The movement of the arm’s pronation and supination is caused by the rotation of the radius bone, while the ulna bone remains still. This movement involves two joints: the proximal and distal radio-ulnar joints. The humerus bone remains stationary during this process, while the radial head rotates on the humerus’s capitulum. It’s worth noting that the distal carpal bones don’t move in relation to the distal radius during pronation and supination.

Anatomy of the Radius Bone

The radius bone is one of the two long bones in the forearm that extends from the lateral side of the elbow to the thumb side of the wrist. It has two expanded ends, with the distal end being the larger one. The upper end of the radius bone has articular cartilage that covers the medial to lateral side and articulates with the radial notch of the ulna by the annular ligament. The biceps brachii muscle attaches to the tuberosity of the upper end.

The shaft of the radius bone has several muscle attachments. The upper third of the body has the supinator, flexor digitorum superficialis, and flexor pollicis longus muscles. The middle third of the body has the pronator teres muscle, while the lower quarter of the body has the pronator quadratus muscle and the tendon of supinator longus.

The lower end of the radius bone is quadrilateral in shape. The anterior surface is covered by the capsule of the wrist joint, while the medial surface has the head of the ulna. The lateral surface ends in the styloid process, and the posterior surface has three grooves that contain the tendons of extensor carpi radialis longus and brevis, extensor pollicis longus, and extensor indicis. Understanding the anatomy of the radius bone is crucial in diagnosing and treating injuries and conditions that affect this bone.

The bone in question is a small one with only one articular facet. It protrudes from the triquetral bone on the ulnar side of the wrist, and is commonly considered a sesamoid bone located within the tendon of the flexor carpi ulnaris.

Carpal Bones: The Wrist’s Building Blocks

The wrist is composed of eight carpal bones, which are arranged in two rows of four. These bones are convex from side to side posteriorly and concave anteriorly. The trapezium is located at the base of the first metacarpal bone, which is the base of the thumb. The scaphoid, lunate, and triquetrum bones do not have any tendons attached to them, but they are stabilized by ligaments.

In summary, the carpal bones are the building blocks of the wrist, and they play a crucial role in the wrist’s movement and stability. The trapezium bone is located at the base of the thumb, while the scaphoid, lunate, and triquetrum bones are stabilized by ligaments. Understanding the anatomy of the wrist is essential for diagnosing and treating wrist injuries and conditions.

Damage to the axillary nerve results in a loss of sensation in the area of the upper limb known as the regimental badge.

Innervation of Upper Limb Areas:
– Medial aspect of forearm: Innervated by the medial antebrachial cutaneous nerve, which originates from spinal nerves C8 and T1.
– Medial one and a half fingers: Innervated by the ulnar nerve.
– Anterior aspect of lateral three and a half fingers: Innervated by the median nerve.
– Lateral aspect of forearm: Innervated by the lateral antebrachial cutaneous nerve, which originates from spinal nerves C5 and C6.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

Primary hyperparathyroidism is indicated by elevated levels of serum calcium, decreased levels of serum phosphate, increased levels of ALP, and increased levels of PTH.

Lab Values for Bone Disorders

When it comes to bone disorders, certain lab values can provide important information about the condition. In cases of osteoporosis, calcium, phosphate, alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels are typically normal. However, in osteomalacia, calcium and phosphate levels are decreased while ALP and PTH levels are increased. Primary hyperparathyroidism, which can lead to osteitis fibrosa cystica, is characterized by increased calcium and PTH levels but decreased phosphate levels. Chronic kidney disease can result in secondary hyperparathyroidism, which is marked by decreased calcium levels and increased phosphate and PTH levels. Paget’s disease, on the other hand, typically shows normal calcium and phosphate levels but increased ALP levels. Finally, osteopetrosis is associated with normal levels of calcium, phosphate, ALP, and PTH. By analyzing these lab values, healthcare professionals can better diagnose and treat bone disorders.

The fibular head serves as the insertion point for both the long and short head of the biceps femoris muscle. However, sudden contractions of the biceps femoris can lead to an avulsion fracture of the fibular head, where the fracture fragment may be attached to the lateral collateral ligament or biceps femoris tendon.

The fibularis brevis muscle originates from the distal two-thirds of the fibular bone. If the ankle joint suddenly inverts, it can pull on the fibularis tendon and cause an avulsion of the tuberosity at the base of the fifth metatarsal.

The flexor hallucis longus muscle originates from the distal two-thirds of the posterior surface of the fibular bone. This muscle not only allows for flexion of the big toe but also contributes to plantarflexion and inversion of the foot.

The soleus muscle originates from the proximal one-third of the posterior surface of the fibular bone. It is a large muscle covered in thick fascia, which aids in its secondary function of pumping venous blood back into the heart through the skeletal muscle pump.

The Biceps Femoris Muscle

The biceps femoris is a muscle located in the posterior upper thigh and is part of the hamstring group of muscles. It consists of two heads: the long head and the short head. The long head originates from the ischial tuberosity and inserts into the fibular head. Its actions include knee flexion, lateral rotation of the tibia, and extension of the hip. It is innervated by the tibial division of the sciatic nerve and supplied by the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery.

On the other hand, the short head originates from the lateral lip of the linea aspera and the lateral supracondylar ridge of the femur. It also inserts into the fibular head and is responsible for knee flexion and lateral rotation of the tibia. It is innervated by the common peroneal division of the sciatic nerve and supplied by the same arteries as the long head.

Understanding the anatomy and function of the biceps femoris muscle is important in the diagnosis and treatment of injuries and conditions affecting the posterior thigh.

The tricep muscle, which gets its name from the Latin word for three-headed muscles, is responsible for extending the elbow. It is made up of three heads: the long head, which originates from the infraglenoid tubercle of the scapular; the lateral head, which comes from the dorsal surface of the humerus; and the medial head, which originates from the posterior surface of the humerus. These three heads come together to form a single tendon that inserts onto the olecranon process of the ulna.

Anatomy of the Triceps Muscle

The triceps muscle is a large muscle located on the back of the upper arm. It is composed of three heads: the long head, lateral head, and medial head. The long head originates from the infraglenoid tubercle of the scapula, while the lateral head originates from the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve. The medial head originates from the posterior surface of the humerus on the inferomedial side of the radial groove and both of the intermuscular septae.

All three heads of the triceps muscle insert into the olecranon process of the ulna, with some fibers inserting into the deep fascia of the forearm and the posterior capsule of the elbow. The triceps muscle is innervated by the radial nerve and supplied with blood by the profunda brachii artery.

The primary action of the triceps muscle is elbow extension. The long head can also adduct the humerus and extend it from a flexed position. The radial nerve and profunda brachii vessels lie between the lateral and medial heads of the triceps muscle. Understanding the anatomy of the triceps muscle is important for proper diagnosis and treatment of injuries or conditions affecting this muscle.

The medial femoral circumflex artery is a significant supplier of blood to the femoral head, while the perforating branches of the profunda femoris artery supply the medial and posterior thigh. The lateral femoral circumflex artery provides blood to some muscles of the lateral thigh and a portion of the femoral head. Additionally, the anterior branch of the obturator artery supplies blood to the obturator externus, pectineus, adductor muscles, and gracilis muscles.

Anatomy of the Femur: Structure and Blood Supply

The femur is the longest and strongest bone in the human body, extending from the hip joint to the knee joint. It consists of a rounded head that articulates with the acetabulum and two large condyles at its inferior aspect that articulate with the tibia. The superior aspect of the femur comprises a head and neck that pass inferolaterally to the body and the two trochanters. The neck meets the body of the femur at an angle of 125o and is demarcated from it by a wide rough intertrochanteric crest. The greater trochanter has discernible surfaces that form the site of attachment of the gluteal muscles, while the linea aspera forms part of the origin of the attachments of the thigh adductors.

The femur has a rich blood supply, with numerous vascular foramina existing throughout its length. The blood supply to the femoral head is clinically important and is provided by the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head. It is important to note that the neck is covered by synovial membrane up to the intertrochanteric line, and the posterior aspect of the neck is demarcated from the shaft by the intertrochanteric crest. Understanding the anatomy of the femur, including its structure and blood supply, is crucial for medical professionals in diagnosing and treating injuries and conditions related to this bone.

The sural nerve is situated behind the lateral malleolus, which is commonly fractured due to direct trauma. In this patient, the lateral malleolus fracture is displaced posteriorly, posing a risk of direct compression and potential injury to the sural nerve. Other structures located behind the lateral malleolus include the short saphenous vein, peroneus longus tendon, and peroneus brevis tendon. The anterior talofibular ligament is a flat band that extends from the front edge of the lateral malleolus to the neck of the talus, just ahead of the fibular facet. The remaining options are incorrect.

Anatomy of the Lateral Malleolus

The lateral malleolus is a bony prominence on the outer side of the ankle joint. Posterior to the lateral malleolus and superficial to the superior peroneal retinaculum are the sural nerve and short saphenous vein. These structures are important for sensation and blood flow to the lower leg and foot.

On the other hand, posterior to the lateral malleolus and deep to the superior peroneal retinaculum are the peroneus longus and peroneus brevis tendons. These tendons are responsible for ankle stability and movement.

Additionally, the calcaneofibular ligament is attached at the lateral malleolus. This ligament is important for maintaining the stability of the ankle joint and preventing excessive lateral movement.

Understanding the anatomy of the lateral malleolus is crucial for diagnosing and treating ankle injuries and conditions. Proper care and management of these structures can help prevent long-term complications and improve overall ankle function.

The saphenous nerve and the superficial branch of the femoral artery are both present in this area.

The Adductor Canal: Anatomy and Contents

The adductor canal, also known as Hunter’s or the subsartorial canal, is a structure located in the middle third of the thigh, immediately distal to the apex of the femoral triangle. It is bordered laterally by the vastus medialis muscle and posteriorly by the adductor longus and adductor magnus muscles. The roof of the canal is formed by the sartorius muscle. The canal terminates at the adductor hiatus.

The adductor canal contains three important structures: the saphenous nerve, the superficial femoral artery, and the superficial femoral vein. The saphenous nerve is a sensory nerve that supplies the skin of the medial leg and foot. The superficial femoral artery is a major artery that supplies blood to the lower limb. The superficial femoral vein is a large vein that drains blood from the lower limb.

In order to expose the contents of the adductor canal, the sartorius muscle must be removed. Understanding the anatomy and contents of the adductor canal is important for medical professionals who perform procedures in this area, such as nerve blocks or vascular surgeries.

Rheumatoid arthritis is more prevalent in female patients, with a 3-fold higher incidence compared to males. It is characterized by symmetrical pain and stiffness, particularly in the morning. Rheumatoid arthritis can affect individuals of any age and is treated with medications such as prednisolone. Contrary to popular belief, gout does not increase the likelihood of developing rheumatoid arthritis. Additionally, ethnicity, specifically being of white descent, is not considered a risk factor for this condition.

Understanding the Epidemiology of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic autoimmune disease that affects people of all ages, but it typically peaks between the ages of 30 and 50. The condition is more common in women, with a female-to-male ratio of 3:1. The prevalence of rheumatoid arthritis is estimated to be around 1% of the population. However, there are some ethnic differences in the incidence of the disease, with Native Americans having a higher prevalence than other groups.

Researchers have identified a genetic link to rheumatoid arthritis, with the HLA-DR4 gene being associated with the development of the condition. This gene is particularly linked to a subtype of rheumatoid arthritis known as Felty’s syndrome. Understanding the epidemiology of rheumatoid arthritis is important for healthcare professionals to provide appropriate care and support to those affected by the disease. By identifying risk factors and understanding the prevalence of the condition, healthcare providers can better tailor their treatment plans to meet the needs of their patients.

Erysipelas is a skin infection that is localized and caused by Streptococcus pyogenes. It is often seen in elderly patients with weakened immune systems, such as those with diabetes mellitus. Symptoms include a raised, painful rash with clear boundaries.

Ringworm is commonly caused by Trichophyton rubrum. This results in a circular, scaly, and itchy rash that is red in color.

While Staphylococcus epidermidis is a normal part of the skin’s flora, it is more commonly associated with infections of foreign devices and endocarditis rather than skin infections.

Understanding Erysipelas: A Superficial Skin Infection

Erysipelas is a skin infection that is caused by Streptococcus pyogenes. It is a less severe form of cellulitis, which is a more widespread skin infection. Erysipelas is a localized infection that affects the skin’s upper layers, causing redness, swelling, and warmth. The infection can occur anywhere on the body, but it is most commonly found on the face, arms, and legs.

The treatment of choice for erysipelas is flucloxacillin, an antibiotic that is effective against Streptococcus pyogenes. Other antibiotics may also be used, depending on the severity of the infection and the patient’s medical history.

The radial vein is not involved in avascular necrosis of the scaphoid. The abductor pollicis brevis muscle, which is responsible for thumb movement and located near the scaphoid bone, is supplied by the superficial palmar arch and is not typically affected by avascular necrosis in scaphoid fractures. Nonunion refers to the failure of bony union beyond a certain period of time, but as it has only been one month since the injury and only one radiograph has been taken, it is premature to diagnose non-union in this patient.

A scaphoid fracture is a type of wrist fracture that usually occurs when a person falls onto an outstretched hand or during contact sports. It is important to identify scaphoid fractures as they can lead to avascular necrosis due to the unusual blood supply of the scaphoid bone. Patients with scaphoid fractures typically experience pain along the radial aspect of the wrist and loss of grip or pinch strength. Clinical examination involves checking for tenderness over the anatomical snuffbox, wrist joint effusion, pain on telescoping of the thumb, tenderness of the scaphoid tubercle, and pain on ulnar deviation of the wrist. Plain film radiographs and scaphoid views are used to diagnose scaphoid fractures, but MRI is considered the definitive investigation. Initial management involves immobilization with a splint or backslab and referral to orthopaedics. Orthopaedic management depends on the type of fracture, with undisplaced fractures typically treated with a cast and displaced fractures requiring surgical fixation. Complications of scaphoid fractures include non-union and avascular necrosis.

If there is a disc herniation at the L3-L4 level, it can impact the L4 spinal nerve and lead to issues with the femoral nerve’s function. A herniation at the L2-L3 level can cause L3 radiculopathy and result in weakness in hip adduction. On the other hand, a herniation at the L3-L4 level can cause L4 radiculopathy and lead to weakness in knee extension, with a greater contribution from L4 than L3, as well as a decrease in the patellar reflex.

Understanding Prolapsed Disc and its Features

A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

The surgical management of carpal tunnel syndrome involves dividing the flexor retinaculum, which is the structure spanning the anteromedial surface of the ulna and the distal interphalangeal joints of the phalanges. This procedure is indicated by symptoms such as thenar wasting and a positive Tinel’s test. It is important to note that the cubital retinaculum, Osborne’s ligament, palmar aponeurosis, and pisometacarpal ligament are not involved in the treatment of carpal tunnel syndrome.

Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

In contrast to osteoarthritis, rheumatoid arthritis is characterized by longer morning stiffness lasting more than 30-60 minutes. It typically affects three or more joints symmetrically, but spares the distal interphalangeal joints. Diagnosis is based on clinical features and can be supported by positive anti-cyclic citrullinated peptide (anti-CCP) or rheumatoid factor (RF) serological testing. X-rays may show periarticular osteopenia, marginal bony erosions, and joint space narrowing. Additionally, Raynaud’s phenomenon can be an extra-articular manifestation of rheumatoid arthritis.

Comparison of Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis and rheumatoid arthritis are two types of arthritis that affect the joints. Osteoarthritis is caused by mechanical wear and tear, resulting in the localized loss of cartilage, remodelling of adjacent bone, and associated inflammation. On the other hand, rheumatoid arthritis is an autoimmune disease that affects women more commonly than men and can occur in adults of all ages. It typically affects the MCP and PIP joints, causing bilateral symptoms and systemic upset, while osteoarthritis affects large weight-bearing joints such as the hip and knee, as well as the carpometacarpal joint and DIP and PIP joints, causing unilateral symptoms and no systemic upset.

The typical history of osteoarthritis involves pain following use, which improves with rest, while rheumatoid arthritis involves morning stiffness that improves with use. X-ray findings for osteoarthritis include loss of joint space, subchondral sclerosis, subchondral cysts, and osteophytes forming at joint margins. For rheumatoid arthritis, X-ray findings include loss of joint space, juxta-articular osteoporosis, periarticular erosions, and subluxation.

In summary, while both osteoarthritis and rheumatoid arthritis affect the joints, they have different causes, affected joints, symptoms, and X-ray findings. Understanding these differences can help with accurate diagnosis and appropriate treatment.

Guttate psoriasis is frequently seen after a streptococcal infection, with group-A streptococcus being the likely culprit. The condition is characterized by the appearance of small, teardrop shaped red lesions. Scarlet fever, which is also caused by group-A streptococcus, presents with a rough rash, fever, swollen lymph nodes, and a red tongue. Pityriasis rosea, on the other hand, typically follows a viral infection and is identified by a single scaly patch followed by a widespread salmon-pink rash. Acne vulgaris and impetigo are not commonly associated with a streptococcal sore throat.

Guttate psoriasis is a type of psoriasis that is more commonly seen in children and adolescents. It is often triggered by a streptococcal infection that occurred 2-4 weeks prior to the appearance of the lesions. The condition is characterized by the presence of tear drop-shaped papules on the trunk and limbs, along with pink, scaly patches or plaques of psoriasis. The onset of guttate psoriasis tends to be acute, occurring over a few days.

In most cases, guttate psoriasis resolves on its own within 2-3 months. There is no clear evidence to support the use of antibiotics to treat streptococcal infections associated with the condition. Treatment options for guttate psoriasis include topical agents commonly used for psoriasis and UVB phototherapy. In cases where the condition recurs, a tonsillectomy may be necessary.

It is important to differentiate guttate psoriasis from pityriasis rosea, which is another skin condition that can present with similar symptoms. Guttate psoriasis is typically preceded by a streptococcal sore throat, while pityriasis rosea may be associated with recent respiratory tract infections. The appearance of guttate psoriasis is characterized by tear drop-shaped, scaly papules on the trunk and limbs, while pityriasis rosea presents with a herald patch followed by multiple erythematous, slightly raised oval lesions with a fine scale. Pityriasis rosea is self-limiting and resolves after around 6 weeks.

The lesser trochanter is the insertion point for the psoas major, which contracts during the act of raising the trunk from a supine position. In cases where there are oestolytic lesions in the femur, the lesser trochanter may become avulsed.

The Psoas Muscle: Origin, Insertion, Innervation, and Action

The psoas muscle is a deep-seated muscle that originates from the transverse processes of the five lumbar vertebrae and the superficial part originates from T12 and the first four lumbar vertebrae. It inserts into the lesser trochanter of the femur and is innervated by the anterior rami of L1 to L3.

The main action of the psoas muscle is flexion and external rotation of the hip. When both sides of the muscle contract, it can raise the trunk from the supine position. The psoas muscle is an important muscle for maintaining proper posture and movement, and it is often targeted in exercises such as lunges and leg lifts.

The typical striated appearance of skeletal and cardiac muscle is due to sarcomeres, which are the fundamental unit of muscles.

The Process of Muscle Contraction

Muscle contraction is a complex process that involves several steps. It begins with an action potential reaching the neuromuscular junction, which causes a calcium ion influx through voltage-gated calcium channels. This influx leads to the release of acetylcholine into the extracellular space, which activates nicotinic acetylcholine receptors, triggering an action potential. The action potential then spreads through the T-tubules, activating L-type voltage-dependent calcium channels in the T-tubule membrane, which are close to calcium-release channels in the adjacent sarcoplasmic reticulum. This causes the sarcoplasmic reticulum to release calcium, which binds to troponin C, causing a conformational change that allows tropomyosin to move, unblocking the binding sites. Myosin then binds to the newly released binding site, releasing ADP and pulling the Z bands towards each other. ATP binds to myosin, releasing actin.

The components involved in muscle contraction include the sarcomere, which is the basic unit of muscles that gives skeletal and cardiac muscles their striated appearance. The I-band is the zone of thin filaments that is not superimposed by thick filaments, while the A-band contains the entire length of a single thick filament. The H-zone is the zone of the thick filaments that is not superimposed by the thin filaments, and the M-line is in the middle of the sarcomere, cross-linking myosin. The sarcoplasmic reticulum releases calcium ion in response to depolarization, while actin is the thin filaments that transmit the forces generated by myosin to the ends of the muscle. Myosin is the thick filaments that bind to the thin filament, while titin connects the Z-line to the thick filament, altering the structure of tropomyosin. Tropomyosin covers the myosin-binding sites on actin, while troponin-C binds with calcium ions. The T-tubule is an invagination of the sarcoplasmic reticulum that helps co-ordinate muscular contraction.

There are two types of skeletal muscle fibres: type I and type II. Type I fibres have a slow contraction time, are red in colour due to the presence of myoglobin, and are used for sustained force. They have a high mitochondrial density and use triglycerides as

The condition is developmental dysplasia of the hip, which is typically observed in individuals under the age of 4.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

The gluteus medius and minimus muscles are responsible for hip abduction, while the gluteus maximus muscle externally rotates and extends the hip. The gluteus maximus muscle originates from the sacrum, coccyx, and posterior surface of the ilium, and inserts onto the gluteal tuberosity. The other gluteal muscles attach to the greater trochanter to facilitate abduction.

Anatomy of the Hip Joint

The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

Chlorphenamine is a medication.

Antihistamines for Allergic Rhinitis and Urticaria

Antihistamines, specifically H1 inhibitors, are effective in treating allergic rhinitis and urticaria. Sedating antihistamines like chlorpheniramine have antimuscarinic properties that can cause dry mouth and urinary retention. On the other hand, non-sedating antihistamines like loratadine and cetirizine are less likely to cause drowsiness. However, there is some evidence that cetirizine may still cause some level of drowsiness compared to other non-sedating antihistamines. Overall, antihistamines are a valuable treatment option for those suffering from allergic rhinitis and urticaria.

The primary role of the Biceps Brachii muscle is to facilitate supination and elbow flexion. It is particularly effective in supination when the elbow is flexed, such as when using a screwdriver. The muscles located in the posterior compartment of the forearm are responsible for wrist flexion, while the triceps are responsible for elbow extension and the deltoid is mostly responsible for shoulder abduction.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The patient is experiencing paraesthesia (pins and needles) and pain in the thumb and index finger, which worsens at night. This is likely due to nerve compression, specifically the median nerve, which supplies sensation to the palmar aspect of the lateral 3½ fingers.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

Stone formation is favored by the thick consistency of submandibular gland secretions. Additionally, the majority of stones are visible on radiographs. During gland removal surgery, the facial artery is typically tied off as it runs between the gland and mandible. The lingual artery may also be encountered later in the procedure when Wharton’s duct is being moved.

Anatomy of the Submandibular Gland

The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

The Adductor Canal: Anatomy and Contents

The adductor canal, also known as Hunter’s or the subsartorial canal, is a structure located in the middle third of the thigh, immediately distal to the apex of the femoral triangle. It is bordered laterally by the vastus medialis muscle and posteriorly by the adductor longus and adductor magnus muscles. The roof of the canal is formed by the sartorius muscle. The canal terminates at the adductor hiatus.

The adductor canal contains three important structures: the saphenous nerve, the superficial femoral artery, and the superficial femoral vein. The saphenous nerve is a sensory nerve that supplies the skin of the medial leg and foot. The superficial femoral artery is a major artery that supplies blood to the lower limb. The superficial femoral vein is a large vein that drains blood from the lower limb.

In order to expose the contents of the adductor canal, the sartorius muscle must be removed. Understanding the anatomy and contents of the adductor canal is important for medical professionals who perform procedures in this area, such as nerve blocks or vascular surgeries.

If there is tenderness in the base of the anatomical snuffbox, a scaphoid fracture should be suspected as it is a common injury caused by a fall onto an outstretched hand. It is important to note that bony tenderness would not be a symptom of a tendon rupture.

The scaphoid bone has various articular surfaces for different bones in the wrist. It has a concave surface for the head of the capitate and a crescentic surface for the lunate. The proximal end has a wide convex surface for the radius, while the distal end has a tubercle that can be felt. The remaining articular surface faces laterally and is associated with the trapezium and trapezoid bones. The narrow strip between the radial and trapezial surfaces and the tubercle gives rise to the radial collateral carpal ligament. The tubercle also receives part of the flexor retinaculum and is the only part of the scaphoid bone that allows for the entry of blood vessels. However, this area is commonly fractured and can lead to avascular necrosis.

The cubital fossa contains the following structures in order from lateral to medial: radial nerve, brachial tendon, brachial artery, and median nerve. A helpful mnemonic to remember this order is Really Need Beer To Be At My Nicest. It is important to note that the ulnar nerve is not part of the contents of the cubital fossa.

The Antecubital Fossa: Anatomy and Clinical Significance

The antecubital fossa is a depression located on the anterior aspect of the arm, between the arm and forearm. It is an important area for medical professionals as it is where venous blood samples are typically taken from. The borders of the antecubital fossa are the brachioradialis muscle laterally, the pronator teres medially, and a line between the medial and lateral epicondyles superiorly.

There are both deep and superficial structures found in the antecubital fossa. Deep structures include the radial nerve, tendon of the biceps muscle, brachial artery, and medial nerve. Superficial structures consist of a network of veins, including the cephalic vein and basilic vein, which come together as the median cubital vein.

The main clinical relevance of the antecubital fossa is its use for blood sampling and cannulation. However, it is also important to have a working knowledge of the anatomy as structures can become damaged. Excessive straining of the biceps tendon can cause it to rupture, leading to a ‘Popeye sign’. Damage to the medial nerve can also occur, resulting in muscle paralysis in the forearm and hand. Overall, understanding the anatomy and clinical significance of the antecubital fossa is crucial for medical professionals.

The anastomoses encircling the femoral head are created by vessels originating from the medial and lateral circumflex femoral arteries, typically sourced from the profunda femoris artery.

Anatomy of the Hip Joint

The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

In cases of hip fracture, the affected leg is typically shortened and externally rotated. This is due to the muscles pulling on the fractured femur, causing it to become misaligned and overlap. The short external rotators, such as piriformis, gemellus superior, obturator internus, and psoas muscle, contribute to the external rotation of the leg. It may also be abducted. It’s important to note that internal rotation is more commonly associated with a posterior hip dislocation, not a hip fracture.

Hip fractures are a common occurrence, particularly in elderly women with osteoporosis. The femoral head’s blood supply runs up the neck, making avascular necrosis a risk in displaced fractures. Symptoms include pain and a shortened and externally rotated leg. Patients with non-displaced or incomplete neck of femur fractures may still be able to bear weight. Hip fractures are classified based on their location, either intracapsular or extracapsular. The Garden system is a commonly used classification system that categorizes fractures into four types based on stability and displacement. Blood supply disruption is most common in Types III and IV.

Undisplaced intracapsular fractures can be treated with internal fixation or hemiarthroplasty if the patient is unfit. Displaced fractures require replacement arthroplasty, with total hip replacement being preferred over hemiarthroplasty if the patient was able to walk independently outdoors with no more than a stick, is not cognitively impaired, and is medically fit for anesthesia and the procedure. Extracapsular fractures are managed with a dynamic hip screw for stable intertrochanteric fractures and an intramedullary device for reverse oblique, transverse, or subtrochanteric fractures.

Understanding Osteopetrosis: A Rare Disorder of Bone Resorption

Osteopetrosis, also known as marble bone disease, is a rare disorder that affects the normal function of osteoclasts, leading to a failure of bone resorption. This results in the formation of dense, thick bones that are more prone to fractures. Individuals with osteopetrosis often experience bone pains and neuropathies. Despite the abnormal bone growth, levels of calcium, phosphate, and ALP remain normal.

Treatment options for osteopetrosis include stem cell transplant and interferon-gamma therapy. However, these treatments are not always effective and may have significant side effects. As such, early diagnosis and management of osteopetrosis is crucial in preventing complications and improving quality of life for affected individuals.

Understanding Ulnar Nerve Injury at the Wrist

The ulnar nerve is a major nerve that runs from the neck down to the hand. At the wrist, it divides into two branches: the superficial and deep branches. The superficial branch provides sensation to the skin of the medial third of the palm and one and a half fingers. Meanwhile, the deep branch supplies the abductor and short flexor of the little finger, as well as the opponens digiti minimi. It also passes over the Hook of the Hamate bone and ends in the first dorsal interosseous muscle. In the palm, the deep branch innervates the lumbricals and interosseous muscles.

Ulnar nerve injury at the wrist can occur due to various reasons, such as trauma, compression, or repetitive strain. Symptoms may include numbness, tingling, weakness, and pain in the affected area. Treatment options depend on the severity of the injury and may include rest, physical therapy, medication, or surgery.

What is the location of an erb’s palsy? This condition is a nerve disorder in the arm that results from damage to the upper group of the brachial plexus, primarily affecting the C5-C6 nerves in the upper trunk. It is often caused by trauma to the head and neck, which can stretch the nerves in the plexus and cause more damage to the upper trunk.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

Systemic lupus erythematosus (SLE) can be investigated through various tests, including antibody tests. ANA testing is highly sensitive and useful for ruling out SLE, but it has low specificity. About 99% of SLE patients are ANA positive. Rheumatoid factor testing is positive in 20% of SLE patients. Anti-dsDNA testing is highly specific (>99%) but less sensitive (70%). Anti-Smith testing is also highly specific (>99%) but has a lower sensitivity (30%). Other antibody tests that can be used include anti-U1 RNP, SS-A (anti-Ro), and SS-B (anti-La).

Monitoring of SLE can be done through various markers, including inflammatory markers such as ESR. During active disease, CRP levels may be normal, and a raised CRP may indicate an underlying infection. Complement levels (C3, C4) are low during active disease due to the formation of complexes that lead to the consumption of complement. Anti-dsDNA titres can also be used for disease monitoring, but it is important to note that they are not present in all SLE patients. Overall, these investigations can help diagnose and monitor SLE, allowing for appropriate management and treatment.

The sural nerve provides sensory innervation to the posterolateral leg and lateral foot, while the saphenous nerve innervates the medial aspect of the leg and foot. The lateral femoral cutaneous nerve supplies the lateral thigh.

Cutaneous Sensation in the Foot

Cutaneous sensation in the foot is the ability to feel touch, pressure, temperature, and pain on the skin of the foot. Different regions of the foot are innervated by different nerves, which are responsible for transmitting sensory information to the brain. The lateral plantar region is innervated by the sural nerve, while the dorsum (excluding the 1st web space) is innervated by the superficial peroneal nerve. The 1st web space is innervated by the deep peroneal nerve, and the extremities of the toes are innervated by the medial and lateral plantar nerves. The proximal plantar region is innervated by the tibial nerve, while the medial plantar region is innervated by the medial plantar nerve and the lateral plantar region is innervated by the lateral plantar nerve. Understanding the innervation of the foot is important for diagnosing and treating conditions that affect cutaneous sensation in this area.

The correct answer is the long head of biceps brachii, which originates from the supraglenoid tubercle. The coracoid process of the scapula serves as the site of origin for coracobrachialis and the short head of biceps brachii, as well as the site of insertion for pectoralis minor. Additionally, it serves as the attachment site for the coracoclavicular, coracoacromial, and coracohumeral ligaments.

During the Laterjet procedure, a portion of the coracoid process and its attached muscles are removed and repositioned to the front of the glenoid. This helps to prevent dislocation by using the coracoid as a block and reinforcing the front of the shoulder capsule. This procedure is typically performed to treat a bony Bankart lesion, which is a bone lesion in the anterior glenoid fossa that can cause anterior dislocation of the shoulder joint.

The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

The median nerve innervates the abductor pollicis brevis and flexor pollicis brevis muscles. To remember other muscles innervated by the median nerve, use the acronym LOAF for lumbricals (first and second), opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis. De Quervain Syndrome affects the extensor pollicis brevis and abductor pollicis longus muscles. Structures within the carpal tunnel include the flexor digitorum profundus (four tendons), flexor digitorum superficialis (four tendons), flexor pollicis longus, and median nerve.

Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

The deep peroneal nerve is in the front compartment and the tibial nerve is on the inner side. The tibial nerve is located beneath the flexor retinaculum at its end.

Anatomy of the Posterior Tibial Artery

The posterior tibial artery is a major branch of the popliteal artery that terminates by dividing into the medial and lateral plantar arteries. It is accompanied by two veins throughout its length and its position corresponds to a line drawn from the lower angle of the popliteal fossa to a point midway between the medial malleolus and the most prominent part of the heel.

The artery is located anteriorly to the tibialis posterior and flexor digitorum longus muscles, and posteriorly to the surface of the tibia and ankle joint. The posterior tibial nerve is located 2.5 cm distal to its origin. The proximal part of the artery is covered by the gastrocnemius and soleus muscles, while the distal part is covered by skin and fascia. The artery is also covered by the fascia overlying the deep muscular layer.

Understanding the anatomy of the posterior tibial artery is important for medical professionals, as it plays a crucial role in the blood supply to the foot and ankle. Any damage or blockage to this artery can lead to serious complications, such as peripheral artery disease or even amputation.

The correct nerve that is likely injured in a patient with difficulty abducting their arm following a humeral neck fracture is the axillary nerve. This nerve provides motor function to the deltoid muscle, which is responsible for arm abduction at the shoulder joint, and cutaneous sensation to the deltoid region. Proximal humerus fractures, which are common in individuals of the patient’s age and gender, can often result in injury to the axillary nerve.

The brachial plexus is an incorrect answer as injuries to this nerve bundle are rare and would likely result in neurological dysfunction beyond the shoulder. The musculocutaneous nerve is also an incorrect answer as it provides motor function to the anterior compartment of the arm and sensation to the lateral forearm, but not to the deltoid region. The radial nerve is also an incorrect answer as it is typically injured in humeral shaft fractures and would result in wrist drop and paresthesia over the dorsal hand and wrist. The suprascapular nerve is also an incorrect answer as it provides motor innervation to different muscles and sensation to different joints than those affected in this case.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The Antecubital Fossa: Anatomy and Clinical Significance

The antecubital fossa is a depression located on the anterior aspect of the arm, between the arm and forearm. It is an important area for medical professionals as it is where venous blood samples are typically taken from. The borders of the antecubital fossa are the brachioradialis muscle laterally, the pronator teres medially, and a line between the medial and lateral epicondyles superiorly.

There are both deep and superficial structures found in the antecubital fossa. Deep structures include the radial nerve, tendon of the biceps muscle, brachial artery, and medial nerve. Superficial structures consist of a network of veins, including the cephalic vein and basilic vein, which come together as the median cubital vein.

The main clinical relevance of the antecubital fossa is its use for blood sampling and cannulation. However, it is also important to have a working knowledge of the anatomy as structures can become damaged. Excessive straining of the biceps tendon can cause it to rupture, leading to a ‘Popeye sign’. Damage to the medial nerve can also occur, resulting in muscle paralysis in the forearm and hand. Overall, understanding the anatomy and clinical significance of the antecubital fossa is crucial for medical professionals.

The most probable diagnosis for this patient is pseudogout, which is characterized by the deposition of calcium pyrophosphate dihydrate crystals in the synovium, resulting in pain during movement. The knee joint is commonly affected, and the presence of rhomboid-shaped crystals that are positively birefringent in polarised-light microscopy of joint aspirate confirms the diagnosis. Radiography may also reveal chondrocalcinosis.

A fracture would require a history of trauma and would be visible on the radiograph, neither of which is present in this case, making it an unlikely diagnosis.

Reactive arthritis is associated with immune-mediated destruction of the joint, but there is no recent history of diarrhoea, coryza, conjunctivitis, or urethritis, which are commonly associated with this condition. The light microscopy of joint aspirate and radiography findings do not support this diagnosis.

Joint infection typically presents with a hot, swollen joint that rapidly develops after a history of trauma. The joint aspirate would be expected to contain turbid fluid and grow organisms. However, none of these features are present in this patient, making joint infection an unlikely diagnosis.

Understanding Pseudogout

Pseudogout, also known as acute calcium pyrophosphate crystal deposition disease, is a type of microcrystal synovitis that occurs when calcium pyrophosphate dihydrate crystals are deposited in the synovium. This condition is commonly associated with increasing age, but younger patients who develop pseudogout usually have an underlying risk factor such as haemochromatosis, hyperparathyroidism, low magnesium or phosphate levels, acromegaly, or Wilson’s disease.

The knee, wrist, and shoulders are the most commonly affected joints in pseudogout. Diagnosis is made through joint aspiration, which reveals weakly-positively birefringent rhomboid-shaped crystals, and x-rays, which show chondrocalcinosis. In the knee, linear calcifications of the meniscus and articular cartilage can be seen.

Management of pseudogout involves joint fluid aspiration to rule out septic arthritis, followed by treatment with NSAIDs or intra-articular, intra-muscular, or oral steroids, similar to the treatment for gout. Understanding the risk factors and symptoms of pseudogout can help with early diagnosis and effective management of this condition.

Infliximab targets TNF through its monoclonal antibody action, while rituximab targets CD20, cetuximab acts as an antagonist to epidermal growth factor receptor, alemtuzumab targets CD52, and OKT3 targets CD3.

Understanding Tumour Necrosis Factor and its Inhibitors

Tumour necrosis factor (TNF) is a cytokine that plays a crucial role in the immune system. It is mainly secreted by macrophages and has various effects on the immune system, such as activating macrophages and neutrophils, acting as a costimulator for T cell activation, and mediating the body’s response to Gram-negative septicaemia. TNF also has anti-tumour effects and binds to both the p55 and p75 receptor, inducing apoptosis and activating NFkB.

TNF has endothelial effects, including increased expression of selectins and production of platelet activating factor, IL-1, and prostaglandins. It also promotes the proliferation of fibroblasts and their production of protease and collagenase. TNF inhibitors are used to treat inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Examples of TNF inhibitors include infliximab, etanercept, adalimumab, and golimumab.

Infliximab is also used to treat active Crohn’s disease unresponsive to steroids. However, TNF blockers can have adverse effects such as reactivation of latent tuberculosis and demyelination. Understanding TNF and its inhibitors is crucial in the treatment of various inflammatory conditions.

The Koebner phenomenon is a term used to describe the appearance of skin lesions at the site of injury. Patients with a history of psoriasis and recent skin trauma are at risk of developing this phenomenon, which can also occur in individuals with other skin conditions like warts and vitiligo. Lichen planus is another condition where the Koebner phenomenon is observed. In contrast, the Nikolsky phenomenon is a dermatological phenomenon seen in pemphigus vulgaris, where the epidermis can be moved over the dermis upon palpation. Psoriatic arthritis is a type of arthritis that affects some individuals with psoriasis, causing joint inflammation, pain, stiffness, and swelling.

The Koebner Phenomenon: Skin Lesions at the Site of Injury

The Koebner phenomenon refers to the occurrence of skin lesions at the site of injury. This phenomenon is commonly observed in various skin conditions such as psoriasis, vitiligo, warts, lichen planus, lichen sclerosus, and molluscum contagiosum. In other words, if a person with any of these skin conditions experiences trauma or injury to their skin, they may develop new lesions in the affected area.

This phenomenon is named after Heinrich Koebner, a German dermatologist who first described it in 1876. The exact mechanism behind the Koebner phenomenon is not fully understood, but it is believed to be related to the immune system’s response to injury. In some cases, the injury may trigger an autoimmune response, leading to the development of new lesions.

The Koebner phenomenon can be a frustrating and challenging aspect of managing skin conditions. It is important for individuals with these conditions to take precautions to avoid injury to their skin, such as wearing protective clothing or avoiding activities that may cause trauma. Additionally, prompt treatment of any new lesions that develop can help prevent further spread of the condition.

To reach the cerebrospinal fluid in the subarachnoid space during a mid-line approach to a spinal anaesthetic, the needle must pass through three ligaments and two meningeal layers. These include the supraspinatus ligament, interspinous ligament, ligamentum flavum, epidural space, subdural space, and subarachnoid space. Local anaesthetics, such as bupivacaine with or without opioids, are injected into the CSF to block Na+ channels and inhibit the action potential. This can reduce surgical stress and sympathetic stimulation in high-risk patients, but may also lead to vasodilation and hypotension. Spinal anaesthesia may be contraindicated in patients with coagulopathy, severe hypovolemia, increased intracranial pressure, severe aortic or mitral stenosis, or infection over the overlying skin.

Anatomy of the Vertebral Column

The vertebral column is composed of 33 vertebrae, which are divided into four regions: cervical, thoracic, lumbar, and sacral. The cervical region has seven vertebrae, the thoracic region has twelve, the lumbar region has five, and the sacral region has five. However, the spinal cord segmental levels do not always correspond to the vertebral segments. For example, the C8 cord is located at the C7 vertebrae, and the T12 cord is situated at the T8 vertebrae.

The cervical vertebrae are located in the neck and are responsible for controlling the muscles of the upper extremities. The C3 cord contains the phrenic nucleus, which controls the diaphragm. The thoracic vertebrae are defined by those that have a rib and control the intercostal muscles and associated dermatomes. The lumbosacral vertebrae are located in the lower back and control the hip and leg muscles, as well as the buttocks and anal regions.

The spinal cord ends at the L1-L2 vertebral level, and below this level is a spray of spinal roots called the cauda equina. Injuries below L2 represent injuries to spinal roots rather than the spinal cord proper. Understanding the anatomy of the vertebral column is essential for diagnosing and treating spinal cord injuries and other related conditions.

To memorize the nerve roots and their corresponding reflexes:

1-2: Ankle reflex (S1-S2)
3-4: Knee reflex (L3-L4)
5-6: Biceps reflex (C5-C6)
7-8: Triceps reflex (C7-C8)

It’s important to note that the radial nerve provides innervation to all three heads of the triceps muscle, with a distinct branch to each head.

Anatomy of the Triceps Muscle

The triceps muscle is a large muscle located on the back of the upper arm. It is composed of three heads: the long head, lateral head, and medial head. The long head originates from the infraglenoid tubercle of the scapula, while the lateral head originates from the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve. The medial head originates from the posterior surface of the humerus on the inferomedial side of the radial groove and both of the intermuscular septae.

All three heads of the triceps muscle insert into the olecranon process of the ulna, with some fibers inserting into the deep fascia of the forearm and the posterior capsule of the elbow. The triceps muscle is innervated by the radial nerve and supplied with blood by the profunda brachii artery.

The primary action of the triceps muscle is elbow extension. The long head can also adduct the humerus and extend it from a flexed position. The radial nerve and profunda brachii vessels lie between the lateral and medial heads of the triceps muscle. Understanding the anatomy of the triceps muscle is important for proper diagnosis and treatment of injuries or conditions affecting this muscle.

The lunate is positioned towards the middle in the anatomical plane. Injuries that involve high velocity and result in scaphoid fractures may also lead to dislocation of the lunate.

The scaphoid bone has various articular surfaces for different bones in the wrist. It has a concave surface for the head of the capitate and a crescentic surface for the lunate. The proximal end has a wide convex surface for the radius, while the distal end has a tubercle that can be felt. The remaining articular surface faces laterally and is associated with the trapezium and trapezoid bones. The narrow strip between the radial and trapezial surfaces and the tubercle gives rise to the radial collateral carpal ligament. The tubercle also receives part of the flexor retinaculum and is the only part of the scaphoid bone that allows for the entry of blood vessels. However, this area is commonly fractured and can lead to avascular necrosis.

P-GO-GO-Q is a mnemonic for remembering the lateral hip rotators in order from top to bottom: Piriformis, Gemellus superior, Obturator internus, Gemellus inferior, Obturator externus, and Quadratus femoris.

Anatomy of the Hip Joint

The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

The carpal tunnel only allows the median nerve to pass through it, providing sensory innervation to the palmar aspect of the thumb, index, middle, and radial aspect of the ring finger. If the median nerve is damaged, it can also cause weakness in wrist flexion.

If any of the other nerves are affected, they would cause different patterns of sensory disturbance. For example, an ulnar nerve palsy would typically cause paresthesia on the ulnar half of the ring finger, the entire little finger, and the dorsal medial (ulnar) aspect of the hand. A radial nerve palsy would cause paresthesia on the dorsal lateral (radial) aspect of the hand, but not beyond the metacarpal-phalangeal joint. An axillary nerve palsy would only cause paresthesia in the deltoid area and not affect the sensation in the hands. Finally, a musculocutaneous nerve palsy would cause paresthesia along the lateral aspect of the forearm, but the sensation in the hand would remain intact.

Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

Dermatomyositis is characterized by muscle weakness, muscle pain, and a skin rash, and is often associated with the anti-Jo-1 antibody. The weakness typically affects proximal muscles and can even impact breathing, while systemic symptoms may include dysphagia, arrhythmias, and joint calcifications. One key feature to look out for is the heliotrope rash, which is a purple discoloration often seen in dermatomyositis cases.

There are several other antibodies that can be associated with dermatomyositis, such as ANA, anti M2, and anti-Jo1. However, anti-Jo-1 is more commonly found in polymyositis, although it can also be present in dermatomyositis cases.

Other antibodies that are associated with different autoimmune conditions include anti-smooth muscle antibody (autoimmune hepatitis), anti-histone (drug-induced lupus), and anti Scl-70 (scleroderma).

Understanding Dermatomyositis

Dermatomyositis is a condition that causes inflammation and weakness in the muscles, as well as distinct skin lesions. It can occur on its own or be associated with other connective tissue disorders or underlying malignancies. Patients with dermatomyositis may experience symmetrical, proximal muscle weakness, and photosensitive skin rashes. The skin lesions may include a macular rash over the back and shoulders, a heliotrope rash in the periorbital region, Gottron’s papules, and mechanic’s hands. Other symptoms may include Raynaud’s, respiratory muscle weakness, interstitial lung disease, dysphagia, and dysphonia.

To diagnose dermatomyositis, doctors may perform various tests, including screening for underlying malignancies. The majority of patients with dermatomyositis are ANA positive, and around 30% have antibodies to aminoacyl-tRNA synthetases, such as anti-synthetase antibodies, antibodies against histidine-tRNA ligase (Jo-1), antibodies to signal recognition particle (SRP), and anti-Mi-2 antibodies.

In summary, dermatomyositis is a condition that affects both the muscles and skin. It can be associated with other disorders or malignancies, and patients may experience a range of symptoms. Proper diagnosis and management are essential for improving outcomes and quality of life for those with dermatomyositis.

Understanding the Rotator Cuff Muscles

The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

Only the abductor pollicis brevis is innervated by the median nerve, while the other muscles are innervated by different nerves. It is important to be careful not to confuse the terms adductor and abductor when discussing muscle innervation.

Abductor Pollicis Brevis: Anatomy and Function

The abductor pollicis brevis is a muscle located in the palm of the hand. It originates from the flexor retinaculum, scaphoid, and trapezium bones and inserts into the radial side of the proximal phalanx of the thumb via a short tendon. The muscle is innervated by the recurrent branch of the median nerve in the palm.

The main function of the abductor pollicis brevis is to abduct the thumb at the carpometacarpal and metacarpophalangeal joints. This causes the thumb to move anteriorly at right angles to the plane of the palm and to rotate medially, which is useful for activities such as typing. When the thumb is fully abducted, there is an angulation of around 30 degrees between the proximal phalanx and the metacarpal.

Abduction of the thumb involves medial rotation of the metacarpal, and the abductor pollicis brevis is used along with the opponens pollicis in the initial stages of thumb opposition. Overall, the abductor pollicis brevis plays an important role in the movement and function of the thumb.

Most rotator cuff muscles insert into the greater tuberosity, except for subscapularis which inserts into the lesser tuberosity.

The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

The cuboid bone is situated on the outer side of the foot, positioned between the heel bone at the back and the fourth and fifth toe bones towards the front.

The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

The spinous process is created by the fusion of two laminae at the back.

Anatomy of the Vertebral Column

The vertebral column is composed of 33 vertebrae, which are divided into four regions: cervical, thoracic, lumbar, and sacral. The cervical region has seven vertebrae, the thoracic region has twelve, the lumbar region has five, and the sacral region has five. However, the spinal cord segmental levels do not always correspond to the vertebral segments. For example, the C8 cord is located at the C7 vertebrae, and the T12 cord is situated at the T8 vertebrae.

The cervical vertebrae are located in the neck and are responsible for controlling the muscles of the upper extremities. The C3 cord contains the phrenic nucleus, which controls the diaphragm. The thoracic vertebrae are defined by those that have a rib and control the intercostal muscles and associated dermatomes. The lumbosacral vertebrae are located in the lower back and control the hip and leg muscles, as well as the buttocks and anal regions.

The spinal cord ends at the L1-L2 vertebral level, and below this level is a spray of spinal roots called the cauda equina. Injuries below L2 represent injuries to spinal roots rather than the spinal cord proper. Understanding the anatomy of the vertebral column is essential for diagnosing and treating spinal cord injuries and other related conditions.

The correct location of the sternal angle, also known as the angle of Louis, is at the lower border of the T4 vertebrae. While some sources may state that it lies between the 4th and 5th intercostal space, this still does not make the third answer correct as the sternal angle would then be located between the lower border of the 4th vertebrae and the upper border of the 5th vertebrae, which are the boundaries of the intercostal space between the two vertebral planes.

The sternal angle is a significant anatomical landmark located at the level of the upper sternum and manubrium. It is characterized by several structures, including the upper part of the manubrium, left brachiocephalic vein, brachiocephalic artery, left common carotid, left subclavian artery, lower part of the manubrium, and costal cartilages of the 2nd ribs. Additionally, the sternal angle marks the transition point between the superior and inferior mediastinum, and is also associated with the arch of the aorta, tracheal bifurcation, union of the azygos vein and superior vena cava, and the crossing of the thoracic duct to the midline. Overall, the sternal angle is a crucial anatomical structure that serves as a reference point for various medical procedures and diagnoses.

The anterior tibial artery continues as the dorsalis pedis.

The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

To recall the attachments of the ACL, one can imagine placing their hand in their pocket and moving from the superolateral to inferomedial direction. Conversely, for the PCL, the movement would be from inferolateral to superomedial.

The ACL originates from the medial surface of the lateral condyle, while the PCL originates from the lateral surface of the medial condyle.

Located in the medial compartment of the knee, beneath the medial condyle of the femur, is the medial meniscus.

The knee joint is the largest and most complex synovial joint in the body, consisting of two condylar joints between the femur and tibia and a sellar joint between the patella and femur. The degree of congruence between the tibiofemoral articular surfaces is improved by the presence of the menisci, which compensate for the incongruence of the femoral and tibial condyles. The knee joint is divided into two compartments: the tibiofemoral and patellofemoral compartments. The fibrous capsule of the knee joint is a composite structure with contributions from adjacent tendons, and it contains several bursae and ligaments that provide stability to the joint. The knee joint is supplied by the femoral, tibial, and common peroneal divisions of the sciatic nerve and by a branch from the obturator nerve, while its blood supply comes from the genicular branches of the femoral artery, popliteal, and anterior tibial arteries.

The posterior tibial artery is responsible for supplying oxygenated blood to the posterior compartment of the leg as well as the plantar surface of the foot.

Anatomy of the Posterior Tibial Artery

The posterior tibial artery is a major branch of the popliteal artery that terminates by dividing into the medial and lateral plantar arteries. It is accompanied by two veins throughout its length and its position corresponds to a line drawn from the lower angle of the popliteal fossa to a point midway between the medial malleolus and the most prominent part of the heel.

The artery is located anteriorly to the tibialis posterior and flexor digitorum longus muscles, and posteriorly to the surface of the tibia and ankle joint. The posterior tibial nerve is located 2.5 cm distal to its origin. The proximal part of the artery is covered by the gastrocnemius and soleus muscles, while the distal part is covered by skin and fascia. The artery is also covered by the fascia overlying the deep muscular layer.

Understanding the anatomy of the posterior tibial artery is important for medical professionals, as it plays a crucial role in the blood supply to the foot and ankle. Any damage or blockage to this artery can lead to serious complications, such as peripheral artery disease or even amputation.

When the brachialis muscle contracts, it aids in elbow flexion by inserting some of its fibers into the fibrous joint of the elbow capsule.

Anatomy of the Elbow Joint

The elbow joint is a large synovial hinge joint that connects the bones of the forearm to the lower end of the humerus. It consists of the humeral articular surface, which comprises the grooved trochlea, the spheroidal capitulum, and the sulcus between them, and the ulnar and radial surfaces. The joint is encased within a fibrous capsule that is relatively weak anteriorly and posteriorly but strengthened at the sides to form the radial and ulnar collateral ligaments. The synovial membrane follows the attachments of the fibrous capsule, and the joint is innervated by the musculocutaneous, median, radial, and ulnar nerves.

Movement occurs around a transverse axis, with flexion occurring when the forearm makes anteriorly a diminishing angle with the upper arm and extension when the opposite occurs. The axis of movement passes through the humeral epicondyles and is not at right angles with either the humerus or bones of the forearm. In full extension with the forearm supinated, the arm and forearm form an angle which is more than 180 degrees, the extent to which this angle is exceeded is termed the carrying angle. The carrying angle is masked when the forearm is pronated.

Anatomy of the Lateral Malleolus

The lateral malleolus is a bony prominence on the outer side of the ankle joint. Posterior to the lateral malleolus and superficial to the superior peroneal retinaculum are the sural nerve and short saphenous vein. These structures are important for sensation and blood flow to the lower leg and foot.

On the other hand, posterior to the lateral malleolus and deep to the superior peroneal retinaculum are the peroneus longus and peroneus brevis tendons. These tendons are responsible for ankle stability and movement.

Additionally, the calcaneofibular ligament is attached at the lateral malleolus. This ligament is important for maintaining the stability of the ankle joint and preventing excessive lateral movement.

Understanding the anatomy of the lateral malleolus is crucial for diagnosing and treating ankle injuries and conditions. Proper care and management of these structures can help prevent long-term complications and improve overall ankle function.

The risk of myelosuppression can be reduced by prescribing folate along with methotrexate, as folate supplements can counteract the inhibition of folate caused by methotrexate. This is important because methotrexate targets fast-dividing cells by preventing DNA, RNA, and protein synthesis, and the cells in the bone marrow are heavily reliant on folate due to their rapid division.

Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

Systemic lupus erythematosus (SLE) is a connective tissue disorder that is more common in females and typically arises between the ages of 20 and 40. SLE can cause a range of symptoms, including a malar facial rash, arthritis, pericarditis, pleuritis, kidney disease, and neurological and psychiatric symptoms. SLE is thought to occur due to autoimmune attack against intracellular substances, such as double stranded DNA, ribonucleoproteins, histones, and phospholipids. SLE patients may release greater levels of intracellular substances due to low levels of complement factor 4 (C4), which prevents their clearance by macrophages. Anti-double stranded DNA antibodies are a specific marker of SLE, but their absence does not rule out the condition. Antibodies against citrullinated proteins are uncommon in SLE and are more commonly seen in rheumatoid arthritis. Anticentromere antibodies are rarely produced in SLE patients and are usually detected in patients with CREST syndrome. The body has high tolerance to its own cell surface proteins, including Class 1 Major Histocompatibility Complexes (MHCs), which present foreign antigens on the surfaces of cells to natural killer cells, T- and B-lymphocytes.

Understanding Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease that is much more common in females, with a ratio of 9:1 compared to males. It is also more prevalent in Afro-Caribbeans and Asian communities. The onset of SLE usually occurs between the ages of 20-40 years, and its incidence has risen substantially over the past 50 years. SLE is considered a type 3 hypersensitivity reaction and is associated with HLA B8, DR2, and DR3.

The pathophysiology of SLE is characterized by immune system dysregulation, leading to immune complex formation. These immune complexes can deposit in any organ, including the skin, joints, kidneys, and brain. It is important to note that the incidence of SLE in black Africans is much lower than in black Americans, and the reasons for this are unclear.

In summary, SLE is a complex autoimmune disease that affects multiple organs and is more common in females and certain ethnic groups. Understanding the pathophysiology of SLE is crucial in developing effective treatments and improving patient outcomes.

The structures passing through the lesser and greater sciatic foramina, from medial to lateral, are the pudendal nerve, internal pudendal artery, and nerve to obturator internus. The pudendal nerve originates from the ventral rami of the second, third, and fourth sacral nerves and passes through the greater sciatic foramen before crossing the spine of the ischium and reentering the pelvis through the lesser sciatic foramen. It gives off the inferior rectal nerves and terminates into the perineal nerve and the dorsal nerve of the penis or clitoris.

The Greater Sciatic Foramen and its Contents

The greater sciatic foramen is a space in the pelvis that is bounded by various ligaments and bones. It serves as a passageway for several important structures, including nerves and blood vessels. The piriformis muscle is a landmark for identifying these structures as they pass through the sciatic notch. Above the piriformis muscle, the superior gluteal vessels can be found, while below it are the inferior gluteal vessels, the sciatic nerve (which passes through it in only 10% of cases), and the posterior cutaneous nerve of the thigh.

The boundaries of the greater sciatic foramen include the greater sciatic notch of the ilium, the sacrotuberous ligament, the sacrospinous ligament, and the ischial spine. The anterior sacroiliac ligament forms the superior boundary. Structures passing through the greater sciatic foramen include the pudendal nerve, the internal pudendal artery, and the nerve to the obturator internus.

In contrast, the lesser sciatic foramen is a smaller space that contains the tendon of the obturator internus, the pudendal nerve, the internal pudendal artery and vein, and the nerve to the obturator internus. Understanding the contents and boundaries of these foramina is important for clinicians who may need to access or avoid these structures during surgical procedures or other interventions.

The thyrocervical trunk gives rise to the inferior thyroid artery, which is a derivative of the subclavian artery.

Anatomy of the Thyroid Gland

The thyroid gland is a butterfly-shaped gland located in the neck, consisting of two lobes connected by an isthmus. It is surrounded by a sheath from the pretracheal layer of deep fascia and is situated between the base of the tongue and the fourth and fifth tracheal rings. The apex of the thyroid gland is located at the lamina of the thyroid cartilage, while the base is situated at the fourth and fifth tracheal rings. In some individuals, a pyramidal lobe may extend from the isthmus and attach to the foramen caecum at the base of the tongue.

The thyroid gland is surrounded by various structures, including the sternothyroid, superior belly of omohyoid, sternohyoid, and anterior aspect of sternocleidomastoid muscles. It is also related to the carotid sheath, larynx, trachea, pharynx, oesophagus, cricothyroid muscle, and parathyroid glands. The superior and inferior thyroid arteries supply the thyroid gland with blood, while the superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid vein drains into the brachiocephalic veins.

In summary, the thyroid gland is a vital gland located in the neck, responsible for producing hormones that regulate metabolism. Its anatomy is complex, and it is surrounded by various structures that are essential for its function. Understanding the anatomy of the thyroid gland is crucial for the diagnosis and treatment of thyroid disorders.

If the superior gluteal nerve is damaged, it can result in a positive Trendelenburg sign. This nerve is responsible for providing innervation to the gluteus minimus and gluteus medius muscles, which are important for abducting and medially rotating the lower limb, as well as preventing pelvic drop of the opposing limb. For example, when standing on only the right leg, the right gluteus minimus and gluteus medius muscles stabilize the pelvis. However, if the right superior gluteal nerve is damaged, the right gluteus minimus and gluteus medius muscles will not receive proper innervation, leading to instability and a drop in the left pelvis when standing on the right leg. On the other hand, the inferior gluteal nerve innervates the gluteus maximus muscles, which are responsible for extending the thigh and performing lateral rotation.

The Trendelenburg Test: Assessing Gluteal Nerve Function

The Trendelenburg test is a diagnostic tool used to assess the function of the superior gluteal nerve. This nerve is responsible for the contraction of the gluteus medius muscle, which is essential for maintaining balance and stability while standing on one leg.

When the superior gluteal nerve is injured or damaged, the gluteus medius muscle is weakened, resulting in a compensatory shift of the body towards the unaffected side. This shift is characterized by a gravitational shift, which causes the body to be supported on the unaffected limb.

To perform the Trendelenburg test, the patient is asked to stand on one leg while the physician observes the position of the pelvis. In a healthy individual, the gluteus medius muscle contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from dipping towards the unsupported side. However, in a person with paralysis of the superior gluteal nerve, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non-functional. This is known as a positive Trendelenburg test.

It is important to note that the Trendelenburg test is also used in vascular investigations to determine the presence of saphenofemoral incompetence. In this case, tourniquets are placed around the upper thigh to assess blood flow. However, in the context of assessing gluteal nerve function, the Trendelenburg test is a valuable tool for diagnosing and treating motor deficits and gait abnormalities.

Ankylosing spondylitis is a condition that typically affects young men and causes lower back pain and stiffness that is worse in the mornings. It is a type of seronegative spondyloarthropathy that leads to inflammation of the lower axial skeleton. Sacroiliitis, which is inflammation of the sacroiliac joints, is a common sign on x-ray. Unlike many other rheumatological conditions, ankylosing spondylitis is more prevalent in men than women.

Intervertebral disc herniation is not the correct answer. This condition typically causes back pain and dermatomal leg pain that does not improve throughout the day or with exercise. It is usually caused by an injury rather than developing gradually without a clear cause.

Reactive arthritis is also an incorrect answer. This is another type of seronegative spondyloarthropathy that occurs after exposure to certain gastrointestinal and genitourinary infections, such as Chlamydia, Salmonella, and Campylobacter jejuni.

Rheumatoid arthritis is also not the correct answer. This is a chronic inflammatory condition that causes inflammation of the synovial tissue and is more common in women. It typically presents with symmetrical, polyarticular arthritis of the small joints.

Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more commonly seen in young males, with a sex ratio of 3:1, and typically presents with lower back pain and stiffness that develops gradually. The stiffness is usually worse in the morning and improves with exercise, while the patient may experience night pain that improves upon getting up.

Clinical examination of patients with ankylosing spondylitis may reveal reduced lateral and forward flexion, as well as reduced chest expansion. The Schober’s test, which involves drawing a line 10 cm above and 5 cm below the back dimples and measuring the distance between them when the patient bends forward, may also be used to assess the condition. Other features associated with ankylosing spondylitis include apical fibrosis, anterior uveitis, aortic regurgitation, Achilles tendonitis, AV node block, amyloidosis, cauda equina syndrome, and peripheral arthritis (which is more common in females).

Structures Passing Posterior to the Medial Malleolus

The medial malleolus is a bony prominence on the inner side of the ankle joint. Several important structures pass posterior to it, including the tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, tibial nerve, and tendon of flexor hallucis longus.

The tibialis posterior tendon is responsible for plantar flexion and inversion of the foot, while the flexor digitorum longus tendon helps to flex the toes. The posterior tibial artery supplies blood to the foot and ankle, while the tibial nerve provides sensation and motor function to the muscles of the lower leg and foot. Finally, the tendon of flexor hallucis longus helps to flex the big toe.

It is important to be aware of these structures when performing any procedures or surgeries in the area, as damage to them can result in significant complications. Understanding the anatomy of the ankle and foot can also help in the diagnosis and treatment of various conditions affecting these structures.

Bisphosphonates, particularly alendronate, are the recommended treatment for fragility fractures in postmenopausal women. Additionally, calcium and vitamin D supplementation should be considered, along with lifestyle advice on nutrition, exercise, and fall prevention.

Bisphosphonates: Uses, Adverse Effects, and Patient Counselling

Bisphosphonates are drugs that mimic the action of pyrophosphate, a molecule that helps prevent bone demineralization. They work by inhibiting osteoclasts, the cells responsible for breaking down bone tissue. Bisphosphonates are commonly used to prevent and treat osteoporosis, hypercalcemia, Paget’s disease, and pain from bone metastases.

However, bisphosphonates can cause adverse effects such as oesophageal reactions, osteonecrosis of the jaw, and an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate. Patients may also experience an acute phase response, which includes fever, myalgia, and arthralgia following administration. Hypocalcemia may also occur due to reduced calcium efflux from bone, but this is usually clinically unimportant.

To minimize the risk of adverse effects, patients taking oral bisphosphonates should swallow the tablets whole with plenty of water while sitting or standing. They should take the medication on an empty stomach at least 30 minutes before breakfast or another oral medication and remain upright for at least 30 minutes after taking the tablet. Hypocalcemia and vitamin D deficiency should be corrected before starting bisphosphonate treatment. However, calcium supplements should only be prescribed if dietary intake is inadequate when starting bisphosphonate treatment for osteoporosis. Vitamin D supplements are usually given.

The duration of bisphosphonate treatment varies depending on the level of risk. Some experts recommend stopping bisphosphonates after five years if the patient is under 75 years old, has a femoral neck T-score of more than -2.5, and is at low risk according to FRAX/NOGG.

Dermoid cysts are remnants from embryonic development and can be lined with hair and squamous epithelium, similar to teratomas. They are typically found in the midline and may be connected to deeper structures, resulting in a dumbbell-shaped lesion. Complete removal is necessary as they have a tendency to recur locally if not completely excised.

On the other hand, desmoid tumors are distinct from dermoid cysts. They usually develop in ligaments and tendons and are also known as aggressive fibromatosis. These tumors consist of dense fibroblasts, resembling scar tissue. Treatment for desmoid tumors should be similar to that of soft tissue sarcomas.

Skin Diseases

Skin diseases can be classified into malignant and non-malignant conditions. Malignant skin diseases include basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and Kaposi sarcoma. Basal cell carcinoma is the most common form of skin cancer and typically occurs on sun-exposed areas. Squamous cell carcinoma may arise from pre-existing solar keratoses and can metastasize if left untreated. Malignant melanoma is characterized by changes in size, shape, and color and requires excision biopsy for diagnosis. Kaposi sarcoma is a tumor of vascular and lymphatic endothelium and is associated with immunosuppression.

Non-malignant skin diseases include dermatitis herpetiformis, dermatofibroma, pyogenic granuloma, and acanthosis nigricans. Dermatitis herpetiformis is a chronic itchy condition linked to underlying gluten enteropathy. Dermatofibroma is a benign lesion usually caused by trauma and consists of histiocytes, blood vessels, and fibrotic changes. Pyogenic granuloma is an overgrowth of blood vessels that may mimic amelanotic melanoma. Acanthosis nigricans is characterized by brown to black hyperpigmentation of the skin and is commonly caused by insulin resistance. In the context of a malignant disease, it is referred to as acanthosis nigricans maligna.

In summary, skin diseases can range from benign to malignant conditions. It is important to seek medical attention for any suspicious skin lesions or changes in the skin’s appearance. Early diagnosis and treatment can improve outcomes and prevent complications.

The Sartorius Muscle: Anatomy and Function

The sartorius muscle is the longest strap muscle in the human body and is located in the anterior compartment of the thigh. It is the most superficial muscle in this region and has a unique origin and insertion. The muscle originates from the anterior superior iliac spine and inserts on the medial surface of the body of the tibia, anterior to the gracilis and semitendinosus muscles. The sartorius muscle is innervated by the femoral nerve (L2,3).

The primary action of the sartorius muscle is to flex the hip and knee, while also slightly abducting the thigh and rotating it laterally. It also assists with medial rotation of the tibia on the femur, which is important for movements such as crossing one leg over the other. The middle third of the muscle, along with its strong underlying fascia, forms the roof of the adductor canal. This canal contains important structures such as the femoral vessels, the saphenous nerve, and the nerve to vastus medialis.

In summary, the sartorius muscle is a unique muscle in the anterior compartment of the thigh that plays an important role in hip and knee flexion, thigh abduction, and lateral rotation. Its location and relationship to the adductor canal make it an important landmark for surgical procedures in the thigh region.

Salmonella is the most common infecting organism in children with osteomyelitis worldwide.

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 in the bloodstream and is usually monomicrobial. It is more common in children and can be caused by risk factors such as sickle cell anaemia, intravenous drug use, immunosuppression, and infective endocarditis. On the other hand, non-haematogenous osteomyelitis is caused by 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 are more prevalent. To diagnose osteomyelitis, MRI is the imaging modality of choice, with a sensitivity of 90-100%.

The treatment for osteomyelitis involves a course of antibiotics for six weeks. Flucloxacillin is the preferred antibiotic, but clindamycin can be used for patients who are allergic to penicillin. Understanding the types, causes, and treatment of osteomyelitis is crucial in managing this bone infection.

The muscles located in the deep posterior compartment are:

Muscular Compartments of the Lower Limb

The lower limb is composed of different muscular compartments that perform various actions. The anterior compartment includes the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus muscles. These muscles are innervated by the deep peroneal nerve and are responsible for dorsiflexing the ankle joint, inverting and evert the foot, and extending the toes.

The peroneal compartment, on the other hand, consists of the peroneus longus and peroneus brevis muscles, which are innervated by the superficial peroneal nerve. These muscles are responsible for eversion of the foot and plantar flexion of the ankle joint.

The superficial posterior compartment includes the gastrocnemius and soleus muscles, which are innervated by the tibial nerve. These muscles are responsible for plantar flexion of the foot and may also flex the knee.

Lastly, the deep posterior compartment includes the flexor digitorum longus, flexor hallucis longus, and tibialis posterior muscles, which are innervated by the tibial nerve. These muscles are responsible for flexing the toes, flexing the great toe, and plantar flexion and inversion of the foot, respectively.

Understanding the muscular compartments of the lower limb is important in diagnosing and treating injuries and conditions that affect these muscles. Proper identification and management of these conditions can help improve mobility and function of the lower limb.

Ankylosing spondylitis is associated with the HLA-B27 serotype, with approximately 90% of patients with the condition testing positive for it. Adrenal 21-hydroxylase deficiency is thought to be linked to HLA-B47, while HLA-DQ2 is associated with coeliac disease and the development of autoimmune diseases. HLA-DR4 is primarily linked to rheumatoid arthritis, while HLA-DR2 is associated with systemic lupus erythematosus, multiple sclerosis, and leprosy, but not ankylosing spondylitis.

Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more common in males aged 20-30 years old. Inflammatory markers such as ESR and CRP are often elevated, but normal levels do not rule out ankylosing spondylitis. HLA-B27 is not very useful in making the diagnosis as it is positive in 90% of patients with ankylosing spondylitis and 10% of normal patients. The most useful diagnostic tool is a plain x-ray of the sacroiliac joints, which may show subchondral erosions, sclerosis, squaring of lumbar vertebrae, bamboo spine, and syndesmophytes. If the x-ray is negative but suspicion for AS remains high, an MRI may be obtained to confirm the diagnosis. Spirometry may show a restrictive defect due to pulmonary fibrosis, kyphosis, and ankylosis of the costovertebral joints.

Management of ankylosing spondylitis includes regular exercise such as swimming, NSAIDs as first-line treatment, physiotherapy, and disease-modifying drugs such as sulphasalazine if there is peripheral joint involvement. Anti-TNF therapy such as etanercept and adalimumab may be given to patients with persistently high disease activity despite conventional treatments, according to the 2010 EULAR guidelines. Research is ongoing to determine whether anti-TNF therapies should be used earlier in the course of the disease.

The primary neurovascular structure that can be affected by a scaphoid fracture is the dorsal carpal branch of the radial artery. This artery is responsible for supplying blood to the scaphoid bone, and a fracture can lead to a high risk of avascular necrosis in the proximal pole of the bone. Symptoms of a scaphoid fracture include tenderness in the anatomical snuffbox, pain when compressing the thumb longitudinally, and a loss of grip strength. While an X-ray may not provide a conclusive diagnosis, further imaging studies can confirm the presence of an occult fracture.

The other answer choices are incorrect. The common digital arteries originate from the superficial palmar arch and supply the fingers. The deep palmar arch primarily supplies the thumb and index finger. The proper digital arteries arise from the common digital arteries and supply the fingers.

A scaphoid fracture is a type of wrist fracture that usually occurs when a person falls onto an outstretched hand or during contact sports. It is important to identify scaphoid fractures as they can lead to avascular necrosis due to the unusual blood supply of the scaphoid bone. Patients with scaphoid fractures typically experience pain along the radial aspect of the wrist and loss of grip or pinch strength. Clinical examination involves checking for tenderness over the anatomical snuffbox, wrist joint effusion, pain on telescoping of the thumb, tenderness of the scaphoid tubercle, and pain on ulnar deviation of the wrist. Plain film radiographs and scaphoid views are used to diagnose scaphoid fractures, but MRI is considered the definitive investigation. Initial management involves immobilization with a splint or backslab and referral to orthopaedics. Orthopaedic management depends on the type of fracture, with undisplaced fractures typically treated with a cast and displaced fractures requiring surgical fixation. Complications of scaphoid fractures include non-union and avascular necrosis.

Adhesive capsulitis is identified by a decrease in shoulder mobility, both when moving the shoulder voluntarily and when it is moved by someone else. The ability to rotate the shoulder outward is more affected than the ability to rotate it inward or lift it away from the body.

On the other hand, a tear in the rotator cuff muscles will result in a reduction in active movement due to muscle weakness. Passive movement may also be restricted due to pain. However, we would not anticipate a rigid joint that opposes passive movement.

Adhesive capsulitis, also known as frozen shoulder, is a common cause of shoulder pain that is more prevalent in middle-aged women. The exact cause of this condition is not fully understood. It is associated with diabetes mellitus, with up to 20% of diabetics experiencing an episode of frozen shoulder. Symptoms typically develop over a few days and affect external rotation more 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. Bilateral frozen shoulder occurs in up to 20% of patients, and the episode typically lasts between 6 months and 2 years.

The diagnosis of frozen shoulder is usually made based on clinical presentation, although imaging may be necessary for atypical or persistent symptoms. There is no single intervention that has been proven to improve long-term outcomes. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, oral corticosteroids, and intra-articular corticosteroids. It is important to note that the management of frozen shoulder should be tailored to the individual patient, and a multidisciplinary approach may be necessary for optimal outcomes.

The flexor digitorum superficialis and flexor digitorum profundus muscles are accountable for inducing flexion. The tendons of the superficialis muscle attach to the bases of the middle phalanges, while the tendons of the profundus muscle attach to the bases of the distal phalanges. Both tendons are responsible for flexing the wrist, MCP, and PIP joints, but only the tendons of the profundus muscle are responsible for flexing the DIP joints.

Anatomy of the Hand: Fascia, Compartments, and Tendons

The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

The patient’s lab results suggest that they have osteomalacia, a condition caused by vitamin D deficiency that results in weak and soft bones. This deficiency leads to poor absorption of calcium in the gastrointestinal tract, which causes low serum calcium levels. In response, the body produces more parathyroid hormone (PTH) to compensate, which lowers serum phosphate levels and increases alkaline phosphatase (ALP) due to increased osteoclast activity.

Osteoporosis also causes weak bones, but it is not a metabolic disease and does not affect electrolyte and hormone levels. Paget’s disease, on the other hand, is characterized by bone pain and abnormal bone growth, but typically has normal calcium, phosphate, and PTH levels. Primary hyperparathyroidism causes high PTH levels, leading to high serum calcium and low serum phosphate levels, and can cause bone pain and fractures. Secondary hyperparathyroidism occurs in chronic kidney disease and is characterized by low serum calcium and high serum phosphate levels, with elevated PTH and ALP levels.

Lab Values for Bone Disorders

When it comes to bone disorders, certain lab values can provide important information about the condition. In cases of osteoporosis, calcium, phosphate, alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels are typically normal. However, in osteomalacia, calcium and phosphate levels are decreased while ALP and PTH levels are increased. Primary hyperparathyroidism, which can lead to osteitis fibrosa cystica, is characterized by increased calcium and PTH levels but decreased phosphate levels. Chronic kidney disease can result in secondary hyperparathyroidism, which is marked by decreased calcium levels and increased phosphate and PTH levels. Paget’s disease, on the other hand, typically shows normal calcium and phosphate levels but increased ALP levels. Finally, osteopetrosis is associated with normal levels of calcium, phosphate, ALP, and PTH. By analyzing these lab values, healthcare professionals can better diagnose and treat bone disorders.

Psoriasis typically appears on the extensor surfaces, but guttate psoriasis is more common in teenagers and presents as tear-drop shaped plaques. Palmo-plantar psoriasis is characterized by small pustules on the palms and soles, while chronic plaque psoriasis appears as well-defined plaques on extensor surfaces. Flexural psoriasis is most commonly found in areas such as the axillae, sub-mammary, and groin. Erythrodermic psoriasis causes the skin to become deep red all over.

Psoriasis: A Chronic Skin Disorder with Various Subtypes and Complications

Psoriasis is a prevalent chronic skin disorder that affects around 2% of the population. It is characterized by red, scaly patches on the skin, but it is now known that patients with psoriasis are at an increased risk of arthritis and cardiovascular disease. The pathophysiology of psoriasis is multifactorial and not yet fully understood. It is associated with genetic factors such as HLA-B13, -B17, and -Cw6, and abnormal T cell activity that stimulates keratinocyte proliferation. Environmental factors such as skin trauma, stress, streptococcal infection, and sunlight exposure can worsen, trigger, or improve psoriasis.

There are several recognized subtypes of psoriasis, including plaque psoriasis, flexural psoriasis, guttate psoriasis, and pustular psoriasis. Each subtype has its own unique characteristics and affects different areas of the body. Psoriasis can also cause nail signs such as pitting and onycholysis, as well as arthritis.

Complications of psoriasis include psoriatic arthropathy, metabolic syndrome, cardiovascular disease, venous thromboembolism, and psychological distress. It is important for patients with psoriasis to receive proper management and treatment to prevent these complications and improve their quality of life.

The most common complication of shingles is post-herpetic neuralgia, which is characterized by a burning pain in the affected dermatome. This condition is likely to occur in older individuals, who are also at risk of experiencing more severe and prolonged pain. While bacterial superinfection of cutaneous lesions can occur, it is typically caused by Staphylococcus aureus or group A streptococcal species. Shingles can also lead to complications such as pneumonia, meningoencephalitis, hepatitis, and acute retinal necrosis if it affects internal organs.

Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.

The radial nerve supplies the skin on the dorsal aspect of the hand, while the axillary nerve innervates teres minor and deltoid muscle and provides sensory innervation to the badge area. The median nerve is the main nerve of the anterior compartment of the forearm, and the ulnar nerve innervates muscles in the forearm and intrinsic muscles of the hand. The musculocutaneous nerve supplies muscles in the upper arm and terminates as the lateral cutaneous nerve of the forearm.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The Koebner Phenomenon: Skin Lesions at the Site of Injury

The Koebner phenomenon refers to the occurrence of skin lesions at the site of injury. This phenomenon is commonly observed in various skin conditions such as psoriasis, vitiligo, warts, lichen planus, lichen sclerosus, and molluscum contagiosum. In other words, if a person with any of these skin conditions experiences trauma or injury to their skin, they may develop new lesions in the affected area.

This phenomenon is named after Heinrich Koebner, a German dermatologist who first described it in 1876. The exact mechanism behind the Koebner phenomenon is not fully understood, but it is believed to be related to the immune system’s response to injury. In some cases, the injury may trigger an autoimmune response, leading to the development of new lesions.

The Koebner phenomenon can be a frustrating and challenging aspect of managing skin conditions. It is important for individuals with these conditions to take precautions to avoid injury to their skin, such as wearing protective clothing or avoiding activities that may cause trauma. Additionally, prompt treatment of any new lesions that develop can help prevent further spread of the condition.

Smith’s fracture is the name given to a fracture of the distal radius with anterior displacement of the distal fragment, while Colles’ fracture refers to a fracture of the distal radius with posterior displacement of the distal fragment, resulting in a dinner fork deformity. Another type of fracture involving the forearm is the Monteggia fracture, which involves a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius.

Understanding Colles’ Fracture: A Common Injury from a Fall

Colles’ fracture is a type of injury that typically occurs when a person falls onto an outstretched hand, also known as a FOOSH. This type of fracture involves the distal radius, which is the bone located near the wrist joint. The fracture is characterized by a dorsal displacement of the bone fragments, resulting in a deformity that resembles a dinner fork.

Classical Colles’ fractures have three distinct features. Firstly, the fracture is transverse, meaning it occurs horizontally across the bone. Secondly, the fracture is located approximately one inch proximal to the radio-carpal joint, which is the joint that connects the radius to the wrist bones. Finally, the fracture results in dorsal displacement and angulation of the bone fragments.

Winged scapula is caused by paralysis of serratus anterior, which affects arm abduction. Triceps brachii is responsible for extension, biceps brachii for flexion, and latissimus dorsi for adduction.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The rectus sheath includes the inferior epigastric artery and the superior epigastric vein.

Muscles and Layers of the Abdominal Wall

The abdominal wall is composed of various muscles and layers that provide support and protection to the organs within the abdominal cavity. The two main muscles of the abdominal wall are the rectus abdominis and the quadratus lumborum. The rectus abdominis is located anteriorly, while the quadratus lumborum is located posteriorly.

The remaining abdominal wall is made up of three muscular layers, each passing from the lateral aspect of the quadratus lumborum to the lateral margin of the rectus sheath. These layers are muscular posterolaterally and aponeurotic anteriorly. The external oblique muscle lies most superficially and originates from the 5th to 12th ribs, inserting into the anterior half of the outer aspect of the iliac crest, linea alba, and pubic tubercle. The internal oblique arises from the thoracolumbar fascia, the anterior 2/3 of the iliac crest, and the lateral 2/3 of the inguinal ligament, while the transversus abdominis is the innermost muscle, arising from the inner aspect of the costal cartilages of the lower 6 ribs, the anterior 2/3 of the iliac crest, and the lateral 1/3 of the inguinal ligament.

During abdominal surgery, it is often necessary to divide either the muscles or their aponeuroses. It is desirable to divide the aponeurosis during a midline laparotomy, leaving the rectus sheath intact above the arcuate line and the muscles intact below it. Straying off the midline can lead to damage to the rectus muscles, particularly below the arcuate line where they may be in close proximity to each other. The nerve supply for these muscles is the anterior primary rami of T7-12.

The only content of the cubital fossa is the median nerve, while the ulnar nerve passes posterior to the medial epicondyle to enter the forearm. The femoral nerve and artery are located in the femoral canal, and the tricep tendon is situated on the posterior aspect of the arm.

The Antecubital Fossa: Anatomy and Clinical Significance

The antecubital fossa is a depression located on the anterior aspect of the arm, between the arm and forearm. It is an important area for medical professionals as it is where venous blood samples are typically taken from. The borders of the antecubital fossa are the brachioradialis muscle laterally, the pronator teres medially, and a line between the medial and lateral epicondyles superiorly.

There are both deep and superficial structures found in the antecubital fossa. Deep structures include the radial nerve, tendon of the biceps muscle, brachial artery, and medial nerve. Superficial structures consist of a network of veins, including the cephalic vein and basilic vein, which come together as the median cubital vein.

The main clinical relevance of the antecubital fossa is its use for blood sampling and cannulation. However, it is also important to have a working knowledge of the anatomy as structures can become damaged. Excessive straining of the biceps tendon can cause it to rupture, leading to a ‘Popeye sign’. Damage to the medial nerve can also occur, resulting in muscle paralysis in the forearm and hand. Overall, understanding the anatomy and clinical significance of the antecubital fossa is crucial for medical professionals.

The patient in the vignette is experiencing impaired hip extension and lateral rotation, making it difficult for them to rise from a seat and climb stairs. These symptoms are consistent with inferior gluteal nerve palsy, which can be caused by nerve entrapment or compression. The inferior gluteal nerve runs anterior to the piriformis and can be damaged during hip replacement surgery or by sitting for prolonged periods with a wallet in a rear pocket.

Other nerves that can be affected in the lower limb include the femoral nerve, which supplies the lower limb extensively and can be injured by direct trauma or compression. Lateral femoral cutaneous nerve compression can cause meralgia paresthetica, which leads to burning, tingling, and numbness in the front and lateral aspect of the thigh. The obturator nerve is rarely injured but can cause medial thigh sensory changes, weak hip adduction, and a wide-based gait if damaged. The superior gluteal nerve innervates the gluteus medius and minimus and can be assessed with tests that assess hip abductor and stabilizer function.

Overall, understanding the anatomy and function of these nerves can help diagnose and manage lower limb nerve injuries.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

The anatomical snuffbox is situated above the scaphoid bone. The radial nerve’s cutaneous branch is located closer to the surface and closer to the center.

The Anatomical Snuffbox: A Triangle on the Wrist

The anatomical snuffbox is a triangular depression located on the lateral aspect of the wrist. It is bordered by tendons of the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus muscles, as well as the styloid process of the radius. The floor of the snuffbox is formed by the trapezium and scaphoid bones. The apex of the triangle is located distally, while the posterior border is formed by the tendon of the extensor pollicis longus. The radial artery runs through the snuffbox, making it an important landmark for medical professionals.

In summary, the anatomical snuffbox is a small triangular area on the wrist that is bordered by tendons and bones. It is an important landmark for medical professionals due to the presence of the radial artery.

The deep peroneal nerve innervates all the muscles in the anterior compartment, including the Tibialis anterior, Extensor digitorum longus, Peroneus tertius, and Extensor hallucis longus. Additionally, the Anterior tibial artery is also located in this compartment.

Muscular Compartments of the Lower Limb

The lower limb is composed of different muscular compartments that perform various actions. The anterior compartment includes the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus muscles. These muscles are innervated by the deep peroneal nerve and are responsible for dorsiflexing the ankle joint, inverting and evert the foot, and extending the toes.

The peroneal compartment, on the other hand, consists of the peroneus longus and peroneus brevis muscles, which are innervated by the superficial peroneal nerve. These muscles are responsible for eversion of the foot and plantar flexion of the ankle joint.

The superficial posterior compartment includes the gastrocnemius and soleus muscles, which are innervated by the tibial nerve. These muscles are responsible for plantar flexion of the foot and may also flex the knee.

Lastly, the deep posterior compartment includes the flexor digitorum longus, flexor hallucis longus, and tibialis posterior muscles, which are innervated by the tibial nerve. These muscles are responsible for flexing the toes, flexing the great toe, and plantar flexion and inversion of the foot, respectively.

Understanding the muscular compartments of the lower limb is important in diagnosing and treating injuries and conditions that affect these muscles. Proper identification and management of these conditions can help improve mobility and function of the lower limb.

It is located deeply to the pronator teres muscle, which creates a separation from the median nerve.

Anatomy of the Ulnar Artery

The ulnar artery is a blood vessel that begins in the middle of the antecubital fossa and runs obliquely downward towards the ulnar side of the forearm. It then follows the ulnar border to the wrist, where it crosses over the flexor retinaculum and divides into the superficial and deep volar arches. The artery is deep to the pronator teres, flexor carpi radialis, and palmaris longus muscles, and lies on the brachialis and flexor digitorum profundus muscles. At the wrist, it is superficial to the flexor retinaculum.

The ulnar nerve runs medially to the lower two-thirds of the artery, while the median nerve is in relation with the medial side of the artery for about 2.5 cm before crossing over it. The artery also gives off a branch called the anterior interosseous artery.

Understanding the anatomy of the ulnar artery is important for medical professionals, as it plays a crucial role in the blood supply to the forearm and hand.

Osteomyelitis is most commonly caused by Staphylococcus aureus in both adults and children. IV drug use is a known risk factor for this condition as it can introduce microorganisms directly into the bloodstream. While Escherichia coli can also cause osteomyelitis, it is more prevalent in children than adults. Mycobacterium tuberculosis can also lead to osteomyelitis, but it is less common than Staphylococcus aureus. Bone introduction typically occurs via the circulatory system from pulmonary tuberculosis. However, antitubercular therapy has reduced the incidence of tuberculosis, making bone introduction less likely than with Staphylococcus aureus, which is part of the normal skin flora. Salmonella enterica is the most common cause of osteomyelitis in individuals with sickle cell disease. As the patient is not known to have sickle cell, Staphylococcus aureus remains the most probable cause.

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 in the bloodstream and is usually monomicrobial. It is more common in children and can be caused by risk factors such as sickle cell anaemia, intravenous drug use, immunosuppression, and infective endocarditis. On the other hand, non-haematogenous osteomyelitis is caused by 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 are more prevalent. To diagnose osteomyelitis, MRI is the imaging modality of choice, with a sensitivity of 90-100%.

The treatment for osteomyelitis involves a course of antibiotics for six weeks. Flucloxacillin is the preferred antibiotic, but clindamycin can be used for patients who are allergic to penicillin. Understanding the types, causes, and treatment of osteomyelitis is crucial in managing this bone infection.

Fractures of the clavicle typically occur in the medial third, with the lateral aspect being displaced inferiorly by the weight of the arm and medially by the pull of the pectoralis major muscle. Meanwhile, the medial aspect of the fracture is usually displaced superiorly due to the pull of the sternocleidomastoid muscle.

Anatomy of the Clavicle

The clavicle is a bone that runs from the sternum to the acromion and plays a crucial role in preventing the shoulder from falling forwards and downwards. Its inferior surface is marked by ligaments at each end, including the trapezoid line and conoid tubercle, which provide attachment to the coracoclavicular ligament. The costoclavicular ligament attaches to the irregular surface on the medial part of the inferior surface, while the subclavius muscle attaches to the intermediate portion’s groove.

The superior part of the clavicle medial end has a raised surface that gives attachment to the clavicular head of sternocleidomastoid, while the posterior surface attaches to the sternohyoid. On the lateral end, there is an oval articular facet for the acromion, and a disk lies between the clavicle and acromion. The joint’s capsule attaches to the ridge on the margin of the facet.

In summary, the clavicle is a vital bone that helps stabilize the shoulder joint and provides attachment points for various ligaments and muscles. Its anatomy is marked by distinct features that allow for proper function and movement.

The Gell and Coombs classification divides hypersensitivity reactions into four types. Type 1 is immediate and IgE mediated, type 2 is mediated by IgG and IgM causing cell death, type 3 is mediated by immune complexes, and type 4 is delayed and mediated by T lymphocytes causing contact dermatitis. Examples of each type include allergic rhinitis, Goodpasture syndrome, and rheumatoid arthritis. Nickel is a common cause of contact dermatitis.

Understanding Contact Dermatitis

Contact dermatitis is a skin condition that can be caused by two main types of reactions. The first type is irritant contact dermatitis, which is a non-allergic reaction that occurs due to exposure to weak acids or alkalis, such as detergents. This type of dermatitis is commonly seen on the hands and is characterized by erythema, but crusting and vesicles are rare.

The second type of contact dermatitis is allergic contact dermatitis, which is a type IV hypersensitivity reaction. This type of dermatitis is uncommon and is often seen on the head following hair dyes. It presents as an acute weeping eczema that predominantly affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid is indicated for this type of dermatitis.

Cement is a frequent cause of contact dermatitis. The alkaline nature of cement may cause an irritant contact dermatitis, while the dichromates in cement can also cause an allergic contact dermatitis. It is important to understand the different types of contact dermatitis and their causes to effectively manage and treat this condition.

The tendon sheath that runs from the little finger to the proximal part of the carpal tunnel poses a considerable risk of facilitating the spread of infections towards the proximal direction.

Anatomy of the Hand: Fascia, Compartments, and Tendons

The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

The biceps brachii is mainly responsible for supination and elbow flexion. If the tendon associated with this muscle is torn, it can affect these movements.

External rotation is primarily performed by the infraspinatus and teres minor muscles, not the biceps brachii.

The teres major muscle, not the biceps brachii, is responsible for internal rotation.

Pronation is performed by the pronator quadratus and pronator teres muscles, while elbow flexion is performed by the triceps muscle. Therefore, these actions are not associated with the biceps brachii.

Shoulder abduction involves muscles such as the supraspinatus and deltoid, but it does not involve the biceps brachii.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

When a hip fracture occurs within the joint capsule, there is a higher chance of the femoral head experiencing avascular necrosis. This type of fracture is considered displaced and requires treatment with hemiarthroplasty or total hip replacement, especially for older patients. However, younger patients may opt for hip fixation instead of replacement as prosthetic joints have a limited lifespan.

Hip fractures are a common occurrence, particularly in elderly women with osteoporosis. The femoral head’s blood supply runs up the neck, making avascular necrosis a risk in displaced fractures. Symptoms include pain and a shortened and externally rotated leg. Patients with non-displaced or incomplete neck of femur fractures may still be able to bear weight. Hip fractures are classified based on their location, either intracapsular or extracapsular. The Garden system is a commonly used classification system that categorizes fractures into four types based on stability and displacement. Blood supply disruption is most common in Types III and IV.

Undisplaced intracapsular fractures can be treated with internal fixation or hemiarthroplasty if the patient is unfit. Displaced fractures require replacement arthroplasty, with total hip replacement being preferred over hemiarthroplasty if the patient was able to walk independently outdoors with no more than a stick, is not cognitively impaired, and is medically fit for anesthesia and the procedure. Extracapsular fractures are managed with a dynamic hip screw for stable intertrochanteric fractures and an intramedullary device for reverse oblique, transverse, or subtrochanteric fractures.

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 taken 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.

The femoral nerve is responsible for loss of knee extension and sensory loss to the anterior and medial aspect of the thigh following a stab injury. The muscles innervated by the femoral nerve are responsible for hip flexion and knee extension, while the nerve is responsible for sensation over the anterior thigh. Injury to the inferior gluteal nerve would result in loss of hip extension, while injury to the obturator nerve would result in a loss of sensation to the medial thigh and impaired hip adduction. Although the quadriceps tendon is vital to knee extension, it would not explain the sensory deficit and the location of the injury.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

Celecoxib inhibits COX-2 in a reversible manner, while aspirin inhibits both COX-1 and COX-2 irreversibly. Celecoxib is classified as a selective NSAID that works by reducing the production of prostaglandins.

Understanding Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and COX-2 Selective NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that work by inhibiting the activity of cyclooxygenase enzymes, which are responsible for producing key mediators involved in inflammation such as prostaglandins. By reducing the production of these mediators, NSAIDs can help alleviate pain and reduce inflammation. Examples of NSAIDs include ibuprofen, diclofenac, naproxen, and aspirin.

However, NSAIDs can also have important and common side-effects, such as peptic ulceration and exacerbation of asthma. To address these concerns, COX-2 selective NSAIDs were developed. These medications were designed to reduce the incidence of side-effects seen with traditional NSAIDs, particularly peptic ulceration. Examples of COX-2 selective NSAIDs include celecoxib and etoricoxib.

Despite their potential benefits, COX-2 selective NSAIDs are not widely used due to ongoing concerns about cardiovascular safety. This led to the withdrawal of rofecoxib (‘Vioxx’) in 2004. As with any medication, it is important to discuss the potential risks and benefits of NSAIDs and COX-2 selective NSAIDs with a healthcare provider before use.

Psoriasis is caused by type 1 helper T cells that participate in the cellular immune response, as opposed to type 2 helper T cells.

Psoriasis: A Chronic Skin Disorder with Various Subtypes and Complications

Psoriasis is a prevalent chronic skin disorder that affects around 2% of the population. It is characterized by red, scaly patches on the skin, but it is now known that patients with psoriasis are at an increased risk of arthritis and cardiovascular disease. The pathophysiology of psoriasis is multifactorial and not yet fully understood. It is associated with genetic factors such as HLA-B13, -B17, and -Cw6, and abnormal T cell activity that stimulates keratinocyte proliferation. Environmental factors such as skin trauma, stress, streptococcal infection, and sunlight exposure can worsen, trigger, or improve psoriasis.

There are several recognized subtypes of psoriasis, including plaque psoriasis, flexural psoriasis, guttate psoriasis, and pustular psoriasis. Each subtype has its own unique characteristics and affects different areas of the body. Psoriasis can also cause nail signs such as pitting and onycholysis, as well as arthritis.

Complications of psoriasis include psoriatic arthropathy, metabolic syndrome, cardiovascular disease, venous thromboembolism, and psychological distress. It is important for patients with psoriasis to receive proper management and treatment to prevent these complications and improve their quality of life.

Understanding Tumour Necrosis Factor and its Inhibitors

Tumour necrosis factor (TNF) is a cytokine that plays a crucial role in the immune system. It is mainly secreted by macrophages and has various effects on the immune system, such as activating macrophages and neutrophils, acting as a costimulator for T cell activation, and mediating the body’s response to Gram-negative septicaemia. TNF also has anti-tumour effects and binds to both the p55 and p75 receptor, inducing apoptosis and activating NFkB.

TNF has endothelial effects, including increased expression of selectins and production of platelet activating factor, IL-1, and prostaglandins. It also promotes the proliferation of fibroblasts and their production of protease and collagenase. TNF inhibitors are used to treat inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Examples of TNF inhibitors include infliximab, etanercept, adalimumab, and golimumab.

Infliximab is also used to treat active Crohn’s disease unresponsive to steroids. However, TNF blockers can have adverse effects such as reactivation of latent tuberculosis and demyelination. Understanding TNF and its inhibitors is crucial in the treatment of various inflammatory conditions.

Volkmaan’s ischemic contractures can be caused by a supracondylar fracture of the humerus, which poses a risk of damage to the brachial artery and subsequent ischemia distal to the fracture. This type of fracture is more common in children, while a Colles fracture, which can also lead to Volkmaan’s ischemic contractures, is more common in adults. Another fracture that can result in Volkmaan’s ischemic contractures is a Monteggia fracture, which involves a fracture of the proximal third of the ulna and dislocation of the proximal head of the radius.

The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

The superficial branch of the femoral nerve provides innervation to it. It is a constituent of the pes anserinus.

The Sartorius Muscle: Anatomy and Function

The sartorius muscle is the longest strap muscle in the human body and is located in the anterior compartment of the thigh. It is the most superficial muscle in this region and has a unique origin and insertion. The muscle originates from the anterior superior iliac spine and inserts on the medial surface of the body of the tibia, anterior to the gracilis and semitendinosus muscles. The sartorius muscle is innervated by the femoral nerve (L2,3).

The primary action of the sartorius muscle is to flex the hip and knee, while also slightly abducting the thigh and rotating it laterally. It also assists with medial rotation of the tibia on the femur, which is important for movements such as crossing one leg over the other. The middle third of the muscle, along with its strong underlying fascia, forms the roof of the adductor canal. This canal contains important structures such as the femoral vessels, the saphenous nerve, and the nerve to vastus medialis.

In summary, the sartorius muscle is a unique muscle in the anterior compartment of the thigh that plays an important role in hip and knee flexion, thigh abduction, and lateral rotation. Its location and relationship to the adductor canal make it an important landmark for surgical procedures in the thigh region.

The infant’s arm is observed to be hanging loosely after a difficult forceps delivery, with adduction and internal rotation and extension of the elbow, indicating an injury to the upper trunk of the brachial plexus involving nerve roots C5 and C6. This is known as Erb’s palsy, which is commonly associated with difficult forceps deliveries and requires specialized management. Lower brachial plexus injuries affecting nerve roots C7 and C8 are less frequent and would cause wrist and forearm pathology rather than shoulder and elbow weakness. Isolated damage to the C6 nerve root is unlikely, as it is typically affected alongside the C5 nerve root.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

P-GO-GO-Q is a mnemonic for remembering the lateral hip rotators in order from top to bottom: Piriformis, Gemellus superior, Obturator internus, Gemellus inferior, and Obturator externus.

Anatomy of the Hip Joint

The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

The patient is experiencing acute inflammatory arthritis, which is likely caused by pseudogout. This condition occurs when calcium pyrophosphate dihydrate crystals are deposited in the synovial fluid, and it is often associated with chronic hypercalcemia resulting from primary hyperparathyroidism. Pseudogout typically affects the knee joint, and the presence of rhomboid-shaped calcium pyrophosphate crystals in the synovial fluid is diagnostic. Calcium hydroxyapatite crystals are typically found in tendons, while calcium oxalate is the most common component of renal calculi. Xanthomas refer to the deposition of cholesterol and other lipids in soft tissues, while gout is characterized by the deposition of monosodium urate in joints and soft tissues.

Understanding Pseudogout

Pseudogout, also known as acute calcium pyrophosphate crystal deposition disease, is a type of microcrystal synovitis that occurs when calcium pyrophosphate dihydrate crystals are deposited in the synovium. This condition is commonly associated with increasing age, but younger patients who develop pseudogout usually have an underlying risk factor such as haemochromatosis, hyperparathyroidism, low magnesium or phosphate levels, acromegaly, or Wilson’s disease.

The knee, wrist, and shoulders are the most commonly affected joints in pseudogout. Diagnosis is made through joint aspiration, which reveals weakly-positively birefringent rhomboid-shaped crystals, and x-rays, which show chondrocalcinosis. In the knee, linear calcifications of the meniscus and articular cartilage can be seen.

Management of pseudogout involves joint fluid aspiration to rule out septic arthritis, followed by treatment with NSAIDs or intra-articular, intra-muscular, or oral steroids, similar to the treatment for gout. Understanding the risk factors and symptoms of pseudogout can help with early diagnosis and effective management of this condition.

The facial nerve innervates the posterior belly of digastric, while the mylohoid nerve innervates the anterior belly.

The Anterior Triangle of the Neck: Boundaries and Contents

The anterior triangle of the neck is a region that is bounded by the anterior border of the sternocleidomastoid muscle, the lower border of the mandible, and the anterior midline. It is further divided into three sub-triangles by the digastric muscle and the omohyoid muscle. The muscular triangle contains the neck strap muscles, while the carotid triangle contains the carotid sheath, which houses the common carotid artery, the vagus nerve, and the internal jugular vein. The submandibular triangle, located below the digastric muscle, contains the submandibular gland, submandibular nodes, facial vessels, hypoglossal nerve, and other structures.

The digastric muscle, which separates the submandibular triangle from the muscular triangle, is innervated by two different nerves. The anterior belly of the digastric muscle is supplied by the mylohyoid nerve, while the posterior belly is supplied by the facial nerve.

Overall, the anterior triangle of the neck is an important anatomical region that contains many vital structures, including blood vessels, nerves, and glands. Understanding the boundaries and contents of this region is essential for medical professionals who work in this area.

The depressor anguli oris and depressor labii inferioris muscles are supplied by the marginal mandibular nerve, which is located beneath the platysma muscle. Damage to this nerve can result in facial asymmetry and drooling.

Anatomy of the Submandibular Gland

The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

If a lift-off test shows abnormal results, it suggests that the subscapularis muscle may be involved.

Rotator cuff injuries are a common cause of shoulder problems and can be classified into four types of disease: subacromial impingement, calcific tendonitis, rotator cuff tears, and rotator cuff arthropathy. The symptoms of a rotator cuff injury include shoulder pain that worsens during abduction. The signs of a rotator cuff injury include tenderness over the anterior acromion and a painful arc of abduction. The painful arc of abduction is typically between 60 and 120 degrees for subacromial impingement, while for rotator cuff tears, the pain may be in the first 60 degrees. Proper diagnosis and treatment are essential to prevent further damage and improve shoulder function.

The muscles located in the deep posterior compartment are:

Muscular Compartments of the Lower Limb

The lower limb is composed of different muscular compartments that perform various actions. The anterior compartment includes the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus muscles. These muscles are innervated by the deep peroneal nerve and are responsible for dorsiflexing the ankle joint, inverting and evert the foot, and extending the toes.

The peroneal compartment, on the other hand, consists of the peroneus longus and peroneus brevis muscles, which are innervated by the superficial peroneal nerve. These muscles are responsible for eversion of the foot and plantar flexion of the ankle joint.

The superficial posterior compartment includes the gastrocnemius and soleus muscles, which are innervated by the tibial nerve. These muscles are responsible for plantar flexion of the foot and may also flex the knee.

Lastly, the deep posterior compartment includes the flexor digitorum longus, flexor hallucis longus, and tibialis posterior muscles, which are innervated by the tibial nerve. These muscles are responsible for flexing the toes, flexing the great toe, and plantar flexion and inversion of the foot, respectively.

Understanding the muscular compartments of the lower limb is important in diagnosing and treating injuries and conditions that affect these muscles. Proper identification and management of these conditions can help improve mobility and function of the lower limb.

The correct nerve that supplies the serratus anterior muscle is the long thoracic nerve. This muscle is responsible for pulling the scapula around the thorax, and damage to this nerve can cause medial winging of the scapula.

The axillary nerve is not the correct answer as it supplies the deltoid muscle, which is responsible for shoulder abduction. Damage to this nerve results in a flattened deltoid muscle, not winging of the scapula.

The musculocutaneous nerve supplies the biceps brachii muscle, which is responsible for elbow flexion. Damage to this nerve does not affect the scapulae.

The spinal accessory nerve supplies the sternocleidomastoid and trapezius muscles, and injury to this nerve may result in difficulty turning the head from side to side or shrugging the shoulders. It does not affect the scapulae.

Trauma to the thoracodorsal nerve may cause atrophy of the latissimus dorsi muscle and difficulty moving the affected shoulder, but it does not cause winging of the scapula.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The structures that pass behind the medial malleolus can be remembered using the mnemonic Tom, Dick and Very Nervous Harry which stands for Tibialis posterior, flexor Digitorum longus, posterior tibial Artery, posterior tibial Vein, tibial Nerve and flexor Hallucis longus.

The patient in this case is experiencing tarsal tunnel syndrome which is characterized by numbness and tingling along the distribution of the posterior tibial nerve. Tinel’s test, which involves tapping on the area behind the medial malleolus, can help diagnose nerve compression.

The abductor hallucis muscle is responsible for abducting the big toe and its tendon does not pass through the tarsal tunnel. Dorsiflexion of the foot is primarily performed by the tibialis anterior muscle, while the tibialis posterior tendon runs through the tarsal tunnel. Extension of the big toe is performed by the extensor hallucis brevis and longus muscles, while extension of the toes is primarily performed by the extensor digitorum longus muscle. The big toe can be extended independently from the other toes due to the action of the extensor hallucis muscles.

Anatomy of the Ankle Joint

The ankle joint is a type of synovial joint that is made up of the tibia and fibula superiorly and the talus inferiorly. It is supported by several ligaments, including the deltoid ligament, lateral collateral ligament, and talofibular ligaments. The calcaneofibular ligament is separate from the fibrous capsule of the joint, while the two talofibular ligaments are fused with it. The syndesmosis is composed of the antero-inferior tibiofibular ligament, postero-inferior tibiofibular ligament, inferior transverse tibiofibular ligament, and interosseous ligament.

The ankle joint allows for plantar flexion and dorsiflexion movements, with a range of 55 and 35 degrees, respectively. Inversion and eversion movements occur at the level of the sub talar joint. The ankle joint is innervated by branches of the deep peroneal and tibial nerves.

Reference:
Golano P et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):557-69.

Oesophageal problems can be caused by bisphosphonates, which are commonly used to prevent and treat osteoporosis. These drugs can lead to gastrointestinal issues, including oesophagitis, which should prompt discontinuation of the medication. Long-term use of bisphosphonates can also result in atypical femoral fractures and osteonecrosis of the jaw. Therefore, patients should be periodically re-evaluated to assess the benefits and risks of continuing treatment, especially after five or more years of use. Before starting bisphosphonate treatment, patients should have a dental check-up and any necessary dental work should be performed.

Gliclazide, a sulfonylurea drug, can cause hypoglycemia symptoms such as dizziness, lack of energy, drowsiness, headache, and sweating.

Metformin is associated with lactic acidosis and gastrointestinal problems.

Bisoprolol can cause erectile dysfunction, cold hands and feet, bradycardia, and hypotension.

Paracetamol, unlike NSAIDs, is not known to cause indigestion.

Bisphosphonates: Uses, Adverse Effects, and Patient Counselling

Bisphosphonates are drugs that mimic the action of pyrophosphate, a molecule that helps prevent bone demineralization. They work by inhibiting osteoclasts, the cells responsible for breaking down bone tissue. Bisphosphonates are commonly used to prevent and treat osteoporosis, hypercalcemia, Paget’s disease, and pain from bone metastases.

However, bisphosphonates can cause adverse effects such as oesophageal reactions, osteonecrosis of the jaw, and an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate. Patients may also experience an acute phase response, which includes fever, myalgia, and arthralgia following administration. Hypocalcemia may also occur due to reduced calcium efflux from bone, but this is usually clinically unimportant.

To minimize the risk of adverse effects, patients taking oral bisphosphonates should swallow the tablets whole with plenty of water while sitting or standing. They should take the medication on an empty stomach at least 30 minutes before breakfast or another oral medication and remain upright for at least 30 minutes after taking the tablet. Hypocalcemia and vitamin D deficiency should be corrected before starting bisphosphonate treatment. However, calcium supplements should only be prescribed if dietary intake is inadequate when starting bisphosphonate treatment for osteoporosis. Vitamin D supplements are usually given.

The duration of bisphosphonate treatment varies depending on the level of risk. Some experts recommend stopping bisphosphonates after five years if the patient is under 75 years old, has a femoral neck T-score of more than -2.5, and is at low risk according to FRAX/NOGG.

There are a total of 8 muscles that are involved in the movement of the thumb. These include two flexors, namely flexor pollicis brevis and flexor pollicis longus, two extensors, namely extensor pollicis brevis and longus, two abductors, namely abductor pollicis brevis and longus, one adductor, namely adductor pollicis, and one muscle that opposes the thumb by rotating the CMC joint, known as opponens pollicis. The flexor and extensor longus muscles are responsible for moving both the MCP and IP joints and insert on the distal phalanx.

Anatomy of the Hand: Fascia, Compartments, and Tendons

The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

Propionibacterium acnes is the bacteria responsible for contributing to the formation of acne.

The patient’s facial papules, pustules, and comedones indicate a diagnosis of acne vulgaris, which is more prevalent in adolescents and those with oily skin. While bacteria can play a role in the development of acne, it is important to note that acne vulgaris is not a contagious rash. Propionibacterium acnes is the most common pathogen associated with acne vulgaris, as it triggers enzymes and inflammatory mediators that worsen the existing rash and inflammation.

Staphylococcus aureus is linked to bacterial skin conditions like impetigo and cellulitis, which often require more intensive antibiotic treatment.

Staphylococcus epidermidis is a commensal bacterium typically found on the skin’s surface. It may cause opportunistic bacterial skin infections in immunocompromised patients, but it is not involved in acne development.

Streptococcus pyogenes also causes bacterial skin infections like cellulitis and erysipelas, similar to Staphylococcus aureus. If either bacterium were implicated in acne vulgaris, it would cause significant inflammation and infection (e.g., fever, erythema, swelling). However, they do not play a role in the normal development of acne.

Understanding Acne Vulgaris

Acne vulgaris is a prevalent skin condition that typically affects teenagers, with around 80-90% of them experiencing it. It commonly appears on the face, neck, and upper trunk and is characterized by the blockage of hair follicles with keratin plugs, leading to the formation of comedones, inflammation, and pustules. However, acne may persist beyond adolescence, with 10-15% of females and 5% of males over 25 years old still being affected.

The pathophysiology of acne vulgaris is multifactorial. It involves the overgrowth of skin cells in hair follicles, leading to the formation of keratin plugs that obstruct the follicles. Although androgen levels may control the activity of sebaceous glands, which produce oil, they are often normal in patients with acne. Additionally, the anaerobic bacterium Propionibacterium acnes can colonize the blocked follicles, leading to inflammation and the formation of pimples.

Overall, understanding the pathophysiology of acne vulgaris is crucial in developing effective treatments for this common skin condition.

Osteonecrosis of the jaw is a potential side effect of bisphosphonates, particularly alendronate, and the risk increases with prolonged use. However, the other options listed are not associated with this condition. While denosumab is also linked to osteonecrosis of the jaw, it is less common than with bisphosphonates. It is unlikely that the patient is taking denosumab as there is no mention of any contraindications to bisphosphonates, and alendronate is the first-line drug for bone protection. Additionally, denosumab is significantly more expensive than alendronate.

Bisphosphonates: Uses, Adverse Effects, and Patient Counselling

Bisphosphonates are drugs that mimic the action of pyrophosphate, a molecule that helps prevent bone demineralization. They work by inhibiting osteoclasts, the cells responsible for breaking down bone tissue. Bisphosphonates are commonly used to prevent and treat osteoporosis, hypercalcemia, Paget’s disease, and pain from bone metastases.

However, bisphosphonates can cause adverse effects such as oesophageal reactions, osteonecrosis of the jaw, and an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate. Patients may also experience an acute phase response, which includes fever, myalgia, and arthralgia following administration. Hypocalcemia may also occur due to reduced calcium efflux from bone, but this is usually clinically unimportant.

To minimize the risk of adverse effects, patients taking oral bisphosphonates should swallow the tablets whole with plenty of water while sitting or standing. They should take the medication on an empty stomach at least 30 minutes before breakfast or another oral medication and remain upright for at least 30 minutes after taking the tablet. Hypocalcemia and vitamin D deficiency should be corrected before starting bisphosphonate treatment. However, calcium supplements should only be prescribed if dietary intake is inadequate when starting bisphosphonate treatment for osteoporosis. Vitamin D supplements are usually given.

The duration of bisphosphonate treatment varies depending on the level of risk. Some experts recommend stopping bisphosphonates after five years if the patient is under 75 years old, has a femoral neck T-score of more than -2.5, and is at low risk according to FRAX/NOGG.

Anatomy of the Axilla

The axilla, also known as the armpit, is a region of the body that contains important structures such as nerves, veins, and lymph nodes. It is bounded medially by the chest wall and serratus anterior, laterally by the humeral head, and anteriorly by the lateral border of the pectoralis major. The floor of the axilla is formed by the subscapularis muscle, while the clavipectoral fascia forms its fascial boundary.

One of the important nerves that passes through the axilla is the long thoracic nerve, which supplies the serratus anterior muscle. The thoracodorsal nerve and trunk, on the other hand, innervated and vascularize the latissimus dorsi muscle. The axillary vein, which is the continuation of the basilic vein, lies at the apex of the axilla and becomes the subclavian vein at the outer border of the first rib. The intercostobrachial nerves, which provide cutaneous sensation to the axillary skin, traverse the axillary lymph nodes and are often divided during axillary surgery.

The axilla is also an important site of lymphatic drainage for the breast. Therefore, any pathology or surgery involving the breast can affect the lymphatic drainage of the axilla and lead to lymphedema. Understanding the anatomy of the axilla is crucial for healthcare professionals who perform procedures in this region, as damage to any of the structures can lead to significant complications.

The most frequently encountered organism in cases of septic arthritis is Staphylococcus aureus.

Septic Arthritis in Adults: Causes, Symptoms, and Treatment

Septic arthritis is a condition that occurs when bacteria infect a joint, leading to inflammation and swelling. The most common organism that causes septic arthritis in adults is Staphylococcus aureus, while Neisseria gonorrhoeae is the most common organism in sexually active young adults. The infection is usually spread through the bloodstream, often from distant bacterial infections such as abscesses. The knee is the most commonly affected joint in adults.

Symptoms of septic arthritis include acute joint swelling, restricted movement, warmth to the touch, and fever. To diagnose the condition, synovial fluid sampling is necessary and should be done before administering antibiotics if needed. Blood cultures and joint imaging may also be necessary.

Treatment for septic arthritis involves intravenous antibiotics that cover Gram-positive cocci, such as flucloxacillin or clindamycin if the patient is allergic to penicillin. Antibiotics are typically given for several weeks, and patients may be switched to oral antibiotics after two weeks. Needle aspiration is used to decompress the joint, and arthroscopic lavage may be required. Overall, prompt diagnosis and treatment are essential to prevent joint damage and other complications.

The area between Z lines is known as the sarcomere. The skeletal muscle is composed of the following elements, as shown in the diagram.

The Process of Muscle Contraction

Muscle contraction is a complex process that involves several steps. It begins with an action potential reaching the neuromuscular junction, which causes a calcium ion influx through voltage-gated calcium channels. This influx leads to the release of acetylcholine into the extracellular space, which activates nicotinic acetylcholine receptors, triggering an action potential. The action potential then spreads through the T-tubules, activating L-type voltage-dependent calcium channels in the T-tubule membrane, which are close to calcium-release channels in the adjacent sarcoplasmic reticulum. This causes the sarcoplasmic reticulum to release calcium, which binds to troponin C, causing a conformational change that allows tropomyosin to move, unblocking the binding sites. Myosin then binds to the newly released binding site, releasing ADP and pulling the Z bands towards each other. ATP binds to myosin, releasing actin.

The components involved in muscle contraction include the sarcomere, which is the basic unit of muscles that gives skeletal and cardiac muscles their striated appearance. The I-band is the zone of thin filaments that is not superimposed by thick filaments, while the A-band contains the entire length of a single thick filament. The H-zone is the zone of the thick filaments that is not superimposed by the thin filaments, and the M-line is in the middle of the sarcomere, cross-linking myosin. The sarcoplasmic reticulum releases calcium ion in response to depolarization, while actin is the thin filaments that transmit the forces generated by myosin to the ends of the muscle. Myosin is the thick filaments that bind to the thin filament, while titin connects the Z-line to the thick filament, altering the structure of tropomyosin. Tropomyosin covers the myosin-binding sites on actin, while troponin-C binds with calcium ions. The T-tubule is an invagination of the sarcoplasmic reticulum that helps co-ordinate muscular contraction.

There are two types of skeletal muscle fibres: type I and type II. Type I fibres have a slow contraction time, are red in colour due to the presence of myoglobin, and are used for sustained force. They have a high mitochondrial density and use triglycerides as

The anterior tibial artery continues directly into the dorsalis pedis artery.

The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

Streptococcus pyogenes is the primary cause of erysipelas, a localized skin infection. However, Staphylococcus aureus can also be a culprit. Haemophilus influenzae type B used to be a common cause before vaccination was available. Diphtheria, which can lead to serious renal and nervous system complications if left untreated, is caused by Corynebacterium diphtheriae. Enterococcus faecium, a gut bacterium, may also be involved in meningitis and endocarditis.

Understanding Erysipelas: A Superficial Skin Infection

Erysipelas is a skin infection that is caused by Streptococcus pyogenes. It is a less severe form of cellulitis, which is a more widespread skin infection. Erysipelas is a localized infection that affects the skin’s upper layers, causing redness, swelling, and warmth. The infection can occur anywhere on the body, but it is most commonly found on the face, arms, and legs.

The treatment of choice for erysipelas is flucloxacillin, an antibiotic that is effective against Streptococcus pyogenes. Other antibiotics may also be used, depending on the severity of the infection and the patient’s medical history.

Joint aspiration is a valuable diagnostic tool for differentiating between various causes of joint swelling, including septic arthritis and pseudogout. In the case of gout, joint aspiration will reveal needle-shaped monosodium urate crystals that are negatively birefringent under polarised light. These crystals form when uric acid levels remain persistently high and deposit in tissues, leading to the characteristic inflammatory response seen in gout.

It is important to note that a green-colored aspirate with a positive gram stain for Staphylococcus aureus is not indicative of gout, but rather suggests septic arthritis. In this case, the aspirate may have a raised white cell count and appear yellow or green.

Similarly, the presence of negatively birefringent needle-shaped calcium oxalate crystals is not associated with gout, but rather with kidney stones. These crystals form when there are high concentrations of calcium oxalate in the urine and are typically octahedral or envelope-shaped.

Finally, positively birefringent rhomboid-shaped calcium pyrophosphate crystals are not seen in gout, but rather in pseudogout. Pseudogout presents with similar symptoms to gout and more commonly affects the knee joint.

Understanding Gout: Symptoms and Diagnosis

Gout is a type of arthritis that causes inflammation and pain in the joints. Patients experience episodes of intense pain that can last for several days, followed by periods of no symptoms. The acute episodes usually reach their peak within 12 hours and can affect various joints, with the first metatarsophalangeal joint being the most commonly affected. Swelling and redness are also common symptoms of gout.

If left untreated, repeated acute episodes of gout can lead to joint damage and chronic joint problems. To diagnose gout, doctors may perform synovial fluid analysis to look for needle-shaped, negatively birefringent monosodium urate crystals under polarised light. Uric acid levels may also be checked once the acute episode has subsided, as they can be high, normal, or low during the attack.

Radiological features of gout include joint effusion, well-defined punched-out erosions with sclerotic margins, and eccentric erosions. Unlike rheumatoid arthritis, gout does not cause periarticular osteopenia. Soft tissue tophi may also be visible.

Pseudogout is a condition where calcium pyrophosphate dihydrate crystals are deposited in the joints, causing inflammation. This is different from gout, which is caused by the deposition of monosodium urate crystals due to factors such as inadequate urea excretion or high purine intake from foods like seafood.

Treatment for pseudogout involves the use of anti-inflammatory medications and joint replacement surgery may be necessary if the condition causes significant joint damage.

In gout, urea levels may be increased, but during an acute attack, they may actually be decreased. Struvite stones are formed from bacterial products, while staghorn stones are large stones that are often caused by Proteus mirabilis and can obstruct the renal pelvis.

Understanding Pseudogout

Pseudogout, also known as acute calcium pyrophosphate crystal deposition disease, is a type of microcrystal synovitis that occurs when calcium pyrophosphate dihydrate crystals are deposited in the synovium. This condition is commonly associated with increasing age, but younger patients who develop pseudogout usually have an underlying risk factor such as haemochromatosis, hyperparathyroidism, low magnesium or phosphate levels, acromegaly, or Wilson’s disease.

The knee, wrist, and shoulders are the most commonly affected joints in pseudogout. Diagnosis is made through joint aspiration, which reveals weakly-positively birefringent rhomboid-shaped crystals, and x-rays, which show chondrocalcinosis. In the knee, linear calcifications of the meniscus and articular cartilage can be seen.

Management of pseudogout involves joint fluid aspiration to rule out septic arthritis, followed by treatment with NSAIDs or intra-articular, intra-muscular, or oral steroids, similar to the treatment for gout. Understanding the risk factors and symptoms of pseudogout can help with early diagnosis and effective management of this condition.

The adductor canal’s distal boundary is demarcated by a foramen located within the adductor magnus. The vessel traverses this area to reach the popliteal fossa.

The Adductor Canal: Anatomy and Contents

The adductor canal, also known as Hunter’s or the subsartorial canal, is a structure located in the middle third of the thigh, immediately distal to the apex of the femoral triangle. It is bordered laterally by the vastus medialis muscle and posteriorly by the adductor longus and adductor magnus muscles. The roof of the canal is formed by the sartorius muscle. The canal terminates at the adductor hiatus.

The adductor canal contains three important structures: the saphenous nerve, the superficial femoral artery, and the superficial femoral vein. The saphenous nerve is a sensory nerve that supplies the skin of the medial leg and foot. The superficial femoral artery is a major artery that supplies blood to the lower limb. The superficial femoral vein is a large vein that drains blood from the lower limb.

In order to expose the contents of the adductor canal, the sartorius muscle must be removed. Understanding the anatomy and contents of the adductor canal is important for medical professionals who perform procedures in this area, such as nerve blocks or vascular surgeries.

A patient with a humeral midshaft fracture is experiencing wrist drop, which is indicative of radial nerve injury. This is characterized by the inability to extend the forearm, wrist, and fingers, and unopposed flexion of the wrist. It is important to note that injury to the axillary nerve results in flattened deltoid, while median nerve injury can cause paralysis of the thenar muscles or loss of pronation of the forearm and weak wrist flexion. Musculocutaneous nerve injury primarily affects elbow flexion and supination and is unlikely to affect the movements of the forearm, wrist, and fingers. Ulnar nerve injury, on the other hand, leads to a claw hand rather than wrist drop.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

Trapezius is not related to the mnemonic for the carpal bones.

Carpal Bones: The Wrist’s Building Blocks

The wrist is composed of eight carpal bones, which are arranged in two rows of four. These bones are convex from side to side posteriorly and concave anteriorly. The trapezium is located at the base of the first metacarpal bone, which is the base of the thumb. The scaphoid, lunate, and triquetrum bones do not have any tendons attached to them, but they are stabilized by ligaments.

In summary, the carpal bones are the building blocks of the wrist, and they play a crucial role in the wrist’s movement and stability. The trapezium bone is located at the base of the thumb, while the scaphoid, lunate, and triquetrum bones are stabilized by ligaments. Understanding the anatomy of the wrist is essential for diagnosing and treating wrist injuries and conditions.

Sports that involve sudden bending of the knee, such as sprinting, often result in injuries to the biceps femoris, particularly if the athlete has not properly warmed up. The most frequent type of injury is avulsion, which occurs at the point where the long head connects to the ischial tuberosity. Compared to the other hamstrings, the biceps femoris is more prone to injury.

The Biceps Femoris Muscle

The biceps femoris is a muscle located in the posterior upper thigh and is part of the hamstring group of muscles. It consists of two heads: the long head and the short head. The long head originates from the ischial tuberosity and inserts into the fibular head. Its actions include knee flexion, lateral rotation of the tibia, and extension of the hip. It is innervated by the tibial division of the sciatic nerve and supplied by the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery.

On the other hand, the short head originates from the lateral lip of the linea aspera and the lateral supracondylar ridge of the femur. It also inserts into the fibular head and is responsible for knee flexion and lateral rotation of the tibia. It is innervated by the common peroneal division of the sciatic nerve and supplied by the same arteries as the long head.

Understanding the anatomy and function of the biceps femoris muscle is important in the diagnosis and treatment of injuries and conditions affecting the posterior thigh.

When accessing the submandibular gland, the facial vein and submandibular lymph nodes are the structures that are most easily visible. The gland is divided into a superficial and deep part by the mylohyoid muscle. The facial artery runs along the surface of the gland and can be seen in a groove. It then passes between the gland and the mandible before emerging on the face. During surgery, the facial vein is encountered first as the incision is made 4 cm below the mandible to prevent damage to the marginal mandibular nerve.

Anatomy of the Submandibular Gland

The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

The superior gluteal nerve is responsible for innervating the gluteus minimus and gluteus medius muscles. These muscles are involved in the abduction and medial rotation of the lower limb, as well as preventing pelvic drop of the opposing limb. For instance, when standing on only the right leg, the right gluteus minimus and gluteus medius muscles stabilize the pelvis. However, if the right superior gluteal nerve is damaged, the right gluteus minimus and gluteus medius muscles will not receive innervation, resulting in a lack of stability when standing on the right leg and causing the left pelvis to drop. On the other hand, the inferior gluteal nerve innervates the gluteus maximus muscles, which primarily functions as the main extensor of the thigh and also performs lateral rotation.

The Trendelenburg Test: Assessing Gluteal Nerve Function

The Trendelenburg test is a diagnostic tool used to assess the function of the superior gluteal nerve. This nerve is responsible for the contraction of the gluteus medius muscle, which is essential for maintaining balance and stability while standing on one leg.

When the superior gluteal nerve is injured or damaged, the gluteus medius muscle is weakened, resulting in a compensatory shift of the body towards the unaffected side. This shift is characterized by a gravitational shift, which causes the body to be supported on the unaffected limb.

To perform the Trendelenburg test, the patient is asked to stand on one leg while the physician observes the position of the pelvis. In a healthy individual, the gluteus medius muscle contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from dipping towards the unsupported side. However, in a person with paralysis of the superior gluteal nerve, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non-functional. This is known as a positive Trendelenburg test.

It is important to note that the Trendelenburg test is also used in vascular investigations to determine the presence of saphenofemoral incompetence. In this case, tourniquets are placed around the upper thigh to assess blood flow. However, in the context of assessing gluteal nerve function, the Trendelenburg test is a valuable tool for diagnosing and treating motor deficits and gait abnormalities.

The posterior longitudinal ligament covers both the posterior surface of the vertebral bodies and the intervertebral disks.

Intervertebral Discs

Intervertebral discs are composed of two main parts: the outer annulus fibrosus and the inner nucleus pulposus. The annulus fibrosus is made up of multiple layers of fibrocartilage, while the nucleus pulposus contains loose fibers suspended in a mucoprotein gel with a jelly-like consistency. The nucleus of the disc acts as a shock absorber, and pressure on the disc can cause the posterior protrusion of the nucleus pulposus. This is most commonly seen in the lumbrosacral and lower cervical areas.

The discs are separated by hyaline cartilage, and there is one disc between each pair of vertebrae, except for C1/2 and the sacrococcygeal vertebrae. Understanding the structure and function of intervertebral discs is important in the diagnosis and treatment of spinal conditions. By providing support and cushioning to the spine, these discs play a crucial role in maintaining spinal health and mobility.

The greater tubercle of the humerus is the correct answer. It is the insertion site for the supraspinatus muscle, which is one of three rotator cuff muscles that insert onto the greater tubercle. The infraspinatus muscle inserts onto the middle facet of the greater tubercle, while the teres minor muscle inserts onto the inferior facet.

The lesser tubercle of the humerus is located on the anteromedial aspect of the bone and is the insertion site for the subscapularis muscle, which is the remaining rotator cuff muscle.

The deltoid tuberosity is found on the lateral surface of the humeral shaft and is the insertion site for the deltoid muscle.

The intertubercular sulcus is a groove in the humerus that houses the tendon of the long head of biceps brachii. The floor of the intertubercular sulcus is the insertion site for the latissimus dorsi muscle.

The capitulum of the humerus is located at the distal end of the bone and articulates with the head of the radius.

PASTA lesions are partial tears of the supraspinatus tendon where it inserts into the humerus. They typically occur in athletes after a pulling or twisting injury.

The empty can test, also known as Jobe’s test, is used to test the supraspinatus tendon. It involves slight abduction of the arm, rotating the arm so the thumbs point downwards (as though holding two empty cans), and resisting downward pressure from the examiner. A positive test result indicates a PASTA lesion.

Understanding the Rotator Cuff Muscles

The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

The patient is experiencing pins and needles and pain in the thumb and index finger, which worsens at night. These symptoms are indicative of carpal tunnel syndrome, which occurs when the median nerve is compressed due to increased pressure in the carpal tunnel. The distribution of the patient’s symptoms aligns with the area supplied by the median nerve.

The inferior lateral cutaneous nerve does not innervate the thumb and index finger, so it cannot explain the patient’s symptoms. Damage to the musculocutaneous nerve would cause weakness in the upper arm flexors and impaired sensation in the lateral forearm, but not in the thumb and index finger.

The radial nerve is responsible for wrist extension, and damage to it would result in wrist drop and altered sensation in the dorsum of the hand. The ulnar nerve causes clawing of the hand and paraesthesia in the medial two fingers when damaged, which is not consistent with the patient’s symptoms.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The patient is exhibiting signs and symptoms of aortic dissection, which occurs when there is a tear in the inner wall of the aorta. This can be caused by chronic uncontrolled hypertension or a weakening of the aortic wall. However, in this case, the patient has a family history of Marfan syndrome, a genetically inherited condition that affects the glycoprotein fibrillin and leads to a range of symptoms such as joint hypermobility and chest deformities. Menkes disease, on the other hand, is a genetically inherited condition that involves an accumulation of copper in some body tissues and is inherited in an X-linked recessive pattern. Alpha-1-antitrypsin deficiency is characterized by a deficiency of the enzyme alpha-1-antitrypsin, which normally inhibits elastase and can lead to pan-acinar emphysema and liver impairment. Wrinkles and decreased skin elasticity in the elderly population are a result of normal aging, while scurvy is caused by vitamin C deficiency.

Understanding Marfan’s Syndrome

Marfan’s syndrome is a genetic disorder that affects the connective tissue in the body. It is caused by a defect in the FBN1 gene on chromosome 15, which codes for the protein fibrillin-1. This disorder is inherited in an autosomal dominant pattern and affects approximately 1 in 3,000 people.

Individuals with Marfan’s syndrome often have a tall stature with an arm span to height ratio greater than 1.05. They may also have a high-arched palate, arachnodactyly (long, slender fingers), pectus excavatum (sunken chest), pes planus (flat feet), and scoliosis (curvature of the spine). In addition, they may experience cardiovascular problems such as dilation of the aortic sinuses, mitral valve prolapse, and aortic aneurysm, which can lead to aortic dissection and aortic regurgitation. Other symptoms may include repeated pneumothoraces (collapsed lung), upwards lens dislocation, blue sclera, myopia, and ballooning of the dural sac at the lumbosacral level.

In the past, the life expectancy of individuals with Marfan’s syndrome was around 40-50 years. However, with regular echocardiography monitoring and medication such as beta-blockers and ACE inhibitors, the life expectancy has significantly improved. Despite this, cardiovascular problems remain the leading cause of death in individuals with Marfan’s syndrome.

The correct nerve associated with loss of shoulder abduction due to denervation of the deltoid muscle in an elderly man with a proximal humerus fracture is the axillary nerve (C5,C6). Injury to the long thoracic, musculocutaneous, radial, and ulnar nerves are less likely based on the mechanism of injury and examination findings.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The tendons of the extensor pollicis brevis and abductor pollicis longus form the lateral border of the anatomical snuffbox, not the muscles themselves. This patient’s pain and tenderness over the anatomical snuffbox suggest a likely scaphoid fracture, which is a common injury resulting from a fall on an outstretched hand. It is important to keep in mind the boundaries of the anatomical snuffbox, which include the tendons of the extensor pollicis longus, brevis, and abductor pollicis muscles. The proximal border is the styloid process of the radius, the distal border is the apex of the snuffbox triangle, and the floor is made up of the trapezium and scaphoid bones.

The Anatomical Snuffbox: A Triangle on the Wrist

The anatomical snuffbox is a triangular depression located on the lateral aspect of the wrist. It is bordered by tendons of the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus muscles, as well as the styloid process of the radius. The floor of the snuffbox is formed by the trapezium and scaphoid bones. The apex of the triangle is located distally, while the posterior border is formed by the tendon of the extensor pollicis longus. The radial artery runs through the snuffbox, making it an important landmark for medical professionals.

In summary, the anatomical snuffbox is a small triangular area on the wrist that is bordered by tendons and bones. It is an important landmark for medical professionals due to the presence of the radial artery.

Fractures involving the shaft can compromise the radial nerve, which is located in this groove.

The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

The patella, which is the largest sesamoid bone in the body, shares an articular space with the femur and tibia. Sesamoid bones are embedded in tendons and often pass over joints to protect the tendon from damage.

Long bones, such as the femur, humerus, tibia, and fibula, have a body that is longer than it is wide.

Short bones, like the carpals, are as wide as they are long.

Flat bones are plate-like structures that serve to protect vital organs.

Irregular bones, such as the vertebrae and mandible, do not fit into any of the other categories.

Knee Problems in Children and Young Adults

Knee problems are common in children and young adults, and can be caused by a variety of conditions. Chondromalacia patellae is a condition that affects teenage girls and is characterized by softening of the cartilage of the patella. This can cause anterior knee pain when walking up and down stairs or rising from prolonged sitting. However, it usually responds well to physiotherapy.

Osgood-Schlatter disease, also known as tibial apophysitis, is often seen in sporty teenagers. It causes pain, tenderness, and swelling over the tibial tubercle. Osteochondritis dissecans can cause pain after exercise, as well as intermittent swelling and locking. Patellar subluxation can cause medial knee pain due to lateral subluxation of the patella, and the knee may give way. Patellar tendonitis is more common in athletic teenage boys and causes chronic anterior knee pain that worsens after running. It is tender below the patella on examination.

It is important to note that referred pain may come from hip problems such as slipped upper femoral epiphysis. Understanding the key features of these common knee problems can help with early diagnosis and appropriate treatment.

The teres minor is the correct answer, as it is a rotator cuff muscle. The supraspinatus and infraspinatus are also rotator cuff muscles that are innervated by the suprascapular nerve, while the subscapularis is innervated by the superior and inferior subscapular nerves. The teres major, however, is not a rotator cuff muscle and is innervated by the inferior subscapular nerve. Fractures of the surgical neck of the humerus can result in injury to the axillary nerve and posterior circumflex artery, making it important to test for axillary nerve function by checking sensation in the ‘regimental badge’ area of the arm and observing shoulder movements.

Understanding the Rotator Cuff Muscles

The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

The correct answer is posterior ciliary artery. When a patient presents with temporal arteritis, they may experience a headache, jaw claudication, and visual symptoms that can progress to anterior ischemic optic neuropathy. This occurs due to occlusion of the posterior ciliary artery, which is a branch of the ophthalmic artery. When this artery is blocked, it can result in retinal ischemia and necrosis, leading to visual loss.

The answer of anterior ciliary artery is incorrect because it does not have a direct supply to the retina. Instead, it supplies the conjunctiva, sclera, and rectus muscles. Therefore, it would not show a pale swollen optic disc on fundoscopy, which suggests retinal ischemia.

Central retinal artery is also an incorrect answer because it is not typically affected in temporal arteritis. When this artery is occluded, it results in a cherry red spot on fundoscopy without associated mastication symptoms.

Finally, the lacrimal artery is an incorrect answer because it supplies the lacrimal gland, conjunctiva, and eyelids, but not the retina. Therefore, it would not show a pale optic disc on fundoscopy.

Temporal arteritis is a type of large vessel vasculitis that often occurs in patients over the age of 60 and is commonly associated with polymyalgia rheumatica. This condition is characterized by changes in the affected artery that skip certain sections while damaging others. Symptoms of temporal arteritis include headache, jaw claudication, and visual disturbances, with anterior ischemic optic neuropathy being the most common ocular complication. A tender, palpable temporal artery is also often present, and around 50% of patients may experience symptoms of PMR, such as muscle aches and morning stiffness.

To diagnose temporal arteritis, doctors will typically look for elevated inflammatory markers, such as an ESR greater than 50 mm/hr or elevated CRP levels. A temporal artery biopsy may also be performed to confirm the diagnosis, with skip lesions often being present. Treatment for temporal arteritis involves urgent high-dose glucocorticoids, which should be given as soon as the diagnosis is suspected and before the temporal artery biopsy. If there is no visual loss, high-dose prednisolone is typically used, while IV methylprednisolone is usually given if there is evolving visual loss. Patients with visual symptoms should be seen by an ophthalmologist on the same day, as visual damage is often irreversible. Other treatments may include bone protection with bisphosphonates and low-dose aspirin, although the evidence supporting the latter is weak.

The sternocleidomastoid muscle is located medial (i.e. deep) to the external jugular vein.

The Sternocleidomastoid Muscle: Anatomy and Function

The sternocleidomastoid muscle is a large muscle located in the neck that plays an important role in head and neck movement. It is named after its origin and insertion points, which are the sternum, clavicle, mastoid process, and occipital bone. The muscle is innervated by the spinal part of the accessory nerve and the anterior rami of C2 and C3, which provide proprioceptive feedback.

The sternocleidomastoid muscle has several actions, including extending the head at the atlanto-occipital joint and flexing the cervical vertebral column. It also serves as an accessory muscle of inspiration. When only one side of the muscle contracts, it can laterally flex the neck and rotate the head so that the face looks upward to the opposite side.

The sternocleidomastoid muscle divides the neck into anterior and posterior triangles, which are important landmarks for medical professionals. The anterior triangle contains several important structures, including the carotid artery, jugular vein, and thyroid gland. The posterior triangle contains the brachial plexus, accessory nerve, and several lymph nodes.

Overall, the sternocleidomastoid muscle is a crucial muscle for head and neck movement and plays an important role in the anatomy of the neck.

The iliofemoral ligament is the strongest ligament stabilizing the hip joint, making posterior dislocations more common. The deep acetabulum of the hip provides stability and reduces the risk of anterior dislocation. The ischiofemoral ligament is the weakest of the three capsular ligaments and does not play a significant role in hip stability. Therefore, the iliofemoral ligament is the most important factor in preventing hip dislocation.

Anatomy of the Hip Joint

The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

The long head of biceps tendon runs from the supraglenoid tubercle of the scapula. A ruptured tendon of the long head of biceps brachii is more common in older individuals and may present with the ‘Popeye’ sign. Management is dependent on the patient, with surgical repair for younger patients or those with co-existing rotator cuff tears, and a conservative approach for most patients.

The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

To identify the affected nerve, it is crucial to accurately diagnose the underlying condition. The patient’s symptoms, such as numbness and tingling in the thumb and middle finger (and possibly the radial half of the ring finger), suggest carpal tunnel syndrome. Additionally, the patient’s occupation involving computer use and hypothyroidism are risk factors for this condition.

Carpal tunnel syndrome occurs when the median nerve is compressed at the carpal tunnel as it passes through the wrist.

Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

When using denosumab, there is a higher chance of developing osteonecrosis of the jaw. This is because denosumab inhibits the formation, function, and survival of osteoclasts, which are responsible for bone resorption and calcium release. However, denosumab does not cause constipation, but it can lead to dyspnea and diarrhea as common side effects. Patients should be informed of the risk of osteonecrosis of the jaw before starting denosumab treatment.

Denosumab for Osteoporosis: Uses, Side Effects, and Safety Concerns

Denosumab is a human monoclonal antibody that inhibits the development of osteoclasts, the cells that break down bone tissue. It is given as a subcutaneous injection every six months to treat osteoporosis. For patients with bone metastases from solid tumors, a larger dose of 120mg may be given every four weeks to prevent skeletal-related events. While oral bisphosphonates are still the first-line treatment for osteoporosis, denosumab may be used as a next-line drug if certain criteria are met.

The most common side effects of denosumab are dyspnea and diarrhea, occurring in about 1 in 10 patients. Other less common side effects include hypocalcemia and upper respiratory tract infections. However, doctors should be aware of the potential for atypical femoral fractures in patients taking denosumab and should monitor for unusual thigh, hip, or groin pain.

Overall, denosumab is generally well-tolerated and may have an increasing role in the management of osteoporosis, particularly in light of recent safety concerns regarding other next-line drugs. However, as with any medication, doctors should carefully consider the risks and benefits for each individual patient.

Mefenamic acid is classified as an NSAID because it works by inhibiting COX, which ultimately leads to a decrease in prostaglandin production. Any response indicating an increase or alteration in prostaglandin levels would be inaccurate. The idea of blocking dorsal horn sodium channels is more characteristic of a neuropathic medication rather than an NSAID.

Understanding Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and COX-2 Selective NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that work by inhibiting the activity of cyclooxygenase enzymes, which are responsible for producing key mediators involved in inflammation such as prostaglandins. By reducing the production of these mediators, NSAIDs can help alleviate pain and reduce inflammation. Examples of NSAIDs include ibuprofen, diclofenac, naproxen, and aspirin.

However, NSAIDs can also have important and common side-effects, such as peptic ulceration and exacerbation of asthma. To address these concerns, COX-2 selective NSAIDs were developed. These medications were designed to reduce the incidence of side-effects seen with traditional NSAIDs, particularly peptic ulceration. Examples of COX-2 selective NSAIDs include celecoxib and etoricoxib.

Despite their potential benefits, COX-2 selective NSAIDs are not widely used due to ongoing concerns about cardiovascular safety. This led to the withdrawal of rofecoxib (‘Vioxx’) in 2004. As with any medication, it is important to discuss the potential risks and benefits of NSAIDs and COX-2 selective NSAIDs with a healthcare provider before use.

The patient’s low serum calcium, high serum phosphate, high ALP, and high PTH levels suggest that they have chronic kidney disease leading to secondary hyperparathyroidism. This occurs when the kidneys are unable to synthesize enough vitamin D, resulting in low calcium levels. Additionally, poor kidney function leads to high phosphate levels. As a compensatory mechanism, the parathyroid hormone levels increase, causing lytic bone lesions and high ALP, which explains the patient’s diffuse musculoskeletal tenderness.

Humoral hypercalcemia of malignancy is a condition where parathyroid hormone-related peptide acts similarly to parathyroid hormone, leading to high calcium levels. However, phosphate levels would be low or normal due to the effect of this hormone. In contrast, this patient’s parathyroid hormone levels are high, indicating secondary hyperparathyroidism.

Liver disease alone does not typically cause disturbances in calcium metabolism.

Primary hyperparathyroidism is characterized by excess secretion of parathyroid hormone, resulting in high serum calcium and parathyroid hormone levels. However, in this condition, phosphate levels are low due to the effect of high parathyroid hormone. This patient’s blood work does not suggest primary hyperparathyroidism.

Tertiary hyperparathyroidism occurs in end-stage renal disease, where longstanding secondary hyperparathyroidism leads to excess production of parathyroid hormone and eventual hypercalcemia, rather than hypocalcemia.

Lab Values for Bone Disorders

When it comes to bone disorders, certain lab values can provide important information about the condition. In cases of osteoporosis, calcium, phosphate, alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels are typically normal. However, in osteomalacia, calcium and phosphate levels are decreased while ALP and PTH levels are increased. Primary hyperparathyroidism, which can lead to osteitis fibrosa cystica, is characterized by increased calcium and PTH levels but decreased phosphate levels. Chronic kidney disease can result in secondary hyperparathyroidism, which is marked by decreased calcium levels and increased phosphate and PTH levels. Paget’s disease, on the other hand, typically shows normal calcium and phosphate levels but increased ALP levels. Finally, osteopetrosis is associated with normal levels of calcium, phosphate, ALP, and PTH. By analyzing these lab values, healthcare professionals can better diagnose and treat bone disorders.

The correct answer is that the flexor digitorum profundus muscle is responsible for flexing the distal interphalangeal joint. The other options, such as the flexor digitorum superficialis and flexor pollicis longus, are responsible for different movements and are therefore incorrect. The palmar interossei are also not responsible for flexion at the distal interphalangeal joint. Lastly, there is no such muscle as the flexor digiti medius.

The forearm flexor muscles include the flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, and flexor digitorum profundus. These muscles originate from the common flexor origin and surrounding fascia, and are innervated by the median and ulnar nerves. Their actions include flexion and abduction of the carpus, wrist flexion, adduction of the carpus, and flexion of the metacarpophalangeal and interphalangeal joints.

The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

The patient exhibits a positive Trendelenburg sign, indicating weakness in the gluteus medius and minimus muscles responsible for hip abduction and pelvic stabilization. This is likely due to injury to the superior gluteal nerve. In contrast, injuries to the inferior gluteal nerve affect the gluteus maximus muscle and result in difficulty rising from a seated position or climbing stairs. The femoral nerve is responsible for knee extension and does not play a role in hip abduction. The lateral cutaneous nerve of the thigh causes pain in the posterolateral aspect of the thigh but does not cause motor impairment, while the obturator nerve controls thigh adduction and does not cause a positive Trendelenburg sign.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

Sjogren’s syndrome is the most appropriate answer as it can affect multiple systems of the body, including the lacrimal and salivary glands, which can lead to xerophthalmia and xerostomia. Additionally, it can predispose individuals to conditions such as COPD and bronchiectasis due to mucosal dryness. Early stages of bronchiectasis, early COPD, and parotitis are not the most appropriate answers as they do not fully explain the oral symptoms and other systemic manifestations associated with Sjogren’s syndrome.

Understanding Sjogren’s Syndrome

Sjogren’s syndrome is a medical condition that affects the exocrine glands, leading to dry mucosal surfaces. It can either be primary or secondary to other connective tissue disorders, such as rheumatoid arthritis. The condition is more common in females, with a ratio of 9:1. Patients with Sjogren’s syndrome have a higher risk of developing lymphoid malignancy, which is 40-60 times more likely than the general population.

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, as well as check for the presence of rheumatoid factor, ANA, anti-Ro (SSA) antibodies, and anti-La (SSB) antibodies.

Management of Sjogren’s syndrome involves the use of artificial saliva and tears, as well as medications like pilocarpine to stimulate saliva production. It is important for patients with Sjogren’s syndrome to receive regular medical care and monitoring to manage their symptoms and reduce the risk of complications.

De Quervain’s tenosynovitis is a condition characterized by inflammation of the synovium surrounding a tendon. Specifically, it affects the tendon sheath that encloses two adjacent tendons – the extensor pollicis brevis and abductor pollicis longus – responsible for extending and abducting the thumb. It is important to note that De Quervain’s syndrome only affects these two tendons and not the extensor pollicis longus or any flexors. Additionally, the adductor pollicis muscle is not involved in this condition. Tenderness over the first dorsal compartment is a common sign of De Quervain’s tenosynovitis, as the affected tendons do not travel underneath it.

De Quervain’s Tenosynovitis: Symptoms, Diagnosis, and Treatment

De Quervain’s tenosynovitis is a condition that commonly affects women between the ages of 30 and 50. It occurs when the sheath containing the tendons of the extensor pollicis brevis and abductor pollicis longus becomes inflamed. The condition is characterized by pain on the radial side of the wrist, tenderness over the radial styloid process, and pain when the thumb is abducted against resistance. A positive Finkelstein’s test, in which pain is elicited by ulnar deviation and longitudinal traction of the thumb, is also indicative of the condition.

Treatment for De Quervain’s tenosynovitis typically involves analgesia, steroid injections, and immobilization with a thumb splint (spica). In some cases, surgical intervention may be necessary. With proper diagnosis and treatment, patients can experience relief from the pain and discomfort associated with this condition.

When a disc herniates at the L5-S1 level, it can impact the L5 spinal nerve and result in a loss of sensation on the top of the foot. Additionally, it can affect the function of the sciatic nerve, leading to pain that travels down the leg from the lower back. This pain can be detected through the sciatic nerve stretch test.

If the disc herniation occurs at the L3-L4 level, it can cause a loss of sensation in the front of the thigh and knee. The femoral nerve stretch test would be positive in this case.

Finally, if the disc herniation is at the S1-S2 level, it can cause a loss of sensation on the back and side of the leg, as well as the outer edge of the foot.

Understanding Prolapsed Disc and its Features

A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

The nine flexor tendons found in the carpal tunnel include the flexor digitorum profundus, flexor digitorum superficialis, and flexor pollicis longus. Among these tendons, the flexor digitorum profundus is situated deepest in the tunnel and is therefore closest to the hamate bone.

Carpal Bones: The Wrist’s Building Blocks

The wrist is composed of eight carpal bones, which are arranged in two rows of four. These bones are convex from side to side posteriorly and concave anteriorly. The trapezium is located at the base of the first metacarpal bone, which is the base of the thumb. The scaphoid, lunate, and triquetrum bones do not have any tendons attached to them, but they are stabilized by ligaments.

In summary, the carpal bones are the building blocks of the wrist, and they play a crucial role in the wrist’s movement and stability. The trapezium bone is located at the base of the thumb, while the scaphoid, lunate, and triquetrum bones are stabilized by ligaments. Understanding the anatomy of the wrist is essential for diagnosing and treating wrist injuries and conditions.

The tendon of the subscapularis runs in front of the shoulder capsule, while the supraspinatus tendon runs above it. The tendons of the infraspinatus and teres minor run behind the shoulder capsule, with the infraspinatus tendon positioned above the teres minor tendon. It should be noted that the teres major muscle is not part of the rotator cuff. A Bankart lesion refers to a tear in the front part of the glenoid labrum and is commonly seen in cases of anterior shoulder dislocation.

Understanding the Rotator Cuff Muscles

The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

If a patient is unable to adduct their thigh after an anterior hip dislocation, it is likely due to damage to the obturator nerve. This nerve supplies the hip adductor muscles and sensation to the medial thigh. In contrast, damage to the femoral nerve would result in an inability to flex the hip or extend the knee, making it an unlikely cause for this specific symptom. Compression of the inferior gluteal nerve can cause piriformis syndrome, while compression of the lateral femoral cutaneous nerve can lead to meralgia paresthetica, but neither of these would affect the patient’s ability to adduct their leg. Damage to the superior gluteal nerve would result in a positive Trendelenburg’s sign.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteal lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

The medial femoral circumflex artery is the primary supplier of blood to the femoral head. This artery wraps around the back of the femur to provide blood to the neck and head of the femur. In cases of femoral neck fractures, damage to this artery can occur, leading to a disruption of blood supply and resulting in osteonecrosis of the femoral head.

The deep femoral artery, also known as the profunda femoris, is a branch of the femoral artery that supplies the deep tissues of the thigh. It branches into the lateral and medial femoral circumflex arteries and the perforating arteries, but it does not directly supply the femoral head. It is not typically affected in cases of femoral neck fractures and is therefore not the correct answer.

The femoral artery is responsible for providing blood supply to the lower limb, but it does not directly supply the femoral head. It is not typically affected in cases of femoral neck fractures and is therefore not the correct answer.

The lateral femoral circumflex artery wraps around the front and side of the femur to supply the femoral neck and musculature on the lateral aspect of the thigh. While it does provide some blood supply to the femoral head, it is not the primary supplier and is therefore not the correct answer.

The popliteal artery is a continuation of the femoral artery at the adductor hiatus and supplies the knee, lower leg, and foot. It is not directly involved in the blood supply to the femoral head and is therefore not the correct answer.

Anatomy of the Femur: Structure and Blood Supply

The femur is the longest and strongest bone in the human body, extending from the hip joint to the knee joint. It consists of a rounded head that articulates with the acetabulum and two large condyles at its inferior aspect that articulate with the tibia. The superior aspect of the femur comprises a head and neck that pass inferolaterally to the body and the two trochanters. The neck meets the body of the femur at an angle of 125o and is demarcated from it by a wide rough intertrochanteric crest. The greater trochanter has discernible surfaces that form the site of attachment of the gluteal muscles, while the linea aspera forms part of the origin of the attachments of the thigh adductors.

The femur has a rich blood supply, with numerous vascular foramina existing throughout its length. The blood supply to the femoral head is clinically important and is provided by the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head. It is important to note that the neck is covered by synovial membrane up to the intertrochanteric line, and the posterior aspect of the neck is demarcated from the shaft by the intertrochanteric crest. Understanding the anatomy of the femur, including its structure and blood supply, is crucial for medical professionals in diagnosing and treating injuries and conditions related to this bone.

The axillary nerve is frequently injured in cases of surgical neck fractures of the humerus, as it passes through this area. Symptoms of axillary nerve injury include loss of sensation in the regimental badge area and difficulty with arm abduction due to the affected deltoid and teres minor muscles.

Damage to the median nerve is uncommon in cases of proximal or mid-shaft humeral fractures, as it is protected by surrounding muscle. However, it may be affected in distal humeral fractures as it passes through the cubital fossa.

The musculocutaneous nerve is well-protected by muscle and is rarely injured in cases of proximal humeral fractures.

The radial nerve is most commonly injured in midshaft humeral fractures, as it runs along the radial groove of the humerus.

Similarly to the median nerve, the ulnar nerve arises from the brachial plexus and runs along the medial surface of the upper arm. It is most commonly injured in cases of distal humeral fractures.

The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

The correct answer is the lateral lip of the intertubercular sulcus, which is the insertion site of the latissimus dorsi muscle.

A ruptured pectoralis major tendon is a common injury in weight training, often occurring during the bench press exercise. The patient may experience a painful snap or hear a snapping noise, and the tension in the muscle is lost, causing the chest wall to lose its shape. Bruising may be visible on the chest or arm.

Other anatomical features mentioned in the question include the lesser and greater tubercles of the humerus, which are insertion sites for various rotator cuff muscles, and the pectineal line on the femur, which is the insertion site for the pectineus muscle.

Pectoralis Major Muscle: Origin, Insertion, Nerve Supply, and Actions

The pectoralis major muscle is a large, fan-shaped muscle located in the chest region. It originates from the medial two thirds of the clavicle, manubrium, and sternocostal angle and inserts into the lateral edge of the bicipital groove of the humerus. The muscle is innervated by the lateral pectoral nerve and its main actions include adduction and medial rotation of the humerus.

In simpler terms, the pectoralis major muscle is responsible for bringing the arm towards the body and rotating it inward. It is an important muscle for movements such as pushing, pulling, and lifting. The muscle is commonly targeted in strength training exercises such as bench press and push-ups. Understanding the origin, insertion, nerve supply, and actions of the pectoralis major muscle is important for proper exercise form and injury prevention.

The middle scalene is located posterior to the subclavian artery.

The Scalene Muscles and Thoracic Outlet Syndrome

The scalene muscles are a group of three paired muscles located in the neck that play a role in elevating the ribs and tilting the neck. The scalenus anterior and medius muscles elevate the first rib and laterally flex the neck to the same side, while the scalenus posterior muscle elevates the second rib and tilts the neck to the opposite side. These muscles are innervated by spinal nerves C4-6 and originate from the transverse processes of C2 to C7, inserting into the first and second ribs.

The scalene muscles are important because the brachial plexus and subclavian artery pass between the anterior and middle scalenes through a space called the scalene hiatus or fissure. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as it crosses over the first rib. However, the scalenes are at risk of adhering to the fascia surrounding the brachial plexus or shortening, which can cause compression of the brachial plexus when it passes between the clavicle and first rib. This condition is known as thoracic outlet syndrome.

In summary, the scalene muscles play an important role in the neck and chest, but can also cause issues if they become adhered or shortened, leading to thoracic outlet syndrome. It is important to be aware of this condition and seek medical attention if experiencing symptoms such as pain, numbness, or tingling in the arm or hand.

Psoriasis is characterized by the infiltration of neutrophils into the stratum corneum. This is suggested by the skin changes on the extensor surfaces, which are exacerbated by lithium. Bullous pemphigoid is associated with the destruction of hemidesmosomes, while pemphigus vulgaris is linked to damage to desmoglein. Acne vulgaris is characterized by follicular hyperkeratosis and increased sebum production.

Psoriasis: A Chronic Skin Disorder with Various Subtypes and Complications

Psoriasis is a prevalent chronic skin disorder that affects around 2% of the population. It is characterized by red, scaly patches on the skin, but it is now known that patients with psoriasis are at an increased risk of arthritis and cardiovascular disease. The pathophysiology of psoriasis is multifactorial and not yet fully understood. It is associated with genetic factors such as HLA-B13, -B17, and -Cw6, and abnormal T cell activity that stimulates keratinocyte proliferation. Environmental factors such as skin trauma, stress, streptococcal infection, and sunlight exposure can worsen, trigger, or improve psoriasis.

There are several recognized subtypes of psoriasis, including plaque psoriasis, flexural psoriasis, guttate psoriasis, and pustular psoriasis. Each subtype has its own unique characteristics and affects different areas of the body. Psoriasis can also cause nail signs such as pitting and onycholysis, as well as arthritis.

Complications of psoriasis include psoriatic arthropathy, metabolic syndrome, cardiovascular disease, venous thromboembolism, and psychological distress. It is important for patients with psoriasis to receive proper management and treatment to prevent these complications and improve their quality of life.

Due to the fact that the blood supply to the scaphoid enters from a small non-articular surface near its distal end, there is a risk of non-union with transverse fractures of the scaphoid.

The scaphoid bone has various articular surfaces for different bones in the wrist. It has a concave surface for the head of the capitate and a crescentic surface for the lunate. The proximal end has a wide convex surface for the radius, while the distal end has a tubercle that can be felt. The remaining articular surface faces laterally and is associated with the trapezium and trapezoid bones. The narrow strip between the radial and trapezial surfaces and the tubercle gives rise to the radial collateral carpal ligament. The tubercle also receives part of the flexor retinaculum and is the only part of the scaphoid bone that allows for the entry of blood vessels. However, this area is commonly fractured and can lead to avascular necrosis.

Gout is commonly associated with Lesch-Nyhan syndrome, an inherited enzyme deficiency also known as ‘juvenile gout’. This condition is also characterized by self-injuring behavior, cognitive impairment, and nervous system impairment. However, juvenile idiopathic arthritis and osteoarthritis, which also cause joint pain and swelling, are not strongly linked to gout. On the other hand, pseudogout is associated with hyperparathyroidism.

Predisposing Factors for Gout

Gout is a type of synovitis caused by the accumulation of monosodium urate monohydrate in the synovium. This condition is triggered by chronic hyperuricaemia, which is characterized by uric acid levels exceeding 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.

Decreased excretion of uric acid can be caused by various factors, including the use of diuretics, chronic kidney disease, and lead toxicity. On the other hand, increased production of uric acid can be triggered by myeloproliferative/lymphoproliferative disorders, cytotoxic drugs, and severe psoriasis.

In rare cases, gout can also be caused by genetic disorders such as Lesch-Nyhan syndrome, which is characterized by hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency. This condition is x-linked recessive, which means it is only seen in boys. Lesch-Nyhan syndrome is associated with gout, renal failure, neurological deficits, learning difficulties, and self-mutilation.

It is worth noting that aspirin in low doses (75-150mg) is not believed to have a significant impact on plasma urate levels. Therefore, the British Society for Rheumatology recommends that it should be continued if necessary for cardiovascular prophylaxis.

Understanding Prolapsed Disc and its Features

A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

The correct answer is the lateral cutaneous nerve of the thigh. The patient’s symptoms suggest meralgia paraesthetica, which is caused by compression of the nerve near the ASIS. The location of the tingling and numbness, as well as the absence of motor symptoms, point towards this diagnosis.

The femoral nerve, obturator nerve, and sciatic nerve are not the correct answers. Each of these nerves would cause different symptoms and are typically injured in different ways.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

Bisphosphonates, such as alendronate and risedronate, are used to treat osteoporosis by preventing bone resorption through the inhibition of osteoclasts. These drugs are taken up by the osteoclasts, preventing them from adhering to the bone surface and continuing the resorption process.

Denosumab is a monoclonal antibody that works by binding to the receptor activator of nuclear factor kappa-B ligand (RANK-L), which blocks the interaction between RANK-L and RANK, ultimately reducing bone resorption.

Raloxifene is a selective estrogen receptor modulator that has estrogen-like effects on bone, leading to decreased bone resorption and improved bone density.

Romosozumab is a monoclonal antibody that inhibits the action of sclerostin, a regulatory factor in bone metabolism, ultimately leading to increased bone formation.

Bisphosphonates: Uses, Adverse Effects, and Patient Counselling

Bisphosphonates are drugs that mimic the action of pyrophosphate, a molecule that helps prevent bone demineralization. They work by inhibiting osteoclasts, the cells responsible for breaking down bone tissue. Bisphosphonates are commonly used to prevent and treat osteoporosis, hypercalcemia, Paget’s disease, and pain from bone metastases.

However, bisphosphonates can cause adverse effects such as oesophageal reactions, osteonecrosis of the jaw, and an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate. Patients may also experience an acute phase response, which includes fever, myalgia, and arthralgia following administration. Hypocalcemia may also occur due to reduced calcium efflux from bone, but this is usually clinically unimportant.

To minimize the risk of adverse effects, patients taking oral bisphosphonates should swallow the tablets whole with plenty of water while sitting or standing. They should take the medication on an empty stomach at least 30 minutes before breakfast or another oral medication and remain upright for at least 30 minutes after taking the tablet. Hypocalcemia and vitamin D deficiency should be corrected before starting bisphosphonate treatment. However, calcium supplements should only be prescribed if dietary intake is inadequate when starting bisphosphonate treatment for osteoporosis. Vitamin D supplements are usually given.

The duration of bisphosphonate treatment varies depending on the level of risk. Some experts recommend stopping bisphosphonates after five years if the patient is under 75 years old, has a femoral neck T-score of more than -2.5, and is at low risk according to FRAX/NOGG.

The femoral triangle is bordered by the Adductor longus medially, Inguinal ligament superiorly, and Sartorius muscle laterally. The Adductor longus muscle is located along the medial border of the femoral triangle and is closely associated with the long saphenous vein and the profunda branch of the femoral artery. The femoral nerve is located inferiorly to the Adductor longus muscle. However, the tendon of iliacus inserts proximally and does not come into contact with the Adductor longus muscle.

Adductor Longus Muscle

The adductor longus muscle originates from the anterior body of the pubis and inserts into the middle third of the linea aspera. Its main function is to adduct and flex the thigh, as well as medially rotate the hip. This muscle is innervated by the anterior division of the obturator nerve, which originates from the spinal nerves L2, L3, and L4. The adductor longus is one of the adductor muscles, which are a group of muscles located in the thigh that work together to bring the legs towards the midline of the body. The schematic image below illustrates the relationship of the adductor muscles.

The patient has been diagnosed with carpal tunnel syndrome, which is often caused by rheumatological disorders. During the clinical examination, it is important to look for signs of rheumatoid arthritis, such as rheumatoid nodules, vasculitic lesions, and arthritis in the metacarpophalangeal joints.

Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

The attachment point of the anterior cruciate ligament is the anterior intercondylar area of the tibia. From there, it extends in a posterolateral direction and inserts into the posteromedial aspect of the lateral femoral condyle.

The knee joint is the largest and most complex synovial joint in the body, consisting of two condylar joints between the femur and tibia and a sellar joint between the patella and femur. The degree of congruence between the tibiofemoral articular surfaces is improved by the presence of the menisci, which compensate for the incongruence of the femoral and tibial condyles. The knee joint is divided into two compartments: the tibiofemoral and patellofemoral compartments. The fibrous capsule of the knee joint is a composite structure with contributions from adjacent tendons, and it contains several bursae and ligaments that provide stability to the joint. The knee joint is supplied by the femoral, tibial, and common peroneal divisions of the sciatic nerve and by a branch from the obturator nerve, while its blood supply comes from the genicular branches of the femoral artery, popliteal, and anterior tibial arteries.

If a patient exhibits a positive Froment’s sign, it suggests that they may have ulnar nerve palsy. The ulnar nerve is responsible for controlling finger adduction and abduction. Meanwhile, the median nerve is responsible for thumb abduction and wrist pronation, while the radial nerve controls wrist extension.

Nerve signs are used to assess the function of specific nerves in the body. One such sign is Froment’s sign, which is used to assess for ulnar nerve palsy. During this test, the adductor pollicis muscle function is tested by having the patient hold a piece of paper between their thumb and index finger. The object is then pulled away, and if the patient is unable to hold the paper and flexes the flexor pollicis longus to compensate, it may indicate ulnar nerve palsy.

Another nerve sign used to assess for carpal tunnel syndrome is Phalen’s test. This test is more sensitive than Tinel’s sign and involves holding the wrist in maximum flexion. If there is numbness in the median nerve distribution, the test is considered positive.

Tinel’s sign is also used to assess for carpal tunnel syndrome. During this test, the median nerve at the wrist is tapped, and if the patient experiences tingling or electric-like sensations over the distribution of the median nerve, the test is considered positive. These nerve signs are important tools in diagnosing and assessing nerve function in patients.

The muscle responsible for flexing the MCPs and PIPs is the flexor digitorum superficialis. The flexor digitorum profundus is responsible for flexing the distal interphalangeal joint, while the flexor carpi ulnaris flexes and adducts the wrist. The flexor digiti minimi brevis is responsible for flexing the little (5th) finger. It should be noted that there is no muscle called the flexor indicis distalis.

The forearm flexor muscles include the flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, and flexor digitorum profundus. These muscles originate from the common flexor origin and surrounding fascia, and are innervated by the median and ulnar nerves. Their actions include flexion and abduction of the carpus, wrist flexion, adduction of the carpus, and flexion of the metacarpophalangeal and interphalangeal joints.

The anterior compartment contains the quadriceps femoris.

Fascial Compartments of the Leg

The leg is divided into compartments by fascial septae, which are thin layers of connective tissue. In the thigh, there are three compartments: the anterior, medial, and posterior compartments. The anterior compartment contains the femoral nerve and artery, as well as the quadriceps femoris muscle group. The medial compartment contains the obturator nerve and artery, as well as the adductor muscles and gracilis muscle. The posterior compartment contains the sciatic nerve and branches of the profunda femoris artery, as well as the hamstrings muscle group.

In the lower leg, there are four compartments: the anterior, posterior (divided into deep and superficial compartments), lateral, and deep posterior compartments. The anterior compartment contains the deep peroneal nerve and anterior tibial artery, as well as the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius muscles. The posterior compartment contains the tibial nerve and posterior tibial artery, as well as the deep and superficial muscles. The lateral compartment contains the superficial peroneal nerve and peroneal artery, as well as the peroneus longus and brevis muscles. The deep posterior compartment contains the tibial nerve and posterior tibial artery, as well as the flexor hallucis longus, flexor digitorum longus, tibialis posterior, and popliteus muscles.

The hamstring muscle group consists of three muscles: the biceps femoris, which is located on the lateral side, and the semitendinosus and semimembranosus, which are located on the medial side. While less common, it is possible for the gastrocnemius and soleus muscles to also experience a rupture.

The Biceps Femoris Muscle

The biceps femoris is a muscle located in the posterior upper thigh and is part of the hamstring group of muscles. It consists of two heads: the long head and the short head. The long head originates from the ischial tuberosity and inserts into the fibular head. Its actions include knee flexion, lateral rotation of the tibia, and extension of the hip. It is innervated by the tibial division of the sciatic nerve and supplied by the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery.

On the other hand, the short head originates from the lateral lip of the linea aspera and the lateral supracondylar ridge of the femur. It also inserts into the fibular head and is responsible for knee flexion and lateral rotation of the tibia. It is innervated by the common peroneal division of the sciatic nerve and supplied by the same arteries as the long head.

Understanding the anatomy and function of the biceps femoris muscle is important in the diagnosis and treatment of injuries and conditions affecting the posterior thigh.

Tense haematomas can develop due to the unyielding nature of the pretracheal fascia that encloses the thyroid.

Anatomy of the Thyroid Gland

The thyroid gland is a butterfly-shaped gland located in the neck, consisting of two lobes connected by an isthmus. It is surrounded by a sheath from the pretracheal layer of deep fascia and is situated between the base of the tongue and the fourth and fifth tracheal rings. The apex of the thyroid gland is located at the lamina of the thyroid cartilage, while the base is situated at the fourth and fifth tracheal rings. In some individuals, a pyramidal lobe may extend from the isthmus and attach to the foramen caecum at the base of the tongue.

The thyroid gland is surrounded by various structures, including the sternothyroid, superior belly of omohyoid, sternohyoid, and anterior aspect of sternocleidomastoid muscles. It is also related to the carotid sheath, larynx, trachea, pharynx, oesophagus, cricothyroid muscle, and parathyroid glands. The superior and inferior thyroid arteries supply the thyroid gland with blood, while the superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid vein drains into the brachiocephalic veins.

In summary, the thyroid gland is a vital gland located in the neck, responsible for producing hormones that regulate metabolism. Its anatomy is complex, and it is surrounded by various structures that are essential for its function. Understanding the anatomy of the thyroid gland is crucial for the diagnosis and treatment of thyroid disorders.

The origin of palmaris longus is in the forearm.

Anatomy of the Hand: Fascia, Compartments, and Tendons

The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

The external carotid artery is located posterior to the hypoglossal nerve, while the lingual arterial branch is situated below it. In case of damage to the nerve, the genioglossus, hyoglossus, and styloglossus muscles on the same side will become paralyzed. When the patient is instructed to stick out their tongue, it will deviate towards the affected side.

The Anterior Triangle of the Neck: Boundaries and Contents

The anterior triangle of the neck is a region that is bounded by the anterior border of the sternocleidomastoid muscle, the lower border of the mandible, and the anterior midline. It is further divided into three sub-triangles by the digastric muscle and the omohyoid muscle. The muscular triangle contains the neck strap muscles, while the carotid triangle contains the carotid sheath, which houses the common carotid artery, the vagus nerve, and the internal jugular vein. The submandibular triangle, located below the digastric muscle, contains the submandibular gland, submandibular nodes, facial vessels, hypoglossal nerve, and other structures.

The digastric muscle, which separates the submandibular triangle from the muscular triangle, is innervated by two different nerves. The anterior belly of the digastric muscle is supplied by the mylohyoid nerve, while the posterior belly is supplied by the facial nerve.

Overall, the anterior triangle of the neck is an important anatomical region that contains many vital structures, including blood vessels, nerves, and glands. Understanding the boundaries and contents of this region is essential for medical professionals who work in this area.