nyuuzyou/wikis huggingface dataset:
Furcal Nerve

The furcal nerve (furcal = fork) is an independent nerve that forms a link between the lumbar and sacral plexuses. It has its own ventral and dorsal branches (rootlets). It is most commonly found at the L4 level. Atypical presentations of sciatica are common. They may be due to the patient having two lesions, variations of cutaneous supply of the dorsal rami, nerve root anomalies, and the presence of a furcal nerve. The furcal nerve is the most common cause of double nerve root contribution in unilateral radiculopathies.
==Anatomy==
The lumbar plexus is formed by the ventral and dorsal rami of L1-L4 nerve roots, with a contribution from the subcostal nerve. It is located within the psoas muscle anterior to the transverse process. The lumbosacral trunk is formed with a branch from the ventral ramus of L4 with the ventral ramus of L5. The sacral plexus is formed by the lumbosacral trunk and anterior divisions of the first to third sacral nerves. The plexus can be pre-fixed (L3 contribution) or postfixed (L5 contribution).
The furcal nerve is an independent nerve, and it has its own ventral and dorsal rootlets. It is most commonly found to arise at the L4 level (93%). It tends to be found superior and ventral to the L4 nerve roots, and runs beside it in the intervertebral foramen. The L3 level is the second most common site. Double furcal nerves exist but are rare. They may be part of conjoined nerve roots, and combined with intradural anomalies.
The furcal nerve connects the lumbar and sacral plexuses. It's dorsal root has a separate dorsal root ganglion. It supplies branches to the femoral nerve, lumbosacral trunk, and obturator nerve
There are two sub-types of furcal nerve - the intra-foraminal, and extra-foraminal variants. The majority bifurcate extra-foraminally.
==Epidemiology==
Haijiao et al found that the incidence of furcal nerve to be 15.1% (57/376), and it was the most common nerve root anomaly. It is found very commonly in fetuses, possibly universal.
==Clinical Relevance==
The furcal nerve causes disparity between imaging and clinical presentations. The patient may have motor weakness and sensory disturbance at levels not explained by standard imaging. Transitional anatomy if present, can also contribute to variable clinical presentations.
==Diagnosis==
Diagnostic single nerve root block can help with diagnosis. Meticulous reading the the imaging is required.
==External Resources==
* Review by Harshavardhana et al.
* Review and case report by Decater et al
==References==
Category:Lumbar Spine Anatomy
Category:Nerves of the Spine
Genicular Nerve Injection

==Background==
A genicular nerve injection can be used to treat knee osteoarthritis pain with or without steroid. The addition of steroid provides a longer effect but this wanes between 4-8 weeks. With lidocaine alone the effect wanes by 2-4 weeks. However clinically significant relief is only maintained for two weeks. Clinical improvements in functional capacity persist for one week in both options. The use of corticosteroid to enhance a peripheral nerve block remains controversial. Kim DH, Choi SS, Yoon SH, et al. Ultrasound-Guided Genicular Nerve Block for Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial of Local Anesthetic Alone or in Combination with Corticosteroid. Pain Physician. 2018;21(1):41-52.
==Anatomy==
There are three main nerves that supply sensory input to the knee joint. The superior lateral, the superior medial, and the inferior medial genicular nerves. 
==Indications==
==Contraindications==
==Technique==
===Ultrasound Guided===
*Position: Supine with pillow under the knee.
*The genicular nerves (superior lateral, superior medial, and inferior medial) run next to the genicular arteries next to the periosteum of the distal femoral condyle and medial tibial metaphysis.
*The nerves may be unidentifiable which does not make the procedure contraindicated
*confirm vessel location using colour doppler.
*Deposit 2mL next to each genicular artery, for a total of 6mL, plus steroid if using.
===Non-ultrasound Guided===
==Complications==
==Aftercare==
==Videos==
==See Also==
Knee and Leg
==External Links==
==References==
Category:Infoboxes
Category:Knee and Leg Procedures
Category:Stubs
Gluteus Maximus

The gluteus maximus muscle is the largest and most superficial of the three gluteal muscles. During the normal gait, the hamstrings provide most hip extension rather than the gluteus maximus.
==Gluteus Maximus Lurch==
Normally the gluteus maximus contracts at the point of heel strike during gait, arresting hip flexion, and thereby slowing forward motion of the trunk. A weakened gluteus maximus causes a backwards lurch (trunk extension) at heel strike on the weakened side, interrupting the forward motion of the trunk. This compensates for the weakness of hip extension. 
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Category:Muscles of the Lower Limb
Glyceryl Trinitrate

Glyceryl Trinitrate is a treatment for Tendinopathy. It is applied to the degenerative area and may enhance collagen synthesis via the nitric oxide signaling molecule. 
==Formulations==
There are two formulations in New Zealand.
*Patches - 5mg/24 hour or 10mg/24 hour Nitroderm TTS patches are available. The literature describes using one-fourth to one-half of one of these doses but if you cut Nitroderm the medication leaks out. One can try use the full 5mg/24 hour dose or put medical tape under a portion of it. The patches are fully funded.
*Ointment - 0.2% Rectogesic. This is not funded.
==Evidence==
There is no clear evidence of efficacy. A 2019 systematic review identified 10 eligible RCTs. There was improvement up to 6 months in pain, strength, and patient satisfaction with a mean effect size ranges from 0.12 to 0.26. It can be useful for all chronic tendinopathies as an adjunct to a loading programme. It can take up to 12 to 24 weeks to experience significant improvement.
==Adverse effects==
Head is the most common in up to one in five patients.
==Contraindications==
*Hypotension
*Migraine headaches
*Rosacea
*Head injury
*Severe anaemia
*Ingestion of phosphodiesterase inhibitors
*Ingestion of oral or sublingual nitroglycerin
== Resources ==
==See Also==
*Tendinopathy
== References ==
Category:Pharmacology
Gracilis

The gracilis muscle is a fusiform muscle located in the medial compartment of the thigh. Superiorly it is thin, flattened and broad, and tapers is it descends. It is the most superficial of the adductor muscles, and is innervated by the obturator nerve (L2-L4).
Functionally, the gracilis muscle acts as a primary adductor and medial rotator of the thigh, as well as assisting in flexion of the knee joint. It also plays a role in stabilizing the knee during standing and ambulation.
Due to its superficial location and relatively small size, the gracilis muscle is commonly used as a donor muscle for reconstruction in various surgical procedures, including anterior cruciate ligament (ACL) repair and urethral reconstruction.
Clinically, dysfunction of the gracilis muscle can present as pain and weakness in the medial thigh and knee, and can be assessed through manual muscle testing and imaging techniques such as MRI.
Category:Muscles of the Lower Limb
Guyon's Canal Syndrome

The sensory loss is the same as in Ulnar Neuropathy at the Elbow
The motor loss may include all [[Ulnar Nerve|ulnar] nerve] innervated hand muscles i.e. interossei, lumbricals of digits 4/5, adductor pollicis, palmaris brevis, abductor digiti minimi, flexor digiti minimi, and opponens digiti minimi.
Category:Mononeuropathies
Category:Elbow and Forearm Conditions
Hamstring Examination

==Gait==
*Limited hip flexion on the affected side
*Lack of full hip extension
*Decreased lift in the swing phase
*Antalgic gait
==Inspection==
*Swelling
*Ecchymosis
*Muscular defects
*Atrophy
==Palpation==
*Pay attention to the origin at the ischial tuberosity, and popliteal fossa, looking for focal tenderness
*Palpate all muscles
**Biceps femoris
**Semimembrinosis
**Semitendinosis
==Movement==
*Strength testing
**Hamstring concentric strength at 90 degrees of flexion
**Hamstring eccentric strength with 15-30 degrees of knee extension
**Biceps femoris tested by externally rotating the leg
**Semimembranosus testing by internally rotating the leg
*Range of motion
**Hip flexors
**Hip Extensors
**Hip Abductors
**Hip Adductors
==Special Tests==
*Modified bent knee test - supine with hip and knee maximally flexed, the examiner then quickly passively extends the knee. A positive test is pain felt near the ischial tuberosity
*Slump test and straight leg raise test if radicular symptoms present
==Other==
*Lumbar Spine Examination
*Sacroiliac Joint Examination
*Hip Examination
Category:Pelvis, Hip and Thigh
Category:Examination
Hand and Wrist Examination

==Inspection==
*	Expose both limbs to the elbow
**	All aspects
**	Don’t forget forearm or ulna aspects
*	Seated, hands on pillow or desk
**	Posture/alignment
**	Tremor
**	Swelling
**	Colour
**	Wasting
**	Scars
==Movement==
*	Wrist
**	Observe supination/pronation rhythm as you inspect
**	Flexion/extension
**	Radial/ulnar deviation
**	Pronation/supination
*	Fingers
**	Flexion/Extension
**	MCPJs – 0-90°
**	PIPJs – 0-110°
**	DIPJs – 0-90°
**	Abduction/Adduction
*	Thumb
**	Adduction, abduction, opposition, flexion, extension
*	Note any hypermobility and skin hyperextensibility.
==Palpation==
Assess landmarks for tenderness, swelling (ganglions, dactylitis, synovitis, bone or soft tissue), temperature, vasomotor, and sudomotor changes.
Landmarks
Dorsal Wrist Pain
:A = Intersection syndrome
:B = De Quervain’s tenosynovitis
:C = Scaphoid fracture / Wartenbergs Syndrome (nerve entrapment)
:D = Base of thumb arthritis
:E = Ulnar collateral ligament injury
:F = Carpal boss
:G = Scapholunate ligament tear
:H = Keinbock’s disease
:I = Lunotriquetral ligament tear
:J = DRUJ (distal radioulnar joint) arthritis / instability
:K = Ulnar impaction / TFCC tear
:L = ECU dislocation / tendonitis
Volar Wrist Pain
:A = FCU tendonitis
:B = Pisiotriquetral arthritis / Ulnar nerve entrapment / ulnar artery thrombosis
:C = Hook of hamate fracture
:D = Trigger finger
:E = Base of thumb arthritis
==Special Tests==
Special Tests (depends on site of pain, ulnar, radial or mid)
*	Scapholunate instability - Watson test
*	Lunotriquetral instability – lunotriquetral ballotment test
*	DRUJ instability - Compression/ballotment test, Piano key, Drawer
*	De Quervain - Finklesteins and Eichoffs for
*	Carpal Tunnel Syndrome - Phalens and Tinels
*	Radiocarpal and midcarpal drawer tests
*	Ulnocarpal stress test
*	ECU subluxation
*	1st CMC OA – CMC grind test, shuck test, see progressive adduction with hyperextension
===Tendons===
===Neurological Exam===
== Paediatric Examination ==
A consensus approach to the MSK examination in children was developed by Foster et al in 2011. The underlined components are those that are additional to the adult examination The italicised components are those that the doctor should be aware of but not necessarily competent in.
* Look at the hands (palms and backs) for muscle wasting, joint swelling, skin and nail changes
* Feel for radial pulse, tendon thickening and bulk of thenar and hypothenar eminences
* Feel for skin temperature
* Squeeze metacarpophalangeal joints (MCPJs)
* Bimanually feel /palpate small joints of the hands including wrists and especially if there are swollen or painful joints or restricted movement noted)
* Look and feel along ulnar border
* Assess full finger extension and full finger tuck
* Assess wrist flexion and extension, abduction and adduction  – active and passive
* Assess function: grip and pinch, picking up small object, writing / drawing
* Option – hypermobility syndromes, muscle power, capillaroscopy, peripheral nerves
== References ==
Category:Examination
Category:Hand and Wrist
Hindfoot Radiographs

The subtalar joint is difficult to evaluate radiographically. Usually a weight-bearing AP or mortise view along with a lateral view is sufficient for foot and ankle assessment. 
*Weight-bearing AP or mortise view
*Weight-bearing lateral view
*Dorso-plantar view allows assessment of the talo-calcaneal angle. This angle is increased in flat feet and reduced in cavus feet.
*Hindfoot view (e.g. hindfoot alignment view, long axial view). This allows assessment of the hindfoot axis in chronic ankle instability
*Stress radiographs. These aren't generally recommended. Intra-operatively however they can be used to distinguish between ankle and subtalar joint instability
*Harries-Beth, Broden, lateral oblique axial views. These can allows proper assessment of the subtalar joint
*Hindfoot alignment view.
*Long axial view. Also allows viewing hindfoot alignemnt
*Subtalar view
==References==
Category:Foot and Ankle
Category:Radiology
Hinge Joint

A hinge joint is an articulation between the convex end of one bone and the concave end of another. This type of joint is uniaxial because it only permits movement in one axis. In the body, this axis of movement is usually bending and straightening, or flexion and extension. Examples include the elbow, knee, ankle, and interphalangeal joints. 
== List of s ==
== References ==
Category:Joint Types
Hip History

==Site==
Ask the patient to point where they get most of their pain, either where it is most painful or where they feel it most often.
Midinguinal region think of hip joint. Medial groin also think hip joint but also consider adductors, symphysis pubis, etc. Hip pain can also be felt laterally and posteriorly.
An intra-articular source of pain is suggested by the "C-sign", "deep pointer sign", or "coordinate fingers" (see Figure 1)
Category:Hip Joint
Category:Stubs
Hip Joint Aspiration

==Overview==
==Indications==
==Contraindications==
==Equipment Needed==
==Procedure==
===General Setup===
*Prep area with betadine or chlorhexadine using circular motion moving away from joint x 3
*Drape joint in sterile fashion 
*Inject lidocaine with 25-30ga needle superficially and then into deeper tissues
*Insert 18ga needle (for larger joints) into joint space while pulling back on syringe 
*Stop once you aspirate fluid; aspirate as much fluid as possible
**Send: cell count, culture, gram stain, crystal analysis
===Specific Approach*Freeman, K., A. Dewitz, et al. (2007). "Ultrasound-guided hip arthrocentesis in the ED." Am J Emerg Med 25(1): 80-86.===
*Should only be done under ultrasound guidance
*Orient your probe along the axis of the femoral neck (indicator towards abdomen)
*Identify Landmarks (Femoral V/A/N, Acetabular Labrum, Femoral Head/Neck)
*Effusion will be seen between femoral head/neck and the iliopsoas muscle
*Insert needle under probe, making sure that you know where patient's femoral V/A/N are
==Evaluation==
==Complications==
==External Links==
*http://www.youtube.com/watch?v=fZ2dcZhoGP8 Arthrocentesis
*http://emprocedures.com/arthrocentesis/introduction.htm
==References==
Category:Pelvis, Hip and Thigh Procedures
Hip Nerve Entrapment Syndromes

Sites of nerve entrapment in the hip region. From Martin et al 2017 Martin R, Martin HD, Kivlan BR. NERVE ENTRAPMENT IN THE HIP REGION: CURRENT CONCEPTS REVIEW. Int J Sports Phys Ther. 2017;12(7):1163-1173. doi:10.26603/ijspt20171163
Nerve 	Site of entrapment 	Clinical features
Anterior Nerve Entrapments 	Anterior Nerve Entrapments 	Anterior Nerve Entrapments
Obturator 	Obturator CanalAdductor muscle fascia 	Pain in medial thighAggravation with movement into abduction
Femoral 	Beneath iliopsoas tendonInguinal ligamentAdductor canal 	Reproduction of symptoms with modified Thomas test positionQuadriceps muscle weaknessPain in the anteromedial knee joint, medial leg, and foot
Lateral Femoral Cutaneous 	Inguinal ligament 	Positive pelvic compression test
Posterior Nerve Entrapments	Posterior Nerve Entrapments 	Posterior Nerve Entrapments
Sciatic 	Piriformis and obturator internus/gemelli complexProximal hamstringLesser trochanter and ischium 	Positive seated piriformis stretch and/or active piriformis testsIschial tendernessPain in the posterior thigh to the popliteal fossa aggravated with runningPositive ischial femoral impingement test
Pudendal 	Ischial spine, sacrospinous ligament, and lesser sciatic notch entrance.Greater sciatic notch and piriformisAlcock's canal and obturator internus	Pain medial to ischiumSciatic notch tenderness and piriformis muscle spasm and tendernessObturator internus spasm and tenderness
==References==
Category:Mononeuropathies
Category:Pelvis, Hip and Thigh Conditions
Category:Stubs
Hydroxychloroquine

Hydroxychloroquine (HCQ) has been used since the 1950s to treat rheumatic diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). It's less effective than other immunosuppressive or biologic therapies for RA, but is commonly used in combination regimens or as monotherapy for milder SLE.
== Pharmacology ==
HCQ is orally absorbed (~70%), with a slow clearance from the body, taking about 3 months to reach steady-state concentrations. It is excreted mostly by renal clearance, it has a half-life of around 40 days and can interact with drugs like digoxin and beta-blockers.
== Mode of Action ==
nitially believed to affect phagosomal and lysosomal function, HCQ now appears to work by inhibiting intracellular TLRs, especially TLR9, impacting SLE, RA, diabetes, and hyperlipidemia. It reduces IFN-α levels, which are significant in SLE pathogenesis, and has potential benefits in antiphospholipid syndrome.
== Efficacy ==
* RA: Shows moderate efficacy as monotherapy and is often used in combination with other DMARDs.
* SLE: Proven effective for joint and cutaneous manifestations and preventing disease flares.
* Metabolic Effects: May benefit cardiovascular disease, diabetes, and dyslipidemia patients due to its effects on lipid and glucose metabolism.
== Toxicity ==
It is generally safe, but can cause gastrointestinal, skin, and ocular side effects. It can cause ocular toxicity, including retinopathy, is rare but can progress to irreversible damage. Risk increases with long-term use. It requires careful monitoring, especially after 5 years of use.
== Dosing ==
It is generally dosed at maximum 5 mg/kg per day. So usually the dose is somewhere between 200-400mg based on weight.
This summary should give you a comprehensive overview of the key aspects of HCQ in the treatment of RA and SLE, its pharmacological properties, mode of action, efficacy, safety profile, and dosing recommendations.
Category:Pharmacology
Idiopathic Intracranial Hypertension

Idiopathic Intracranial Hypertension (IIH) is disorder that causes clinical features related to increased intracranial pressure without any other cause found. Patients with Idiopathic Intracranial Hypertension can end up seeing a Musculoskeletal Physician because it can commonly cause neck pain. Hence it is important to keep this condition in mind especially in obese women.
== Epidemiology ==
It is almost exclusively a disease of obese women of childbearing age. The average BMI is ~40, and average age is 29.
== Clinical Features ==
Idiopathic Intracranial Hypertension causes headache in most patients. Neck pain is very common as well. The condition can cause a myriad of different symptoms. One symptom that may help differentiate it is pulsatile tinnitus.
* Headache (84%)
* Transient visual obscurations (68%)
* Pulse synchronous tinnitus (52%)
* Visual loss (32%)
* Back pain (53%)
* Neck pain (?52% - shown in graph format only)
* Dizziness (?52% - shown in graph format only)
* Photophobia (?48% - shown in graph format only)
These symptoms are very common in age and gender matched controls. Pulsatile tinnitus is the most useful distinguishing feature. It is also important to be weary of the difference between correlation and causation. Back pain for example is extremely common in obese individuals.
== Assessment ==
MRI with and without contrast plus MRV is the imaging of choice. There are several findings that are suggestive of IIH, but are not diagnostic. These are empty sella, flattening of the posterior globe, distension of the perioptic subarachnoid space, and transverse sinus stenosis.
Lumbar puncture is done after MRI. The patient should be lying on their side with their legs extended. Pressures greater than 250 mmH2O are supportive of the diagnosis. Pressures between 200-250 are equivocal. The fluid should be sent for analysis, and should be normal in the condition.
Ophalmologic assessment is required. This includes dilated fundus examination, optic nerve photographs, and visual field testing is very important.
Blood pressure should be checked to assess for malignant hypertension.
There are no highly useful blood tests, but a complete blood count can be considered.
== Diagnosis ==
The diagnostic criteria requires all of the following: 
* Papilloedema OR sixth nerve palsy (either unilateral or bilateral)
* Otherwise normal neurological examination
* MRI/MRV shows normal brain parenchyma. 
* LP shows elevated opening pressure
* Normal CSF composition
== Resources ==
== References ==
Category:Head and Jaw Conditions
Category:Headache Disorders
Ilioinguinal Neuralgia

==Anatomy==
The ilioinguinal nerve originates from the L1 nerve root along with the iliohypogastric nerve. It is a mixed nerve providing motor supply to the Internal Oblique and Transversus Abdominis muscles, and sensory supply to the anterior one third of the scrotum/labia and root of the penis/clitoris, as well as to the superior medial thigh.
==Aetiology==
Due to their specific location and varying course, they are prone to damage during surgical operations involving the lower abdomen. Such injuries are recognized risks in procedures like open appendicectomy, inguinal hernia repair, low transverse incisions (like the Pfannenstiel incision), and during trocar insertion in laparoscopic surgeries of the abdomen and pelvis. These nerves can sustain damage through various means, such as direct trauma, with or without neuroma formation, nerve compression by scar tissue or haematoma, or being sutured into fascial closure or mesh incorporation.
*Post-surgical
**Inguinal hernia repair
**Traumatic trochar from laparoscopic surgery
**Appendectomy and hysterectomy
**Abdominoplasty
**Orchiectomy
*Other Trauma
**Blunt abdominal trauma
**Femoral catheterization
**Lower external oblique aponeurosis disruption (hockey players) 
*Pregnancy
*Idiopathic, entrapment at:
**Paravertebral area
**Iliac crest
**Rectus border muscle
**Inguinal region
== Clinical Features ==
Typically, patients with pain resulting from irritation of these nerves report groin pain that may extend to the scrotum or testicle in males, the labia majora in females, and the inner part of the thigh.
== Diagnosis ==
Blocking the ilioinguinal and iliohypogastric nerves (they lie within the same fascial plane) can serve a diagnostic and therapeutic role in patients reporting chronic pain in this nerve distribution.
==Differential Diagnosis==
==References==
*Elsakka KM, M Das J, Allam AE. Ilioinguinal Neuralgia. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538256/
Category:Mononeuropathies
Category:Pelvis, Hip and Thigh Conditions