nyuuzyou/wikis huggingface dataset:
Illness Scripts

An illness script is a structured mental summary of a doctor's knowledge about a specific disease. It represents a their knowledge about a particular disease, and may be as short as a paragraph for a rare disease, or as long as a book chapter for a commonly encountered illness. Classically, the components of a thorough illness script fall into three main categories: 
* Risk factors for the disease
* Pathophysiology
* Clinical characteristics.
Within these categories, illness scripts often include a disease's pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment. For example, a provider’s illness script for lateral femoral cutaneous nerve entrapment (LFCNE) may include:
Illness Script Example: Lateral Femoral Cutaneous Nerve Entrapment
Pathophysiology	Entrapment of the lateral femoral cutaneous nerve
Epidemiology 	3.4–4.3/10,000 person-years
It is significantly linked to carpal tunnel syndrome, pregnancy, obesity, and diabetes mellitus
Time course 	Chronic
Salient Symptoms 
and Signs	Pain and/or dysaesthesia, and sensory changes without motor findings, in the distribution of the lateral femoral cutaneous nerve.
Diagnostics 	Usually clinical diagnosis. Diagnostic injection and MRI can corroborate the diagnosis.
Treatment 	Conservative management, injection, hydro-dissection.
With experience, providers hone their illness scripts in three important ways:
# They encode a predictive value for each feature of the disease, enabling them to estimate the likelihood of a diagnosis when that feature is present or absent. Example: The absence of a pain does not exclude the diagnosis of LFCNE.
# They emphasize distinguishing characteristics whose presence or absence significantly alters the likelihood of the diagnosis, and helps differentiate it from another related diagnosis. Example: symptoms occurring in a well circumscribed area in the distribution of the lateral femoral cutaneous nerve highly suggestive of LFCNE and makes lumbar radicular pain causes less likely.
# They develop a list of disease mimickers to consider when an illness script of a particular diagnosis is invoked. Example: L2 or L3 radiculopathy, pelvic mass, superior gluteal nerve entrapment, hip joint pain, inguinal hernia, GTPS, femoral neuropathy.
This iterative process continued throughout a clinician’s career, adds depth, precision and differentiating power to the foundational scripts developed during training. Diseases encountered less frequently will have less robust scripts.
The key to diagnosis lies in appropriately selecting which details to commit to memory.
==Articles==
*Scripts and clinical reasoning - Charlin 2007
*:Media:Scripts and Medical Diagnostic Knowledge - Charlin 2000.pdf
*How expertise develops in medicine: knowledge encapsulation and illness scripts - Schmidt 2007
*Thirty years of illness scripts - Custers 2014
*Educational Strategies to Promote Clinical Diagnostic Reasoning - Cox 2006
*Illness Scripts Overview - JGIM
*Illness scripts in general medicine
== References ==
Category:Clinical Reasoning
Inferior Calcaneal Nerve (Baxter Nerve)

The first branch of the lateral plantar nerve is also known as the inferior calcaneal nerve or Baxter's nerve.
==Proximal and Related Structures==
The L4-S4 ventral rami form the sciatic nerve. The sciatic nerve divides in the distal thigh into the tibial nerve and peroneal nerve. The tibial nerve passes through the deep posterior compartment of the leg. 
The tibial nerve ramifies into the medial plantar nerve, lateral plantar nerve, and medial calcaneal nerves. The nerves exit the tarsal tunnel and continue to the plantar aspect of the foot. 
The medial plantar nerve runs anterior to the lateral plantar nerve. It supplies sensory information to the medial two thirds of the plantar foot, and motor innervation to the flexor digitorum brevis, abductor hallucis, flexor hallucis brevis, and first lumbrical.
The lateral plantar nerve supplies sensation to the lateral plantar aspect of the foot, 5th toe, and lateral half of the 4th toe. It supplies motor innervation to the remaining foot muscles that aren't innervated by the medial plantar nerve.
==Course==
Baxter's nerve is first branch of the lateral plantar nerve. It arises from the lateral plantar nerve at various levels under the deep fascia of the Abductor Hallucis muscle. It runs vertically in between the Abductor Hallucis and Quadratus Plantae and then makes a sharp 90 degree turn horizontally. It passes laterally under the Calcaneus to supply the Abductor Digiti Minimi muscle.
==Innervation==
It is a mixed nerve. 
Motor supply is to the Abductor Digiti Minimi, and occasionally to the Flexor Digitorum Brevis and lateral half of the Quadratus Plantae
Sensory supply is to the calcaneal periosteum, long plantar ligament, and adjacent vessels.
==Variation==
It can originate directly from the Posterior Tibial Nerve
Inferior Cluneal Nerve Entrapment

The cluneal nerves are a group of pure sensory nerves (superior, medial or middle, and inferior) that provide sensory supply to the buttocks. This article covers inferior cluneal nerve entrapment. See also the more common superior cluneal nerve entrapment, as well as middle cluneal nerve entrapment.
==Anatomy==
The cluneal nerves are divided into the superior cluneal nerve (SCN), middle cluneal nerve (MCN), and inferior cluneal nerve (ICN).
The inferior cluneal nerves (ICN) arise from the posterior femoral cutaneous nerve of the thigh (PFCN), which in turn is derived from the sensory branches of S1-3. The PFCN travels with the sciatic and pudendal nerves and passes through the sciatic notch. In the subgluteal region it ramifies into the inferior cluneal and perineal branches. The nerves have a recurrent course around the inferior margin of gluteus maximus. It innervates the inferior region of the buttocks, lateral anal region (but not the anus itself), and lateral labia majora (but not labia minora or vagina).
==Pathophysiology==
Entrapment occurs with sitting and the site can be at the inferior margin of the ischium or at the level of the sciatic spine and piriformis. 
==Epidemiology==
The epidemiology is unknown.
==Clinical Features==
The patient may report a history of a fall onto their buttocks. Sitting, especially on hard seats, may cause symptoms. Examine for deep tenderness along the inferior edge of the gluteus maximus between the ischium and greater trochanter. Look for hyperaesthesia with pin prick and decreased light touch sensation over the inferior buttocks. 
==Diagnosis==
There is are no agreed diagnostic criteria.
==Treatment==
Injections can be done.
==References==
Category:Lumbar Spine Conditions
Category:Mononeuropathies
Category:Pelvis, Hip and Thigh Conditions
Interphalangeal Joints (Foot)

The great toe (hallux) has a single interphalangeal joint. The lateral four times have both a proximal and distal interphalangeal joint.
All of these joints have a similar concave-convex configuration, along with a single axis of motion in the sagittal plane producing dorsiflexion and plantarflexion.
There are collateral ligaments that are similar in location and function to those of the metatarsophalangeal joints.
There is a limited range of motion. Generally flexion is greater than extension. The proximal interphalangeal joint generally has a greater range of motion than the distal interphalangeal joint.
==References==
*Basic Biomechanics of the Musculoskeletal System - Nordin 4th edition 2012
Category:Foot and Ankle Anatomy
Category:Joints
Category:Joints of the Lower Limb
Interscalene Nerve Block

*Provides anesthesia to the shoulder and upper arm.Ullah H. et al. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database Syst Rev. 2014 CD007080
*Performed by injecting local anesthetic to the nerves of the brachial plexus as it passes through the groove between the anterior and middle scalene muscles, at the level of the cricoid cartilage.
==Indications==
*Post operative analgesia for shoulder surgery
*Humerus fracture
*Lacerations or abscesses of upper arm and deltoid
*Shoulder dislocation
==Contraindications==
*Severe lung disease
**Due to risk of unilateral pneumothorax
*Overlying infection
*Allergy to anaesthetics
*Phrenic nerve dysfunction
**Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis
==Equipment Needed==
*Ultrasound (linear probe)
*Syringe with 25g needle
*5-10cc local anaesthetic
==Procedure==
# Place the linear probe at the level of the larynx and find the IJ vein and the overlying sternocleidomastoid muscle (SCM)
# Slide the probe laterally until the tapering edge of the SCM is visualized
# The anterior and middle scalene muscles lie directly below the edge of the SCM, and the brachial plexus is sandwiched in between the muscles
# The C5-C7 roots are usually well visualized and resemble a "traffic light" while C8 and T1 roots are variably visualized
# Check with colour doppler to ensure no blood vessels in the vicinity
# Insert the needle in the long axis underneath the probe and inject the local anethetic next the the roots after hydrodissecting the roots with test injections
==Complications==
*Phrenic nerve paralysisBorgeat A et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001 Oct. 95(4):875-80 
**Causing unilateral diaphragmatic paralysis and respiratory distress.
*PneumothoraxAuroy Y. et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov. 97(5):1274-80.
**On the side of the nerve block
==External Links==
*http://highlandultrasound.com/interscalene-block/
===Videos===
<youtube>7DRPiS3ZrVo</youtube>
==References==
Category:Shoulder Procedures
Intertarsal and Tarsometatarsal Joints

The intertarsal joints include the three cuneonavicular joints, the intercuneiform joints, the cuboideonavicular joint, and the cuneocuboid joint. The tarsometatarsal (TMT) joint complex, known as the Lisfranc joints, is comprised of the five metatarsals, the three cuneiforms and the cuboid. 
==Motion==
The base of the second metatarsal is recessed into the midfoot, and forms a key-like configuration with the intermediate cuneiform. The rigid second metatarsal (and also so some degree the third) provides a central rigid structure to the longitudinal arch, allowing a rigid lever for push-off in late stance. 
The motion of the first, fourth, and fifth tarsometatarsal joints are much greater than the second metatarsal. The first tarsometatarsal joint has approximately 10° of plantar flexion during late stance. There is negligible motion in other plantes of motion for these joints. The intertarsal joints are closely congruent with minimal gliding motion between each other. 
==Ligaments==
The Lisfranc ligament has an integral role in providing midfoot stability. It attaches from the medial cuneiform to the base of the 2nd metatarsal with its three segments. The TMJ joint complex is intrinsically stable because of the arch-like configuration which is best seen in cross-section. 
==Pronator and Supinator Forefoot Twist==
The most medial and lateral tarsometatarsal joints are flexible and allow the forefoot to invert and evert independently of the hindfoot. 
With the action of peroneus longus, and plantarflexion of the first MTPJ to 10°, a "pronator twist" of the forefoot is produced. The medial foot moves plantarward, and the entire surface of the foot faces more laterally. Likewise, when the ground reaction force of an uneven terrain pushes the medial forefoot is a dorsal direction, a "supinator twist" is produced.
The pronator and supinator twists allows accomodation to variable terrain and also provides sufficient push-off from the medial border of the foot.
==See Also==
*Lisfranc Injury
==References==
*Basic Biomechanics of the Musculoskeletal System - Nordin 4th edition 2012
Category:Foot and Ankle Anatomy
Category:Joints
Category:Joints of the Lower Limb
Joint Aspiration

==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 Procedure===
See joint-specific page for procedures
*Arthrocentesis: shoulder
*Arthrocentesis: elbow
*Arthrocentesis: wrist
*Arthrocentesis: finger
*Arthrocentesis: hip
*Arthrocentesis: knee
*Arthrocentesis: toe
==Complications==
==Evaluation==
==External Links==
*http://www.youtube.com/watch?v=fZ2dcZhoGP8 Arthrocentesis
*http://emprocedures.com/arthrocentesis/introduction.htm
==References==
Category:General Procedure Concepts
Joint Mobilisation

Joint mobilisation refers to a therapeutic passive motion of a painful or dysfunctional peripheral or axial joint. Mobilisation under the Maitland system is classified into four grades of passive therapeutic motion based on the state of tension. Grade V is the same as manipulation.
Grade I – small amplitude movement at the beginning of the available range of movement
Grade II – large amplitude movement within the available range of movement. The maximal end range is not achieved.
Grade III – large amplitude movement that moves into the maximal end range.
Grade IV – small amplitude movement close to end range
Grade V – This is the same as high velocity low amplitude manipulation at the end range.
Lower grades (I + II) are used to reduce pain and irritability (use VAS + SIN scores).
Higher grades (III + IV) are used to stretch the joint capsule and passive tissues which support and stabilise the joint so increase range of movement.
The rate of mobilisation should be thought of as an oscillation in a rhythmical fashion at 2Hz (120 movements per minute) for 30 seconds to 1 minute.
<youtube>https://www.youtube.com/watch?v=G_QI7bVrHN0</youtube>
== See Also ==
Fibrous_Connective_Tissues#Biomechanics
Category:Functional Approaches
Knee Joint Aspiration

==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===
*Can be entered medially or laterally to the patella, superior or inferior to patella
*Fully extend knee and ensure quadriceps muscle is relaxed (optionally bump with 20 deg of flexion)
**Place your thumb on the patella and slide it over as you enter with needle
**For Suprapatellar Approach 1 cm lateral and 1 cm superior 
*Identify midpoint of patella; insert needle either 1 cm lateral or medial
*Direct needle posterior to patella and horizontally toward the joint space
*Compression or "milking" applied to both sides of joint space may facilitate aspiration
==Evaluation==
==Complications==
==External Links==
*http://www.youtube.com/watch?v=fZ2dcZhoGP8 Arthrocentesis
*http://emprocedures.com/arthrocentesis/introduction.htm
==Video==
<youtube>V8idT6fwU0Q</youtube>
==References==
Category:Knee and Leg
Category:Knee and Leg Procedures
Knee Joint Injection

==Anatomy==
==Indications==
==Contraindications==
Infection, uncontrolled coagulopathy, joint prosthesis, poor response to previous injections. Allergy to eggs or feathers is a relative contraindication to hyaluronic acid.
==Pre-procedural Evaluation==
==Injectate==
A variety of options exist for injectates - steroid, visco-supplementation, platelet rich plasma, stem cells, and dextrose prolotherapy.
==Equipment==
==Technique==
===Ultrasound Guided===
===Fluoroscopy Guided===
===Landmark Guided===
*Protective gloves and use sterile technique.
*Position: Lie supine with the knee slightly flexed, supported underneath with a rolled towel or cushion.
*Palpate and identify the borders of the patella and mark the entry site
*Clean the skin
*Draw up the injectate mixture.
*Optional infiltration of skin with 3-5mL local anaesthetic with 27-30g needle.
*Use a 20-27 gauge 1 inch needle on a 10 ml syringe to enter the joint.
*Approach
**Lateral: Enter the skin 1 cm superior and 1 cm lateral to the superior lateral aspect of the patella; direct the needle at a 45° angle, tilting below the patella, and aim toward the middle of the medial side of the joint
**Medial: Enter the medial aspect of the knee at the middle of the patella, aiming toward the lateral midpole.
**Anterior: The patient's knee should be flexed 90°; keeping the needle parallel to the tibial plateau, enter just medial or lateral to the patellar tendon
*May feel a "pop" when penetrating the joint capsule. Flow of the injection should not meet resistance.
*Change the path of the needle slightly if injecting the medication is difficult; the needle may be within a fat pad or thick synovium.
*Redirect or withdraw the needle if severe pain occurs; the needle may be hitting the cartilaginous surface.
*Apply a bandage after withdrawing the needle.
==Complications==
Repetitive intra-articular corticosteroid injections may cause accelerated cartilage loss. McAlindon evaluated triamcinolone vs saline repeated every 12 weeks for 2 years in 141 patients with knee osteoarthritis. The steroid group had greater cartilage loss (-0.21 mm vs -0.10mm), and no significant difference in pain. There was a small increase in HbA1c levels in the steroid group. The steroid group had 5 complications, and the saline group had 3.
Other complications include bleeding, infection (1:10,000), postinjection flare (1%-2%), no response, non-sustained response, temporary glucose elevated. Allergic reactions are rare.
Specific to hyaluronic acid is that it can more frequently cause pain and can cause a large joint effusion, rash, and itching.
==Aftercare==
Rest the knee, avoid strenuous activity for 48 hours, shower/bathe as normal. Post-injection flares can be treated with ice and NSAIDs. Safety netting for injection.
==Videos==
==See Also==
==External Links==
==References==
Category:Infoboxes
Category:Knee and Leg Procedures
Category:Stubs
Leg Length Discrepancy

Leg length discrepancy also known as leg length inequality refers to unequal lower limb lengths. It may a factor for pain in hip osteoarthritis, knee osteoarthritis, and chronic low back pain.
== Aetiology ==
Anatomic: This refers to LLD due to fracture, trauma or tumour of the growth plate, degenerative disorders, post arthroplasty, Legg-Calvé-Perthes disease, arteriovenous fistula, vascular tumours, post hip arthroplasty.
Developmental: From congenital aplasia, hypoplasia, developmental dysplasia of the hip, clubfoot, hemihypertrophy syndromes, clubfoot
Function: This refers to joint contracture, soft tissue shortening, ligamentous laxity, axial malalignment, and abnormal foot mechanics.
Environmental: repeated exposure to uneven ground such as repeated running on a cambered road.
== Biomechanics ==
The biomechanics were reviewed and assessed by Kakushima et al. They found that there was an asymmetrical lateral bending motion during heel-raising gait as compensation for the LLD.
== Classification ==
* Mild: <30mm
* Moderate: 30-60mm
* Severe: >60mm
== Epidemiology ==
LLD is present in up to 90% of the population, with 59% having an LLD of at least 5mm.
== Clinical Features ==
LLD may be a source of pain and disability. Knee and hip osteoarthritis may develop in the longer limb.
Examine from behind looking at the levels of the PSIS, inferior gluteal folds, and popliteal creases. Each anatomic landmark should be at approximately the same level. If a LLD exists then one hip usually appears lower than the other. There may be a compensatory scoliosis or pelvic obliquity. A compensatory scoliosis usually disappears when the LLD is corrected by placing a block under the shorter leg.
If there is an asymmetry then take careful leg length measurements. One method involves placing the patient supine, making sure the pelvis is level, then measuring from the ASIS to the medial malleolus with the tape running medial to the patella. If the pelvis isn't level then there can be an artificial LLD.
==Treatment==
There is low quality evidence that shoe lifts reduce pain and improve function in patients with LLD and associated painful musculoskeletal conditions. The percentage correction varies between studies. Trailing 50% correction may be a good starting point.
Surgery can be considered if the discrepancy is over 25mm.
==Resources==
== References ==
Category:Pelvis, Hip and Thigh Conditions
Lesser Occipital Nerve Injection

The lesser occipital nerve (LON) is commonly injected alongside the greater occipital nerve for headache disorders.
==Anatomy==
The lesser occipital nerve (LON) arises from the primary ventral rami of the second and third cervical nerves. It passes superiorly along the posterior border of sternocleidomastoid. It divides into cutaneous branches that supply the lateral portion of the posterior scalp. 
;Cranio-cervical Dermatomes.
==Procedure==
===Landmark guided===
*The procedure is similar to the the greater occipital nerve injection
*Locate the LON by going two-thirds of the way between the occipital protuberance and the mastoid process.
*Enter perpendicular to the skip, stop at the periosteum.
*Aspirate gently and then inject.
==See Also==
* Cervical Facet Joint Injection
* Greater Occipital Nerve Injection
* Paraspinous Cervical Block
* Third Occipital Nerve Injection
==References==
Category:Cervical Spine Procedures
Category:Head and Jaw Procedures
Category:Infoboxes
Category:Partially complete articles