Shoulder dislocations happen when the humeral head becomes detached from the glenoid cavity of the scapula. This is the most common type of joint dislocation, with the shoulder accounting for around half of all major joint dislocations. In particular, anterior shoulder dislocations make up over 95% of cases.

There are many different techniques for reducing shoulders, but there is limited evidence to suggest that one is better than another. If the dislocation is recent, it may be possible to attempt reduction without any pain relief or sedation. However, some patients may require analgesia and/or sedation to ensure that the rotator cuff muscles are relaxed.

Understanding Osteomyelitis: Types, Causes, and Treatment

Osteomyelitis is a bone infection that can be classified into two types: haematogenous and non-haematogenous. Haematogenous osteomyelitis is caused by bacteria that enter the bloodstream and is usually monomicrobial. It is more common in children, with vertebral osteomyelitis being the most common form in adults. Risk factors include sickle cell anaemia, intravenous drug use, immunosuppression, and infective endocarditis. On the other hand, non-haematogenous osteomyelitis results from the spread of infection from adjacent soft tissues or direct injury to the bone. It is often polymicrobial and more common in adults, with risk factors such as diabetic foot ulcers, pressure sores, diabetes mellitus, and peripheral arterial disease.

Staphylococcus aureus is the most common cause of osteomyelitis, except in patients with sickle-cell anaemia where Salmonella species predominate. To diagnose osteomyelitis, MRI is the imaging modality of choice, with a sensitivity of 90-100%. Treatment for osteomyelitis involves a six-week course of flucloxacillin. Clindamycin is an alternative for patients who are allergic to penicillin.

In summary, osteomyelitis is a bone infection that can be caused by bacteria entering the bloodstream or spreading from adjacent soft tissues or direct injury to the bone. It is more common in children and adults with certain risk factors. Staphylococcus aureus is the most common cause, and MRI is the preferred imaging modality for diagnosis. Treatment involves a six-week course of flucloxacillin or clindamycin for penicillin-allergic patients.

Chemotherapy can lead to a higher risk of gout due to the increased production of uric acid from the breakdown of cells. However, it is not associated with an increased risk of pseudogout or rheumatoid arthritis, which are caused by different factors such as calcium pyrophosphate crystals and genetics, respectively.

Understanding the Predisposing Factors of Gout

Gout is a type of microcrystal synovitis that occurs when monosodium urate monohydrate is deposited in the synovium. This condition is caused by chronic hyperuricaemia, which is characterized by uric acid levels that exceed 0.45 mmol/l. There are two main factors that contribute to the development of hyperuricaemia: decreased excretion of uric acid and increased production of uric acid.

One of the primary causes of decreased uric acid excretion is the use of diuretics. Chronic kidney disease and lead toxicity can also lead to decreased excretion of uric acid. On the other hand, increased production of uric acid can be caused by myeloproliferative/lymphoproliferative disorders, cytotoxic drugs, and severe psoriasis. Additionally, Lesch-Nyhan syndrome, which is an x-linked recessive disorder that is only seen in boys, can also lead to increased production of uric acid.

It is important to note that aspirin in low doses is not thought to have a significant effect on plasma urate levels. Therefore, it is recommended that it should be continued if required for cardiovascular prophylaxis. Understanding the predisposing factors of gout can help individuals take preventative measures to reduce their risk of developing this painful condition.

Prompt reduction of an ankle fracture is crucial to avoid skin damage, as pressure on the skin can result in skin necrosis.

Before contacting a vascular surgeon, it is essential to reduce the fracture to prevent bone displacement from compressing the artery. If the pulse remains absent after reduction, then it is appropriate to call a vascular surgeon.

Ankle Fractures and their Classification

Ankle fractures are a common reason for emergency department visits. To minimize the unnecessary use of x-rays, the Ottawa ankle rules are used to aid in clinical examination. These rules state that x-rays are only necessary if there is pain in the malleolar zone and an inability to weight bear for four steps, tenderness over the distal tibia, or bone tenderness over the distal fibula. There are several classification systems for describing ankle fractures, including the Potts, Weber, and AO systems. The Weber system is the simplest and is based on the level of the fibular fracture. Type A is below the syndesmosis, type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis, and type C is above the syndesmosis, which may itself be damaged. A subtype known as a Maisonneuve fracture may occur with a spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, requiring surgery.

Management of Ankle Fractures

The management of ankle fractures depends on the stability of the ankle joint and patient co-morbidities. Prompt reduction of all ankle fractures is necessary to relieve pressure on the overlying skin and prevent necrosis. Young patients with unstable, high velocity, or proximal injuries will usually require surgical repair, often using a compression plate. Elderly patients, even with potentially unstable injuries, usually fare better with attempts at conservative management as their thin bone does not hold metalwork well. It is important to consider the patient’s overall health and any other medical conditions when deciding on the best course of treatment.

Colchicine is known to induce diarrhoea as a side effect.

One of the common side effects of colchicine, a medication utilized for treating acute gout attacks, is diarrhoea. Due to this, some physicians opt for naproxen or prednisolone instead of prescribing colchicine. The remaining drugs on the list are not typically associated with diarrhoea.

Gout is caused by chronic hyperuricaemia and is managed acutely with NSAIDs or colchicine. Urate-lowering therapy (ULT) is recommended for patients with >= 2 attacks in 12 months, tophi, renal disease, uric acid renal stones, or prophylaxis if on cytotoxics or diuretics. Allopurinol is first-line ULT, with an initial dose of 100 mg od and titrated to aim for a serum uric acid of < 300 µmol/l. Lifestyle modifications include reducing alcohol intake, losing weight if obese, and avoiding high-purine foods. Consideration should be given to stopping precipitating drugs and losartan may be suitable for patients with coexistent hypertension.

The observed symptoms indicate that the femoral nerve has been affected. Although nerve damage during instrumental delivery is uncommon, it can occur during challenging deliveries and mid-cavity forceps use. The table below outlines the nerves that may be impacted by forceps and the corresponding clinical manifestations.
Nerve Clinical features
Femoral nerve Weakness in extending the knee, absence of the patellar reflex, and numbness in the thigh
Lumbosacral trunk Weakness in dorsiflexing the ankle and numbness in the calf and foot.

Selected Facts about Lower Limb Anatomy

The lower limb anatomy is a complex system that is often tested in medical examinations. One of the important aspects of this system is the nerves that control the motor and sensory functions of the lower limb. The femoral nerve, for example, controls knee extension and thigh flexion, and is responsible for the sensation in the anterior and medial aspect of the thigh and lower leg. This nerve is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds.

Another important nerve is the obturator nerve, which controls thigh adduction and provides sensation to the medial thigh. Injuries to this nerve can occur in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh, on the other hand, does not control any motor function but is responsible for the sensation in the lateral and posterior surfaces of the thigh. Compression of this nerve near the ASIS can lead to meralgia paraesthetica, a condition characterized by pain, tingling, and numbness in the distribution of the lateral cutaneous nerve.

The tibial nerve controls foot plantarflexion and inversion and provides sensation to the sole of the foot. This nerve is not commonly injured as it is deep and well-protected. The common peroneal nerve, which controls foot dorsiflexion and eversion, is often injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and is commonly injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve results in a positive Trendelenburg sign. Finally, the inferior gluteal nerve controls hip extension and lateral rotation and is generally injured in association with the sciatic nerve. Injury to this nerve results in difficulty rising from a seated position, as well as an inability to jump or climb stairs.

Patients who have been diagnosed with Sjogren’s syndrome are at a higher risk of developing lymphoid malignancies. The presence of symptoms such as weight loss, night sweats, and painless swelling may indicate the possibility of lymphoma. Breast cancer is unlikely in this male patient, especially since there is no breast lump. Tuberculosis of the lymph glands is typically localized to the cervical chains or supraclavicular fossa and is often bilateral. While Hidradenitis suppurativa can cause painful abscesses in the axilla, it is an unlikely diagnosis since the lumps in this case are painless.

Understanding Sjogren’s Syndrome

Sjogren’s syndrome is a medical condition that affects the exocrine glands, leading to dry mucosal surfaces. It is an autoimmune disorder that can either be primary or secondary to other connective tissue disorders, such as rheumatoid arthritis. The onset of the condition usually occurs around ten years after the initial onset of the primary disease. Sjogren’s syndrome is more common in females, with a ratio of 9:1. Patients with this condition have a higher risk of developing lymphoid malignancy, which is 40-60 times more likely.

The symptoms of Sjogren’s syndrome include dry eyes, dry mouth, vaginal dryness, arthralgia, Raynaud’s, myalgia, sensory polyneuropathy, recurrent episodes of parotitis, and subclinical renal tubular acidosis. To diagnose the condition, doctors may perform a Schirmer’s test to measure tear formation, check for hypergammaglobulinaemia, and low C4. Nearly 50% of patients with Sjogren’s syndrome test positive for rheumatoid factor, while 70% test positive for ANA. Additionally, 70% of patients with primary Sjogren’s syndrome have anti-Ro (SSA) antibodies, and 30% have anti-La (SSB) antibodies.

The management of Sjogren’s syndrome involves the use of artificial saliva and tears to alleviate dryness. Pilocarpine may also be used to stimulate saliva production. Understanding the symptoms and management of Sjogren’s syndrome is crucial for patients and healthcare providers to ensure proper treatment and care.

The patient’s symptoms suggest osteoarthritis, which commonly affects small joints in the hand and can cause swelling at the distal interphalangeal joints (Heberden’s nodes). Gout, pseudogout, and reactive arthritis are unlikely diagnoses based on the patient’s symptoms.

Understanding Osteoarthritis of the Hand

Osteoarthritis of the hand, also known as nodal arthritis, is a condition that occurs when the cartilage at synovial joints is lost, leading to the degeneration of underlying bone. It is more common in women, usually presenting after the age of 55, and may have a genetic component. Risk factors include previous joint trauma, obesity, hypermobility, and certain occupations. Interestingly, osteoporosis may actually reduce the risk of developing hand OA.

Symptoms of hand OA include episodic joint pain, stiffness that worsens after periods of inactivity, and the development of painless bony swellings known as Heberden’s and Bouchard’s nodes. These nodes are the result of osteophyte formation and are typically found at the distal and proximal interphalangeal joints, respectively. In severe cases, there may be reduced grip strength and deformity of the carpometacarpal joint of the thumb, resulting in fixed adduction.

Diagnosis is typically made through X-ray, which may show signs of osteophyte formation and joint space narrowing before symptoms develop. While hand OA may not significantly impact a patient’s daily function, it is important to manage symptoms through pain relief and joint protection strategies. Additionally, the presence of hand OA may increase the risk of future hip and knee OA, particularly for hip OA.

To prevent pathological fractures in bone metastases, bisphosphonates and denosumab are viable options. However, if the patient’s eGFR is less than 30, denosumab is the preferred choice. Alendronic acid should be avoided due to the patient’s history of severe reflux during previous use. Denosumab is a novel treatment for osteoporosis that inhibits the development of osteoclasts by blocking RANKL. It is administered via subcutaneous injection and is also effective in preventing skeletal-related events in adults with bone metastases from solid tumors. Cinacalcet is not indicated for the management of osteoporosis or pathological fractures, but rather for hyperparathyroidism and hypercalcemia in parathyroid carcinoma. Hormone-replacement therapy (HRT) is not recommended for the treatment of osteoporosis in older postmenopausal women due to its unfavorable risk-benefit ratio.

Denosumab: A New Treatment for Osteoporosis

Denosumab is a human monoclonal antibody that inhibits the development of osteoclasts, which are responsible for breaking down bone tissue. It is administered as a subcutaneous injection every six months at a dose of 60mg. A larger dose of 120mg may be given every four weeks to prevent skeletal-related events in adults with bone metastases from solid tumors.

When it comes to managing osteoporosis, oral bisphosphonates are still the first-line treatment, with alendronate being the preferred option. If alendronate is not tolerated, an alternative bisphosphonate such as risedronate or etidronate may be used. Next-line medications are only started if certain T score and other risk factor criteria are met. Raloxifene and strontium ranelate were previously recommended as next-line drugs, but due to safety concerns regarding strontium ranelate, denosumab is becoming increasingly popular.

Denosumab is generally well-tolerated, with dyspnea and diarrhea being the most common side effects. However, doctors should be aware of the potential for atypical femoral fractures in patients taking denosumab and should look out for patients complaining of unusual thigh, hip, or groin pain.

Overall, denosumab is a promising new treatment for osteoporosis that may be particularly useful for patients who cannot tolerate oral bisphosphonates or who have other risk factors that make them unsuitable for these medications.

If patients with polymyalgia rheumatica do not respond well to steroids, it is important to consider other possible diagnoses. While alendronic acid is useful for protecting bones during long-term steroid use, it will not alleviate symptoms. Amitriptyline is better suited for chronic or neuropathic pain rather than inflammatory conditions. Aspirin and naproxen may provide some relief due to their anti-inflammatory properties, but the response will not be as significant as with prednisolone.

Polymyalgia Rheumatica: A Condition of Muscle Stiffness in Older People

Polymyalgia rheumatica (PMR) is a common condition that affects older people. It is characterized by muscle stiffness and elevated inflammatory markers. Although it is closely related to temporal arthritis, the underlying cause is not fully understood, and it does not appear to be a vasculitic process. PMR typically affects patients over the age of 60 and has a rapid onset, usually within a month. Patients experience aching and morning stiffness in proximal limb muscles, along with mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, and night sweats.

To diagnose PMR, doctors look for raised inflammatory markers, such as an ESR of over 40 mm/hr. Creatine kinase and EMG are normal. Treatment for PMR involves prednisolone, usually at a dose of 15 mg/od. Patients typically respond dramatically to steroids, and failure to do so should prompt consideration of an alternative diagnosis.

For non-displaced or minimally displaced scaphoid fractures (less than 0.5mm), immobilization for 6 weeks is sufficient for union. However, since these fractures can lead to avascular necrosis and other long-term complications, it is crucial to seek specialized medical attention. It is unnecessary to immobilize the elbow with a standard above-elbow backslab for suspected scaphoid fractures.

Understanding Scaphoid Fractures

A scaphoid fracture is a type of wrist fracture that typically occurs when a person falls onto an outstretched hand or during contact sports. It is important to recognize this type of fracture due to the unusual blood supply of the scaphoid bone. Interruption of the blood supply can lead to avascular necrosis, which is a serious complication. Patients with scaphoid fractures typically present with pain along the radial aspect of the wrist and loss of grip or pinch strength. Clinical examination is highly sensitive and specific when certain signs are present, such as tenderness over the anatomical snuffbox and pain on telescoping of the thumb.

Plain film radiographs should be requested, including scaphoid views, but the sensitivity in the first week of injury is only 80%. A CT scan may be requested in the context of ongoing clinical suspicion or planning operative management, while MRI is considered the definite investigation to confirm or exclude a diagnosis. Initial management involves immobilization with a splint or backslab and referral to orthopaedics. Orthopaedic management depends on the patient and type of fracture, with undisplaced fractures of the scaphoid waist typically treated with a cast for 6-8 weeks. Displaced scaphoid waist fractures require surgical fixation, as do proximal scaphoid pole fractures. Complications of scaphoid fractures include non-union, which can lead to pain and early osteoarthritis, and avascular necrosis.

The development of avascular necrosis of the femoral head is strongly associated with long-term steroid use, as seen in this patient who is taking prednisolone for polymyalgia rheumatica.

Understanding Avascular Necrosis of the Hip

Avascular necrosis of the hip is a condition where bone tissue dies due to a loss of blood supply, leading to bone destruction and loss of joint function. This condition typically affects the epiphysis of long bones, such as the femur. There are several causes of avascular necrosis, including long-term steroid use, chemotherapy, alcohol excess, and trauma.

Initially, avascular necrosis may not present with any symptoms, but as the condition progresses, pain in the affected joint may occur. Plain x-ray findings may be normal in the early stages, but osteopenia and microfractures may be seen. As the condition worsens, collapse of the articular surface may result in the crescent sign.

MRI is the preferred investigation for avascular necrosis as it is more sensitive than radionuclide bone scanning. In severe cases, joint replacement may be necessary to manage the condition. Understanding the causes, features, and management of avascular necrosis of the hip is crucial for early detection and effective treatment.

Early signs of rheumatoid arthritis can be observed through x-rays, specifically the presence of juxta-articular osteoporosis/osteopenia.

X-Ray Changes in Rheumatoid Arthritis

Rheumatoid arthritis is a chronic autoimmune disease that affects the joints, causing pain, stiffness, and swelling. X-ray imaging is often used to diagnose and monitor the progression of the disease. Early x-ray findings in rheumatoid arthritis include a loss of joint space, juxta-articular osteoporosis, and soft-tissue swelling. These changes indicate that the joint is being damaged and that the bones are losing density.

As the disease progresses, late x-ray findings may include periarticular erosions and subluxation. Periarticular erosions are areas of bone loss around the joint, while subluxation refers to the partial dislocation of the joint. These changes can lead to deformities and functional impairment.

It is important to note that x-ray findings may not always correlate with the severity of symptoms in rheumatoid arthritis. Some patients may have significant joint damage on x-ray but experience minimal pain, while others may have severe pain despite minimal x-ray changes. Therefore, x-ray imaging should be used in conjunction with other clinical assessments to determine the best course of treatment for each individual patient.

A knee injury caused by twisting can lead to a tear in the meniscus, potentially accompanied by a sprain in the medial collateral ligament. The affected knee would be swollen and tender to the touch, and a positive McMurray’s’s test (painful clicking) would also be present. Patella dislocation, which can result from direct trauma to the knee, is indicated by a positive patellar apprehension test rather than a positive McMurray’s’s test. Falling onto a bent knee can cause injury to the posterior cruciate ligament, which is indicated by a positive posterior drawer test. Hyperextension knee injury, on the other hand, most commonly results in a rupture of the anterior cruciate ligament, which is indicated by a positive anterior drawer test. Repeated jumping and landing on hard surfaces can lead to patella tendinopathy or ‘jumper’s knee’, which causes anterior knee pain that worsens with exercise and jumping over a period of 2-4 weeks.

Understanding Meniscal Tear and its Symptoms

Meniscal tear is a common knee injury that usually occurs due to twisting injuries. Its symptoms include pain that worsens when the knee is straightened, a feeling that the knee may give way, tenderness along the joint line, and knee locking in cases where the tear is displaced. To diagnose a meniscal tear, doctors may perform Thessaly’s test, which involves weight-bearing at 20 degrees of knee flexion while the patient is supported by the doctor. If the patient experiences pain on twisting the knee, the test is considered positive.

A potential complication of total hip replacement is posterior dislocation, which can present with sudden leg shortening, internal rotation, and a clunk sound. This may occur due to direct impact on a flexed hip, such as when sitting in a car. The hip will be adducted, internally rotated, and flexed in a posterior dislocation. Therefore, options suggesting hip abduction, external rotation, or hyperextension are incorrect.

Osteoarthritis (OA) of the hip is a prevalent condition, with the knee being the only joint more commonly affected. It is particularly prevalent in older individuals, and women are twice as likely to develop it. Obesity and developmental dysplasia of the hip are also risk factors. The condition is characterized by chronic groin pain that is exacerbated by exercise and relieved by rest. However, if the pain is present at rest, at night, or in the morning for more than two hours, it may indicate an alternative cause. The Oxford Hip Score is a widely used tool to assess the severity of the condition.

If the symptoms are typical, a clinical diagnosis can be made. Otherwise, plain x-rays are the first-line investigation. Management of OA of the hip includes oral analgesia and intra-articular injections, which provide short-term relief. However, total hip replacement is the definitive treatment.

Total hip replacement is a common operation in the developed world, but it is not without risks. Perioperative complications include venous thromboembolism, intraoperative fracture, nerve injury, surgical site infection, and leg length discrepancy. Postoperatively, posterior dislocation may occur during extremes of hip flexion, presenting with a clunk, pain, and inability to weight bear. Aseptic loosening is the most common reason for revision, and prosthetic joint infection is also a potential complication.

If a patient has a known allergy to a sulfa drug like co-trimoxazole, they should avoid taking sulfasalazine. However, hydroxychloroquine, leflunomide, methotrexate, and sarilumab are not contraindicated for this patient. These drugs may be considered as first-line treatments for rheumatoid arthritis, depending on the patient’s disease activity and response to other medications. It is important to note that sulfasalazine should be avoided in patients with a sulfa drug allergy.

Sulfasalazine: A DMARD for Inflammatory Arthritis and Bowel Disease

Sulfasalazine is a type of disease modifying anti-rheumatic drug (DMARD) that is commonly used to manage inflammatory arthritis, particularly rheumatoid arthritis, as well as inflammatory bowel disease. This medication is a prodrug for 5-ASA, which works by reducing neutrophil chemotaxis and suppressing the proliferation of lymphocytes and pro-inflammatory cytokines.

However, caution should be exercised when using sulfasalazine in patients with G6PD deficiency or those who are allergic to aspirin or sulphonamides due to the risk of cross-sensitivity. Adverse effects of sulfasalazine may include oligospermia, Stevens-Johnson syndrome, pneumonitis/lung fibrosis, myelosuppression, Heinz body anaemia, megaloblastic anaemia, and the potential to color tears and stain contact lenses.

Despite these potential side effects, sulfasalazine is considered safe to use during pregnancy and breastfeeding, making it a viable option for women who require treatment for inflammatory arthritis or bowel disease. Overall, sulfasalazine is an effective DMARD that can help manage the symptoms of these conditions and improve patients’ quality of life.

The pain’s position and its improvement when walking uphill make it unlikely that there is a vascular cause underlying it.

Lumbar spinal stenosis is a condition where the central canal in the lower back is narrowed due to degenerative changes, such as a tumor or disk prolapse. Patients may experience back pain, neuropathic pain, and symptoms similar to claudication. However, one distinguishing factor is that the pain is positional, with sitting being more comfortable than standing, and walking uphill being easier than downhill. Degenerative disease is the most common cause, starting with changes in the intervertebral disk that lead to disk bulging and collapse. This puts stress on the facet joints, causing cartilage degeneration, hypertrophy, and osteophyte formation, which narrows the spinal canal and compresses the nerve roots of the cauda equina. MRI scanning is the best way to diagnose lumbar spinal stenosis, and treatment may involve a laminectomy.

Overall, lumbar spinal stenosis is a condition that affects the lower back and can cause a range of symptoms, including pain and discomfort. It is often caused by degenerative changes in the intervertebral disk, which can lead to narrowing of the spinal canal and compression of the nerve roots. Diagnosis is typically done through MRI scanning, and treatment may involve a laminectomy. It is important to note that the pain associated with lumbar spinal stenosis is positional, with sitting being more comfortable than standing, and walking uphill being easier than downhill.

Fractures of the 5th metatarsal are commonly caused by the foot and ankle being forcefully inverted. These types of fractures are often seen in athletes, including dancers, football players, and rugby players, but can also occur from minor incidents such as stepping off a curb. Avulsion fractures are a specific type of 5th metatarsal fracture that result from the peroneus brevis muscle pulling on the proximal part of the bone during foot inversion. It is important to note that 5th metatarsal fractures are not associated with any other movements of the ankle or hip.

Metatarsal fractures are a common occurrence, with the potential to affect one or multiple metatarsals. These fractures can result from direct trauma or repeated mechanical stress, known as stress fractures. The metatarsals are particularly susceptible to stress fractures, with the second metatarsal shaft being the most common site. The proximal 5th metatarsal is the most commonly fractured metatarsal, while the 1st metatarsal is the least commonly fractured.

Fractures of the proximal 5th metatarsal can be classified as either proximal avulsion fractures or Jones fractures. Proximal avulsion fractures occur at the proximal tuberosity and are often associated with lateral ankle sprains. Jones fractures, on the other hand, are transverse fractures at the metaphyseal-diaphyseal junction and are much less common.

Symptoms of metatarsal fractures include pain, bony tenderness, swelling, and an antalgic gait. X-rays are typically used to distinguish between displaced and non-displaced fractures, which guides subsequent management options. However, stress fractures may not appear on X-rays and may require an isotope bone scan or MRI to establish their presence. Overall, metatarsal fractures are a common injury that can result from a variety of causes and require prompt diagnosis and management.

Adhesive capsulitis is the correct answer as it is commonly seen in middle-aged females, diabetic patients, and following trauma. The classic impairment in adhesive capsulitis is external rotation, both on active and passive movement. On the other hand, calcific tendonosis would present with bursitis, causing pain, restriction in movement, and a hot and swollen shoulder. Cervical nerve root entrapment would cause pain in the neck and/or shoulder, with possible radiation to the arm and impaired neck range of movement. Supraspinatus tendonosis and torn rotator cuff would primarily affect abduction, not external rotation.

Understanding Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis, commonly known as frozen shoulder, is a prevalent cause of shoulder pain that primarily affects middle-aged women. The exact cause of this condition is not yet fully understood. However, studies have shown that up to 20% of diabetics may experience an episode of frozen shoulder. Symptoms typically develop over several days, with external rotation being more affected than internal rotation or abduction. Both active and passive movement are affected, and patients usually experience a painful freezing phase, an adhesive phase, and a recovery phase. In some cases, the condition may affect both shoulders, which occurs in up to 20% of patients. The episode typically lasts between 6 months and 2 years.

Diagnosis of adhesive capsulitis is usually clinical, although imaging may be necessary for atypical or persistent symptoms. Unfortunately, no single intervention has been proven to improve the outcome in the long-term. However, there are several treatment options available, including nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, oral corticosteroids, and intra-articular corticosteroids.

Osteochondritis dissecans is commonly seen in the knee joint and is characterized by knee pain after exercise, locking, and ‘clunking’. This condition is often caused by overuse of joints due to sports activities and can lead to secondary effects on joint cartilage, including pain, swelling, and possible formation of free bodies. Baker’s cyst, Osgood-Schlatter disease, and osteoarthritis are not the correct diagnoses as they present with different symptoms and causes.

Understanding Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is a condition that affects the subchondral bone, usually in the knee joint, and can lead to secondary effects on the joint cartilage. It is most commonly seen in children and young adults and can progress to degenerative changes if left untreated. Symptoms of OCD include knee pain and swelling, catching, locking, and giving way, as well as a painful clunk when flexing or extending the knee. Signs of the condition include joint effusion and tenderness on palpation of the articular cartilage of the medial femoral condyle when the knee is flexed.

To diagnose OCD, X-rays and MRI scans are often used. X-rays may show the subchondral crescent sign or loose bodies, while MRI scans can evaluate cartilage, visualize loose bodies, stage the condition, and assess the stability of the lesion. Early diagnosis is crucial, as clinical signs may be subtle in the early stages. Therefore, there should be a low threshold for imaging and/or orthopedic opinion.

Overall, understanding OCD is important for recognizing its symptoms and seeking appropriate medical attention. With early diagnosis and management, patients can prevent the progression of the condition and maintain joint health.