examination

Diagnostic Issues

Supraclavicular

- nerve root patterns of sensation and motor disturbance

Infraclavicular

- peripheral nerve root pattern / cord

Supraclavicular preganglionic

- dorsal scapular / long thoracic / suprascapular nerves injured

- Horner's

- lack of sensation supraclavicular

- no tinel's

Definition

Palmar Fibromatosis 

Aetiology

AD with variable penetration

Pathogenesis

Murrell's Theory of Pathogenesis

1. Microvascular ischaemia

Definition

Groin pain in athletes

- secondary to tear in external oblique fascia

Epidemiology

Sports with aggressive adduction

- hockey / soccer

Pathology

Tears in external oblique fascia

- tend to be central

- around spermatic cord and ilioinguinal nerve

- pain may be from nerve entrapment

DDx

Adductor Longus Tear

Aetiology

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

History

Initially

- lose velocity / accuracy

Develop medial pain

40% ulna nerve symptoms

Definition

A fixed equinus deformity of the forefoot in relation to the hindfoot 

- resulting in an abnormally high arch that fails to flatten with weight bearing

- deformity may be forefoot, hindfoot or combination

Aetiology

Aetiology

Intrinsic

- inflammatory

- degenerative

Extrinsic

- traumatic

- spur

Epidemiology

F > 40

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

Definition

Bunion

- medial prominence of head of 1st MT

Hallux Valgus

- medial deviation 1st MT

- lateral deviation of great toe

Anatomy

Metatarsal head

- has 2 grooves separating ridge (cristae)

Differential Diagnosis of the Painful TKA 

Surgical Diagnosis  

1.  Prosthetic loosening and failure 

2.  Infection 

3.  Patellofemoral tracking problems  

4.  Instability 

5.  Recurrent intra-articular soft-tissue impingement / Component overhang  

Nonsurgical Diagnoses  

1.  Referred pain - Hip / Back  

Pathology

ITB rubbing on LFC

- long distance runners (slow running more at risk than fast)

- cyclists (seat too high, improper technique)

ITB becomes tight, especially posterior portion

Develop inflammed tissue under ITB

- synovium

- bursa

Aetiology

Overuse 

- sudden increase in distance

- hill running

- genu varum 

- improper shoe wear

Graft selection

A.  Synthetic Grafts

Good initial results but unacceptably high failure rate with longer follow-up

Problems

1.   Too stiff (low ultimate strain) 

- poor resistance to abrasion

- ligament failure by attrition most common

2.  Recurrent synovitis, infection, loosening and osteolysis

B.  Autograft