nyuuzyou/wikis huggingface dataset:
Shoulder 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
===Anterior approach===
*Sit patient upright facing you
*Insert needle just lateral to coracoid process (between coracoid process and humeral head)
*Direct needle posteriorly
===Posterior Approach===
*Sit patient upright with back facing you
*Palpate scapular spine to its lateral limit (the acromion)
*Identify the posterolateral corner of the acromion
*Insert 1.5-in needle 1 cm inferior and 1 cm medial to this corner
*Direct needle anterior and medial toward presumed position of coracoid process
*Glenohumeral joint is located at a depth of approximately 1-1.5in
==Evaluation==
==Complications==
==See Also==
*Arthrocentesis
==External Links==
*https://www.nuemblog.com/blog/joint-aspiration?rq=arthrocentesis
==References==
Category:Shoulder Procedures
Shoulder Pain after Neurological Injury

Causes of Shoulder Pain Following Neurological Injury
Cause 	History Features 	Examination Findings 	Investigations 	Management
Hypotonia and Subluxation 	Pain at rest (especially if unsupported) and/or movement-related pain	Low tone, inferior subluxation evident 	X-ray shows inferior subluxation; Ultrasound may show rotator cuff tears or tendinosis 	Strengthening exercises, neuromuscular electrical stimulation, kinesiology taping; corticosteroid injections if inflammation is present; surgical referral in refractory cases
Spasticity 	Pain and/or stiffness; spasticity may worsen with pain 	Velocity-dependent increase in tone, internal rotation, and adduction; anterior subluxation of the humeral head	X-ray may show anterior subluxation; Ashworth scale used for severity 	Address aggravating factors, therapist-led positioning, botulinum toxin, oral spasticity medications; surgical release in severe cases
Subacromial Pain Syndrome 	Pain worsens with or after lifting the arm 	Malalignment of the shoulder joint; poor scapulohumeral rhythm; worsened pain during/after lifting 	X-ray may show osteoarthritis or osseous abnormalities; Ultrasound shows tendinopathy, tears, bursitis	Supervised exercise program, corticosteroid injection, surgical referral for refractory cases (e.g., decompression, rotator cuff repair)
Frozen Shoulder 	Pain-dominant early phase, stiffness-dominant later phase 	Gradual loss of active and passive range of motion, particularly external rotation 	X-ray to exclude skeletal pathology; Ultrasound shows thickened capsule and diminished axillary recess	Stretching and strengthening exercises, intra-articular corticosteroid injections, hydrodilatation; surgical options include manipulation or arthroscopic release
Shoulder-Hand Syndrome 	Allodynia, hyperalgesia, pain at night; dystonia or tremor possible 	Swelling, discolored and cool skin, altered sensation, dystrophic skin 	Clinical diagnosis; imaging to rule out other conditions 	Neurorehabilitation referral, multidisciplinary pain management, suprascapular nerve block for acute cases
Other Factors (e.g., Central Post-Stroke Pain)	Burning pain, hypersensitivity; may accompany stroke-related deficits	Misinterpretation of sensory inputs, allodynia, hyperalgesia 	Thalamic or medullary stroke on imaging 	Neuropathic pain medications (e.g., amitriptyline, gabapentin); psychological support; multidisciplinary approach
==Resources==
Category:Shoulder Conditions
Category:Neurology
Snapping Hip Syndrome

==Classification==
;External Snapping Hip
Either the iliotibial band, anterior fibres of gluteus maximus, the tensor fascia lata, or a combination snap over the greater trochanter. Often the fibres are thickened and there may be associated bursitis. There may be an imbalance between activation of the gluteus maximus and tensor fascia lata. The snapping is produced by a combination of flexion, abduction, and external rotation.
;Internal Snapping Hip
Iliopsoas implicated as it snaps over the iliopectineal eminence, femoral head, or lesser trochanter. Snapping occurs from flexion to extension.
== Differential Diagnosis ==
A variety of disorders can create the sensation of snapping
* Tendon Snapping, Coxa Saltans
* Hip Intraarticular Bodies
* Hip Labral Tear
* Synovial Chondromatosis
* Osteochondroma
* Cartilage Abnormalities (Flap)
* Ligamentum Teres Tear
* Ischiofemoral Impingement
* Proximal Hamstring Origin
* Hip Osteonecrosis
== Investigations ==
As a dynamic disorder the best imaging modality is ultrasound.
== Resources ==
==References==
Category:Pelvis, Hip and Thigh Conditions
Category:Stubs
Somatic Dysfunction

Somatic dysfunction is an Osteopathic concept that refers to impaired functioning of the somatic system with or without any significant disease process. It is akin to irritable bowel syndrome in Gastroenterology, epilepsy in Neurology, and dysrhythmia in a structurally normal heart. 
== Definition ==
Somatic dysfunction has been defined as "impaired or altered function of related components of the body framework system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements. It is characterised by positional asymmetry, restricted range of motion, tissue texture abnormalities, and/or tenderness."Glossary of Osteopathic Terminology (Third Edition) (aacom.org) Full Text
== Diagnosis ==
The principles of dysfunction diagnosis is based on the diagnostic triad - ART or TART depending if tenderness is added.
* T: Tissue texture changes. Palpation is done in a layered approach.
* A: Asymmetry of form of function of related parts of the somatic system. Comparisons are made of paired structures. Skeletal asymmetry may have an influence on functional asymmetry.
* R: Range of motion whether normal, increased, or decreased. The usual finding is of decreased ROM in somatic dysfunction. The motion is assessed for pathological and anatomical barriers and endfeel.
* (T): Tenderness on palpation.
It is said that acute somatic dysfunction is characterised by "pain, erythema, a palpable sense of relative warmth, moisture and bogginess, vasodilation, oedema, tenderness, and tissue contraction"
It is said that chronic somatic dysfunction is characterised by itching, paraesthesias, palpable sense of tissue dryness, coolness, tissue contracture, fibrosis, tenderness, and pallor"
== Classification ==
Type I somatic dysfunction: a group dysfunction of the thoracic and lumbar vertebrae. The vertebrae are neutral in the sagittal plane but are sidebent and rotated in opposite directions (e.g. sidebent right and rotated left or vice versa)
Type II somatic dysfunction: a single segmental dysfunction of the thoracic or lumbar vertebrae. The vertebrae is significantly flexed or extended and is sidebent and rotated in the same direction (e.g. sidebent right and rotated right or vice versa)
== See Also ==
* Myofascial Pain Syndrome
* 
== References ==
Category:Functional Approaches
Somatic Referred Pain

Somatic referred pain is pain perceived in a region innervated by nerves coming from somatic structures other than those that innervate the source of pain. The mechanism is through convergence. 
Somatic referred pain has a characteristic quality. It is deep, achy, expanding pressure, and is felt in a broad area. The location remains consistent. Patients can clearly identify the centre of pain, but find it hard to define the boundaries.
In contrast, radicular pain is shooting or lancinating, and extends along a narrow band. Neuropathic pain is burning and has sensory abnormalities. Somatic referred pain has no neurological deficit.
Inman and Saunders (1944) were the first to describe sclerotomes. They envisaged sclerotomes representing sensory innervation of skeletal tissues. They were distinct from myotomes and dermatomes. Unfortunately no anatomical basis has been found to corroborate the sclerotome. Dermatomes were originally mapped from patients with herpes zoster, and then confirmed through dorsal rhizotomy. Myotomes were mapped from patients with spinal cord injuries, and then confirmed through EMG studies. We don't know if "sclerotome patterns" are a result of central connections or peripheral segmental innervation.
The interspinous ligaments were the first to be tested by injecting hypertonic saline. Then from the 1970s other structures were investigated. The cervical facet joints are the only pain patterns that have been shown to be fairly consistent between individuals. The source of pain from other regions cannot be easily inferred from pain maps due to high variability.
== See Also ==
* Referred Pain
* Radicular Pain and Radiculopathy
Category:Pain Types
Spine Imaging

*The primary role of imaging is the identification of undiagnosed systemic disease. 
*Spine imaging has a significant specificity fault. 
*There is a high prevalence of asymptomatic degenerative changes. 
*The significance depends on the concordance between imaging findings and the clinical presentation. 
*Spine imaging may be insensitive to dynamic lesions. 
*Ultimately spine imaging may fail to identify the pain source. For example ruptures of the capsule of a facet joint in the cervical spine from whiplash cannot be identified on imaging.
Category:General Spine
Category:Radiology
Strachan Syndrome

Strachan Syndrome (pronounced "Strawn") is a nutritional disorder that presents as a triad of optic, auditory and painful symmetrical sensory polyneuropathy. Clinical features include numbness and cramps in the limbs, reduced vision, and sensorineural deafness. Some patients have a rash of the face and genitals. As this neuropathy is painful, the Musculoskeletal Physician should be aware of it. See also Nutritional Peripheral Neuropathies.
== Risk Factors ==
Vegans are susceptible to B12 and riboflavin (B2) deficiencies, with the latter being less well known. These two vitamins are found predominantly in meat and dairy produce. In New Zealand true veganism is rare at 0.74% of the population. Nutritional deficiencies can occur in a wide array of other conditions such as anorexia nervosa, severe ARFID (e.g. in autism), malabsorption syndromes, and certain genetic conditions.
Bariatric surgery and alcoholism are further risk factors for B1, B6, and B12 deficiencies.
== Specific Deficiencies ==
Thiamine (B1): Vitamin B1 deficiency commonly presents as Wernicke's encephalopathy. However patients can also have a clinical presentation similar to Guillain-Barre syndrome, with predominantly motor effects.
Riboflavin (B2): Vitamin B2 (riboflavin) is an essential, water-soluble component of coenzymes such as FAD and FMN. Deficiency in riboflavin is called ariboflavinosis. 
Symptoms include sore throat, hyperemia of pharyngeal mucous membranes, edema of mucous membranes, cheilitis, stomatitis, and glossitis. Animal studies have shown that deficiency can cause peripheral neuropathy.
There is no good way of testing for riboflavin (B2) nutritional status. You can test plasma levels but this reflects recent dietary intake - In Auckland the test must be vetted by a pathologist. One indirect measure that doesn't need pathologist approval is plasma acetylecarnitine and urine organic acids (fasted - the patient needs to be in a fat dependent catabolic state). These are tests used to detect fatty acid oxidation disorders, so its not the typical test for riboflavin deficiency, but these enzymes require FAD as a cofactor.
Vitamin B12: Well known, not repeated here.
==Resources==
== References ==
Category:Miscellaneous
Subacute Combined Degeneration

This refers to degeneration of the posterior and lateral columns of the spinal cord. It is particularly linked to B12 deficiency but can also occur in copper and folate (B9) deficiencies.
Clinical features are weakness, spasticity, impaired vibratory and proprioceptive sensation, extensor plantar responses. One can also get optic neuropathy, erectile and bladder dysfunction, and cognitive effects.
Category:Neurology
Superficial Radial Nerve

The superficial radial nerve (SRN) is provides part of the sensory innervation of the hand. This article explores the anatomy, function, and clinical significance of the superficial radial nerve in depth.
==Anatomy==
The SRN is a terminal branch of the radial nerve, one of the major nerves originating from the brachial plexus. The radial nerve, after providing motor and sensory branches in the arm and forearm, bifurcates into the deep radial nerve and the superficial radial nerve.
The SRN emerges at the level of the lateral epicondyle, running between the brachioradialis and pronator teres muscles. The nerve then descends along the radial aspect of the forearm before piercing the deep fascia near the wrist. Finally, it branches out into multiple sensory branches to innervate the dorsum of the hand.
==Function==
The primary function of the superficial radial nerve is sensory innervation. It provides cutaneous sensation to the following areas:
*Medial branch supplies ulnar aspect of dorsum of thumb, dorsum of index finger and middle fingers, and radial aspect of fourth fingers
*Lateral branch supplies radial aspect of thumb and dorsal surface of base of thumb.
It is important to note that the SRN does not supply motor function, as the deep radial nerve carries motor fibers to the extensor muscles of the forearm.
==Clinical Significance==
Superficial radial nerve injuries can result from trauma, compression, or entrapment. Symptoms may include:
*Numbness or tingling on the dorsum of the hand
*Pain along the radial aspect of the forearm
*Loss of sensation in the innervated areas
Injury to the SRN can occur from various causes such as fractures, lacerations, and iatrogenic injuries from medical procedures. Conservative management typically involves rest, immobilization, and anti-inflammatory medications. In severe cases or if conservative management fails, surgical intervention may be necessary.
Wartenberg's syndrome, also known as superficial radial nerve entrapment or cheiralgia paresthetica, is a condition in which the superficial radial nerve is compressed as it passes through the forearm's fascial layers. This compression results in pain, numbness, and tingling in the distribution of the SRN. The condition is often caused by repetitive motion, trauma, or tight wristbands and bracelets.
Superior Cluneal Nerve Injection

==Anatomy==
==Indications==
==Contraindications==
==Pre-procedural Evaluation==
==Equipment==
==Technique==
thumb|right|SCN block. The needle is inserted through the thoracolumbar fascia (yellow line), close to the lateral edge of iliocostalis where the posterior layer fuses with the anterior fascial layer (blue line). The red line is the lumbar intermuscular aponeurosis.</br>© American Society of Regional Anesthesia & Pain Medicine 2019
thumb|right|The needle is inserted in plane from a lateral to medial direction through the thoracolumbar fascia (yellow line). Intermuscular aponeurosis is shown (red arrow).</br>© American Society of Regional Anesthesia & Pain Medicine 2019
Injection can be done by landmark guided palpation based on the maximal area of tenderness, and/or by ultrasound guidance. Injections are typically done with local anaesthetic, but dextrose prolotherapy can be used Inklebarger J, Galanis N. The management of cluneal nerve referred pain with prolotherapy. J Prolotherapy. 2018;10:982–91.Full Text
===Ultrasound Guided===
;SCN Injection
An ultrasound guided technique for superior cluneal nerve entrapment has been developed, in a cadaveric and live human randomised study.
*Position:Lateral decubitus
*Target: Subfascial layer between the thoracolumbar fascia and erector spinae to ensure injectate spread to all superior cluneal nerves.
*Probe:High frequency linear transducer.
*Identify the lateral border of the erector spinae muscle at the level of the superior margin of the iliac crest, which fuses laterally with the transverse abdominis aponeurosis.
*Trace the erector spinae caudally to the level of the iliac crest
*Keep the transducer cranial to the level of where the lumbar intermuscular aponeurosis fuses with the posterior layer of the thoracolumbar fascia.
*Insert needle lateral to medial, pierce the thoracolumbar fascia just medial to the point of fusion with the anterior layer at the lateral margin of the erector spinae.
*The erector spinae muscle and posterior layer of the thoracolumbar fascia should separate during injection, and as this happens move the needle medially.
===Fluoroscopy Guided===
===Landmark Guided===
;SCN Injection
*Position: Prone
*Palpate: posterior wings of the iliac crest, 6-7cm lateral from the midline, and mark the area. Often there is a small lipoma, and use this to guide needle placement around the lipoma.
*Advance needle perpendicularly to the marked area under contact with bone.
*Following negative aspiration inject 1mL of solution
==Complications==
==Aftercare==
==Videos==
==See Also==
==External Links==
==References==
Category:Infoboxes
Category:Nonmainstream Articles
Category:Pelvis, Hip and Thigh Procedures
Category:Lumbar Spine Procedures
Category:Stubs
Supraorbital Nerve Injection

==Anatomy==
The supraorbital nerve is a branch of the terminal cutaneous branches of the frontal nerve. It runs through the supraorbital notch and innervates the upper eyelid, forehead, and anterior 1/3 of the scalp. It then ascends up the forehead. It is closely associated with the supraorbital artery medially. The supraorbital nerve is found just above the supraorbital notch.
;Cranio-cervical Dermatomes.
==Indications==
*Headache disorders
*Trauma or need to perform painful procedure on area innervated by supraorbital nerve 
==Contraindications==
*Infection overlying injection site
*Previous allergic reaction to local anesthetic
*Uncooperative patient
*Distortion of anatomical landmarks 
==Equipment Needed==
*local anesthesia
**lidocaine 2% (lasts 30-60 minutes or longer if given with epinephrine, rapid onset of 4-6 minutes)
**Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
*18 gauge needle to draw up anesthetic
*1.5 inch 25 or 27 gauge needle 
*3-5cc syringe
*gauze pads
*gloves
*betadine/chlorhexidine 
==Procedure==
*Obtain informed consent
*Place patient in supine position or seated
*Draw up 2-5cc of anesthetic into syringe
*Palpate the supraorbital notch over the medial aspect of the supraorbital ridge
*Prep area 
*Advance the needle towards foramen to a depth of 4-5mm
*Aspirate, and if no blood, inject 1-3 cc of anesthetic slowly
*Massage area for 10-15 seconds
*If block is unsuccessful, inject a line of anesthetic solution along the orbital rim laterally to medially to block all branches of the ophthalmic nerve 
==Complications==
*Bleeding/hematoma
*Infection
*Pain
*Swelling of face/eyelid
*Allergic reaction to anesthetic
*Damage to nerves/vessels
==References==
*Amsterdam J and Kilgore K. Regional Anesthesia of the Head and Neck. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014
Category:Head and Jaw Procedures
Category:Infoboxes
Category:Partially complete articles
Suprascapular Nerve Injection

==Background==
==Anatomy==
The suprascapular nerve supplies sensation to most of the shoulder joint, especially the superior and posterior regions.
==Indications==
Various conditions that restrict range of motion and cause pain, including Adhesive Capsulitis, calcific tendinitis, and bursitis.
==Contraindications==
==Technique==
===Ultrasound Guided===
===Non-ultrasound Guided===
==Complications==
==Aftercare==
==Videos==
==See Also==
Shoulder
==External Links==
==References==
Category:Infoboxes
Category:Shoulder Procedures
Category:Stubs
Supratrochlear Nerve Injection

==Anatomy==
The supratrochlear nerve is a terminal cutaneous branch of the frontal nerve. The frontal nerve arises from the ophthalmic division of the trigeminal nerve (V1). The supratrochlear nerve exits out from the orbital cavity and runs anterior and then ascends the forehead. It innervates the upper eyelid, forehead, and anterior scalp. The injection site is where it is found superficially at the superomedial aspect of the supraorbital ridge.
;Cranio-cervical Dermatomes.
==Technique==
===Landmark Guided===
*Position the patient supine with their head in a neutral position. 
*Use a 1.0 or 2.5 mL syringe with a 30-gauge needle. 
*Locate the nasal bridge and the medial aspect of the supraorbital ridge. 
*Insert the needle at the medial aspect of the corrugator muscle, just lateral to the procerus and above the eyebrow line to a depth of 4–5 mm. 
*Aspirate to ensure not located in an artery and then inject, producing a small wheal under the skin
==See Also==
* Auriculotemporal Nerve Injection
* Greater Occipital Nerve Injection
* Lesser Occipital Nerve Injection
* Supraorbital Nerve Injection
* TMJ Injection
==References==
Category:Head and Jaw Procedures
Category:Infoboxes
Category:Partially complete articles
TMJ Examination

==Anatomy==
File:TMJ Anatomy.png
File:TMJ Anatomy2.png
File:TMJ Anatomy3.png
==Inspection==
#Oral exam
#Head/chin deviations
#*C curve occurs due to hypomobility, the mandible deviates to the involved side, then returns to centre
#*S curve occurs due to hypermobility as a result of poor neuromuscular control.
==Palpation==
thumb|right|400px|Retrodiscal space
#Retrodiscal space. Line your finger tips up of fingers 2 through 5. Palpate the right and left TMJ with the posterior finger at the tragus. Allow a slight inferior angle of finger alignment.
#Coronoid Process: Begin with mouth closed, palpate inferior to the zygomatic bone. Ask the patient to open their mouth. If the coronoid process does not move forward to touch your finger then ask them to open further or adjust your finger location. Check all easily accessible coronoid aspects. Verbal cues are generally required for maintaining an open mouth. Palpation of the medial aspect can be accomplished intraorally if required.
#Masseter
==Movement==
#Range of motion. normal jaw opening is ~4-7cm, with a wide range of normalZawawi KH, Al-Badawi EA, Lobo SL, Melis M, Mehta NR. An index for the measurement of normal maximum mouth opening. J Can Dent Assoc. 2003;69(11):737-741.
== See Also ==
TMJ Pain
==Videos==
<youtube>Nmg3xl13TY0</youtube>
<youtube>upbs7Hm9tRQ</youtube>
<youtube>MG_JqF1mNb0</youtube>
==MCQs==
<quiz display=simple>
{Which are symptoms of TMD?
|type="()"}
- Muscle pain
- TMJ Pain.
- Difficulty with mouth opening.
- Difficulty with lateral deviation.
- Sounds associated with movement
+ All of the above
{Bruxism and TMD…
|type="()"}
- Have perfect correlation
- Have high correlation.
+ Have low correlation.
||Present in 20% population, 66% of people with TMD
- Have no correlation.
{The temporalis muscle inserts onto…
|type="()"}
- The mandibular condyle and is in front of the zygomatic arch
- The mandibular condyle and is in behind the zygomatic arch
- The mandibular coronoid process and is in front of the zygomatic arch
+ The mandibular coronoid process and is behind of the zygomatic arch
||Temporalis Tendinopathy is common, palpate!
{The masseter inserts onto…
|type="[]"}
- The mandibular condyle
+ The coronoid process
+ The zygomatic arch
||Origin is lateral border of mandibular ramus
- The maxilla
{Roughly how many fingers wide should your mouth open?
|type="()"}
- ~one
- ~two
+ ~three
||Very wide range of normal ~4-7cm, Also check lateral deviation, https://www.ncbi.nlm.nih.gov/pubmed/14653940
- ~four
- ~five
{What other joint or joint complex should you examine?	
|type="()"}
-The shoulder
+The neck
||The TMJ and neck are highly linked. cervical extension causes jaw opening, while flexion causes jaw closing. There is a neural link between the upper c spine and the trigeminal ganglion (e.g. cervicogenic headaches)
-The ACJ
-The SCJ
{Does joint effusion on MRI correlate with pain?
|type="()"}
+ Yes
||Degenerative changes do not correlate with pain or mobility
- No
</quiz>
Category:Head and Jaw
Category:Examination
==References==