on the level and include weakness of extension, supination, wrist drop and sensory loss over the back of the forearm and hand. Treatment involves nerve exploration, primary repair, delayed repair using grafts if needed, and tendon transfers if recovery is delayed. Prognosis depends on factors like age, nature of injury, level of lesion and surgical technique.
This document provides information on tuberculosis of the skeletal system (Potts disease). It discusses the history, epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, microbiological studies, treatment including medical management and surgical options, as well as outcomes of skeletal tuberculosis. Key points include that India accounts for a large portion of global tuberculosis cases, it most commonly involves the thoracic spine, and treatment involves a combination of anti-tubercular medications and surgery in some cases to address complications or deformities.
The document discusses different types of prostheses used to replace missing limbs. It describes exoskeletal and endoskeletal prosthetic designs, and covers the basic components and classifications of prostheses. Myoelectric prostheses that use muscle signals and various types of feet - including SACH, Jaipur and dynamic response feet - are explained. The document provides details on prostheses for transtibial and transfemoral amputations, including PTB and quadrilateral socket designs and considerations for bilateral transfemoral amputees.
contracture ppt for physiotherapy..
definition of contracture
types of contracture
why contracture occurs
therapy of contracture
YouTube link- https://youtu.be/JU1zyft7w9c
Dr. Ramkrishna Dahal presented on common musculoskeletal tuberculosis infections. He discussed the historical aspects and epidemiology of tuberculosis, identifying Potts spine as the most frequent musculoskeletal manifestation. Case illustrations were presented, showing imaging and histopathological findings. Key diagnostic features and treatment approaches for tuberculosis infections of the spine, joints, and bones were summarized.
The document discusses internal derangements of the knee, focusing on injuries to ligaments and cartilages. It describes the anatomy of the knee joint and then examines several specific ligament injuries in more detail, including the medial collateral ligament, lateral collateral ligament, and anterior cruciate ligament. For each, it covers anatomy, mechanisms of injury, clinical findings, and treatment approaches. The most common derangements involve injuries to the medial collateral ligament, medial meniscus, and anterior cruciate ligament.
Hemiarthroplasty involves replacing the femoral head while retaining the natural acetabulum. It is commonly used to treat fractures of the femoral neck in elderly patients. There are two main types - unipolar, which replaces just the head, and bipolar, which adds an inner bearing. Selection depends on factors like bone quality and joint stability. Cemented stems are generally preferred in patients with poor bone stock, while uncemented can be used if bone is adequate. Positioning and fixation are important to optimize function and stability.
This document discusses radial nerve palsy and tendon transfers to restore function after radial nerve injury. It begins by describing the anatomy and functions of the radial nerve. Radial nerve palsy results in loss of wrist, finger, and thumb extension. Tendon transfers can restore this function, such as using the palmaris longus tendon to restore thumb extension via transfer to the extensor pollicis longus. Post-operative rehabilitation focuses on protecting the tendon transfers during early mobilization and strengthening exercises.
This document provides information on tuberculosis of the skeletal system, with a focus on vertebral tuberculosis. It begins with an introduction and history of the topic. It then discusses the epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, laboratory tests, classifications, treatment approaches including drug regimens and surgical indications and techniques. Key points covered include the high prevalence of skeletal TB in India, typical radiological features, classification of neurological deficits, Tuli's middle path treatment regime, and various surgical approaches for abscess drainage and spinal decompression/stabilization.
The document discusses planning and preparation for implant removal surgery. It emphasizes that implant removal requires meticulous planning and should not be underestimated. Key points include determining what implant needs removal, why removal is needed, ensuring the correct tools and information are available, and communicating with the full surgical team. Complications like broken or damaged implants require special equipment and techniques. Proper planning through understanding implant details and surgical needs can help avoid issues during removal.
Amputation is the surgical removal of a limb or part of a limb. It has been performed for centuries as a treatment for trauma, infection, tumors, and other conditions. The procedure involves carefully marking the incision site, administering antibiotics, ligating blood vessels, and creating a conical stump for prosthesis fitting. Factors like adequate blood supply, joint mobility, and wound healing must be considered when determining the appropriate amputation level. With modern techniques, amputation allows many patients to regain mobility and independence through prosthetic devices.
This document discusses radio-ulnar synostosis, a rare condition where the radius and ulna bones of the forearm are fused together. It can be congenital, occurring during early development, or post-traumatic, caused by a forearm fracture. Symptoms include limited rotation of the forearm and pain. Diagnosis is made through x-rays showing the fused bones. Treatment depends on the severity but may include surgery to separate the bones followed by splinting and physical therapy.
Monteggia fracture & galeazzi fractureBipulBorthakur
A Monteggia fracture involves a break in the proximal ulna shaft combined with dislocation of the radial head. It most commonly occurs in children following a fall on an outstretched hand. Treatment involves closed or open reduction of the radial head and restoration of the ulna length, with casting or plating depending on patient age. Complications can include nerve injuries or radial head instability.
A Galeazzi fracture is a break of the radius near the middle-distal junction with disruption of the distal radio-ulnar joint. It typically results from a fall onto an outstretched, pronated forearm. Treatment is always surgical via open reduction and internal fixation of the radius and potential K-wiring or
Distal tibia fractures occur near the ankle joint and account for 3-9% of all tibia fractures. They are challenging injuries with poor soft tissue coverage anteriorly and a high risk of complications. Treatment depends on the fracture classification system used (Rudl Allgower or AO) and the degree of articular involvement. Surgical management focuses on anatomical reduction, stable fixation while protecting the soft tissues to allow early mobilization. Non-surgical treatment is reserved for non or minimally displaced fractures.
1) Tuberculosis of the knee joint is the third most common site of osteoarticular tuberculosis, accounting for around 10% of skeletal tuberculosis cases.
2) Initial pathology involves hematogenous spread to the synovium or subchondral bone, forming tubercles. Advanced cases involve erosion of joint surfaces and destruction of bones.
3) Clinical features include knee swelling, warmth, effusion, tenderness, and restricted painful movement. Advanced cases develop triple deformity of flexion, adduction, and internal rotation.
This document discusses scoliosis, including its classification, presentation, evaluation, and treatment. It defines scoliosis as a lateral curvature of the spine with an element of axial rotation. Evaluation involves physical exam, x-rays like Cobb angle measurement, and sometimes MRI. Treatment depends on curve magnitude and flexibility, ranging from observation for mild curves to bracing for moderate curves to spinal fusion surgery for severe curves. The goal is to prevent curve progression, especially during periods of rapid growth.
This document discusses the classification, causes, symptoms, and treatment of kyphosis, which is an excessive curvature of the spine. It is classified into 15 major groups including postural disorders, Scheuermann's kyphosis, congenital disorders, paralytic disorders, and others. Treatment involves exercise, bracing, medication management, and surgery to correct the deformity and relieve pain or neurological symptoms. Surgical techniques range from posterior fusion to osteotomies to combined anterior-posterior procedures depending on the severity and rigidity of the deformity. The goals of surgery are to restore spinal alignment and remove any neural compression.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
This document discusses avascular necrosis of the femoral head, also known as osteonecrosis. It begins by providing a brief history and definitions. It then discusses the blood supply of the femoral head and covers traumatic vs. non-traumatic causes. Risk factors for atraumatic osteonecrosis like corticosteroids, alcohol abuse, smoking, and others are outlined. The pathophysiology section explores theories of arterial occlusion, fat emboli, and increased bone marrow pressure as causes. Signs and symptoms, diagnostic imaging methods, staging classifications, and non-operative and operative treatment options are summarized.
This document discusses the management of supracondylar humerus fractures in children. It begins by providing background on the injury, including that it is most common in 5-7 year old boys and accounts for 60% of elbow fractures in children. The main goals of treatment are anatomic reduction and functional recovery without complications. It then covers evaluation, classification (using the Gartland system), treatment approaches including closed or open reduction and pinning, and management of associated injuries like vascular complications. For type 1 fractures, immobilization is sufficient. Type 2 and 3 fractures are typically treated with closed reduction and percutaneous pinning. The document concludes that both clinical assessment and diagnostic testing should be considered when deciding whether to observe or surg
Rehabilitation Of Anterior Shoulder DislocationCoachBlake
- Younger patients under age 20 who experience an anterior shoulder dislocation have recurrent dislocation rates as high as 90% in athletic populations, while rates decrease with age to lower than 50% for those ages 20-25 and even lower for those over age 40.
- Rehabilitation following a shoulder dislocation or repair focuses first on restoring range of motion and strengthening the rotator cuff and parascapular muscles, with protocols varying based on surgical versus non-surgical treatment and generally taking 4-6 months to return to full activity.
- While overhead lifting and deep pressing motions carry risk of reinjury, year-round training of the shoulder girdle including sports-specific drills is important to prevent future instability
Rehabilitation for paraplegia and quadriplegiaJose Anilda
This document discusses the rehabilitation of patients with paraplegia and quadriplegia. It begins by defining the terms and explaining the rehabilitation team and measures used. These include stretching, aerobic, and strengthening exercises. Physical agents like heat therapy and electrical stimulation are also used. Symptomatic treatments address issues like pain, spasticity, and nutrition. Orthotics like braces and wheelchairs assist mobility. Gait training helps achieve balance. Home programs and ergonomic advice aid daily living. Therapeutic exercises target specific muscle groups and functions. Rehabilitation aims to return patients to their highest functional ability.
This document discusses tuberculosis of the appendicular skeleton, with a focus on tuberculosis of the hip joint. It notes that tuberculosis is caused by Mycobacterium tuberculosis and is most commonly transmitted through airborne droplets. India has the highest tuberculosis burden in the world, with over 1 million new cases annually. Tuberculosis can affect any bone or joint, with the spine and hip being most common. Symptoms include pain, limping, and deformity. Diagnosis involves tests such as x-rays, biopsy, and molecular testing. Treatment involves a combination of antibiotic therapy and sometimes surgery, with the goals of eliminating symptoms and restoring joint mobility.
This document discusses tuberculosis (TB), which is caused by Mycobacterium tuberculosis bacteria. It notes that India has the highest TB burden in the world, accounting for 20% of global cases. Over 1.8 million people develop TB in India each year, with over 5000 new cases and 2000 deaths daily. Skeletal TB, which affects the bones and joints, constitutes 1-3% of extra-pulmonary TB cases. The hip joint is the second most commonly affected osteoarticular site after the spine. Clinical features, investigations, radiographic findings, and management of TB of various bones and joints such as the spine, hip, knee, shoulder, and skull are described in detail.
The document discusses internal derangements of the knee, focusing on injuries to ligaments and cartilages. It describes the anatomy of the knee joint and then examines several specific ligament injuries in more detail, including the medial collateral ligament, lateral collateral ligament, and anterior cruciate ligament. For each, it covers anatomy, mechanisms of injury, clinical findings, and treatment approaches. The most common derangements involve injuries to the medial collateral ligament, medial meniscus, and anterior cruciate ligament.
Hemiarthroplasty involves replacing the femoral head while retaining the natural acetabulum. It is commonly used to treat fractures of the femoral neck in elderly patients. There are two main types - unipolar, which replaces just the head, and bipolar, which adds an inner bearing. Selection depends on factors like bone quality and joint stability. Cemented stems are generally preferred in patients with poor bone stock, while uncemented can be used if bone is adequate. Positioning and fixation are important to optimize function and stability.
This document discusses radial nerve palsy and tendon transfers to restore function after radial nerve injury. It begins by describing the anatomy and functions of the radial nerve. Radial nerve palsy results in loss of wrist, finger, and thumb extension. Tendon transfers can restore this function, such as using the palmaris longus tendon to restore thumb extension via transfer to the extensor pollicis longus. Post-operative rehabilitation focuses on protecting the tendon transfers during early mobilization and strengthening exercises.
This document provides information on tuberculosis of the skeletal system, with a focus on vertebral tuberculosis. It begins with an introduction and history of the topic. It then discusses the epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, laboratory tests, classifications, treatment approaches including drug regimens and surgical indications and techniques. Key points covered include the high prevalence of skeletal TB in India, typical radiological features, classification of neurological deficits, Tuli's middle path treatment regime, and various surgical approaches for abscess drainage and spinal decompression/stabilization.
The document discusses planning and preparation for implant removal surgery. It emphasizes that implant removal requires meticulous planning and should not be underestimated. Key points include determining what implant needs removal, why removal is needed, ensuring the correct tools and information are available, and communicating with the full surgical team. Complications like broken or damaged implants require special equipment and techniques. Proper planning through understanding implant details and surgical needs can help avoid issues during removal.
Amputation is the surgical removal of a limb or part of a limb. It has been performed for centuries as a treatment for trauma, infection, tumors, and other conditions. The procedure involves carefully marking the incision site, administering antibiotics, ligating blood vessels, and creating a conical stump for prosthesis fitting. Factors like adequate blood supply, joint mobility, and wound healing must be considered when determining the appropriate amputation level. With modern techniques, amputation allows many patients to regain mobility and independence through prosthetic devices.
This document discusses radio-ulnar synostosis, a rare condition where the radius and ulna bones of the forearm are fused together. It can be congenital, occurring during early development, or post-traumatic, caused by a forearm fracture. Symptoms include limited rotation of the forearm and pain. Diagnosis is made through x-rays showing the fused bones. Treatment depends on the severity but may include surgery to separate the bones followed by splinting and physical therapy.
Monteggia fracture & galeazzi fractureBipulBorthakur
A Monteggia fracture involves a break in the proximal ulna shaft combined with dislocation of the radial head. It most commonly occurs in children following a fall on an outstretched hand. Treatment involves closed or open reduction of the radial head and restoration of the ulna length, with casting or plating depending on patient age. Complications can include nerve injuries or radial head instability.
A Galeazzi fracture is a break of the radius near the middle-distal junction with disruption of the distal radio-ulnar joint. It typically results from a fall onto an outstretched, pronated forearm. Treatment is always surgical via open reduction and internal fixation of the radius and potential K-wiring or
Distal tibia fractures occur near the ankle joint and account for 3-9% of all tibia fractures. They are challenging injuries with poor soft tissue coverage anteriorly and a high risk of complications. Treatment depends on the fracture classification system used (Rudl Allgower or AO) and the degree of articular involvement. Surgical management focuses on anatomical reduction, stable fixation while protecting the soft tissues to allow early mobilization. Non-surgical treatment is reserved for non or minimally displaced fractures.
1) Tuberculosis of the knee joint is the third most common site of osteoarticular tuberculosis, accounting for around 10% of skeletal tuberculosis cases.
2) Initial pathology involves hematogenous spread to the synovium or subchondral bone, forming tubercles. Advanced cases involve erosion of joint surfaces and destruction of bones.
3) Clinical features include knee swelling, warmth, effusion, tenderness, and restricted painful movement. Advanced cases develop triple deformity of flexion, adduction, and internal rotation.
This document discusses scoliosis, including its classification, presentation, evaluation, and treatment. It defines scoliosis as a lateral curvature of the spine with an element of axial rotation. Evaluation involves physical exam, x-rays like Cobb angle measurement, and sometimes MRI. Treatment depends on curve magnitude and flexibility, ranging from observation for mild curves to bracing for moderate curves to spinal fusion surgery for severe curves. The goal is to prevent curve progression, especially during periods of rapid growth.
This document discusses the classification, causes, symptoms, and treatment of kyphosis, which is an excessive curvature of the spine. It is classified into 15 major groups including postural disorders, Scheuermann's kyphosis, congenital disorders, paralytic disorders, and others. Treatment involves exercise, bracing, medication management, and surgery to correct the deformity and relieve pain or neurological symptoms. Surgical techniques range from posterior fusion to osteotomies to combined anterior-posterior procedures depending on the severity and rigidity of the deformity. The goals of surgery are to restore spinal alignment and remove any neural compression.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
This document discusses avascular necrosis of the femoral head, also known as osteonecrosis. It begins by providing a brief history and definitions. It then discusses the blood supply of the femoral head and covers traumatic vs. non-traumatic causes. Risk factors for atraumatic osteonecrosis like corticosteroids, alcohol abuse, smoking, and others are outlined. The pathophysiology section explores theories of arterial occlusion, fat emboli, and increased bone marrow pressure as causes. Signs and symptoms, diagnostic imaging methods, staging classifications, and non-operative and operative treatment options are summarized.
This document discusses the management of supracondylar humerus fractures in children. It begins by providing background on the injury, including that it is most common in 5-7 year old boys and accounts for 60% of elbow fractures in children. The main goals of treatment are anatomic reduction and functional recovery without complications. It then covers evaluation, classification (using the Gartland system), treatment approaches including closed or open reduction and pinning, and management of associated injuries like vascular complications. For type 1 fractures, immobilization is sufficient. Type 2 and 3 fractures are typically treated with closed reduction and percutaneous pinning. The document concludes that both clinical assessment and diagnostic testing should be considered when deciding whether to observe or surg
Rehabilitation Of Anterior Shoulder DislocationCoachBlake
- Younger patients under age 20 who experience an anterior shoulder dislocation have recurrent dislocation rates as high as 90% in athletic populations, while rates decrease with age to lower than 50% for those ages 20-25 and even lower for those over age 40.
- Rehabilitation following a shoulder dislocation or repair focuses first on restoring range of motion and strengthening the rotator cuff and parascapular muscles, with protocols varying based on surgical versus non-surgical treatment and generally taking 4-6 months to return to full activity.
- While overhead lifting and deep pressing motions carry risk of reinjury, year-round training of the shoulder girdle including sports-specific drills is important to prevent future instability
Rehabilitation for paraplegia and quadriplegiaJose Anilda
This document discusses the rehabilitation of patients with paraplegia and quadriplegia. It begins by defining the terms and explaining the rehabilitation team and measures used. These include stretching, aerobic, and strengthening exercises. Physical agents like heat therapy and electrical stimulation are also used. Symptomatic treatments address issues like pain, spasticity, and nutrition. Orthotics like braces and wheelchairs assist mobility. Gait training helps achieve balance. Home programs and ergonomic advice aid daily living. Therapeutic exercises target specific muscle groups and functions. Rehabilitation aims to return patients to their highest functional ability.
This document discusses tuberculosis of the appendicular skeleton, with a focus on tuberculosis of the hip joint. It notes that tuberculosis is caused by Mycobacterium tuberculosis and is most commonly transmitted through airborne droplets. India has the highest tuberculosis burden in the world, with over 1 million new cases annually. Tuberculosis can affect any bone or joint, with the spine and hip being most common. Symptoms include pain, limping, and deformity. Diagnosis involves tests such as x-rays, biopsy, and molecular testing. Treatment involves a combination of antibiotic therapy and sometimes surgery, with the goals of eliminating symptoms and restoring joint mobility.
This document discusses tuberculosis (TB), which is caused by Mycobacterium tuberculosis bacteria. It notes that India has the highest TB burden in the world, accounting for 20% of global cases. Over 1.8 million people develop TB in India each year, with over 5000 new cases and 2000 deaths daily. Skeletal TB, which affects the bones and joints, constitutes 1-3% of extra-pulmonary TB cases. The hip joint is the second most commonly affected osteoarticular site after the spine. Clinical features, investigations, radiographic findings, and management of TB of various bones and joints such as the spine, hip, knee, shoulder, and skull are described in detail.
Rheumatoid arthritis is a chronic inflammatory disease that predominantly affects the joints, with peak incidence between ages 40-60. It is characterized by symmetric polyarticular involvement of small joints like the hands and feet. Osteoarthritis is the most common type of arthritis and is characterized by cartilage breakdown in the joints leading to pain and stiffness. Gout is caused by deposition of uric acid crystals in the joints and tissues, causing inflammatory attacks of monoarticular arthritis, often in the big toe.
This document provides information on spinal infections. It discusses two main types of spinal infections - pyogenic and non-pyogenic infections like tuberculosis. Pyogenic infections usually involve the lumbar spine and are caused by bacteria like Staph aureus. Tuberculosis is the most common non-pyogenic infection and usually affects the lower thoracic spine. Clinical features, investigations, management and various surgical approaches for treating spinal infections are described in detail.
This document discusses septic arthritis, which is a joint inflammation caused by an infection. It most commonly affects children under 5 and joints like the knee, hip, elbow and shoulder. Common causes are bacteria like Staphylococcus aureus. Symptoms include fever, pain and reluctance to move the joint. Diagnosis involves blood tests, joint aspiration and imaging. Treatment requires antibiotics, joint drainage if needed, and several weeks of immobilization. Complications can include joint destruction if left untreated. It also describes Tom Smith arthritis, a type of septic arthritis of the hip that destroys the femoral head in infants.
This document discusses septic arthritis, which is a joint inflammation caused by infection. It most commonly affects children under 5 and joints like the knee, hip, elbow and shoulder. Common causes are bacteria like Staphylococcus aureus. Symptoms include fever, pain and reluctance to move the joint. Diagnosis involves blood tests, joint aspiration and imaging. Treatment requires antibiotics, joint drainage if needed, and several weeks of immobilization. Complications can include joint destruction and osteomyelitis if not treated promptly.
This document provides information on dorso-lumbar tuberculosis. It discusses that tuberculosis commonly involves the spine, with 50% of musculoskeletal tuberculosis cases affecting the spine. The dorso-lumbar region is most commonly involved due to factors like movement, weight bearing, and proximity to organs. Clinical presentation depends on disease stage and complications. Investigations include imaging like x-rays showing vertebral collapse, and labs like tuberculin skin test. Management involves antitubercular chemotherapy for 18 months as well as surgery for abscess drainage, debridement, and spinal fusion or fixation.
This study retrospectively analyzed 127 cases of tuberculosis of the spine treated surgically between 2007-2017. Most patients were young adults between 11-30 years old and more were male. Surgical decompression without stabilization was performed in 72 patients for pain or symptoms but no neurological deficit. Surgical decompression with stabilization using implants was performed in 55 patients with neurological deficit, paraplegia, or bone destruction. Histopathology confirmed the diagnosis. Complications were rare. The study concludes early diagnosis and treatment, whether medical or surgical, improves prognosis for spinal tuberculosis.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
Juvenile arthritis is a common condition in children that causes joint inflammation and pain. It can be classified as acute, sub-acute, or chronic based on the duration of symptoms. The most common type is juvenile idiopathic arthritis, which refers to conditions characterized by chronic joint inflammation. Treatment involves medications like NSAIDs and DMARDs to reduce inflammation and pain, physical or occupational therapy to maintain mobility, and surgery in severe cases to correct joint deformities. Nursing care focuses on alleviating pain, increasing mobility through exercise, promoting independence in self-care, and ensuring patients understand their condition and treatment plan.
This document provides an overview of tuberculosis of the skeletal system. It discusses the epidemiology and prevalence of skeletal tuberculosis and describes the various types of bone and joint involvement, including the spine, hip, knee, and shoulder. For each joint, it outlines the clinical presentations, radiological features, and stages of disease. It also reviews the pathology, diagnosis, treatment with anti-tubercular drugs, and surgical management of skeletal tuberculosis.
This document discusses septic arthritis in children. It notes that septic arthritis is a joint inflammation caused by infection, most commonly involving synovial joints. The most common age for septic arthritis is 1 month to 5 years. Staphylococcus aureus is the most common causative organism. Symptoms include fever, pain and reluctance to move the joint. Diagnosis involves blood tests, imaging like x-rays and ultrasound, and joint aspiration. Treatment involves antibiotics, rest, and sometimes surgical drainage of the joint. Complications can include joint destruction and deformity if not treated properly.
Osteoarticular tuberculosis is a common disease globally and in India, with involvement of bones and joints in around 30% of tuberculosis cases. It occurs most commonly in the spine, hip, knee, and other joints. It spreads hematogenously from a primary pulmonary or other visceral lesion. Spinal involvement often leads to deformities like gibbus formation or neurological complications like paraplegia. Treatment involves anti-tubercular medications like ATT along with rest and surgery if needed to drain abscesses or decompress nerves. Hip involvement can progress through stages of synovitis, arthritis, and advanced destruction requiring treatments like joint debridement, arthrodesis, or excision arthroplasty.
Brucellosis is a zoonotic bacterial infection transmitted from animals to humans through contact with infected fluids or consumption of unpasteurized dairy. It causes a broad range of symptoms from fever to arthritis and is a public health problem in many developing countries. Diagnosis involves culture, serology or PCR of blood, bone marrow or tissues. Treatment requires combination antibiotic therapy for at least six weeks, and up to twelve weeks for complications like spondylitis or endocarditis. Doxycycline plus rifampin or streptomycin are common regimens.
Waseem, a 27-year-old technician, presents with a 5-year history of skin rashes and 1-year history of joint pains. Recently he has developed a cough and hemoptysis. Examination finds a vesicular rash on his lower limbs and he is cANCA positive. Investigations reveal granulomatosis with polyangitis (GPA, formerly Wegener's granulomatosis). As GPA can be fatal if untreated, induction therapy with corticosteroids and cyclophosphamide is planned to induce remission, followed by rituximab to maintain remission.
Fractures and dislocations around the hip can include femoral neck fractures, intertrochanteric fractures, subtrochanteric fractures, femoral head fractures, acetabular fractures, and hip dislocations. The document discusses the anatomy, mechanisms of injury, classifications, presentations, imaging, and treatment options for each of these conditions. Treatment may involve nonoperative management or operative procedures like open reduction internal fixation or arthroplasty depending on the fracture pattern and degree of displacement. Complications can include avascular necrosis, nonunion, malunion, and post-traumatic arthritis.
This document provides basic orthopaedic procedures for a tray. It was written by Dr. Seeyan Shah, a postgraduate resident in the Department of Orthopaedics at Government Medical College Srinagar. The document expresses gratitude with the word "Thank You" at the end.
This document discusses open reduction of carpal bone fractures. It begins by describing the carpal arcs and Amsterdam wrist rules for determining when X-rays are needed. It then discusses specific fractures of the scaphoid bone including classification, recommended imaging views, symptoms, treatment criteria involving casting or surgery, and surgical techniques for open reduction and percutaneous screw fixation. It also covers lunate dislocations, including pathoanatomy, imaging views, complications of nonoperative vs operative management, and surgical techniques. Brief sections discuss fractures of the triquetrum, pisiform, and hamate bones.
This document describes the excision of a ganglion cyst. It begins by defining ganglion cysts and their common locations. It then discusses the symptoms, physical exam findings, imaging and treatment options. The main treatment discussed is surgical excision via a transverse incision over the cyst and scapholunate ligament. The cyst is dissected out and excised at its stalk, with hemostasis and wound closure following. Complications of both aspiration and excision are noted.
This document discusses peripheral nerve injuries. It begins by describing the structure and components of peripheral nerves. It then discusses the signs and symptoms of different types of peripheral nerve injuries like radial nerve, ulnar nerve and median nerve palsies. The document also covers the pathophysiology of nerve injury including Wallerian degeneration. It describes the diagnostic tools like electrodiagnostic studies and various treatment options for peripheral nerve injuries including nerve repair techniques.
1) Carpal tunnel syndrome is caused by median nerve entrapment in the carpal tunnel due to thickening of the transverse carpal ligament.
2) Conservative treatments include NSAIDs, night splints, activity modification, and steroid injections. Surgical options are open release, mini-open release, and endoscopic release.
3) The mini-open carpal tunnel release technique has advantages of being less invasive, requiring a shorter operative time and lower complication rates compared to open release, while providing comparable results and patient satisfaction as other techniques in the long run.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
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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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
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10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Cell Therapy Expansion and Challenges in Autoimmune Disease
Tuberculosis
1. Tuberculosis Of the skeleton
system
DrSeeyan Shah
PG Resident,
Deptt ofOrthopaedics,
GMC Srinagar.
2. Tuberculosis is a chronic granulomatous
infectious disease caused by
Mycobacterium Tuberculosis (a gram
positive acid fast bacilli).
Transmitted through the air borne spread
of droplet nuclei produced by patients with
infectious pulmonary tuberculosis.
3. India: highest TB burden in world (accounts
for 1/5 (20%) of global burden)
Every year 1.8 millions develops TB
Every day about 5000 people develop
disease.
2 persons die of TB every 3 min.
More than 1000 people die every day.
4. Increased incidence has been noted with
prevalence of AIDS.
In India EPTB (extra pulmonary tuberculosis)
form 10-15% of all types of TB.
Amongst EPTB, Lymph node TB is the
commonest.
TB of bone and joints constitutes 1-3% of
Extra-pulmonary TB of which the most
commonly involved is the Spine constituting
50% of all Skeletal Tuberculosis.
5. Skeletal tuberculosis (TB) refers to TB
involvement of the bones and/or
joints.
It is an ancient disease; features of
spinal TB have been identified in
Egyptian mummies dating back to
9000 BC
9. Ball and socket type of synovial joint.
Fibrocartilaginous labrum attached to acetabulum,
makes the socket deeper.
Considerable part of articular surface of spherical
femoral head remains uncovered.
Opening of acetabulum directed laterally, downwards
(300) and forward (300).
Femoral neck directed medially, upward and
anteriorly.
Angle of anteversion in adult 10-300, neck shaft angle
around 1250.
10. Insidious onset (c/w pyogenic infections)
Low grade fever
Weight loss
Night sweat
Movement restriction, muscle wasting, regional
lymph node involvement and neurologic symptoms
Weight bearing joints like hip, knee and ankle are
commonly involved, though any part of the
skeleton can get involved
12. 2nd most common osteoarticular
TB (next only to spinal TB)
Commoner in males
INTRODUCTION:
PATHOGENESIS: • Invariably secondary to primary site
elsewhere (lungs, LNs of
mediastinum,mesentry or
cervical,kidney etc)
• The “tubercle” is the microscopic
pathological lesion with central
necrosis surrounded by epitheloid
cells, giant cells and mononuclear cell.
13. ◾Caseating exudative type: when
caseating necrosis and cold abscess
formation predominates
◾Proliferating type: where cellular proliferation
predominates with minimal caseation,
tuberculosis granuloma is the extreme form of
this type
(Former is common in children & latter in adults)
14.
15. Babcock's triangle :
A relatively radiolucent seen
on an anteroposterior
radiograph of the hip in the
subcapital region of the
fermoral head. It is an area of
loosely arranged trabeculae
noted between the more
radiodense lines of the
normal bony trabeculae
groups.
Tuberculosis of hip joint The
disease may start in epiphysis,
Babcock’s Triangle,
acetabular roof or in
synovium.
16. Lesions of upper end femur
Involves joint rapidly
Destruction of articular
surface of head &
acetabulum
Lesions of
acetabululum(roof)
Jnt involvement is
late & by the time
patient presents
Extensive bone
destruction already
present
17. Inferior part of Capsule(weak)
Pelvis
Femoral triangle, medial ,lateral
& posterior aspect of thigh
Above levator ani
Inguinal region
Below levator ani
Ischiorectal fossa
Tracking of abcess away from the joint is usually along
the Neuro-vascular bundle
25. If left untreated,
Healing by absorption & connective tissue
encapsulation occurs.
Leading to distortion, deformity and fibrous
ankylosis of joint
26.
27. Symptoms: (when disease is
active)
Constitutional symptoms
Pain (absent in early stage, night cries/starting
pain)
Limp (earliest, commonest, antalgic gait, asso.
stiffness)
Deformity of limb (stage of involvement)
Fullness around hip (site of cold abcess)
28. General: pallor, emaciation, LNs, signs of pulm TB
Gait: antalgic, trendelenburg
Inspection: deformity of limb, wasting of thigh &
gluteal muscles, swelling around hip
Palpation: confirmation of above findings, muscle
spasm of lower abdomen & adductors of thigh, joint
line tenderness, shift of GT
Movements: fixed deformities, painful ROM
Measurements: Apparent lengthening/shortening,
true shortening (Due to fixed deformities secondary
changes in spine (lordosis, scoliosis etc))
29. Group 1 Painless ROM in all directions
Group 2 Painless range of flexion 35-900
Group 3 Flexion <35 0 with fibrous ankylosis
Group 4 Bony fusion
30.
31.
32.
33. Investigations:
Hb% (anaemia)
TC: increased lymphocytes
DC: lymphocytes – monocyte ratio (5:1) normal.
ESR raised in active stage
Mantaux test (in children)
TB Elisa (usually IgM. Titre is active) : sensitive in
60-80%, but may be negative in patient with
advanced disease.
RNA and DNA based PCR studies
X-ray hip, AP and lateral and X-ray chest PA view.
34. Biopsy and histopathological examination :
smear, culture and guinea pig inoculation.
Culture – 8 wks and only positive in 30-60% case.
Likelihood of identifying organism on a smear is
10-30%.
C-reactive protein – prognosis factor
MRI : effusion, periarticular osteoporosis,
thickening of synovial membrane.
PCR : DNA based PCR can be quite sensitive, it
may not distinguish between viable and non-
viable bacilli. Messenger RNA based reversed
transcription PCR may be more specific
35. To obtain a:
Painless, symptom free
Stable
Freely mobile joint
with the patient having a normal gait
without limp, deformity or shortening.
36. With the advent of modern chemotherapeutic
agents the intervention at early stages with
combination of surgical management
determines the prognosis
Before irreversible change have taken place in
cartilage a good result can be expected from
conservative management.
When head is affected the result is always
doubtful and if there is much bone destruction
ankylosis in a good position is the limit of cure.
37. General treatment :
Liberal diet, fresh air, sunshine, education and
occupation.
Chemotherapy (ATT) :
Chemotherapy forms the basis of treatment in all cases
and must be started immediately once the diagnosis is
made.
The problem lies in deciding upon appropriate duration
of chemotherapy.
Prevailing practice of extending treatment till radiological
evidence of healing in complete, may be unnecessary
38. Minimum of 6 months is a must but some prefer
9 months regime.
Both 6 and 9 months regime appear to give
acceptable relapse rates of within 2%.
Except in pediatric cases, relapses are not
drastically improved by extending treatment to
12 months.
Prolonged treatment is indicated:
• If surgical debridement is indicated but cannot
be done.
• Co-existent HIV/AIDS also necessitate
prolonged treatment. (Interaction between 1st
line ATT and antiretroviral therapy can result in
complications)
39. First line essential drugs (most effective and necessary
component of therapeutic regimen) : Rifampicin,
Isoniazid and Pyrazinamide
First line supplemental drugs (highly effective and
infrequently toxic) : Ethambutol, Streptomycin,
Fluoroquinolines – Cipro and Levofloxacin.
Second line (less effective and elicit severe reaction more
frequently) : PAS, Ethionamide, Cycloserine, Amikacin
and Capreomycin.
Newer drugs: Rifapentine, Gatifloxacin and Moxifloxacin
40.
41.
42. Drug Side effects Management
Rifampin Rash Observe patient / stop drug if significant
Liver dysfunction Monitor AST / limit alcohol consumption / monitor for
hepatitis symptoms
Flulike syndrome Administer at least twice weekly / limit dose to 10 mg/kg
(adults)
Red-orange urine Reassure patient
Drug interactions Consider monitoring levels of other drugs affected by
rifampin, especially with contraceptives, anticoagulants,
and digoxin/avoid use the protease inhibitors.
Isoniazid Fever, chills
Hepatitis
Stop drug
Monitor AST/limit alcohol consumption/monitor for
hepatitis symptoms/educate patient / stop drug at first
symptoms of hepatitis (nausea, vomiting, anorexia, flulike
syndrome)
Peripheral neuritis Aminister vitamin B6
Optic neuritis Administer vitamin B6/ stop drug
Seizures Administer vitamin B6
43. Pyrazinamide Hepatitis Monitor AST/limit daily dosage to 15-
30mg/kg/discontinue with signs or
symptoms of hepatitis
Hyperuricemia Monitor uric acid level only in cases
of gout or renal failure.
Ethambutol Optic neuritis Use lower doses when possible.
Monitor visual acuity (eye chart) and
red-green colour vision (Ishihara
chart). With any visual complaint stop
drug and get ophthalmologic
evaluation.
Streptomycin,
Amikacin,
Capreomycin
Ototoxicity,
Renal toxicity
Limit dose and duration of therapy as
much as possible. Monitor BUN and
serum creatinine levels and conduct
audiometry as needed
44. Definition: Resistance to both INH and Rifampicin, with
or without resistance to any other AT drugs.
Suspect MDR-TB if disease activity does not show signs
of subsiding after 4-6 months of uninterrupted
multidrug therapy.
No standard regimes or guidelines. A regimen of 4 or 5
second line drugs including flouroquinolones is advised
& if needed, these drugs should be changed at sometime.
Treatment, with these drugs takes 2 yr or longer, as
opposed to 6-9 months with INH rifampicin containing
regimen. 2nd line drugs more expensive & toxic initial
part of the treatment should be supervised in hospital.
45. a) Stages of synovitis and early arthritis
ATT (multidrug therapy)
Traction
Palpable cold abscess may be aspirated with
instillation of streptomycin with or without
isoniazid.
Active assisted movements of hip started as soon
as pain has subsided.
Hip mobilization exercises every hour (when
patient is awake) within limits of tolerable pain.
46. With traction : patient progressively encouraged to
sit, touch his forehead, sitting in squatting position
and putting thigh in abduction and external rotation.
After 4-6 months patient is permitted for
ambulation with suitable caliper and crutches.
12 wk non weight bearing, followed by
12 wk partial weight bearing
Nearly 12 months after onset of treatment –
crutches / caliper discarded.
Unprotected weight bearing – usually 18-24 months
later.
If response to conservative treatment is
unfavourable, synovectomy and debridement of
joint performed.
47.
Usual outcome is gross fibrosis ankylosis.
Traction and exercises help to overcome the
deformities.
Once gross ankylosis is anticipated of accepted limb
should be immobilized with help of plaster hip spica
for about 6-9 months.
Ideal position in adults is neutral between
abduction and adduction; 5-10 degree of external
rotation and flexion depending upon age (between
10 degree in children and 30 degree in adult).
After 6 month partial weight bearing is started and
later with crutches / with caliper for 2 years.
48. Indications
To establish diagnosis by obtaining tissue culture
Surgery as a therapeutic measure
Joint debridement and clearance in
moderately involved cases.
Excision arthroplasty or arthrodesis
Very rarely total hip replacement.
If response to non-operative treatment is
unfavourable, then go for synovectomy or
debridement.
49. The deformity and subluxation / dislocation is
corrected or minimized by employing traction or
with plaster under G.A. with or without adductor
tenotomy.
Failure to achieve correction of gross deformities and
minimization of subluxation / dislocation warrants
open arthrotomy, synovectomy and debridement of
the joint.
Arthrodesis / excisional arthroplasty differed till
completion of growth potential. Disease with gross
deformity require an extra articular corrective
osteotomy to make them walk better till skeletal
maturity
50. Hypertropied synovium from inner surface of
capsule and from synovial reflections near
the acetabular rim and femoral neck are
separated.
Diseased and thickened capsule is excised.
Diseased synovium from the retinacular
relfextions on femoral head gently curreted.
Appropriate rotations of hip joint permit
adequate synovectomy from deeper parts of
hip joint without deliberately dislocating hip
joint.
51. In addition to synovectomy,
Remove
▣ the destroyed areas of femoral head & neck and
in the acetabulum.
▣ Loosened pieces of articular cartilage, sequestra,
granulation tissue and loose bodies / debris
within the joint
▣ The diseased thickened capsule
(Synovectomy and joint debridement can be
satisfactorily carried out without dislocating the
hip joint. IR and ER provide access to deeper
parts of joint cavity)
52. 1) Avascular Necrosis
2) Slippage of proximal femoral epiphysis in
children.
3) Fracture of femoral neck or acetabulum.
53. Sound ankylosis in bad position requires upper
femoral corrective osteotomy.
Sometimes unsound (fibrous painful) ankylosis
in bad position becomes an osseous fusion
(sound painless) by a high femoral corrective
osteotomy.
This extra articular procedure can be done at any
age.
Ideal site for corrective osteotomy is as near the
deformed joint as possible.
54. Success of chemotherapy has almost eliminated the
absolute indications for surgical fusion of hip joint.
Surgery deferred till the growth potential of proximal
femur has been completed.
Consider in cases of
Failure of conservative treatment (after 1 year)
Relapse, especially recurrence of pain and deformity after
conservative treatment.
Certain destruction lesions. Ex : formation of sequestra in
head or neck of femur or acetabulum.
55. Problems encountered :
Early development of degenerative osteoarthritis
in lumbosacral spine, ipsilateral knee and
contralateral hip.
Compensatory mechanisms for fused hip
Increased rotation of pelvis (during sitting and
walking)
Activities affected – bending, sitting on floor,
cross legged sitting, squattering, kneeling, sports,
sexual mechanisms (in women) and bicycling.
57.
Best position of Arthrodesis:
300of flexion (depending upon age)
No abduction or adduction (in adults)
5 to 100 of external rotation
(the position of flexion – 10 for each year of
life upto 200 then, a little more is suggested)
Extended hip – comfortable for walking
Flexed hip – comfortable for sitting
This surgery best suited for young active people and for
manual labourer
58. Performed if disease is active, painful fibrous
ankylosis is present
Permits
- To obtain tissue for HPE
- Exploration of joint
- Excision of diseased tissues
- Curettage of juxta articular infected cavities
-Supplementation of bone grafts to obtain
fusion.
59. Procedure :
Standard anterolateral approach, dislocate joint carefully,
Excise cartilage and subchondral bone from femoral head
and acetabulum,curet juxta articular cavities, large ones fill
up with cancellous bone grafts repose head into
acetabulum, place cancellous bone graft around joint line.
Approximate capsule and soft tissue over the site of fusion
Hold hip in functional position, 2-3 Steinmen’s pins passed
from base of greater trochanter to neck, head and into the
acetabulum.
Close wound over suction drain, single hip spica applied.
Post op regime :
Steinmen pin removal after 6 to 8 wks
Single hip spica applied in desired position
Gradual weight bearing with crutches for 4 to 6 months until radiological
E/o bone fusion.
61. Indications :
Extensive destruction of head and neck of femur.
Deficient bone stock due to prior arthroplasty.
Patients life style prefers a strong, fused and
painless hip joint.
Can be done in the presence of active infection or
draining sinuses.
62. Involves excision of femoral head, neck, proximal
part of trochanter and acetabular rim.
Best suited for Indian subcontinent people,
whose essential activities are squatting, sitting
crosslegged and kneeling.
Safely done in healed / active disease after
completion of growth potential.
Provides painless, mobile hip joint with control
of infection and correction of deformity.
63. Upper tibial skeletal traction, mounted in 300-500
abduction for 3 months.
Encouraged to sit soon after surgery and active
assisted movements of hip and knee started
during first week.
Encouraged to place limb in tailor’s position and
squatting posture.
After 3 months – mobilization with caliper /
crutches.
After 6-9 months – they are discarded and to use
walking stick on the contralateral hand.
66. Excision arthroplasty can rarely have a very
unstable hip joint. If happen in young patient, it
need supplementary operation.
Hip stabilization procedure
Pelvic support osteotomy (Milch- Bacheolar type) at
the level of ischeal tuberosity.
Supra acetabular shelf : full thickness iliac crest is used
to provide shelf at upper margin of acetabulum, to
minimize upward excursion of femur on weight
bearing.
An interesting technique of interposition
arthroplasty employing multilayered amniotic
membrane – reported by Vishwakarma (1986).
67. Low friction arthroplasty.
Role of THR is being debated and
performed in highly selected cases.
Most authors suggest this operation at
least 10 yrs after last E/o active
infection / drainage and under cover of
ATT. Despite precaution, reactivation
rate is 10-30%
70. Largest intra-articular space
Involved in about 10 % of osteo-articular
tuberculosis
Any age group
Symptoms - pain, swelling, palpable synovial
thickening and restriction of mobility. Tenderness
in the medial or lateral joint line and patello-
femoral segment of the joint
The initial focus may be in synovium or
subchondral bone of distal femora, proximal tibia
or patella.
71. ▣ Osteoporosis, soft tissue swelling, joint / bursa
effusion.
▣ Distension of supra-patellar bursa on lateral
radiograph of knee
▣ Infection in childhood can lead to accelerated
growth and maturation resulting in big bulbous
squared epiphysis
▣ Widening of the inter-condylar notch (synovitis)
73. Loss of definition of articular surfaces
Marginal erosions
Decreased joint space
Osteoporosis
⚫ Osteolytic cavities with or without sequestra
formation
⚫ Marked reduction of joint space
⚫ Destruction and deformity of joints
⚫ In advanced cases, there is triple deformity of the
knee may occur
76. Differential diagnosis
–
Juvenile rheumatoid arthritis
Villonodular synovitis
Osteochondritis dissecans
Hemophilia
▣ Biopsy of the synovial membrane and aspiration
of the joint fluid followed by smear & culture can
confirm the diagnosis
79. Triple Deformity of knee is seen in :
"TRIPLE“:
T - TUBERCULOSIS ( MOST COMMON CAUSE )
R - RHEUMATOID ARTHRITIS
I - ILIOTIBIAL BAND CONTACTURE
P - POLIO
L - LOW CLOTTING CAPACITY
E - EXCESS BLEEDING / HEMOPHILIA
80. ▣ Can be prevented by adequate
posturing and Bracing in initial
affection of joint
▣ Treatment of Triple Deformity of Knee
in TB:
Double Traction (90-90): For Supple
deformities
Anti- tubercular Therapy
83. Rare entity
More frequent in adults
Incidence of concomitant pulmonary
tuberculosis is high
The classical sites are:
head of humerus,
glenoid,
spine of the scapula,
acromio-clavicular joint,
coracoid process and rarely synovial lesion.
84. ▣ Iatrogenic due to steroid injection given for
a stiff shoulder with the mistaken
diagnosis of frozen shoulder, particularly
in diabetics.
▣ Initial tubercular destruction is typically
widespread (because of the small surface
contact area of articular cartilage)
▣ Symptoms –
◾severe painful movement restriction
particularly abduction and external rotation
◾gross wasting of shoulder muscles
85. Radiologically,
osteoporosis
erosion of articular margins (fuzzy)
osteolytic lesion involving head of humerus,
glenoid or both
The lesion may mimic giant cell tumor.
The joint space involvement and capsular
contracture are seen early in the disease.
Sinus formation
Inferior subluxation of the humeral head
Fibrous ankylosis
88. Caries sicca:
▣ Atrophic type of tuberculosis of the shoulder
▣ Benign course
▣ Without pus formation
▣ Small pitted erosions on the humeral head
🞮 Classical dry type is more common in adults
🞮 fulminating variety with cold abscess or sinus
formation is more common in children
89. Caries sicca: there is erosion and destruction
of humoral head and glenoid cavity with soft
tissue swelling, along with fibrotic opacites in
the right upper and middle lobe.
90. ▣ Differential diagnosis -
◾Peri-arthritis of the shoulder
◾Rheumatoid arthritis
◾Post-traumatic shoulder stiffness
▣ Aspiration of the shoulder and FNAC might be
necessary to establish the diagnosis.
▣ The patients usually respond well to anti-
tubercular drugs.
92. Tubercular dactylitis
primarily a disease of childhood
affects short tubular bones distal to tarsus and
wrist
bones of the hands are more frequently affected
than bones of the feet
proximal phalanx of the index and middle fingers
and metacarpals of the middle and ring fingers
being the most frequent locations
Frequently present as marked swelling on the
dorsum of the hand and soft tissue abscess is
normally a common feature
93.
94. ▣ Monostotic involvement is
common
▣ Often follows a benign course without pyrexia and
acute inflammatory signs, as opposed to acute
osteomyelitis.
▣ Plain radiography is the modality of choice for
evaluation and follow-up.
The radiographic features –
▣ Cystic expansion of the short tubular bones have
led to the name of "spina ventosa" being given to
tubercular dactylitis of the short bones of the
hand.
🞺spina - short bone and
🞺ventosa - expanded with air
95. ▣ Bone destruction and fusiform expansion of the
bone
▣ It is most marked in diaphysis of metacarpals and
metatarsals in children
▣ Periosteal reaction and sequestra are uncommon.
▣ Healing is gradual by sclerosis.
Differential diagnosis –
▣ Syphilitic dactylitis – bilateral and symmetric
involvement, more periostitis, less soft tissue
swelling.
▣ Chronic pyogenic osteomyelitis and mycotic lesions
in the foot
98. • Rare entity
• May be localized and well defined
• Or may be more diffuse
• Associated with cold abscess
Calvarial
tuberculosis
99. 1)Lateral radiograph shows large circumscribed lytic lesion in
frontal bone
2)AP radiograph demonstrates a large frontoparietal lytic lesion
suggestive of diffuse spreading type
3) Frontal radiograph shows a lytic lesion with a sclerotic margin
100.
101. Skull -
▣ Frontal bone most common site
▣ Ill-defined lytic lesion may be the only radiological
feature seen with overlying cold abscess (Potts'
Puffy tumor)
▣ Button sequestrum sometimes seen
▣ Facial bones and mandibular involvement is
extremely rare
104. Tubercular affection of tendons and Bursae
Tubercular Osteomyelitis
Tuberculosis of Ribs and Flat bones
Tubercular infection of Sacroiliac joints
and Pelvis (also read Weaver’s Bottom)
BCG Osteomyelitis/ Arthritis
Atypical Mycobacterial infection
105. ▣ Also k/as Tubercular Rheumatism
▣It is a form of Polyarthriris
occuring in patients suffering
from Tuberculosis, commonly
affecting the Knee and Ankle
joints
106. ▶ Most frequent site of osseous involvement by TB
▶ the disease was first described by Sir Percival Pott
in 1779, hence the name Pott's disease
▶ There has been a resurgence of the
disease in the developed countries
following the HIV pandemic.
▶ Defined - as an infection by Mycobacterium
tuberculosis of one or more of the extradural
components of the spine namely the vertebra,
intervertebral disks, paraspinal soft tissues and
epidural space
TB of Axial Skeleton
107. ▶ Usually by hematogenous route
▶ Peri-vertebral arterial or venous plexus is still in debate,
but arterial route considered more important.
▶ Primary focus in the lung or other extra-osseous foci
such as lymphnodes, GIT or any other viscera
▶ Lower thoracic and lumbar vertebrae are most often
affected
▶Usually two continuous vertebrae are involved but several
vertebrae may be affected, skip lesions and solitary
vertebral involvement may occur
▶ The so-called skip lesions or a second lesion not
contiguous with the more obvious lesion is seen in 4 -
10 % of cases.
Pathophysiology
108.
109. CLINICAL FEATURES
▶ PRESENTATION VARIES FROM NON
SPECIFIC BACK ACHE TO CATASTROPHIC
PARAPLEGIA
COMPLAINTS:
PAIN
STIFFNESS
COLD ABSCESS ( IF EVIDENT EXTERNALLY)
PARAPLEGIA
DEFORMITY
CONSTITUTIONAL SYMPTOMS (20-30%
patients only)
110. EXAMINATION
▶ SHOULD HAVE A HIGH INDEX
OF SUSPICION
▶ AIMS : LOOK FOR FINDINGS OF
TB SPINE
• LOCALISE SITE OF LESION
• DETECT COMPLICATIONS- COLD ABSCESS /
• PARAPLEGIA
• GAIT : SHORT STEPS
• ATTITUDE & DEFORMITY
•PARAVERTEBRAL SWELLING
•TENDERNESS ON THE AFFECTED SPINE
• REDUCED MOBILITY
112. NEUROLOGICAL EXAMINATION
▶ AIMS: DETECT ANY COMPRESSION
LEVEL OF COMPRESSION
SEVERITY OF COMPRESSION
▶ LIMBS – UPPER OR LOWER BASED ON SITE
MOTOR , SENSORY , REFLEXES , BOWEL AND
BLADDER FUNCTIONS
GENERAL EXAMINATION
PHYSICAL EXAMINATION
SYSTEMIC ILLNESS : DM , HYPERTENSION
115. Conventional Radiographs –
▶ Initial investigation
▶ often negative in early disease
▶ More than 30 to 50 % of mineral must be lost
before a radiolucent lesion becomes conspicuous
on the plain films and this takes about 2 to 5
months
Imaging modalities
116. Abscess formation –
▶ Paravertebral soft tissue opacity
▶ Usually out of proportion to the degree of osseous
destruction
▶ commonly bilateral and uniform
▶ may be globular indicating pus under tension
▶ may be minimal in the central variety of tubercular
lesion
▶ cervical region - widening of the pre-vertebral soft
tissues
▶ dorsal spine - the posteromedial pleural line is
displaced laterally & the abscess produces as
typical fusiform shape called the "birds nest"
appearance
120. Advantages –
early detection of bone and soft tissue changes
when plain films are normal
better anatomic localization and
characterization of lesions
evaluation of areas difficult to evaluate on plain
films such as cranio-vertebral junction, cervico-
dorsal junction, sacrum
providing guidance for biopsy and
surgical approach
Computed Tomography
121. ▶ modality of choice
▶ advantages –
multiplanar capability
the direct demonstration of early bone marrow
involvement or edema
unsurpassable assessment of spinal canal and
neural involvement
Soft tissue and Intraosseous abscesses are also
well demonstrated on MR imaging
▶ Higher sensitivity for early infiltrative disease
including endplate changes and marrow
infiltration than bone scan and plain films
Magnetic Resonance Imaging
122. ▶ MRI Scores over CT in-
Detection of early disease (marrow edema)
Skip lesions more easily and more often detected.
Incidence of multilevel noncontiguous vertebral
tuberculosis is generally reported to be between 1.1 and
16 %
Detection of epidural, meningeal and cord involvement
Planning the surgical approach
127. Types of paraplegia
▶ EARLY ONSET – during active phase, <
2 years
▶ INFLAMMATORY EDEMA
▶ EXTRADURAL PUS & GRANULATION
TISSUE – COMMOMN
▶ SEQUESTRA
▶ INFARCTION OF SPINAL CORD
▶ EXTRADURAL GRANULOMA
▶ LATE ONSET – during healed
phase, > 2 years internal
gibbus
recurrence
128. TREATMENT:
What is Middle path regime?(why called middle path)
▶ Rest in bed
▶ Chemotherapy (ATT4HRZE+ 8 HRE)(ATT?)
▶ X-ray & ESRonce in 3 months
▶ MRI/ CTat 6 months interval for 2 years
▶ Gradual mobilization is encouraged in absence of
neural deficits with spinal braces & back extension
exercises at 3 – 9 weeks.
▶ Abscesses – aspirate when near surface & instil 1gm
Streptomycin +/- INH in solution
129. RX of COLD ABSCESS
▶ SMALLER ONES SUBSIDE WITH TB THERAPY
▶ IN SUPERFICIAL ABSCESSES :
▶ ASPIRATION : USING THICK NEEDLE
▶ EVACUATION
▶ PSOAS ABSCESS : drain retroperitoneally
130. Rx of paraplegia
▶ CONSERVATIVE : ANTI TB RX , REST TO
SPINE ,
▶ SURGICAL :
INDICATIONS : PARAPLEGIA IN
CONSERVATIVE Rx
▶ SUDDEN ONSET SEVERE PARAPLEGIA
▶ SEVERE PARAPLEGIA : IN FLEXION,
MOTOR / SENSORY LOSS > 6 MONTHS
OR COMPLETE MOTOR LOSS ONE
MONTH DESPITE CONSERVATIVE Rx
▶ PARAPLEGIA WITH
UNCONTROLLED SPASTICITY
132. Tuberculosis is a major public health
problem in most of the world.
“Before the disease can be treated, it must
be recognized and before it can be
recognized, it must be considered a
diagnostic possibility”.