Lateral epicondylitis, commonly known as tennis elbow, is a painful condition caused by overuse and microtears of the tendons that connect the forearm muscles to the lateral epicondyle of the humerus. The condition results in pain at the outside of the elbow. Conservative treatments include activity modification, bracing, stretching, strengthening exercises, and shock wave therapy. Surgical intervention is considered if conservative treatments fail to provide relief after 6 months.
Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow) are caused by repetitive microtrauma from activities like gripping or flexion/extension. This causes tendon degeneration and inflammation. Patients experience pain worsened with associated motions. Diagnosis is clinical with imaging to rule out other causes. Initial treatment focuses on rest, bracing, NSAIDs, and physical therapy. Corticosteroid injections and surgery are considered if conservative options fail.
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the extensor tendons of the forearm caused by repetitive strain from activities like tennis or manual labor. It presents as lateral elbow pain that is exacerbated by wrist extension movements. While the name suggests it is caused by tennis, 95% of cases occur in non-tennis players engaged in repetitive arm motions. Treatment begins conservatively with rest, ice, braces, and physical therapy, while corticosteroid injections provide temporary pain relief. Surgery is considered if conservative measures fail after 6-12 months.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
This document discusses vertical talus, a rare congenital foot deformity. It begins by defining vertical talus and listing its synonyms. It then discusses the etiology, associated conditions, clinical presentation, radiographic findings, and classification systems for vertical talus. The document concludes by outlining treatment approaches for vertical talus, which typically involves serial casting in infants followed by surgical correction if needed. Surgical techniques described include open reduction with possible navicular excision or arthrodesis depending on the age and severity of the deformity.
This document provides information about pes planus (flat foot), including its components, classification, examination, and treatment. Pes planus is characterized by a lowered or absent medial longitudinal arch. It can be flexible or rigid depending on joint mobility. Flexible flat foot is more common and usually asymptomatic, especially in children. Treatment focuses on orthotics, exercises, or surgery if conservative measures fail. Surgical options include tendon lengthening, arthrodesis, and osteotomies to realign the foot structure.
The document discusses meniscal injuries and pathology. It provides information on the anatomy and function of the menisci, as well as types of meniscal tears. The diagnosis of meniscal tears involves taking a history of the injury and examining for symptoms like joint line tenderness, effusion, and a locking sensation. Investigations may include x-rays, MRI, arthrography and arthroscopy. Treatment options discussed include non-surgical management for minor tears and surgical repair or resection for larger tears.
This document discusses the anatomy, biomechanics, causes, symptoms, diagnosis, and treatment of rotator cuff tears. It begins by introducing the rotator cuff muscles and their function in stabilizing the shoulder joint. Common causes of tears include impingement, trauma, aging, and ischemia. Symptoms include shoulder pain that is worsened with overhead activities. Diagnosis involves physical exam maneuvers like the Neer's and Hawkins tests as well as imaging like x-rays, ultrasound, CT, or MRI. Treatment ranges from rest, physical therapy, and injections for mild cases to surgical repair for larger or chronic tears if conservative measures fail.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
Dr. Ankur Mittal's presentation discusses stenosing tenosynovitis, also known as trigger finger. The anatomy of the flexor tendon sheath and pulley system is described. Trigger finger occurs when a thickened flexor tendon catches on the A1 pulley, most commonly in the ring finger. Conservative treatments include splinting, steroid injections, and exercises, while surgery involves open or percutaneous release of the A1 pulley. Postoperative care focuses on early mobilization while avoiding complications like nerve damage or bowstringing. Surgical synovectomy may be required in rheumatoid patients to address underlying synovitis.
Scapular dyskinesis refers to abnormal static positioning or dynamic motion of the scapula during arm elevation and is associated with shoulder injury. It has multiple potential causes including muscle weakness or imbalance. The document discusses the muscular attachments of the scapula, types of scapular dyskinesis, its effects on dynamic stability and shoulder strength, assessment methods, and rehabilitation treatments focusing on strengthening the lower trapezius and serratus anterior muscles to achieve optimal scapular positioning.
This document provides information about Achilles tendinopathy, including:
- It is a common overuse injury among athletes and the general public.
- It can be classified based on its location as insertional, non-insertional, or proximal tendinopathy.
- Risk factors include excessive loading, tight calf muscles, foot abnormalities, and medical issues.
- Diagnosis involves physical exams like the Arc sign and imaging like ultrasound or MRI.
- Treatment begins with rest, bracing, eccentric exercises, and other conservative methods, with surgery reserved for severe cases.
An ankle sprain is a common injury caused by trauma to the ankle ligaments from excessive inversion or eversion. It can range from mild stretching to complete tears. Incidence is highest among athletes. Symptoms include pain, swelling, bruising and difficulty walking. Assessment involves examining range of motion, stability tests like the anterior drawer test, and imaging to rule out fractures. Treatment depends on severity but may include RICE, bracing and physical therapy.
The document provides information on examining the elbow, including:
- An overview of elbow anatomy focusing on bones, joints, ligaments and muscles
- How to evaluate the elbow through inspection, palpation, range of motion testing and special tests
- Common conditions involving the elbow like lateral epicondylitis, medial epicondylitis, ligament instability and neuropathy/compression syndromes
- Descriptions of special tests to assess for these conditions like Cozen's test, Golfer's elbow test, varus/valgus stress tests and Tinel's sign
This document provides an overview of patellofemoral pain syndrome. It defines the syndrome and discusses relevant anatomy, biomechanics, causes, clinical evaluation, imaging, and treatment options. Regarding treatment, non-operative options including rehabilitation are usually successful for 90% of cases. Surgical techniques are reserved for the remaining 10% and include arthroscopic procedures such as debridement and lateral release as well as bony procedures like tibial tubercle transfer to address malalignment issues.
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
This document provides information on spinal stenosis including its definition, history, clinical anatomy, pathophysiology, types, investigations, and treatment options. Spinal stenosis is defined as a narrowing of the spinal canal or intervertebral foramina causing compression of neural structures. It was first described in the late 19th/early 20th century and can be developmental, degenerative, post-traumatic, or iatrogenic in nature. Clinical features include neurogenic claudication relieved by flexion. Investigations include imaging like MRI, CT, and myelography. Treatment involves conservative options like activity modification initially, with surgery considered if conservative measures fail.
This document provides a review of rotator cuff tears, including their anatomy, function, pathophysiology, clinical presentation, diagnostic tests, differential diagnosis, imaging, and treatment options. It describes the rotator cuff muscles and their role in stabilizing the shoulder joint. Common causes of tears include repeated impingement against bony structures or age-related degeneration. Clinical exams aim to isolate each muscle while imaging such as MRI can determine the size and location of tears. Conservative treatment includes corticosteroid injections and physical therapy, while surgical repair is considered for larger or symptomatic tears.
Adhesive capsulitis is a condition characterized by a painful and progressive loss of shoulder range of motion. It typically progresses through painful, freezing, and thawing phases over 1-2 years. Treatment involves medications to manage pain, physical therapy to restore range of motion, and in refractory cases, procedures like corticosteroid injections or surgery. While pain is usually transient, some patients may develop permanent loss of range of motion.
This document discusses elbow tendinopathy and various treatment options. It begins by explaining common types of elbow tendinopathy and risk factors. Non-surgical treatments like eccentric exercises, corticosteroid injections, platelet-rich plasma injections, and autologous cell implantation are reviewed. Surgical options like arthroscopic and open tennis elbow release are also summarized. The document concludes by discussing the current state of research and the need for further well-designed clinical trials to evaluate the efficacy of emerging non-surgical treatments.
This document provides an overview of rotator cuff disorders and evidence related to diagnosis and management. Key points include:
- Rotator cuff tears can be caused by mechanical or degenerative factors and progress from tendinosis to partial or full thickness tears.
- Physical exams have low diagnostic accuracy for tears but clusters of tests may help. Investigations like ultrasound and MRI can better identify soft tissue pathology.
- Factors like age, tear size, tendon retraction and fatty infiltration affect outcomes, with larger/retracted tears and more fatty changes correlating to poorer prognosis.
- Initial management focuses on rest, analgesics and physiotherapy, with surgery for failed non-operative treatment. Surgical techniques like
The document provides an overview of rotator cuff rehabilitation. It discusses that the rotator cuff has different roles as a stabilizer and torque producer depending on the position of the shoulder. Rehabilitation should focus on improving control, proprioception, timing, loading through the range of motion, and endurance. Exercises should incorporate the kinetic chain and provide rotational control and loading through the full range of movement.
This document discusses the management of painful neuromas, specifically focusing on non-surgical and surgical treatment options. It outlines the decision making process for determining which nerve is involved, what type of nerve it is, and whether the nerve was cut or intact. The key surgical options discussed are neurolysis, nerve repair/grafting, nerve burial/relocation, and nerve transfer. The overall principles of surgery are to move the nerve out of harm's way and give it a functional purpose.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
Non-Surgical Management of a Painful NeuromaThe Arm Clinic
Neuromas are nerve tumors that often form at amputation sites as severed nerve ends regrow abnormally. Clinical diagnosis involves palpating areas of sensitivity, allodynia, or hyperalgesia and observing signs like Tinel's. Investigations may include diagnostic anesthesia, MRI, ultrasound, or nerve conduction studies. Treatment options include medications, patches, neuromodulation, radiofrequency ablation, or chemical neurolysis to manage symptoms palliatively or potentially cure the condition. Drugs commonly used include gabapentinoids, opiates, anti-epileptics, and antidepressants.
Shoulder Impingement : The Surgeon's ApproachThe Arm Clinic
This document discusses the history and treatment of subacromial impingement. It describes Neer's theory of extrinsic impingement from the acromion and coracoacromial ligament. The standard open and arthroscopic approaches to subacromial decompression are outlined. Studies comparing surgery to exercise-based treatment show similar long-term outcomes, though surgery may provide better short-term relief. Factors predicting poorer outcomes include longer symptom duration, lack of social support, and non-compliance with rehabilitation. The role of the surgeon is to establish an accurate diagnosis and ensure adequate rehabilitation, as failure of non-surgical treatment may reflect systemic issues rather than patient factors alone.
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
Tendinopathy is caused by functional overload that leads to structural degradation of tendons over time. The core principles of evidence-based treatment involve restoring capacity through supporting mechanics like bracing and muscle strengthening exercises over a minimum of 12 weeks. Adjunct treatments like shockwave therapy may help if rehab is failing, as it is analgesic and safe for tendons, but should not replace the main treatment of supporting function and strengthening muscle through physiotherapy.
TENDINOPATHY I Dr.RAJAT JANGIR JAIPUR
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Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
This document summarizes a presentation on tendinopathy. It defines tendinopathy, tendinitis, and tendinosis. It discusses that tendinopathy is not always inflammatory and involves degeneration rather than inflammation. For patellar and Achilles tendinopathy, it outlines the typical clinical presentations and recommends validated clinical diagnostic tools. It also reviews the evidence that eccentric and heavy slow resistance exercises are effective treatments for both types of tendinopathy, with no significant differences between the approaches. The presentation emphasizes individualizing treatment and continuing exercises after return to sport.
Overuse injuries are common in professional ballet dancers, with the foot/ankle being the most injured area. Maintaining in-house medical staff can help decrease injury rates and save money. Tendinopathy is a core issue in dance medicine. Puberty is a critical period for collagen synthesis in tendons. New ultrasound tissue characterization technology provides objective data on tendon health and links to research. Treatment involves intelligent loading programs and potentially injections or surgery.
Achilles tendinopathy treatment with triple therapyLevel Medical
1) Achilles tendinopathy is a common cause of heel pain, especially in amateur athletes between ages 28-55.
2) A pilot study used triple therapy involving two laser sources at different wavelengths and powers to treat 5 patients with chronic Achilles tendinopathy.
3) After 9 treatment sessions over 3 weeks, patients experienced significant reductions in pain based on VAS and algometer scores, and improvements on ultrasound and thermography, with no adverse reactions. The study concludes triple therapy may be an appropriate treatment for Achilles tendinopathy.
Atraumatic/MDI - Physiotherapy Principles and ManagementThe Arm Clinic
Physiotherapy management of multidirectional instability (MDI) of the shoulder is complex due to various drivers of the condition. Research on MDI has been difficult to interpret due to inconsistent definitions, heterogeneous populations, lack of standardization, and insensitive outcome measures across studies. Physiotherapy aims to address drivers both local to the shoulder like atypical muscle activation patterns and scapular kinematics, as well as central nervous system drivers involving cortical reorganization. Rehabilitation focuses on normalizing range of motion, improving neuromuscular control, and training into positions of vulnerability using modalities that target specific muscles individually and create synergies between muscles.
Arthroscopic management of rotator cuff tears larissa 2016Aaron Venouziou
Rotator cuff tears are a spectrum of conditions ranging from asymptomatic partial tears to symptomatic rotator cuff arthropathy. The document discusses the anatomy and biomechanics of the rotator cuff and shoulder. It describes the classification, incidence, etiology, and treatment options for partial and full-thickness rotator cuff tears. Surgical techniques for repairing tears are outlined, including considerations for different tear patterns. Post-operative healing rates and functional outcomes are addressed. The conclusion emphasizes the importance of the rotator cuff for shoulder function and discusses factors influencing tear symptoms, healing after repair, and restoration of biomechanical equilibrium.
This document discusses pain from biological, psychological, and social perspectives. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is always subjective and influenced by early life experiences. While often caused by tissue damage, pain can also occur for psychological reasons alone. The document explores how psychological factors like stress and emotions can influence pain experience. It discusses conditions like sadism and masochism in relation to pain. Finally, it notes various social and cultural factors that can impact how individuals experience pain and illness.
Atraumatic Shoulder Instability Principles and AssessmentThe Arm Clinic
The document discusses atraumatic shoulder instability, providing 4 scenarios of 16-year-old girls with unstable shoulders. It describes how to differentiate instability from hyperlaxity and covers the static and dynamic stabilizers of the shoulder. The clinical assessment of atraumatic instability includes assessing contributions from the traumatic history, structural factors like the sulcus sign, and range of motion tests like the Gagey sign. Classification systems for instability including Rockwood and Stanmore are presented.
1) Shoulder impingement syndrome is caused by compression of the rotator cuff tendons between the acromion and humeral head. It commonly results from a hooked acromion or inflammation/thickening of the tendons.
2) Treatment begins conservatively with anti-inflammatories, cortisone injections, and physical therapy. If unsuccessful, surgery such as open or arthroscopic acromioplasty is recommended to remove bone spurs and widen the space.
3) Acromioplasty involves detaching the deltoid muscle, removing the coracoacromial ligament and anterior portion of the acromion, and inspecting/repairing any rotator
Enthesopathies of the upper limb refer to diseases of tendon, ligament, or fascia attachments to bone. This document discusses the definition, pathophysiology, diagnosis, and management options for upper limb enthesopathies. Treatment begins with activity modification, analgesia, and physiotherapy focusing on stretching and progressive strengthening exercises. For refractory cases, corticosteroid injections may provide short-term relief but are not recommended due to risk of tendon damage. Platelet-rich plasma injections and surgery are considered for patients who fail conservative treatments. The goal of any treatment is to balance the mechanical load on tissues with the tendon's capacity through gradual loading programs.
This document discusses evidence and concepts related to rotator cuff repair. It covers rotator cuff function and tears, the progression of cuff disease, making a diagnosis through history, physical exam and investigations, management options, and factors that affect outcomes of cuff repair surgery such as age, tear size, tendon retraction, fatty atrophy, and smoking.
Anterior knee pain is one of the most common conditions affecting active young patients. It has many potential causes including patellofemoral imbalance, lower limb structural abnormalities, and overuse. A thorough history focused on pain location and aggravating/relieving factors is important to identify the underlying cause. Physical examination evaluates alignment, patellar tracking, and identifies tenderness. Imaging like x-rays and MRI may help diagnose conditions like patellar tendinopathy, Osgood Schlatter disease, or cartilage lesions. Treatment is usually initially conservative with physical therapy and modifications, while surgery is considered for issues like instability or advanced arthritis. A holistic approach considering multiple factors is important for managing anterior knee pain.
This document provides an overview of a foot and ankle session. It discusses topics like imaging the foot and ankle, common injuries like lateral ankle sprains and their treatment, and case studies involving various foot and ankle conditions like plantar fasciitis, pes planus, and Achilles tendinopathy. Clinical tests and management strategies are described for different injuries and conditions.
Low back pain is very common, affecting 50-80% of adults at some point. It is the leading cause of disability in the US, costing $50 billion annually. While most cases resolve within 6 weeks, pain and disability may persist longer in up to 12-72% of patients. Risk factors include poor physical fitness, obesity, smoking, and hard physical labor. Mechanical low back pain makes up 90% of cases and involves overuse or injury of back structures, while 10% have non-mechanical systemic causes. Diagnosis involves history, exam, and sometimes imaging to identify pain generators and rule out serious causes requiring prompt treatment. Initial treatment focuses on remaining active, over-the-counter medications,
This document discusses preliminary data on CT bone densitometry scans of Navy recruits with multiple stress fractures. It finds that 58% of recruits with multiple stress fractures had osteopenia based on CT scans. Recruits who were Asian/Pacific Islander made up 52% of multiple stress fracture cases and generally had lower bone densities. The preliminary results suggest CT scanning may help identify recruits with bone density issues contributing to repeated stress fractures. However, more research is still needed to fully understand risk factors and how treatments like calcium supplementation could help.
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
- Osteoarthritis is a degenerative joint disease affecting cartilage that commonly occurs in weight-bearing joints like the knee. It can be primary with no underlying cause or secondary to other joint issues.
- Symptoms include joint pain that worsens with use and improves with rest, morning stiffness, and crepitus. Conservative treatment focuses on lifestyle changes, physical therapy including exercises, bracing, and medications like acetaminophen, NSAIDs, or injections. Surgery is considered if conservative options provide insufficient relief.
Tendinopathy, or tendon injuries, are very common soft tissue disorders that affect millions of people annually. The document discusses Tendofit, a patented supplement containing mucopolysaccharides and collagen type 1 that is clinically proven to aid tendon recovery from injuries. It does so by protecting tendon cells, stimulating collagen production, and improving tendon structure based on multiple clinical trials. The document promotes Tendofit as a natural solution for tendinopathy recovery and prevention of reinjury.
1. Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing pain and stiffness. Over time, repeated inflammation can result in fusion of the vertebrae (bamboo spine).
2. AS was first described in ancient Egyptian mummies from over 3000 years ago. It typically presents in early adulthood between 15-35 years of age and is more common in men. Diagnosis can be difficult due to nonspecific symptoms and delays of 8-10 years on average.
3. Diagnostic criteria include inflammatory back pain, limitation of spinal movement, and radiographic evidence of sacroiliitis. Newer MRI criteria allow for earlier
Interventions are the minimally invasive techniques to control chronic knee and joint pains. Some procedures are even offered to patients who are not fit to undergo surgery.
Foot and ankle trauma, common pitfalls, imaging modalities and radiographic occult fractures. The concept of the PITFL or "pitiful injury" an easily overlooked ligamentous injury of the talocrural joint
1. Tendinopathy is a complex pathology of tendons commonly caused by overuse that results in tendon degeneration and damage.
2. It involves multiple pathological processes including dysregulated apoptosis, mechanical overload, inflammation, and imbalance of matrix metalloproteinases and their inhibitors.
3. Common sites are the rotator cuff, Achilles, elbow, wrist, and knee tendons. Risk factors include high body mass, genetics, and repetitive strain from occupational or sports activities.
4. Treatment options include physiotherapy, NSAIDs, corticosteroid injections, shockwave therapy, and eccentric exercises, with the goal of reducing pain and inflammation and stimulating healing.
16001107 01 X Stop Surgeon To Patient FinalWilliamYoungMD
This document summarizes lumbar spinal stenosis, including its symptoms, treatment options, and a new minimally invasive treatment called the X-STOP spacer. Lumbar spinal stenosis causes back and leg pain due to narrowing of the spinal canal. Treatment options discussed include non-operative care, laminectomy, and the X-STOP procedure, which separates the spinous processes with an implanted spacer to relieve pressure on nerves. The X-STOP procedure provides relief of symptoms with less risks and recovery time compared to laminectomy.
Proximal fibular osteotomy - What is the evidence?Dr Saseendar MD
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
This document discusses a preliminary study conducted on US Navy recruits with multiple stress fractures who underwent CT bone densitometry scans. The study found that 58% of recruits with multiple stress fractures had osteopenia, and osteopenia was more common in Asian/Pacific Islander recruits and male recruits. The study concludes that CT bone densitometry may be a useful tool to identify insufficiency as a contributing factor to stress fractures in military recruits, as many cases of osteopenia were identified that otherwise would have been overlooked. However, more research is still needed to fully understand risk factors and how to treat recruits identified as osteopenic.
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
This document provides an overview of arthritis pain management strategies without compromising patient safety. It discusses the disease states and diagnostic criteria for osteoarthritis and rheumatoid arthritis. It then reviews the goals and treatment options for managing the pain and symptoms of osteoarthritis and rheumatoid arthritis, including both non-pharmacologic and pharmacologic approaches. It also discusses the efficacy and gastrointestinal safety profile of the drug celecoxib for treating arthritis pain.
This document discusses various degenerative spine diseases. It begins with the anatomy of the spine, including details on intervertebral discs, facet joints, and other structures. Common imaging tests are then outlined, such as plain x-rays, MRI, CT, and myelography. Common causes of back pain like muscle strains, herniated discs, and spinal stenosis are reviewed. The document also discusses Waddell signs which are used to evaluate non-organic causes of back pain. Finally, conditions such as degenerative disc disease, spondylosis, and spondylolisthesis are introduced.
This document discusses various tendon transfer procedures for rotator cuff tears, including latissimus dorsi, pectoralis major, and teres major transfers. It provides indications for tendon transfers, such as massive rotator cuff tears with weakness and functional strength loss. It also lists prerequisites for tendon transfers, such as having an intact antagonist muscle and deltoid. The document then focuses on specific procedures like latissimus dorsi transfers for massive posterior superior rotator cuff tears and pectoralis major transfers for massive subscapularis tears. It provides criteria for candidates for each procedure and discusses outcomes from studies on latissimus dorsi and pectoralis major tendon transfers. Superior capsular
Atraumatic Shoulder Instability ManagementThe Arm Clinic
This document discusses atraumatic shoulder instability and treatment options. It presents the Stanmore classification system for shoulder instability, which categorizes types of instability as traumatic structural (Polar I), atraumatic structural (Polar II), or motor control (Polar III). For atraumatic structural instability (Polar II), options include small lesion repair, capsular plications, or large lesion repair/reconstruction along with rehabilitation. The document outlines a proposed randomized controlled trial to determine whether surgical stabilization plus physiotherapy improves outcomes for atraumatic instability compared to physiotherapy alone.
Introduction to hydrodilatation treatment for Frozen Shoulder.
Infographic designed by The Arm Clinic.
The Arm Clinic are a group of specialist upper-limb consultants based in the North West of England, UK
Frozen Shoulder Symptoms and Treatment OptionsThe Arm Clinic
Symptoms and treatment options for frozen shoulder. Infographic designed by The Arm Clinic.
The Arm Clinic are a group of specialist upper-limb consultants based in the North West of England, UK.
Physiotherapy in the Management of Frozen ShoulderThe Arm Clinic
This study compared the effectiveness of three physiotherapy treatment options for frozen shoulder: group exercise class, individual physiotherapy, and home exercises. The group exercise class showed significantly greater improvement in shoulder function scores compared to individual physiotherapy or home exercises. Individual physiotherapy also produced significantly better results than home exercises. The group exercise class achieved clinically meaningful improvement in shoulder function for 91% of patients within 6 weeks. This study provides evidence that group exercise classes are an effective first-line treatment for frozen shoulder.
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
Hepatocarcinoma today between guidelines and medical therapy. The role of sur...Gian Luca Grazi
Today more than ever, hepatocellular carcinoma therapy is experiencing profound and substantial changes.
The association atezolizumab (ATEZO) plus bevacizumab (BEVA) has demonstrated its effectiveness in the post-operative treatment of patients, improving the results that can be achieved with liver resections. This after the failure of the use of sorafenib in the already historic STORM study.
On the other hand, the prognostic classification of BCLC is now widely questioned. It is now well recognized that the indications for surgery for patients with hepatocellular carcinoma are certainly narrow in BCLC and no longer reflect what is common everyday clinical practice.
Today, the concept of multiparametric therapeutic hierarchy, which makes the management of patients with hepatocellular carcinoma much more flexible and allows the best therapy for the individual patient to be identified based on their clinical characteristics, is gaining more and more importance.
The presentation traces these profound changes that are taking place in recent years and offers a modern vision of the management of patients with hepatocellular carcinoma.
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Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 2 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/FHV_jNJUt3Y
- Video recording of this lecture in Arabic language: https://youtu.be/D5kYfTMFA8E
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
Importance in Pharmaceuticals: Understanding chemical kinetics is essential for predicting the shelf life of drugs, optimizing storage conditions, and ensuring consistent drug performance.
Rate of Reaction: The speed at which reactants are converted to products.
Factors Influencing Reaction Rates:
Concentration of Reactants: Higher concentrations generally increase the rate of reaction.
Temperature: Increasing temperature typically increases reaction rates.
Catalysts: Substances that increase the reaction rate without being consumed in the process.
Physical State of Reactants: The surface area and physical state (solid, liquid, gas) of reactants can affect the reaction rate.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, discuss NSCLC in this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Coronary Circulation and Ischemic Heart Disease_AntiCopy.pdfMedicoseAcademics
In this lecture, we delve into the intricate anatomy and physiology of the coronary blood supply, a crucial aspect of cardiac function. We begin by examining the physiological anatomy of the coronary arteries, which lie on the heart's surface and penetrate the cardiac muscle mass to supply essential nutrients. Notably, only the innermost layer of the endocardial surface receives direct nourishment from the blood within the cardiac chambers.
We then explore the specifics of coronary circulation, including the dynamics of blood flow at rest and during strenuous activity. The impact of cardiac muscle compression on coronary blood flow, particularly during systole and diastole, is discussed, highlighting why this phenomenon is more pronounced in the left ventricle than the right.
Regulation of coronary circulation is a complex process influenced by autonomic and local metabolic factors. We discuss the roles of sympathetic and parasympathetic nerves, emphasizing the dominance of local metabolic factors such as hypoxia and adenosine in coronary vasodilation. Concepts like autoregulation, active hyperemia, and reactive hyperemia are explained to illustrate how the heart adjusts blood flow to meet varying oxygen demands.
Ischemic heart disease is a major focus, with an exploration of acute coronary artery occlusion, myocardial infarction, and subsequent physiological changes. The lecture covers the progression from acute occlusion to infarction, the body's compensatory mechanisms, and the potential complications leading to death, such as cardiac failure, pulmonary edema, fibrillation, and cardiac rupture.
We also examine coronary steal syndrome, a condition where increased cardiac activity diverts blood flow away from ischemic areas, exacerbating the condition. The long-term impact of myocardial infarction on cardiac reserve is discussed, showing how the heart's capacity to handle increased workloads is significantly reduced.
Angina pectoris, a common manifestation of ischemic heart disease, is analyzed in terms of its causes, presentation, and referred pain patterns. We identify factors that exacerbate anginal pain and discuss both medical and surgical treatment options.
Finally, the lecture includes a case study to apply theoretical knowledge to a practical scenario, helping students understand the real-world implications of coronary circulation and ischemic heart disease. The role of biochemical factors in cardiac pain and the interpretation of ECG changes in myocardial infarction are also covered.
Causes Of Tooth Loss
PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS)
Systemic Causes Of Tooth Loss
1. Diabetes Mellitus
2. Female Sexual Hormones Condition
3. Hyperpituitarism
4. Hyperthyroidism
5. Primary Hyperparathyroidism
6. Osteoporosis
7. Hypophosphatasia
8. Hypophosphatemia
Causes Of Tooth Loss
CARIES/ TOOTH DECAY
Causes Of Tooth Loss
CAUSES OF TOOTH LOSS
Consequence of tooth loss
Anatomic
Loss of ridge volume both height and width
Bone loss :
mandible > maxilla
Posteriorly > anteriorly
Anatomic consequences
Broader mandibular arch with constricting maxilary arch
Attached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.
Anatomic consequences
Tipping of the adjacent teeth
Supraeruption of the teeth
Traumatic occlusion
Premature occlusal contact
Anatomic Consequences
Anatomic Consequences
Physiologic consequences
Physiologic Consequences
Decreased lip support
Decreased lower facial height
Physiologic Consequences
Physiologic consequences
Education of Patient
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Support for Distal Extension Denture Bases
Establishment and Verification of Occlusal Relations and Tooth Arrangements
Initial Placement Procedures
Periodic Recall
Education of Patient
Informing a patient about a health matter to
secure informed consent.
Patient education should begin at the initial
contact with the patient and should continue throughout treatment.
The dentist and the patient share responsibility for the ultimate success of a removable partial denture.
This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Begin with thorough medical and dental histories.
The complete oral examination must include both clinical and radiographic interpretation of:
caries
the condition of existing restorations
periodontal conditions
responses of teeth (especially abutment teeth) and residual ridges to previous stress
The vitality of remaining teeth
Continued…..
Occlusal plan evaluation
Arch form
Evaluation of Occlusal relationship through mounting the diagnostic cast
The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.
Mouth preparations, in the appropriate sequence, should be oriented toward the goal of
providing adequate support, stability,
retention, and
a harmonious occlusion for the partial denture.
Support for Distal Extension Denture Bases
A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading.
The base may be made to fit the form of the ridge when under function.
Support for Distal Extension Denture Bases
This provides support
Ontotext’s Clinical Trials Eligibility Design Assistant helps with one of the most challenging tasks in study design: selecting the proper patient population.
Mainstreaming #CleanLanguage in healthcare.pptxJudy Rees
In healthcare, every day, millions of conversations fail. They fail to cover what’s really important, fail to resolve key issues, miss the point and lead to misunderstandings and disagreements.
Clean Language is one approach that can improve things. It’s a set of precise questions – and a way of asking them – which help us all get clear on what matters, what we’d like to have happen, and what’s needed.
Around 1000 people working in healthcare have trained in Clean Language skills over the past 20+ years. People are using what they’ve learnt, in their own spheres, and share anecdotes of significant successes. But the various local initiatives have not scaled, nor connected with each other, and learning has not been widely shared.
This project, which emerged from work done by the NHS England South-West End-Of-Life Network, with help from the Q Community and especially Hesham Abdalla, aims to fix that.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
8. Function of the RC
• Rotation of the humerus w.r.t Scapula
• Compresses the head into the glenoid-
dynamic stability
• Force coupling - Deltoid / Lattisimus / Pec
Major
11. Acromial shapes
Bigliani, L. U.; Morrison, D. S.; and April, E. W.: The morphology of the acromion and its relationship to
rotator cuff tears. Orthop. Trans.,10: 228, 1986.10228 1986
Higher proportion of RC
tears seen in Curved and
Hooked Acromions
Image courtesy- Shoulderdoc.co.uk
16. Extrinsic Theory doesn’t explain it all
• RCT- Bursectomy vs Bursectomy + acromioplasty- No Difference
• Articular surface tendon damage more common
• No direct relation between acromial shape and impingement
symptoms
Lewis J. Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion? Physical Therapy Reviews. 16(5):388-98. 2011
18. Normal Tendon
Normal Cuff Tendon =
Collagen (Type I predominantly)
Elastin
Glycosaminoglycan
Proteoglycans
Water
Image Courtesy:
www.ouhsc.edu
19. Injured tendon- Usual repair
Total Collagen decreases
Increased gene expression of Type I,VI, IX and III
Decreased Type II expression.
Repair and replacement of normal collagen
Andrew Carr, Paul Harvie Chapter;Tendon Injuries pp 101-118 Rotator Cuff Tendinopathy.
In Tendon Injuries. Maffulli et al Springer, 2005.
23. Tendinopathy
• Excessive remodelling in response to
tendon damage during tendon repair
• Aberrant “quality” Collagen
“Stiffer Extracellular matrix”
24. Normal
Tendinopathy-
Disorganised matrix
Cellular clumping
Is Tendon Structure Associated with symptoms in Chronic Achilles TEndinopathy?
An update on pain mechanisms– Written by Robert-Jan deVos,The Netherlands,Aspetar Sports Medicine Journal 2017
27. Role of genetics
Possible link with “ank” mutation
(This is seen in association with Progressive form of arthritis)
Gene codes for a protein which transports Pyrophosphate out of
the cells…..so a defective gene leads to high concentration of PPi.
Increased Calcium deposition
Andrew Carr, Paul Harvie Chapter;Tendon Injuries pp 101-118 Rotator Cuff Tendinopathy.
In Tendon Injuries. Maffulli et al Springer, 2005.
29. Role of blood supply
Codman’s Critical zone
Debated- perhaps decreased
blood supply a result rather than
a cause
“Chicken or egg”
May explain the location along with external impingement
Andrew Carr, Paul Harvie Chapter;Tendon Injuries pp 101-118 Rotator Cuff Tendinopathy.
In Tendon Injuries. Maffulli et al Springer, 2005.
32. • Why do some partial tears progress to Full
• Why do some small tears progress to large
• Why do only 4% massive tears develop
Cuff tear arthritis
• Presence of Cuff tear without impingement
/ vice versa
33. Discontinuous and multifactorial model
Andrew Carr, Paul Harvie Chapter;Tendon Injuries pp 101-118 Rotator Cuff Tendinopathy.
In Tendon Injuries. Maffulli et al Springer, 2005.
38. History and physical examination provide little
guidance on diagnosis of rotator cuff tears.
Jain NB, Yamaguchi K. Evid Based Med.
2014 Jun;19(3):108.
39. Role of Investigations
• Ultrasound - Good for soft tissues & dynamic
• Xray- Good screening tool for Bone / joint
• CT- Good for bone
• MRI- Good for soft tissues and cross sectional
44. Positive Predictors
(1) Patient expectation of ‘complete recovery’ compared to a
‘slight improvement’ as ‘a result of physiotherapy treatment’,
(2) Lower pain severity specifically at rest,
(3) The absence of a previous major operation (shoulder
surgery excluded),
(4) The absence of pain in the opposite upper quadrant and
(5) Change in pain or range of shoulder elevation with manual
facilitation of the scapula during elevation of the arm.
46. Is Tendinopathy inflammatory?
• No
• Biopsies- No inflammatory cells
• Degenerative changes
Sports Med. 1999 Jun;27(6):393-408.Histopathology of common tendinopathies.
Update and implications for clinical management. Khan KM1, Cook JL, Bonar F,
Harcourt P,Astrom M.
56. Outcomes
20 year follow up 80% satisfied- 14% revision
Arthroscopy. 2015 Oct 24. pii: S0749-8063(15)00704-5. doi: 10.1016/j.arthro.2015.08.026. [Epub ahead of print]
Patients With Impingement Syndrome With and Without Rotator Cuff
Tears Do Well 20 Years After Arthroscopic Subacromial Decompression.
Jaeger M1, Berndt T2, Rühmann O2, Lerch S2.
57. Key Points
• Both Extrinsic and Intrinsic factors play a role
• Tendinopathy is degenerative not inflammatory
• ASD when first line treatment fails
• Reliable outcomes in carefully selected patients