nyuuzyou/wikis huggingface dataset:
Elbow Examination

==Inspection==
*Skin changes such as psoriatic plaques
*Fixed or reducible deformity / soft tissue swelling
**Masses, nodules or tophi
** Carrying angle of the elbow
* Articular or olecranon bursal swelling
* Signs of inflammation
* CRPS signs
==Palpation ==
Determine the exact sight of tenderness. Undertake a systematic approach
*start with palpating bony prominences: medial epicondyle, olecranon, lateral epicondyle, radial head
*Palpate elbow joint line: olecranon fossa, olecranon-humeral joint line
*Palpate ligaments and tendons: medial and lateral collateral ligaments, common flexor, extensor proximal tendons, and distal biceps tendon.
*Cubital tunnel / ulnar nerve
Also assess for hypermobility and skin hyperextensibility.
==Range of movement== 
Assess active and passive range of motion of the elbow joint. Normal flexion is 135-145 degrees, and normal extension is 0-5 degrees Morrey BF, Askew LJ, An KN, et al. A biomechanical study of normal functional elbow motion. J Bone Joint Surg. 1981;63A: 872–6. Compare to the opposite side and assess for end feel of movement.
The forearm range of motion is 85 degrees of supination, and 75 degrees of pronation. The hand should move medially as the forearm pronates Weinberg AM, Pietsch IT, Helm MB, et al. A new kinematic model of pro- and supination of the human forearm. J Biomech. 2000;33:487–91
Also assess varus and valgus stress testing.
==Special Tests==
There are few special tests of the elbowChumbley EM et al. Evaluation of overuse elbow injuries. Am Fam Physician. 2000; 61: 691 – 700.
# The tennis elbow test
# Pain on resisted third finger extension
# Varus and valgus aligned stress testing
# Posterolateral rotary instability test
== 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 for carrying angle, scars, swellings or rashes, deformity 
* Feel for skin temperature
* Feel over head of radius, joint line, medial and lateral epicondyles
* Assess full flexion and extension, pronation and supination – actively and passively
* Assess function – e.g. hand to nose or mouth, hands behind head
* Option – hypermobility syndromes, muscle power, entheses, instability tests 
==References==
Category:Elbow and Forearm
Category:Examination
Elbow History

==Introduction==
==Duration of illness==
Acute or chronic
==Circumstances of onset==
Trauma (direct / indirect), repetitive overload, or spontaneous onset.
==Mode of Onset==
Are there red flags? Was the onset insidious?
==Radiation==
Does it radiate along compartment to the wrist.
==Quality==
Is it deep, dull, aching. Is there dysaethesia. Is it sharp or shooting.
==Frequency==
Is it related to activity.
==Time of Onset==
Does it come on during the day or night.
==Precipitating and Aggravating Factors==
Is it related to gripping / pinching, flexion of the elbow, supination, pronation. Is there pain and stiffness after rest. Is there locking.
==Relieving Factors==
Do certain positions or activities relieve it.
==Associated features==
Is there fever, weight loss, malaise.
==References==
Category:Elbow and Forearm
Elbow Imaging

Xrays are done predominantly for fractures and other red flag conditions, and are not helpful for conditions such as tendinopathies.
Rules for imaging in the trauma setting
*Significant force applied to the elbow
*Immediate loss of elbow function
*Marked soft tissue swelling / contusion
*Bony tenderness with no other diagnosis, as a screen for intra-osseous pathology
*Compression of the joint reproduces pain – as a screen for intra-articular pathology
*Instability shown on examination (varus / valgus aligned stress testing)
*Risk factors for osteoporosis or pathological fractures (Paget’s)
*In the presence of abnormal movements of the elbow (instability / locking)
==References==
Category:Elbow and Forearm
Elbow 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===
*Place elbow in 90o flexion, resting on a table, with hand prone
*Locate radial head, lateral epicondyle, and lateral aspect of olecranon tip
**These landmarks form the anconeus triangle
*Palpate a sulcus just proximal to the radial head (in the middle of the triangle)
*Insert needle into sulcus directed medial and perpendicular to radius toward distal end of antecubital fossa
==Evaluation==
==Complications==
==External Links==
*https://www.nuemblog.com/blog/joint-aspiration?rq=arthrocentesis
==References==
Category:Elbow and Forearm Procedures
Category:Pages with broken file links
Elbow Myofascial Pain

==Introduction==
NB: Bogduk called this Elbow Fibromuscular Impairment which is not a term in current use. A more appropriate term in use today would probably be myofascial pain.
'''
==Lateral Elbow Myofascial Pain==
==Medial Elbow Myofascial Pain==
==References==
Category:Elbow and Forearm Conditions
Category:Myofascial Pain
Elbow Osteoarthritis

Elbow osteoarthritis is extremely rare due to it being a non-weight bearing joint. Risk factors include intraarticular fractures, avulsion injury to the humeral condyles (so called Little League elbow), and osteonecrosis. Any elbow deformity should raise suspicion for an underlying inflammatory arthritis.
==References==
Category:Elbow and Forearm Conditions
Category:Osteoarthritis
Elbow Red Flags

==Introduction==
Red flag conditions to exclude:
Red flag conditions are rare in the elbow. 
==Fractures ==
* Is there a history of major trauma such as a fall directly on to the elbow / MVA / high speed accidents
* Is there a history of minor trauma in an individual with risk factors for osteoporosis. 11% of osteoporotic fractures involve the humerus, mostly surgical neck.
Elbow fractures make up 10% of all upper limb fractures, and 6% of all adult fractures. The incidence is 7.4 per 10,000, and is slightly higher in woman at 7.4 compared to 7.1 for men. There is an association between social deprivation and increased proximal forearm elbow fractures Aiken SA et al. The epidemiology of fractures around the elbow joint. Elective Medicine Journal. 2014: 2(3): 189 – 194
==Malignancy==
Risk factors (theoretical) are age > 50 yrs, past history of cancer, unexplained weight loss, and malaise. The clinician should also be suspicious if the patient fails to improve or is non-responsive to therapy. Suspicious examination findings are palpable soft tissue or bony deformity, and bone tenderness.
==Infection==
It is unclear what is the incidence of infected elbow joints and olecranon bursitis.
The Cardinal indicators for infection are:
*Fever
*Penetrating wound
*Recent procedure with needle, catheter or other instrument
*Immunosuppressed patients
*Children – hematogenous spread most common
*On examination
**Joint swelling / bursal swelling
**Bone tenderness
==Inflammatory Arthropathies ==
Rheumatic disease accounts for over 7% of all conditions presenting to GP’s UK National Morbidity Survey. The most common condition is osteoarthritis at 5-10% of the population. The incidence for arthritis/arthralgia is 38.6 per 1000 population. Rheumatoid arthritis is the most important condition of the inflammatory arthritides to involve the elbow. The population incidence of rheumatoid arthritis is 2-3%. 
Systemic diseases that predispose to arthropathy: 
*Connective tissue disorders
*Diabetes mellitus
*Bleeding disorders
*Previous tuberculosis
*Spondyloarthropathies
*SBE, hepatitis B, rheumatic fever, HIV infection
*Vasculitides
== Referred Pain and Visceral Diseases ==
Ischaemic cardiac pain refers into the upper limb in 30% of cases
Myofascial cervical spine and shoulder girdle structures can refer to the upper limb
Radicular pain syndromes and other neurological syndromes can cause pain in the upper limb
==Recommendations==
In a patient presenting with elbow pain,
Fractures should be considered
*in a history of major trauma
*minor trauma with a background of osteoporosis
Malignancy should be considered
*Palpable mass
*History of cancer or systemic features of cancer
*No other cause found or failure to improve
Infection should be considered
*Systemic features of infection
*Local features of infection
*Bone tenderness
*History of interventional procedures
==References==
Category:Elbow and Forearm
Category:Partially complete articles
Category:Red Flags
Electromyography

Electromyography (EMG) is the study of motor unit and muscle fibre electrical activity. They can be studied individually or collectively. EMG evaluates the electrical activity at rest, and during voluntary muscle contraction.Biller, José. Practical neurology. Philadelphia: Wolters Kluwer, 2017.
The EMG is usually done alongside nerve conduction studies (NCS). A needle electrode is inserted into the muscle of interest, stimulated, and then the action potentials generated by groups of muscle fibres are recorded. The muscle fibres being stimulated are the motor unit potentials (MUPs). The muscle is tested at rest, with slight contraction, and with stronger contraction. In normal situations the muscle is silent at rest. Spontaneous action potentials from single-muscle fibres (fibrillation potentials) may occur in severe or inflammatory myopathies, and in an active neuropathic process. Spontaneous contractions of a single-motor unit (fasciculation potentials) may be observable in certain neuropathic processes such as motor neuron disease and diseases of the proximal root.
There may be changes in MUP parameters in neurogenic or myopathic processes. In neurogenic processes, the MUPs are often increased in amplitude, duration, and degree of polyphasia with reduced fibre recruitment with increase in effort. In myopathic processes, the MUPs may be decreased in amplitude, decreased in duration, and increased in polyphasia and early recruitment. 
Single-fibre EMG is possible which studies single-muscle fibre action potentially. This is used to evaluate neuromuscular junction function, but it can also be abnormal in neuropathic and myopathic disease.
==See Also==
Nerve Conduction Studies
==References==
Category:Physiology
Category:Neurology
Category:Stubs
Exercise Prescription

Physical inactivity is a primary cause of most chronic diseases, including musculoskeletal diseases. The components of an exercise prescription may be divided into Frequency, Intensity, Time, and Type (i.e. modality - cardiovascular training, resistance exercises, weight training, calisthenics). This is known as the FITT approach.
For example
* Frequency: five times a week
* Intensity: Moderate
* Time: At least 30 minutes
* Type: Brisk walking, cardiovascular training 
V for volume and P for progression may be added (FITT-VP). An additional component, enjoyment, may need to be considered.
== See Also ==
* Exercise Induced Hypoalgesia
* Obesity and Chronic Pain
* Textbook: ACSM's Guidelines for Exercise Testing and Prescription 9th Edition
== References ==
Category:Functional Approaches
Familial Episodic Pain Syndrome

Familial episodic pain syndrome (FEPS) encompasses a group of non-inflammatory, paroxysmal pain syndromes primarily affecting the distal extremities. These syndromes can be classified into three types based on the pathogenic gene involved: FEPS1, caused by transient receptor potential cation channel (TRPA1) gene mutation; FEPS2, due to sodium voltage-gated channel alpha subunit 10A (SCN10A) gene mutation; and FEPS3, resulting from sodium voltage-gated channel alpha subunit 11A (SCN11A) gene mutation.
==Resources==
==See Also==
Channelopathies and Chronic Pain
Sodium Channelopathies
Category:Genetic Disorders
Fascia Iliaca Compartment Nerve Block

==Indications==
*Femur Fracture
*Hip Fracture
==Contraindications==
*Infection overlying injection site
*Presence of femoral vascular grafts (relative)
==Equipment Needed==
*Local anaesthetic
*Syringe with blunt fill needle and 27ga needle
*Chloraprep
==Procedure==
*Perform thorough neurovascular exam prior to procedure
*Always calculate your anaesthetic volume beforehand
**Larger volumes of more dilute solution are better for plane blocks. 20 mL of 0.5% lidocaine is better than 10 mL of 1.0% lidocaine.
*This block requires more volume than the standard femoral nerve block
===Ultrasound guided technique===
*High frequency linear probe covered with sterile tegaderm
*Sterile surgilube
*Place probe in transverse on thigh, just inferior to inguinal ligament 1/3 of way from anterior superior iliac spine to the pubic tubercle
*Visualize fascia lata and iliaca as 2 hyperechoic lines
*Introduce 22 gauge spinal needle lateral to medial, parallel to transducer
*After puncturing through fascia iliaca, infiltrate a small volume of the anaesthetic solution. Should see the fascia lift up off of the nerve. Continue to infuse anaesthetic.
*Confirmation = visualizing an expanding anechoic collection just below the fascia iliaca 
===Landmark technique===
#Point = 2/3 laterally along line between ant/sup iliac spine and pubis
##i.e. sig lateral to nerve
#90 deg angle with 22Ga needle (spinal needle)
#2 "pops" through fascial planes (1 inch max)
#Withdraw to check not in vessel
#Apply pressure 1 inch caudally across thigh
#Infuse drug
#Hold pressure on thigh for 2 minutes
##to encourage cephalad spread
^Should see effect in <10 min
==Complications==
*Bleeding/hematoma
*Infection
*Intravascular injection
==External Links==
*Anatomy for EM - Fascia Iliaca Block
*Video: Fascia Iliaca Block
==References==
Category:Pelvis, Hip and Thigh Procedures
Femoral Neck Stress Fracture

Femoral neck stress fractures are a rare sport-related stress fracture, most commonly seen in long distance runners.
==Epidemiology==
It is most commonly seen in female long distance runners with a poor baseline level of fitness. This is due to repetitive submaximal loading in combination with relative energy deficiency. They account for 3% of all sport-related stress fractures.
==Clinical Features ==
Patients report a gradual onset poorly localised hip or groin pain that is exacerbated with weight-bearing exercise. The most consistent examination finding is pain at extreme end range of motion, particularly internal rotation.
==Classification ==
Originally Fullerton & Snowdy with several modifications:
*Type I: Tension sided: supero-lateral femoral neck with vertical fracture line
*Type II: Compression sided: infero-medial femoral neck with oblique fracture line
**Further divided into those where fracture line less than 50% of femoral neck width vs greater than 50%
*Type III: Displaced
*Type IV: Atypical superiorly based incomplete tension
==Differential Diagnosis==
==Investigations ==
Plain films are usually taken first. But quite often MRI is needed for definitive diagnosis.
MRI features include: periosteal oedema and fractur line. 
Classification system by Arendt and Griffiths.
Grade 	Features
grade 1	signals changes only on STIR
grade 2	changes on STIR and T2
grade 3	changes on STIR, T1, and T2 with no fracture line present
grade 4	changes on STIR, T1, and T2 with a fracture line present
== Treatment==
Compression sided fractures are usually treated conservatively with activity modification. Tension sided fractures may need surgery to reduce the risk of fracture completion and osteonecrosis.
==References==
Category:Fractures
Category:Pelvis, Hip and Thigh Conditions
Finger 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
===Metacarpophalangeal===
*Have palm facing down and apply gentle traction to the affected digit 
*Insert needle dorsally just medial or lateral to midline and proximal to the base of the proximal phalanx
===Interphalangeal===
*Have palm facing down and apply gentle traction to the affected digit 
*Insert needle dorsally medial or lateral to midline and proximal to base of middle or distal phalanx
==Evaluation==
==Complications==
==External Links==
*http://www.youtube.com/watch?v=fZ2dcZhoGP8 Arthrocentesis
*http://emprocedures.com/arthrocentesis/introduction.htm
==References==
Category:Hand and Wrist Procedures
First Carpometacarpal Joint Osteoarthritis

Thumb-base osteoarthritis (first CMC joint) is a very common condition that predominantly affects postmenopausal women.
==Aetiology==
The first CMCJ is highly mobile which is probably linked to an increased rate of degeneration. There is also an association with hypermobility
==Epidemiology==
Increases with age, most common in postmenopausal women. The female to male ratio is 6:1.1
==Assessment==
*Base of thumb pain
*Activity related particularly gripping, using taps and door knobs, unscrewing lids, turning keys, sewing.
*Thumb weakness
;Examination
In advanced stages thenar muscle wasting combined with subluxation and adduction of the 1st metacarpal can lead to a characteristic "squaring" joint deformity"
*Deformity at the base of the first MCPJ.
*Adduction of the 1st metacarpal may occur which is visualised by a reduced 1st web space and hyperextension of MCPJ.
*Palpate for tenderness, crepitation, and subluxation
*Range of motion
*Power, pincer strength may be reduced
*Grind test: Hold the 1st metacarpal, move the thumb in a circular motion, and apply axial compression
==Differential Diagnoses==
==Investigations==
Xray
Inflammatory and rheumatological blood tests if required.
==Management==
Treatment options are limited, and the available evidence is poor.Tenti S, Cheleschi S, Mondanelli N, Giannotti S, Fioravanti A. New Trends in Injection-Based Therapy for Thumb-Base Osteoarthritis: Where Are We and where Are We Going? Front Pharmacol. 2021 Apr 13;12:637904. doi: 10.3389/fphar.2021.637904. PMID: 33927620; PMCID: PMC8079141.
Activity Modification
Hand Therapy
Steroid Injection
Corticosteroid injections can be useful to manage pain flares.
Hypertonic Dextrose Injection
Steroid slightly more effective at one month, dextrose slightly more effective at six months.Jahangiri A, Moghaddam FR, Najafi S. Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial. J Orthop Sci. 2014 Sep;19(5):737-43. doi: 10.1007/s00776-014-0587-2. Epub 2014 Aug 27. PMID: 25158896.
Surgery
The main options are arthrodesis and trapeziectomy. See https://www.youtube.com/watch?v=i7_iHbFVtHA for more information.
==References==
Category:Hand and Wrist Conditions
Category:Osteoarthritis
Foot Pain Differential Diagnoses

==Foot (rear foot) and heel pain==
==Foot (mid foot) pain==
*Midtarsal joint sprain
*Tibialis posterior tendinopathy
*Extensor tendinopathy
*Plantar fascia strain
*Stress fractures (navicular most common, less common cuneiform, cuboid, base second metatarsal)
*Peroneal tendinopathy
*Abductor hallucis strain
*Cuboid syndrome
*Tarsal coalition (in adolescents)
*Kohler's disease (in young children)
*Accessory navicular bone
*Lisfranc joint injury (fracture or dislocation)
*Osteoid osteoma
*CRPS
==Foot (fore foot) pain==
*Corns, calluses
*Onychocryptosis
*Synovitis of the MTP joints
*First MTP joint sprain
*Subungual haematoma
*Hallux abducto-valgus
*Hallux limitus
*Morton's neuroma
*Sesamoid pathology
*Stress fractures (second and third most common), sesamoid
*Fracture of the fifth metatarsal
*Freiberg's osteochrondritis
*Joplin's neuritis
*Toe clawing
*Plantar wart
*Subungual exostosis
*Synovitis of the metatarsal-cuneiform joint
*Complex regional pain syndrome
Category:Differential Diagnosis Checklists
Category:Foot and Ankle
Forefoot Examination

Forefoot examination in isolation is a thorough assessment of the hallux and the lesser toes from the dorsum and plantar aspects as well as their tips
Gait 
*Observe particularly the last phase of stance of gait for forefoot problems
*Limp
*Calcaneal varus or valgus
*Marked pronation or supination
*Forefoot valgus (forefoot strikes on first MTP) or varus (first MTP often fails to make solid contact).
Shoes - wear pattern
Hindfoot - assess for relevant pathology as hindfoot problems can lead to gait abnormality and forefoot overload
*Malalignment - looking from behind, should be mildly valgus
*Restricted dorsiflexion
*Unable to single heel raise - tibialis posterior insufficiency or hindfoot or subtalar motion stiffness. 
General Inspection
*Callosities - under metatarsal heads (metatarsal overload) or tips of digits or medial hallux or lateral fifth toe. These can be indicators of painful areas for footwear or during weightbearing activity
*Malalignment - of digits and crowding or clawing of the lesser toes
*Nail deformities and condition
*Wasting, swelling, or tenderness of joints
*Erythema, sensory abnormalities, ulcers
Passive Movement
*Range of motion - hindfoot, ankle, midfoot, hallux, lesser toes
*Deformities - are they correctable
Palpation
*Peripheral pulses
*Tenderness - of MTPJs or digits with palpation or pain with movement
Mulder's click
*Firm palpation with knuckle applied to webspace between affected heads
*The other hand applies compressive force across metatarsal heads
*Looking for clicking and replication of pain in Morton's neuroma.
Video of forefoot examination
Category:Examination
Functional Spinal Unit

The functional spinal unit (FSU) is the smallest motion segment of the spine. It includes two vertebrae with an interleaving intervertebral disc anteriorly and two facet joints posteriorly. In the normal state, approximately 70% of axial compression is transmitted by the vertebral bodies and discs and the remaining 30% posteriorly through the facet joints.
== Components ==
a. Vertebral Bodies: The vertebral bodies are cylindrical-shaped structures that form the anterior part of the FSU. They are responsible for bearing the majority of the axial load and providing structural support to the spine.
b. Intervertebral Discs: These are fibrocartilaginous structures located between the vertebral bodies, acting as shock absorbers and load distributors. They consist of an outer annulus fibrosus, which surrounds the inner nucleus pulposus. The intervertebral disc's primary functions include providing flexibility, maintaining spinal height, and absorbing compressive forces.
c. Facet Joints: Also known as zygapophyseal joints, facet joints are paired synovial joints located posteriorly in the FSU. They provide stability and guide spinal motion by limiting excessive movement in different planes.
==Resources==
== References ==
Category:Regions of the Spine