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Elbow Anatomy

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141. Overview of sport-related injuries

and pain exacerbated by increased activity and use of the involved joint, Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg. 2006;14:90-100. http://www.ncbi.nlm.nih.gov/pubmed/16467184?tool=bestpractice.com Yamaguchi K, Sweet FA, Bindra R, et al. The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am. 1997;79:1653-1662. http://www.ncbi.nlm.nih.gov/pubmed/9384425?tool=bestpractice.com and pain at the posteromedial aspect (...) pain, which is typically aggravated by overhead activities. Other symptoms include shoulder weakness, loss of range of movement, and night pain. Complete separation of 2 articulating bony surfaces, often the result of high-speed energy. Common dislocations include the shoulder, elbow, finger, patella, hip, and knee. Delayed treatment can result in irreparable damage to the joint surface with lifelong consequences and post-traumatic arthritis. A chronic fibrosing condition characterised by insidious

2018 BMJ Best Practice

142. Overview of occupational overuse syndromes

and cumulative stresses to the spinal anatomy. Shelerud RA. Epidemiology of occupational low back pain. Clin Occup Environ Med. 2006;5:501-528. http://www.ncbi.nlm.nih.gov/pubmed/16963373?tool=bestpractice.com The aetiology of cervical spondylosis is underlying spontaneous joint degeneration. It is related to age, and to wear and tear. Binder AI. Cervical spondylosis and neck pain. BMJ. 2007;334:527-531. http://www.ncbi.nlm.nih.gov/pubmed/17347239?tool=bestpractice.com Rao RD, Currier BL, Albert TJ, et al (...) of the forearm muscles that originate at the elbow. Both medial and lateral epicondylitis have been associated with repetitive elbow and forearm activities, such as hammering, typing, meat-cutting, plumbing, and painting, as well as leisure activities including tennis and golf. A group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. Repetitive shear stress through the retinacular sheath causes irritation to the tendon

2018 BMJ Best Practice

143. Clinically Suspected Vascular Malformation of the Extremities

element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Discussion of Procedures by Variant Variant 1: Upper or lower extremity. Suspected vascular malformation presenting with pain or findings of physical deformity including soft-tissue mass, diffuse or focal enlargement, discoloration, or ulceration. Initial imaging. The body regions covered in this clinical scenario are shoulder, humerus, elbow, forearm, wrist, hand, hip, femur, knee, tibia (...) , contrast-enhanced MRA is preferred for improved depiction of smaller vessels and dynamic imaging assessment [6,25]. Arteriography Extremity There is no evidence to support the use of arteriography as the initial imaging evaluation for a suspected vascular malformation because of its invasive nature. MRA is noninvasive and can depict the vascular anatomy of a malformation nearly as well as arteriography [9], making it the preferred initial imaging evaluation. Arteriography does offer the highest

2019 American College of Radiology

144. Management of Rotator Cuff Injuries

. Matuszak, MD American Academy of Family Physicians Amee L. Seitz, PhD, PT American Physical Therapy Association Lori A. Michener, PhD, PT, ATC American Physical Therapy Association 1. Mark R. Hutchinson, MD American College of Sports Medicine Michael A. Shaffer, PT, ATC, OCS American Society of Shoulder and Elbow Therapists Xinning Li, MD American Academy of Orthopaedic Surgeons Michael M. Albrecht, MD American Academy of Orthopaedic Surgeons Christopher C. Schmidt, MD American Shoulder and Elbow (...) Surgeons John Kuhn, MD, MS American Shoulder and Elbow Surgeons Leesa Galatz, MD American Shoulder and Elbow Surgeons View background material via the RC CPG eAppendix 1 View data summaries via the RC CPG eAppendix 2 17 NON-VOTING MEMBERS Oversight Chair Gregory A. Brown, MD, PhD AAOS Staff William O. Shaffer, MD Medical Director Jayson Murray, MA Director, Clinical Quality & Value Ryan Pezold, MA Manager, Clinical Quality & Value Development Kyle Mullen, MPH Manager, Clinical Quality & Value

2019 American Academy of Orthopaedic Surgeons

147. Thoracic Outlet Syndrome.

of US, sonographic diagnosis of compressive effects upon the brachial plexus is a challenge [34], and symptoms of TOS may unmask a deeper regional pathology such as Pancoast tumor or cervical spondylopathy, requiring further imaging. Computed Tomography Angiography Contrast-enhanced CT evaluation of TOS is typically performed as a 2-step procedure in which initial “neutral” images are obtained from elbow to aortic arch with the arms adducted to the side, followed by abduction and repeat imaging (...) (MRI) is now a widely available and utilized modality for reliable, reproducible, noninvasive, and nonionizing evaluation of the vasculature, nervous system, and soft tissues [43]. MRI has inherent advantages over US in its ability to delineate extravascular anatomy, particularly in anatomic sites with poor sonographic windows, and it has advantages over CT in its characterization and differentiation of soft tissues. MRI does, however, have contraindications and is not recommended in certain

2019 American College of Radiology

148. Responsible use of high-risk medical devices: the example of 3D printed medical devices

) and ultrasound with the use of a digital imaging and communication (DICOM). 1 It enables manufacturers to create devices matched to a patient’s anatomy or devices with very complex internal structures. These capabilities have sparked huge interest in 3D printing of medical devices and other 3D printed applications in medicine. The medical and dental sectors together correspond to around 13.1% usage of Additive Manufacturing, and as such are after the industrial and aerospace sector the third largest 3D (...) to a patient’s anatomy. ? Software Workflow: The digital device design is converted to a buildable file that is sent to the printer. This file will often divide the design into layers, include additional support material to aid printing, and tell the printer where to build the device on the printer platform to prepare it for printing. The 3D printer often also requires some preparation to build different designs by changing settings for the material, type of design, and intended use. ? Material Controls

2018 Belgian Health Care Knowledge Centre

150. CRACKCast E143 – Diving Injuries and Dysbarism

of small bubbles of nitrogen gas in the blood and tissues on ASCENT! LOCATION, location, location of the bubbles – determines the type of symptoms that arise Fetal circulation anatomy explains why pregnant women should not dive. Multiple small bubbles normally occur on ascent, but if they become persistent, large or too numerous for the lungs to filter → inflammatory cascades ensue, cytokines, thrombosis, ischemia, obstruction etc. can occur. These bubbles can cause ischemia and hypoxia if large (...) Constitutional: h/a, lightheadedness, inappropriate fatigue, malaise, N/V Dizziness/vertigo Motor weakness Skin findings Muscular stiffness, pressure, cramps Mental status changes dyspnea/cough Auditory Bladder bowel “Decompression-related illness” – all get treated the same!! Type I DCS “The 1’s” -MSK system, skin, lymphatics Type II DCS: the “doubles”; the SERIOUS stuff is SECOND -CNS, ear, lungs, heart Symptoms Periarticular pain in the arms, and legs. Elbow and shoulder pain most common. Watch for cutis

2018 CandiEM

151. Exam Series: Guide to the Shoulder Exam

in the glenohumeral joint, and finally along the spine of the scapula. Assess the muscles of the rotator cuff, biceps, and triceps for atrophy and tenderness especially at points of insertion. Range of Motion (ROM) : Allow the patient to perform active ROM first, followed by passive ROM feeling for crepitus. Normal ROM spans abduction to 180°, adduction (arms crossed in front of the body) to 45°, flexion to 180°, extension to 45°, external rotation (arms at the side and elbows flexed to 90°, ask the patient (...) suggests a supraspinatus tear, subacromial impingement, or subacromial bursitis : Instruct the patient to internally rotate their shoulder such that the back of their hand rests on their low back. Ask the patient to lift-off from their back against resistance. Pain suggests a subscapularis tear. : Place the seated patient in 90° of abduction and 90° elbow flexion. A positive test is failure to externally rotate against resistance, and indicates a tear to teres minor. Impingement: : Assist the patient

2018 CandiEM

152. ACR/SIR Practice Parameter for the Performance of Diagnostic Infusion Venography

Radiology (SIR) in collaboration with the American College of Radiology (ACR), was revised by the ACR in collaboration with the SIR. Diagnostic infusion venography is a radiographic study of venous anatomy using contrast media injection via a peripheral intravenous access. The term does not imply a specific method, type, or rate of contrast media injection. Such a study will often visualize the venous system to the right atrium. However, the term diagnostic infusion venography does not include central (...) or complementary in specific clinical situations [1-4]. In particular, duplex ultrasound has largely replaced diagnostic infusion venography of the upper or lower extremity since the sensitivity and specificity of duplex ultrasound above the elbow or knee are satisfactory for diagnosing acute deep venous thrombosis (DVT) and venous insufficiency [5-20]. Infusion venography has small but definite risks of complications including nephrotoxicity, contrast allergy, and/or infection [21-33]. Diagnostic infusion

2018 Society of Interventional Radiology

153. Shoulder Pain - Atraumatic

, demonstrating accuracies in the detection of rotator cuff and adjacent soft-tissue abnormalities equivalent to MRI [6]. US is usually well tolerated and, as with MRI, involves no ionizing radiation. Imaging in real time allows direct functional assessment of the shoulder during provocative maneuvers (ie, impingement) as well as providing guidance for a variety of interventions. As in other modalities, the upper extremity must be positioned to optimally visualize the anatomy of interest. Discussion (...) of the lesser tuberosity on radiography and MRI: association with subscapularis tendon lesions. AJR Am J Roentgenol 2008;191:100-6. 15. Steinbach LS. MR Imaging of the Rotator Cuff. In: Chung CB, Steinbach LS, eds. MRI of the Upper Extremity : Shoulder, Elbow, Wrist and Hand. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010:244. 16. Chung CB, Gentili A, Chew FS. Calcific tendinosis and periarthritis: classic magnetic resonance imaging appearance and associated findings. J Comput

2018 American College of Radiology

154. CRACKCast E180 – Labor & Delivery

out a baby! While deliveries in the ER are rare, they can be precipitous in a setting with little back up and missing equipment. To make matters worse we probably don’t know the woman’s gestational dates, placental anatomy and obstetric information! The perinatal mortality rate in ED births is 8-10%. This is probably because antepartum hemorrhage, premature rupture of membranes (PROM), eclampsia, premature labor, abruptio placentae, malpresentation, and umbilical cord emergencies (...) , the strength of the contractions correlates poorly with the tracing. The tracings are position and placement sensitive. Fetal heart rate tracings have several components that can be assessed—baseline heart rate, variability, accelerations, decelerations, and diagnostic patterns. Ultrasonography the gestational age, biophysical profile, amniotic fluid index, and a survey of fetal and placental anatomy may be obtained. What are the indications for foetal monitoring during labour? -> Labouring woman 4

2018 CandiEM

155. CRACKCast E176 – Pediatric Musculoskeletal Disorders

CRACKCast E176 – Pediatric Musculoskeletal Disorders CRACKCast E176 – Pediatric Musculoskeletal Disorders - CanadiEM CRACKCast E176 – Pediatric Musculoskeletal Disorders In by Adam Thomas May 10, 2018 Children can injure themselves just like adults, but their growing anatomy can be quite different. Today, let’s explore Rosen’s chapter 175 on paediatric musculoskeletal disorders. Shownotes – Text in italics is from Rosen’s 9 th edition, chapter 175 Key concepts [podcasted items in bold (...) and strengthening of the rotator cuff. Think of the 1-2-3 rule for clavicle fractures. Three parts to it Parts 1 and 3 are “odd” – because they are rare and should probably be run by the ortho on call if there is any displacement Part 2 (middle ⅓) is “even” more common and up to 2 cm of displacement is allowed. [2] List 5 Xray features of supracondylar fracture Until age 8 the ligaments and joint capsule around the elbow are stronger than the bone, so make sure you see three proper views: AP view

2018 CandiEM

156. Respiratory distress including CPAP - neonatal

B: Emergency management of pneumothorax 16 Appendix C: Chest x rays neonatal respiratory distress 20 Acknowledgements 21 List of Tables Table 1. Consultation, retrieval or transfer 7 Table 2. Respiratory distress 7 Table 3. Care principles 8 Table 4. CPAP administration 9 Table 5. Clinical course 10 Table 6. Complications 11 Table 7. Neonatal care 12 Table 8. Other therapies 13 List of Figures Figure 1. Needle aspiration 16 Figure 2. ICC insertion with trocar 17 Figure 3. Anatomy (...) of a pneumothorax. Cross sectional view looking up towards the head 18 Figure 4: Anatomy of a pneumothorax. Lateral view 18 Figure 5. ICC insertion 19 Figure 6. ICC insertion and taping 19 Figure 7: Pneumothorax 20 Figure 8: Pneumothorax with ICC 20 Queensland Clinical Guideline: Neonatal respiratory distress including CPAP Refer to online version, destroy printed copies after use Page 6 of 21 1 Introduction Respiratory distress in a neonate presents as tachypnoea after birth. Symptoms can last from hours

2018 Queensland Health

158. Onychomycosis

) cases are caused by the dermatophyte , T. rubrum . Candida albicans is involved in up to 5% of infections, most commonly in fingernails. Risk factors: Older age Gender – 2.4 times more common in males than females Tinea pedis infection (co-infection very common) Diabetes Peripheral vascular disease Immunodeficiency Psoriasis of the skin Nail trauma Occlusive footwear Sports or other activities involving bare feet Smoking Images: Anatomy of the nail Skinsight: Nail infections, fungal (Onychomycosis (...) atrophy (thinning); often associated with lichen planus lesions (purplish, flat-topped bumps) in other areas of the body – oral mucosa, wrists, shins, torso. – Curved, thickened claw-like nails frequently seen in older adults with vascular insufficiency. - Pitting of nails, symmetrical nail involvement. History of psoriasis, typical lesions (silvery scales) in other areas of body, e.g. knees, elbows. - Papilloma or warty involvement of paronychia (area where nail and skin meet), erosions and scaling

2018 medSask

159. CRACKCast 107 – Peripheral Nerve Disorders

of the ulnar nerve. How can you discern between an ulnar nerve lesion at the elbow or at the wrist? Anatomy: C7 to T1 roots – passes through the brachial plexus to descend medially, without branching, to the ulnar (medial) condylar groove at the elbow. Then goes from cubital canal, it branches to the ulnar wrist flexor and the deep flexors of the fourth and fifth digits. At the wrist it enters Guyon’s Canal between the pisiform and hook of the hamate, after which it bifurcates into the superficial terminal (...) ), or a local issue, e.g., atrophic, dry skin. Refer to figure 97.2 in Rosen’s 9 th Edition for schematic representation of the anatomy of the peripheral nervous system and its interface with the central nervous system When something goes wrong with the PNS, 1 of 3 issues may develop: Myelinopathies , in which the primary site of involvement is limited to the myelin sheath surrounding the axon; Axonopathies , in which the primary site of involvement is the axon, with or without secondary demyelination

2017 CandiEM

160. CRACKCast E088 – Pulmonary Embolism & Deep Venous Thrombosis

of these diseases…. 1) List 8 DDx for DVT First off, DVT… This is a spectrum: isolated calf vein thrombosis ← to → limb threatening illiofemoral clot Here’s the anatomy you HAVE to know! (see picture) From the bottom up: Deep venous system (is what we care about): Distal DVT = Calf veins : ant. + post. Tibial; peroneal vein. Proximal DVT = Thigh veins: popliteal, common femoral vein (formed from the “superficial” femoral vein and the deep femoral vein) NOTE that the superficial femoral vein – IS also known (...) there) Because it can cause a PE – anyone with a u.e. DVT proximal to the elbow require definitive treatment Optimal dosing and duration is debated Usually at least 3 months of anticoagulation (do your risk analysis for everyone though!) Infusion phlebitis ) isolated brachial vein thrombosis – post recent IV infusion may be treated like a superficial thrombophlebitis of the lower leg, but good evidence is lacking. Remember, that we not only treat DVT’s to prevent PE’s, but ALSO because DVT’s damage

2017 CandiEM

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