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Elbow Anatomy

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161. AIUM Practice Parameter for the Performance of a Musculoskeletal Ultrasound Examination

-thickness tear, tendinosis, and/or calcification. Both long- and short-axis views should be obtained. To examine the subscapularis tendon, the elbow remains at the side while the arm is placed in external rotation. The subscapularis is imaged from the musculotendinous junction to the insertion on the lesser tuberosity of the humerus. Dynamic evaluation as the patient moves from internal to external rotation is helpful to evaluate dynamic biceps tendon subluxation or subcoracoid impingement and assess (...) the integrity of the subscapularis tendon. To examine the supraspinatus tendon, the arm is extended posteriorly, and the palmar aspect of the hand can be placed against the superior aspect of the iliac wing with the elbow flexed and directed toward the midline (instruct the patient to place the hand in the ipsilateral back pocket). To scan the supraspinatus and infraspinatus tendons along their long axes, it is important to orient the transducer approximately 45° between the sagittal and coronal planes

2017 American Institute of Ultrasound in Medicine

162. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

(on a calibrated machine that has been validated for use in the pediatric population) or auscultatory (by using a mercury or aneroid sphygmomanometer , ). (Validation status for oscillometric BP devices, including whether they are validated in the pediatric age group, can be checked at .) BP should be measured in the right arm by using standard measurement practices unless the child has atypical aortic arch anatomy, such as right aortic arch and aortic coarctation or left aortic arch with aberrant right (...) and outpatient settings. – Pediatric offices should have access to a wide range of cuff sizes, including a thigh cuff for use in children and adolescents with severe obesity. For children in whom the appropriate cuff size is difficult to determine, the midarm circumference (measured as the midpoint between the acromion of the scapula and olecranon of the elbow, with the shoulder in a neutral position and the elbow flexed to 90° , , ) should be obtained for an accurate determination of the correct cuff size

2017 American Academy of Pediatrics

164. Shoulder Pain-Traumatic

and most shoulder fractures [4,5]. A standard set of shoulder radiographs for trauma should include at least three views: anterior-posterior (AP) views in internal and external rotation and an axillary or scapula-Y view. Axillary or scapula-Y views are vital in evaluating traumatic shoulder injuries as acromioclavicular and glenohumeral dislocations can be misclassified on AP views [6,7]. Radiographs provide good delineation of bony anatomy to assess for fracture and appropriate shoulder alignment (...) bony anatomy can result in underappreciation of the extent of proximal humeral fractures on radiographs. Poor agreement between observers has been shown on grading of humeral head fractures on radiographs [10]. CT is the best examination for delineating fracture patterns and has been shown to be equivocal to MRI in identifying nondisplaced fractures, making it the preferred study for characterizing proximal humeral fractures. Contrast is generally not necessary unless there is concern for arterial

2017 American College of Radiology

165. Soft-Tissue Masses

evaluation and staging a deep soft-tissue mass. Variant 4: Soft-tissue mass. Nondiagnostic initial evaluation. Presenting with spontaneous hemorrhage or suspicion of vascular mass. Next imaging study. The body regions covered in this clinical scenario are: neck, chest, abdomen, pelvis, humerus, elbow, forearm, wrist, hand, femur, knee, tibia, ankle, and foot. US There is little literature specifically addressing the distinction of hemorrhagic tumor and hematoma. Ward et al [37] reviewed 25 such cases (...) and hemorrhagic neoplasm. Enhanced imaging using a subtraction technique (electronic subtraction of precontrast and postcontrast images) has been shown to be a useful technique in distinguishing hematoma and hemorrhagic sarcoma by identifying enhancing areas of tumor [3]. MRA MR angiography (MRA) can be a useful adjunct to assess vascular anatomy as well as lesion vascularity [3]. It is considered complementary to conventional MR imaging and, as such, is usually obtained concurrently. FDG-PET/CT

2017 American College of Radiology

166. 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

167. CRACKCast E083 – Infective Endocarditis and Valvular Disease

the valve leaflets – which make them more prone for bacterial seeding precipitants causing transient bacteremia can occur (endoscopy, dental work, colonoscopy etc. ) in the susceptible host Valvular heart disease Anatomy: Three have three cusps (tricuspid, pulmonic, aortic) mitral – only two cusps. each cusp: double layer of endocardium attached at its based to the fibrous skeleton of the heart. margins of the cusps attached via chordae tendineae to the papillary muscles ventricular contraction opens (...) , carditis, chorea, SubCut nodules, erythema marginatum (<10% of cases) **migratory polyarthritis** affecting large joints (knees, ankles, elbows, wrists) pain out of proportion sterile inflammatory fluid Cardiac manifestations peri/myo/endo-carditis Mitral valve regurg. new high pitched systolic murmur Syndenham Chorea (St Vitus’ dance) random rapid purposeless movements of the upper extremities and face erythema marginatum: non pruritic, painless, smoke ring of erythema on trunk/extremities Nodules

2017 CandiEM

168. Spasticity in under 19s: management

when and where to seek advice. 1.3.8 Advise children and young people and their parents or carers that they may remove an orthosis if it is causing pain that is not relieved despite their repositioning the limb in the orthosis or adjusting the strapping. Specific uses Specific uses 1.3.9 Consider the following orthoses for children and young people with upper limb spasticity: elbow gaiters to maintain extension and improve function rigid wrist orthoses to prevent contractures and limit wrist (...) possible important adverse effects (see also recommendation 1.5.10). 1.5.9 Botulinum toxin type A treatment (including assessment and administration) should be provided by healthcare professionals within the network team who have expertise in child neurology and musculoskeletal anatomy. Deliv Delivering treatment ering treatment 1.5.10 Before starting treatment with botulinum toxin type A, tell children and young people and their parents or carers: to be aware of the following rare but serious

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

169. Shoulder arthroplasty to address the sequelae of anterior instability arthropathy and stabilization procedures: systematic review and meta-analysis. (Abstract)

searched using a combination of the following keywords: shoulder arthroplasty, reverse shoulder arthroplasty, dislocation arthropathy, capsulorrhaphy arthropathy and stabilization procedures.Thirteen studies with 365 patients met inclusion criteria. Since 13 patients were lost to follow-up, 352 were reviewed at an average follow-up of 53.4 months. The average Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scores improved from 35.6 and 35.7 to 72.7 and 77, respectively. The overall (...) as a consequence of the distorted anatomy and severe glenohumeral joint pathology. Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis; however, the difference is not statistically significant. When reverse shoulder arthroplasties (RSA) were considered as a subgroup and compared to anatomic shoulder replacements (total shoulders and hemiarthroplasties), they showed a lower revision rate.

2020 Archives of orthopaedic and trauma surgery

170. Genetics of Skin Cancer (PDQ®): Health Professional Version

cell carcinoma (left panel) and nodular basal cell carcinoma (right panel). Squamous cell carcinomas Figure 4. Squamous cell carcinoma on the face with thick keratin top layer (left panel) and squamous cell carcinoma on the leg (right panel). Melanomas Figure 5. Melanomas with characteristic asymmetry, border irregularity, color variation, and large diameter. References Vandergriff TW, Bergstresser PR: Anatomy and physiology. In: Bolognia JL, Jorizzo JL, Schaffer JV: Dermatology. 3rd ed (...) not have an identifiable PTCH1 variant. Rare syndromes Rombo syndrome Rombo syndrome, a very rare probably autosomal dominant genetic disorder associated with BCC, has been outlined in three case series in the literature.[ - ] The cutaneous examination is within normal limits until age 7 to 10 years, with the development of distinctive of the lips, hands, and feet and early atrophoderma vermiculatum of the cheeks, with variable involvement of the elbows and dorsal hands and feet.[ ] Development of BCC

2018 PDQ - NCI's Comprehensive Cancer Database

171. CRACKCast E053 – Shoulder

means that it accounts for more than 50% of ED dislocations The first method of reduction described was the hippocratic (leg in axilla) technique, but even the egyptians had accurate drawings of shoulder reductions The type of injury is dependant on the strength of bones v. ligaments; children tend to fracture whereas adults tend to sprain or dislocate Anatomy : 3 bones: humerus, scapula Clavicle S shaped strut that pushes arm away from axial skeleton Rosens notes: ‘provides the neck with acceptable (...) on forearm Traction-counter traction Folded sheet in axilla providing counter traction Snowbird – first described in Skiers in Utah Seated patient with elbow at 90. Physician places foot in stockinette tied around elbow for traction External rotation method of leidelmeyer Supine, elbow at 90, slow gentle external rotation Milch Supine, HOB 20-30, slow abduction with ext. rotation. If 90 abduct and 90 ext. rotation, then gentle traction Scapular manipulation Repositioning of glenoid fossa. First obtain

2016 CandiEM

173. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

& sports physical therapy | volume 49 | number 5 | may 2019 | cpg5 Carpal Tunnel Syndrome: Clinical Practice Guidelines The Academy of Hand and Upper Extremity Physical Therapy and the Academy of Orthopaedic Physical Therapy, APTA, Inc appointed content experts to develop CPGs for musculoskel- etal conditions of the elbow, forearm, wrist, and hand. These content experts were given the task to identify impairments of body function and structure, activity limitations, and par- ticipation restrictions (...) d630 Doing housework d640 Remunerative employment d850 SCOPE AND ORGANIZATION OF THE GUIDELINE This guideline includes information related to incidence, prevalence, anatomy, pathoanatomy, clinical course, risk factors, diagnosis, outcomes assessments, and interventions for CTS. Where appropriate, sections contain a summary or evidence synthesis and a statement describing gaps in knowl- edge. Grades of recommendation have been provided for ar- eas related to clinical practice, including diagnosis

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

174. AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery

include regular turning (at least every 2 hours), good hygiene, and the use of special mattresses and proper wheelchair seating to prevent skin injury. After stroke with hemiparesis, 60% of patients will develop joint contracture on the affected side within the first year, with wrist contractures occurring most commonly in patients who do not recover functional hand use. , The occurrence of elbow contractures within the first year after stroke is associated with the presence of spasticity within (...) external rotation for 30 minutes each day either in bed or in a chair can be useful for preventing shoulder contracture. , Applying serial casting or static adjustable splints may be beneficial in preventing elbow or wrist contractures, although data are conflicting. , , , Surgical release of the brachialis, brachioradialis, and biceps muscles is a reasonable option to treat pain and range-of-motion limitations in patients with substantial established elbow flexor contractures. Ankle plantarflexion

2016 American Heart Association

176. TREKK Series | Pediatric Multisystem Trauma

is the insertion site. Distal tibia: Identify the medial malleolus, the flat part of distal tibia 1-2 cm superior to medial malleolus is the insertion site. Proximal humerus: Position the patient so their hand is resting on their abdomen and their elbow is adducted, palpate up the humerus to greater tubercle approx. 1 cm superior to surgical neck of the humerus. Distal femur: Identify patella by palpation, the insertion site is just proximal to patella (max 1 cm) and approximately 1-2 cm medial to the midline (...) important take home message when it comes to managing pediatric trauma – the principles, approach and goals of resuscitation are the same in children as they are in adults, but there are pediatric nuances that clinicians need to be aware of! Wide differences in pediatric anatomy, physiology and developmental maturation account for specific injury patterns in children that are not seen in adults, and for high energy mechanisms, polytrauma is the rule. Traumatic brain injury is the leading cause of injury

2016 CandiEM

177. CRACKCast E051 – Wrist and Forearm Injuries

– and a point for wrist arthrocentesis. Also where the lunate shows up with volar flexion Ulnar to this is the DRUJ and the triquetrum Volar structures: Scaphoid tubercle is distal to the radial styloid Pisiform is distal to the ulnar styloid (by the hypothenars) Distal and radial to the pisiform is the hook of the hamate Nerve and vascular exam 1) Describe normal radiographic relationships: Should get these views: PA, lateral, oblique Anatomy to identify: the ulnar styloid, the extensor carpi ulnaris (...) /instability/# Take home: memory aids: 22 volar tilt – 22 radial inclination – 11 radial length – 1-2 mm carpal bone spacing. Just remembers 1”s and 2”s in some combination. 2) Describe X-Ray findings and management of: Scaphoid fracture Most commonly #’d carpal bone (15-40 yr. Olds with a FOOSH), high complication rate (5-40%) of AVN/non-union Anatomy: 1) tuberosity and distal pole 2) waist 3) proximal pole Physical exam: Dorsal wrist pain – distal to radius Limited ROM of wrist and thumb Snuffbox

2016 CandiEM

178. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma ? SNMMI Endorsement

in a 128×128 matrix in word mode) during the first 10 min after injection is recom- mended for detection of SLNs in head and neck melanoma. Although dynamic images are time consuming, dynamic se- riesshould beacquired wheneverpossible because thisfacil- itates image interpretation [83]. In melanoma of the hand/forearm or foot/leg, dynamic imaging should start over theinjectionsiteandfollowthelymphaticdrainagetotheknee or elbow and axilla or groin to reveal ectopic basins and in- transitlymph nodes (...) .Toreducescatteringartefactfromtheinjectionsite, images with lead shielding of the primary tumour can be Table 2 Recommended regions covered by static images and/or SPECT/CTaccordingtothelocationoftheprimary tumour Tumourlocation Staticimages Trunk Axilla+trunk+groin;orbody scanning fromneck to groin Hand/forearm Elbow+axilla+neck Upperarm Axilla+neck Foot/lowerleg Knee+groin Headneck Neck in multipleprojections Thigh Groin 1756 EurJ NuclMedMolImaging(2015)42:1750–1766added.Thismaybehelpfulespeciallyiftheprimarytumouris located

2015 Society of Nuclear Medicine and Molecular Imaging

180. AIUM Practice Parameter for the Performance of Peripheral Venous Ultrasound Examinations

with the patient’s clinical situation and should be consistent with relevant legal and local health care facility requirements. V . Specifications of the Examination The requesting health care provider should be encouraged to provide the pretest probability of acute deep venous thrombosis and/or the results of a D-dimer assay if known. 4,10,11 Note: The words proximal and distal refer to the relative distance from the attached end of the limb, per Gray’s Anatomy. For example, the proximal femoral vein is closer (...) assessment of all the accessible portions of the internal jugular, subclavian, axillary, and innominate veins, as well as compression gray scale ultrasound of the brachial, basilic, and cephalic veins in the upper arm to the elbow. All accessible veins should be scanned using optimal gray scale and Doppler techniques as well as appro- priate positioning. Venous compression is applied to accessible veins in the transverse plane with adequate pressure on the skin to completely obliterate the normal vein

2015 American Institute of Ultrasound in Medicine

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