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 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.

Once the inflammation has subsided, it is recommended to test the serum urate in suspected cases of gout, as its levels may vary from high to low or normal during an acute attack. Additionally, the patient’s overall good health and moderately elevated CRP levels suggest that septic arthritis is less probable.

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.

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.

The correct muscle for hip abduction is the gluteus medius, which has anterior and posterior parts. The anterior part contributes to hip flexion and internal rotation, while the posterior part contributes to hip extension and external rotation. When both parts work together, they abduct the hip. The gluteus maximus primarily functions for hip extension and external rotation, while the hamstrings coordinate flexion and extension of the hip and knee joints but do not contribute to abduction. The iliopsoas primarily functions for hip extension.

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 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.

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.

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.

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 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.

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.

The adductor canal is bordered laterally by the vastus medialis and its roof is formed by the sartorius muscle. The adductor longus muscle forms the medial boundary of the femoral triangle.

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.

The femoral head and shaft typically form an angle of 130 degrees, but any deviations from this angle may indicate underlying disease or pathology and require further examination.

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 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.

The lateral border of the anatomical snuffbox is formed by the tendons of the extensor pollicis brevis and the abductor pollicis longus, not the muscles.

To remember the borders, use the phrase Brevis sandwich which stands for the abductor pollicis longus tendons, extensor pollicis brevis, and extensor pollicis longus.

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 Supraspinatus muscle is responsible for starting the process of lifting the arm away from the body, up to a point of about 15 degrees. After this point, the Deltoid muscle takes over as the primary muscle responsible for continuing the arm’s upward movement. When the arm is lifted beyond 90 degrees, the Trapezius muscle comes into play, elevating the shoulder and rotating the scapula. Finally, the Infraspinatus muscle is responsible for producing lateral rotation of the arm at the shoulder.

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 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 anatomical snuffbox contains the radial artery and is a common site for scaphoid fractures. The scaphoid bone forms the floor of the snuffbox and the radial artery provides its blood supply. Missing a scaphoid fracture can lead to avascular necrosis. Other structures such as the flexor pollicis longus tendon, median nerve, pisiform bone, and ulnar artery do not lie within the snuffbox.

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.

Patients with rheumatoid arthritis are believed to have a higher likelihood of developing atherosclerotic disorders, even if they are unaware of any pre-existing heart conditions or elevated cardiovascular risk. The underlying cause of this atherosclerosis is attributed to systemic inflammation, which is thought to expedite the progression of the disease.

Complications of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects the joints, causing inflammation and pain. However, it can also lead to a variety of extra-articular complications. These complications can affect different parts of the body, including the respiratory system, eyes, bones, heart, and mental health.

Respiratory complications of RA include pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, and pleurisy. Ocular complications can include keratoconjunctivitis sicca, episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, and chloroquine retinopathy. RA can also lead to osteoporosis, ischaemic heart disease, and an increased risk of infections. Depression is also a common complication of RA.

Less common complications of RA include Felty’s syndrome, which is characterized by RA, splenomegaly, and a low white cell count, and amyloidosis, which is a rare condition where abnormal proteins build up in organs and tissues.

In summary, RA can lead to a variety of complications that affect different parts of the body. It is important for patients with RA to be aware of these potential complications and to work closely with their healthcare providers to manage their condition and prevent or treat any complications that may arise.

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 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 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 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 clavipectoral fascia is located beneath the clavicular part of the pectoralis major muscle and serves as a protective barrier for the axillary vessels and nodes. In cases of breast cancer requiring axillary node clearance, the clavipectoral fascia is incised to allow access to the nodal stations. These stations include level 1 nodes located below the pectoralis minor muscle, level 2 nodes situated behind it, and level 3 nodes above it. In some cases, such as during a Patey Mastectomy, surgeons may need to divide the pectoralis minor muscle to access level 3 nodes. However, with the use of sentinel node biopsy and improved techniques, this procedure is becoming less common.

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, innervate 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.

Humeral shaft fractures can result in a radial nerve palsy, also known as ‘Saturday night palsy’. This condition is characterized by wrist drop, which is the loss of function in the wrist and hand extensor muscles, as well as the inability to form a strong grip and loss of sensation in the first dorsal interosseous muscle.

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 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.

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 patient has been experiencing chronic pain throughout her body for the past 6 months. Rheumatoid arthritis is unlikely as the pain does not seem to be originating from the joints. Fibromyalgia and polymyalgia rheumatica are the two most probable diagnoses, but the absence of weight loss and fever makes polymyalgia rheumatica less likely. Therefore, fibromyalgia is the most likely diagnosis. The patient also reports feeling tired and having sleep disturbances, which are common symptoms of fibromyalgia.

1: This condition primarily affects individuals over 50 years old and is associated with elevated levels of inflammatory markers like ESR and CRP. It is linked to giant cell arteritis, but serum CK and muscle biopsy results are normal.
2: Fibromyalgia is characterized by widespread musculoskeletal pain and tenderness in various points of the body.
3: The patient has not reported any muscle weakness. If weakness in the shoulder region was present, polymyositis would be a more probable diagnosis.
4: This inflammatory musculoskeletal condition primarily affects the axial skeleton and is strongly associated with the HLA-B27 histocompatibility complex. The initial symptom is typically lower back pain due to sacroiliitis.
5:

Fibromyalgia is a condition that causes widespread pain throughout the body, along with tender points at specific anatomical sites. It is more common in women and typically presents between the ages of 30 and 50. Other symptoms include lethargy, cognitive impairment (known as fibro fog), sleep disturbance, headaches, and dizziness. Diagnosis is made through clinical evaluation and the presence of tender points. Management of fibromyalgia is challenging and requires an individualized, multidisciplinary approach. Aerobic exercise is the most effective treatment, along with cognitive behavioral therapy and medication such as pregabalin, duloxetine, and amitriptyline. However, there is a lack of evidence and guidelines to guide treatment.

The most frequent location for clavicle fractures is the middle third, which is the weakest part of the bone and lacks any ligaments or muscles. This is especially common in young children. Fractures in the proximal and distal thirds are less frequent and therefore incorrect answers. While sternum fractures can occur in high-force trauma, the mechanism of injury and visible bony deformity in this case suggest a clavicular fracture. Acromion fractures are rare and would not result in the observed bony injury.

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’s 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 contents of the posterior triangle include the phrenic nerve, while the carotid sheath and its contents are found in the anterior triangle.

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.