Knee Injection with Euflexxa - Non-surgical Knee Pain Relief

Knee Pain Treatment

Brachial Plexus made Easy

Brachial Plexus Made Insanely Easy

Nerve injury

Hook of Hamate Fracture

Kohler's Disease

Foam Roller Mistake

How to Squat Properly

Exercise - anatomy analysis

Lumbar Microscopic Discectomy and Decompression

Disc Decompression Procedure Animation

Low Back Pain - Disc Herniation ,Sciatica

Manual Traction Technique

Manual Traction Technique:

When your physical therapist decides to apply manual cervical traction to treat your neck pain, he or she should explain the procedure to you so you know what to expect. If you have any questions, you should ask your physical therapist before starting.

Manual cervical traction is applied to your neck while you are lying down on your back. You should be resting comfortably on a treatment table, and your head should be near one end of the table. Your physical therapist will then gently hold the back of your neck with one hand. You should feel your therapist's hand near the base of your skull.

Your physical therapist will then cup his or her other hand underneath your chin. This allows your therapist to have good control over the position of your head and neck. Your physical therapist will then gently lean back to provide the traction force to your neck. No forceful tugging of pulling should occur. A slow and gradual traction force is applied and held for 5-10 seconds, and then the traction is gradually released.

You should expect your physical therapist to ask you questions about your symptoms while providing the traction to your neck. If your pain is decreasing while receiving the traction, your physical therapist will likely continue with slow, rhythmic pulls on your neck.

If your symptoms are not changing, your physical therapist may choose to slightly alter the ankle of traction to your neck by raising or lowering your neck a few inches. Be sure to tell your physical therapist what you are feeling while he or she is applying the manual cervical traction to maximize the benefit of the treatment.

Shoulder impingment special tests

Ankylosing Spondylitis

Severe Ankylosing Spondylitis Characteristics

Patients with crippling joint pain caused by severe cases of ankylosing spondylitis tend to have several distinctive characteristics:

• A "curled forward" posture - the chin-to-chest stance - which results in a persistent downward gaze
• Brittle bones in the spine that are prone to fractures
• Significantly limited mobility and movement, such that the patient is permanently disabled.

As the disease progresses from the low back all the way up the spinal column, patients are at risk of developing significant complications that can increase the pain and disability already experienced. Potential complications include:

• Cauda equina syndrome, which can cause pervasive extremity numbness, weakness and bowel or bladder dysfunction
• Spondylodiscitis, an inflammation of the intervertebral disc caused by the hardening of the fibrous tissue that encompasses the disc
• Limited chest expansion, which may impact the ability to breathe freely.

These complications are quite rare and are generally only seen in the most severe cases of ankylosing spondylitis.

Shoulder Exam

Shoulder Exam

Key Learning Points

Learn the checklist and technique of the shoulder exam

Introduction: Careful examination of the shoulder can provide valuable information and help the physician determine when imagine studies may or may not be helpful.

Technique

Inspection: Observe both shoulders together. Note any atrophy or asymmetry.

Palpation:

Exert pressure on the subacromial bursa, which lies lateral to and beneath the acromion. Subacromial bursitis is a common cause of shoulder pain.

Palpate the bicipital tendon in the biciptial groove as the patient rotates the humerus internally and externally. Tenderness on this maneuver is consistent with bicipital tendinitis.

Palpate the acromioclavicular joint. Note tenderness, bony hypertrophy, or (rarely) synovial swelling.

OA & RA often affect the acromioclavicular joint; however, OA rarely involves the glenohumeral joint (exceptions include traumatic or occupational causes of shoulder pain).

Palpate the glenohumeral joint by placing the thumb over the humeral head (medial and inferior to the coracoid process) while the patient rotates the humerus internally and externally.

Tenderness is indicative of glenohumeral pathology.

Very rarely a synovial effusion can be palpated. If appreciated, it may indicate RA, infection, or acute rotator cuff tear.

Range-Of-Motion: With patient sitting up, put both shoulders through full range of motion actively and passively.

Suspect fibromyalgia when glenohumeral pain accompanies diffuse periarticular pain and point tenderness.

Rotator cuff pathology is a common cause of shoulder pain.

Suspect rotator cuff pathology if:

pain is elicited by active abduction against resistance, but not passive abduction

pain is located over the lateral deltoid

presence of night pain

a positive "impingement sign": Impingement syndrome occurs when the space is narrowed between the acromion and the greater tuberosity of the humorous. This can be caused by many things, including formation of bone spurs in osteoarthritis.

Impingement sign: Physician raises patient arm into forced flexion while stabilizing the scapula and so preventing its rotation. Pain developing before 180 degrees of forward flexion is considered positive.

Neer Sign: Place one hand over the shoulder then forward flex the arm 90 degrees in front of the patient followed by internal rotation of the whole arm at the shoulder, finally continue to raise the arm --> pain at shoulder is a positive test

Hawkins Sign: Ask patient to forward flex arm their arm 90 degrees in front of them, then flex the elbow 90 degrees, then have your patient rotate the should internally while you apply resistance with external rotation --> pain at shoulder is a positive test

a positive "drop arm test"

Drop Arm Test: Ask patient raise arm to 90 degrees of abduction and lower it slowly. A suddenly dropped arm is considered positive and suggestive of a rotator cuff tear.

Tendinitis or tear of the rotator cuff can be confirmed by MRI or ultrasound.

Gait Abnormalities

Introduction: Observation of gait is an important aspect of diagnosis that may provide information about several musculoskeletal and neurological conditions. In particular, there are eight basic pathological gaits that can be attributed to neurological conditions: hemiplegic, spastic diplegic, neuropathic, myopathic, Parkinsonian, choreiform, ataxic (cerebellar) and sensory.

Hemiplegic Gait

The patient stands with unilateral weakness on the affected side, arm flexed, adducted and internally rotated. Leg on same side is in extension with plantar flexion of the foot and toes. When walking, the patient will hold his or her arm to one side and drags his or her affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) and extensor hypertonia in lower limb. This is most commonly seen in stroke. With mild hemiparesis, loss of normal arm swing and slight circumduction may be the only abnormalities.

Diplegic Gait

Patients have involvement on both sides with spasticity in lower extremities worse than upper extremities. The patient walks with an abnormally narrow base, dragging both legs and scraping the toes. This gait is seen in bilateral periventricular lesions, such as those seen in cerebral palsy. There is also characteristic extreme tightness of hip adductors which can cause legs to cross the midline referred to as a scissors gait. In countries with adequate medical care, patients with cerebral palsy may have hip adductor release surgery to minimize scissoring.

Neuropathic Gait (Steppage Gait, Equine Gait)

Seen in patients with foot drop (weakness of foot dorsiflexion), the cause of this gait is due to an attempt to lift the leg high enough during walking so that the foot does not drag on the floor. If unilateral, causes include peroneal nerve palsy and L5 radiculopathy. If bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease and other peripheral neuropathies including those associated with uncontrolled diabetes.

Myopathic Gait (Waddling Gait)

Hip girdle muscles are responsible for keeping the pelvis level when walking. If you have weakness on one side, this will lead to a drop in the pelvis on the contralateral side of the pelvis while walking (Trendelenburg sign). With bilateral weakness, you will have dropping of the pelvis on both sides during walking leading to waddling. This gait is seen in patient with myopathies, such as muscular dystrophy.

Parkinsonian Gait

In this gait, the patient will have rigidity and bradykinesia. He or she will be stooped with the head and neck forward, with flexion at the knees. The whole upper extremity is also in flexion with the fingers usually extended. The patient walks with slow little steps known at marche a petits pas (walk of little steps). Patient may also have difficulty initiating steps. The patient may show an involuntary inclination to take accelerating steps, known as festination. This gait is seen in Parkinson's disease or any other condition causing parkinsonism, such as side effects from drugs.

Choreiform Gait (Hyperkinetic Gait)

This gait is seen with certain basal ganglia disorders including Sydenham's chorea, Huntington's Disease and other forms of chorea, athetosis or dystonia. The patient will display irregular, jerky, involuntary movements in all extremities. Walking may accentuate their baseline movement disorder.

Ataxic Gait (Cerebellar)

Most commonly seen in cerebellar disease, this gait is described as clumsy, staggering movements with a wide-based gait. While standing still, the patient's body may swagger back and forth and from side to side, known as titubation. Patients will not be able to walk from heel to toe or in a straight line. The gait of acute alcohol intoxication will resemble the gait of cerebellar disease. Patients with more truncal instability are more likely to have midline cerebellar disease at the vermis.

Sensory Gait

As our feet touch the ground, we receive propioreceptive information to tell us their location. The sensory ataxic gait occurs when there is loss of this propioreceptive input. In an effort to know when the feet land and their location, the patient will slam the foot hard onto the ground in order to sense it. A key to this gait involves its exacerbation when patients cannot see their feet (i.e. in the dark). This gait is also sometimes referred to as a stomping gait since patients may lift their legs very high to hit the ground hard. This gait can be seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or in diseases affecting the peripheral nerves (uncontrolled diabetes). In its severe form, this gait can cause an ataxia that resembles the cerebellar ataxic gait.

Hemiplegia

Gait in the Child With Hemiplegia

Gait refers to the controlled manner of walking or moving on foot.  The functioning of the nervous system and the musculoskeletal system determines the gait pattern. In children who have hemiplegia, this delicate system is out of balance and often results in different types of gait.

Gait in the Child with Hemiplegia

A child with hemiplegia may have a tendency to walk with the toes on the affected foot striking the ground first, instead of the usual heel strike. This “toe drop” often results in our kids taking quite a few falls and tumbles. In order to clear the toe while walking, the child may develop a variety of ways to compensate, which then result in problems with his hip and or knee.   Treatments may include gait analysis, physical therapy, orthotics, serial casting, botulinum toxin and surgery. The goal of treatment is not to “cure” the condition, but to enable the child to achieve her maximum potential.

Walking Abnormalities Treatment

How Are Walking Abnormalities Treated?

A walking abnormality may go away when the underlying condition is treated. If you have a fracture or broken bone, surgery or a cast may be provided to set the bone.

Physical therapy may also be used to help treat walking abnormalities. During physical therapy, you’ll learn exercises designed to strengthen your muscles and correct the way you walk.

If an infection has caused your walking abnormality, antibiotics or antiviral medications will be prescribed to treat the infection, which should improve your symptoms.

If you have a permanent walking abnormality, you may receive assistive devices, such as crutches, a walker, leg braces, or a cane.

Abnormal Gait : Hemiplegic Gait

Abnormal Gait Exam : Hemiplegic Gait

Hemiplegic Gait

The patient stands with unilateral weakness on the affected side, arm flexed, adducted and internally rotated. Leg on same side is in extension with plantar flexion of the foot and toes. When walking, the patient will hold his or her arm to one side and drags his or her affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) and extensor hypertonia in lower limb. This is most commonly seen in stroke. With mild hemiparesis, loss of normal arm swing and slight circumduction may be the only abnormalities.

More:http://stanfordmedicine25.stanford.edu/the25/gait.html 

Peripheral Neuropathy

Treatment

Many treatment strategies for peripheral neuropathy are symptomatic. Some current research in animal models has shown that neurotrophin-3 may oppose the demyelinationpresent in some peripheral neuropathies.

A range of drugs that act on the central nervous system, such as drugs originally intended as antidepressants and antiepileptic drugs, have been found to be useful in managing neuropathic pain. Commonly used treatments include using a tricyclic antidepressant (such as amitriptyline) and antiepileptic therapies such as gabapentin or sodium valproate. These have the advantage that besides being effective in many cases, they are relatively low in cost.

A great deal of research has been conducted between 2005 and 2010 resulting in indications that synthetic cannabinoids and inhaled cannabis are effective treatments for a range of neuropathic disorders.Research has demonstrated that the synthetic oral cannabinoid Nabilone is an effective adjunct treatment option for neuropathic conditions, especially for people who are resistant, intolerant, or allergic to common medications. Oral opiate derivatives were found to be more effective than cannabis for most people. Smoked cannabis has been found to provide relief from HIV-associated sensory neuropathy.Smoked cannabis also was found to relieve neuropathy associated with CRPS type I, spinal cord injury, peripheral neuropathy, and nerve injury

Pregabalin is an anticonvulsant drug used for neuropathic pain. It also has been found effective for generalized anxiety disorder. It was designed as a more potent successor to gabapentin, but is significantly more expensive, especially now that the patent on gabapentin has expired and gabapentin is available as a generic drug. Pregabalin is marketed by Pfizer under the trade name Lyrica.

Duloxetine, a serotonin-norepinephrine reuptake inhibitor, also is being used to reduce neuropathic pain.

Transcutaneous electrical nerve stimulation therapy may be effective and safe in the treatment of diabetic peripheral neuropathy. A recent review of three trials involving 78 patients found some improvement in pain scores after 4 and 6, but not 12 weeks of treatment and an overall improvement in neuropathic symptoms at 12 weeks.A second review of four trials found significant improvement in pain and overall symptoms, with 38% of patients in one trial becoming asymptomatic. The treatment remains effective even after prolonged use, but symptoms return to baseline within a month of cessation of treatment.

Neuropathy has been reported to make winter weather more perilous for older adults.Often, people with neuropathy who live in areas with defined winters (such as the northern United States) report that their symptoms were much less severe after moving to places with an undefined winter, such as Florida or California

Sometimes symptomatic relief for the pain of peripheral neuropathy is obtained by application of topical capsacin. Capsacin is the factor that causes heat in chili peppers. Relief up to 12 weeks is noted with high concentrations of capsacin applied cutaneously. Local anesthesia often is used to counteract the initial discomfort of the capsacin. More information is available in this review by the National Institute of Health.

Heart Anatomy

Fertilization

Meiosis: Crossing Over and Variability

This is why our education system is failing, because teachers do NOT explain like this in school. I learnt this all in 6 minutes even though my teachers spent many 1 hour classes on meiosis and I still did not understand.

Muscle Contraction Part 1: Events at the Neuromuscular Junction

best explanation for muscle contraction "animation"

• mechanism of muscle contraction
• events at Neuromuscular junction
• excitation-contraction coupling 
• the cross bridge cycle

Knee Osteochondritis Dissecans , Wilson's Test 

Physical Examination for Nerve Injuries and Tumors:

Muscle Contraction Process

Muscle Contraction Process: Molecular Mechanism

 

Damn, there is so much information available these days as awesome videos and presentations. I wish if I were born 10 years later then, I wouldn't have to depend on those boring books. I would have never failed during my examinations

Doctor's Examination for Shoulder pain

Doctor's Examination for Shoulder pain

In the case of an acute injury causing intense pain, seek medical care as soon as possible. If the pain is less severe, it may be safe to rest a few days to see if time will resolve the problem. If symptoms persist, see a doctor.

Medical History:

The first step in the evaluation is a thorough medical history. Your doctor may ask how and when the pain started, whether it has occurred before and how it was treated, and other questions to help determine both your general health and the possible causes of your shoulder problem. Because most shoulder conditions are aggravated by specific activities, and relieved by specific activities, a medical history can be a valuable tool in finding the source of your pain.

Physical Examination:

A comprehensive examination will be required to find the causes of your shoulder pain. Your doctor will look for physical abnormalities, swelling, deformity or muscle weakness, and check for tender areas. He or she will observe your shoulder range of motion and strength.

Tests:

Your doctor may order specific tests to help identify the cause of your pain and any other problems.

X-rays. These pictures will show any injuries to the bones that make up your shoulder joint.

Magnetic resonance imaging (MRI) and ultrasound. Thes imaging studies create better pictures of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint.

Computed tomography (CT) scan. This tool combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.

Electrical studies. Your doctor may order a tests, such as the EMG (electromyogram), to evaluate nerve function.

Arthrogram. During this x-ray study, dye is injected into the shoulder to better show the joint and its surrounding muscles and tendons.

Arthroscopy. In this surgical procedure, your doctor looks inside the joint with a fiber-optic camera. Arthroscopy may show soft tissue injuries that are not apparent from the physical examination, x-rays, and other tests. In addition to helping find the cause of pain, arthroscopy may be used to correct the problem.