Orthopedics - Introduction PDF

University of th Stage Medicine t.me Orthopedics | Introduction Contents Electrodiagnosis......................

University of th Stage Medicine t.me Orthopedics | Introduction Contents Electrodiagnosis......................................... 8 Nerve conduction study (NCS)............... 8 Introduction to General Orthopedics.......... 1 Elecromyography (EMG)........................ 8 Symptoms.................................................. 1 Pain: most common complain............. 1 Stiffness;................................................. 1 Swelling;................................................. 1 Deformity;.............................................. 1 Weakness; suggest neurological or muscle disorder.................................... 1 Instability (giving way); ligament laxity or rupture.............................................. 1 Change in sensibility;............................. 1 Loss of function;..................................... 2 Past history;........................................... 2 Examination............................................... 2 ‫عبارة عن مؤشر لبداية موضوع‬ ‫ هذا الملصق‬/‫م‬ LOOK...................................................... 2.‫جديد‬ Feel........................................................ 2 ‫ بامكانك االنتقال الى العناوين بشكل مباشر من‬/‫م‬ Move...................................................... 2.‫خالل الضغط على اسم العنوان‬ Joint stiffness............................................. 3 Deformity................................................... 4 Neurological examination.......................... 4 Diagnostic imaging..................................... 4 Bones......................................................... 5 Joints.......................................................... 5 X-ray with contrast media.......................... 5 CT scan....................................................... 6 Sign Your Progress MRI............................................................ 6 Read Review Diagnostic ultrasound................................ 6 Solve MCQs Radionucleide imaging............................... 7 Bone Meniral densitometry (BMD)............ 7 Blood tests................................................. 7 Synovial fluid analysis................................ 8 Bone biopsy............................................... 8 Arthroscopy............................................... 8  Orthopedics: Deals with the skeletal system and all structures that makes it move; bone, joint, muscle, tendons and nerves. : most common complain. Throbbing; abscess. Stabbing; cut tendon. Aching arthritis. Referred pain; e.g. knee pain with hip jt problems, gluteal pain from lumbr spine,… ; Generalized early morning in rheumatoid arthritis, Knee Joint effusion Localized after immobilization in osteoarthritis. ; Sudden; eg hemarthrosis, Gradual tumor. Infection. ; Sudden; eg elbow dislocation, Heberden nodes Gradual; eg knock knees of rickets ; suggest neurological or muscle disorder. (giving way); ligament laxity or rupture. tingling or numbness e.g. nerve root compression from prolapsed intrvertebal disc, median nerve entrapment in carpal tunnel syndrome, peripheral neuropathy in DM, Lipoma © 2023 Dice Lectures Mohammed Marwan 1  e.g. inability to climb stairs in knee OA, inability to comb hair in frozen shoulder, Ankle trauma; secondary OA. Corticosteroid therapy; osteoporosis, Chronic diarrhea; ankylosing spondylitis Genu varum and valgum Generalized appearance, posture, and gait. Undress the patient properly. LOOK, FEEL, MOVE. Skin; scars, color (eg red inflamed), Shape; swelling, wasting, lump, deformity. Position; eg fixed flexion of the knee, Skin; psoriatic arthritis Skin temperature, Lump, Effusion, Tender points. Active movement; range of motion (ROM), and power. Passive; ROM, crepitus. Provocative tests; e.g. induce dislocation in unstable joints. Bow leg deformity © 2023 Dice Lectures Mohammed Marwan 2  Measurement of Genu Valgum Localized swelling of infrapatellar bursa Skin ulcer of sarcoma Finger gangrene; Raynaud s disease All movements absent; Ankylosis (pathological) e.g fibrous ankylosis of TB. Surgical (arthrodesis) © 2023 Dice Lectures Mohammed Marwan 3  All movements limited; eg post traumatic adhesions. Some movements limited; eg torn meniscus block full knee extension. Varus ; part distal to the joint displaced toward the midline. Valgus ; part distal to the joint displaced Cubitus Varus away from the midline. Kyphosis ; increased posterior convexity of the spine. Scoliosis ; lateral curvature of the spine. Appearance: Abnormal posture; eg claw hand of ulnar nerve injury. Abnormal gait; foot drop of sciatic nerve Arthrogriposis injury. Muscle wasting, trophic ulcers, shiny skin and hair loss. Tone and power. Tendon reflexes. Sensibility. Plain film radiography; most useful diagnostic imaging. How to read an X Ray: Claw hand of ulnar nerve injury o The patient name, age, date, clinical summery. o Projection; eg AP and lateral. o Side; left or right. o Soft tissue: ▪ Shape: swelling, wasting, effusion. ▪ Density: calcification, FB, © 2023 Dice Lectures Mohammed Marwan 4  Shape: o Deformity; eg bow legs. o Periosteal reaction; eg fracture, infection, tumor. o Cortex distruction; eg fracture, tumor. Density: o Increased density; sclerosis. o Decreased density; oseoporosis. o Bone defects or cysts. Shape: Bone cyst o Decreased joint space and oseophytes in osteoarthritis. o Dislocation or subluxation. Density: increased in chondrocalcinosis, loose Bodies Water soluble based iodine liquids. Sinography in chronic discharging sinus. Myositis ossificans Arthrography in joints. Myelography in spinal disorders. Arthrography Of shoulder joint Calcification in knee joint synovial carcinoma © 2023 Dice Lectures Mohammed Marwan 5  Indications: o Depressed fracture in cancellous bone. o Small radiolucent lesion; eg oseoid osteoma. o Complex fractures of spine, pelvis, tarsal and carpal bones. o 3D reconstructed images. Disadvantage: high radiation exposure. Reading of radiofrequency emissions from atoms and molecules of tissues exposed to static magnetic field Indications: o Bone and soft tissue tumors; size and spread. o Spinal disorders; eg disc prolapse. o Cartilage and ligament. Eg meniscus and anterior cruciate ligament injuries. o Inflammation and infection e.g. osteomyelitis, septic arthritis. o Bone viability e.g. avascular necrosis. o Fluid collections e.g. hemarthrosis, synovial effusion, septic arthritis. Free of ionizing radiation. Limitations: MRI of osteosarcoma of femur o Metallic foreign bodies and implants. o Overweight. o Fear of closed spaces. o Irritable patients and children. Advantages: simple, portable, applied anywhere, no side effects. Indications: o Cystic lesion, eg abscess, hematoma, aneurism. o DDH. o Rotator cuff tear. o Knee problems; eg ACL injury, meniscal tear, synovial cysts © 2023 Dice Lectures Mohammed Marwan 6  Technitium 99 m (Tc 99 m) for bone scanning. Selectively concentrated in skeletal tissues. Increased activity (hot spots) in inflammation, infection, metastatic tumors, healing (stress) fractures. Decreased activity (cold spots) in ischemic necrosis (eg Perthe s disease). Double Enrgy X ray Absortiometry (DEXA) is the most reliable in measurement of osteoporosis Leukocytosis: in infection, rheumatoid arthritis, gout… High ESR acute and chronic inflammatory disorders and injury, multiple myeloma. C reactive protein (an acute phase protein); in chronic inflammatory arthritis. Rheumatoid factor; negative in seronegatve arthritis eg ankylosing spondylitis, reiter’s disease, psoriatic arthritis,… Tissue typing e.g. HLA B-27 on chromosome 6 In seronegative arthritis. © 2023 Dice Lectures Mohammed Marwan 7  Indications: Swelling after injury hemarthrosis. Suspected infection. Gout and pseudogout. Chronic synovitis eg TB. Fine Needle Aspiration ( or open biopsy. For suspected tumors. Primary or secondary. Benign or malignant. Diagnostic eg meniscal injury, cruciate ligament injury, biopsy. Therapeutic: eg menisectomy, repair of cruciate ligament, loose body removal. Measurement of velocity of nerve conduction; normally 50 60 m/second. Slowed in peripheral nerve damage or compression. For diagnosis myopathy or muscle denervation. ‫االضافة للمحاضرة‬ Joint laxity Normal in children 5% of people have persistent hypermobility and are more susceptible to dislocation (eg shoulder and patella) and arthralgia. © 2023 Dice Lectures Mohammed Marwan 8