nyuuzyou/wikis huggingface dataset:
Notalgia Paraesthetica

Notalgia paresthetica (NP) is a chronic cutaneous sensory neuropathy that causes localized alloknesis and associated dysesthesias, such as pain, numbness, and tingling in the thoracic spine. 
== Pathophysiology ==
The precise pathophysiology underlying NP is yet to be fully elucidated. However, a prominent hypothesis suggests that degenerative changes in the spine or musculoskeletal compression leads to impingement of the posterior cutaneous branches of T2-T6 spinal nerves, which subsequently causes a thoracic polyradiculopathy and contributes to the pathogenesis of NP. It is believed that this impingement results in damage to the spinal nerves mentioned above. Patients with NP are more likely to have degenerative cervical and thoracic spine disease than those with back pain without pruritis
It can also occur in small fibre neuropathy.
== Epidemiology ==
The condition has a predilection for those in their middle age and affects women 2 to 3 times more often than men.
== Clinical Features ==
This condition is characterized by hyperpigmentation and chronic scratching and rubbing in the thoracic spine. Typically, the symptoms are unilateral and located in the middle or upper back, medial or inferior to the scapula between T2 to T6. 
NP can last for years, with periods of remission and exacerbation. It primarily affects adults, especially women, but hereditary cases have also been reported in younger patients associated with multiple endocrine neoplasia type 2A (MEN 2A).
== Treatment ==
The following have been proposed. Capsaicin seems to have the most research evidence.
Topical agents: capsaicin, tacrolimus, anesthetic cream, and amitriptyline/ketamine
Systemic agents: gabapentin, oxcarbazepine, and TCAs
Procedures: botulinum toxin A and narrowband UVB, and physical therapy.
Other: Exercise, TENS
== Resources ==
== References ==
Category:Polyneuropathies
Category:Thoracic Spine Conditions
OSA and Chronic Pain

There is a strong correlation between obesity and chronic pain. One of the mechanisms for this may be reduced pain tolerance due to Obstructive Sleep Apnoea (OSA), with pain and sleep influencing each other in a bidirectional relationship. CPAP therapy not only improves sleep quality but also has beneficial effects on pain outcomes, including pain intensity, threshold, and tolerance, in patients with OSA.
== Pathophysiology ==
Hyperalgesia is a phenomenon observed in patients with OSA. This condition is primarily attributed to the pathophysiological changes associated with OSA, such as nocturnal hypoxemia, sleep fragmentation, and systemic inflammation.
Nocturnal hypoxemia, a hallmark of OSA, leads to increased expression of proinflammatory cytokines, which can prime nociceptors and enhance pain sensitivity. Additionally, chronic intermittent hypoxia (CIH) associated with OSA has been shown to induce hyperalgesic priming through mechanisms involving peripheral macrophage recruitment and inflammatory cytokine release, which sensitize nociceptors.
Sleep fragmentation, another characteristic of OSA, disrupts normal sleep architecture and has been linked to increased pain sensitivity. This disruption can impair the body's natural pain modulation mechanisms, further contributing to hyperalgesia.
== Treatment ==
A systematic review by McCarthy et al. found that CPAP therapy is associated with improved pain outcomes, particularly in reducing headache pain in patients with OSA. Additionally, Shen et al. demonstrated that CPAP treatment significantly decreased pain intensity in patients with moderate-to-severe OSA after three months of therapy.
In obese patients with OSA, Lahaye et al. observed that CPAP therapy partially reverted enhanced pain sensitivity, indicating an increase in pain threshold after one month of treatment. Similarly, Khalid et al. reported that CPAP therapy reduced pain sensitivity in severe OSA patients, as evidenced by increased finger withdrawal latency to a radiant heat stimulus.
Onen et al. conducted a randomized, double-blind crossover study in 13 elderly patients with OSA and found that CPAP treatment significantly improved pain tolerance.
== References ==
Category:Miscellaneous
Category:Lifestyle
Osgood-Schlatter Disease

Osgood-Schlatter Disease (OSD) also known simply as Osgood-Schlatter is an apophysitis of the tibial tuberosity at the site of attachment of the patellar tendon that typically occurs in adolescents.
==Pathophysiology==
The exact cause is unknown. One prevalent hypothesis is that there is asynchronous development of the tibial tuberosity and the rectus femoris muscle during the maturation stage.
Before full maturity the apophysis is more susceptible to injury. Cartilage swelling and patellar tendon thickening can occur.
==Epidemiology==
Generally seen in active adolescents especially those involved in jumping and kicking activities. It is more common in boys but the gender gap is narrowing with increased participation of girls in sports. The average age is 8 to 13 in girls, and 10 to 15 in boys.
==Classification==
OSD Classificiation of De Flaviis et al.
Classification 	Description
Type 1: cartilage swelling alone 	Hypoechoic zone superficial to the apophysis of the anterior tibial tubercle representing pretibial cartilaginous swelling with forward displacement of the subcutaneous tissues and elevation of the patellar tendon from the tibial outline on the longitudinal view
Type 2: cartilage swelling and bony changes	A fragmented and hypoechoic ossification center in addition to the abovementioned findings
Type 3: associated tendonitis 	Diffuse thickening of the insertion of the patellar tendon with or without vacuolation
Type 4: associated bursitis 	Fluid collection in the retrotendineal soft tissue representing infrapatellar bursitis
==Clinical Features==
The patient has anterior knee pain. The pain is generally brought on by descending stairs, prolonged sitting with knees being immobile, kneeling, and with sporting activities.
==Differential Diagnosis==
==Prognosis==
The prognosis is generally reported as being good but the evidence for this claim is limited, and the common wisdom has been challenged. One case series of 51 10-14 year olds with OSD found that over one third of patients still have pain at two year follow up with a median pain duration of 42 months. This was associated with lower sports related function and quality of life. 
There are documented cases of adults with residual clinical symptoms and radiological findings. This is termed unresolved Osgood-Schlatter Disease. 
==Treatment==
There is limited data on treatment. In particular there is no evidence of the effectiveness of specific exercise programmes. Expert advice in review articles generally includes.
*Rest (but not immobilisation)
*Activity modification (preference for activities like swimming and cycling)
*NSAIDs
*Ice
*Protective knee padding
*Physical therapy
*Surgical treatment in rare cases
Bracing, casting, and corticosteroid injections are generally not recommended.
==Resources==
* Systematic review of treatment recommendations by Neuhaus et al.
==References==
Category:Knee and Leg Conditions
Category:Developmental Disorders
Osteitis Condensans Ilii

Osteitis condensans ilii (OCI) is a benign cause of chronic low back pain whereby there is sacroiliac joint sclerosis of unknown pathophysiology. It can also be asymptomatic. It almost exclusively affects females, often following pregnancy.
== Pathophysiology ==
Unknown. Suspected to be mechanical.
== Clinical Features ==
Chronic sacral spinal pain. Associated with tenderness over the sacroiliac joints.
== Imaging ==
On AP plain films there is a well defined triangular area of sclerosis on the iliac aspect of the bilateral sacroiliac joints. The joint space is relatively well preserved.
On MRI there is extensive sclerosis especially on the iliac side of the sacroiliac joints.
== Differential Diagnosis ==
The most important differential is axial sponyloarthritis.
Similarities and differences between sacroiliitis of spondyloarthritis with osteitis condensans ilii.H Kang. Radiology Illustrated Spine. Springer. 2014
 	Sacroiliitis of spondyloarthritis 	Osteitis condensans ilii
Similarities	Involvement of both sacroiliac joints and subchondral sclerosis	Involvement of both sacroiliac joints and subchondral sclerosis
Differences 	
* Young male 
* Low back pain and morning stiffness 
* Subchondral erosion and ankylosis in late phase 
* Subchondral reactive sclerosis in both sides of sacroiliac joints	
* Young female
* Clinically silent or mild low back pain
* No bone erosion or bony ankylosis
* Well defined sclerotic lesion mainly in iliac side
== Management ==
Unknown. Consider physiotherapy, NSAIDs, corticosteroid injection.
==Further Reading==
== References ==
Category:Sacroiliac Joint Conditions
Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is where a portion of subchondral bone and articular cartilage undergoes separation from the underlying bone. This leaves a bone fragment that can be stable or unstable. It can lead to premature Osteoarthritis
==Epidemiology==
OCD is a rare cause of joint pain. In adults, men are more commonly affected than women, and the ankle is most commonly affected. In children OCD most commonly affects the knee, followed by the elbow and ankle.
==Clinical Features==
Pain is felt in the knee, elbow, or ankle either following a specific injury or following repetitive injury. Patients report that pain is worse with exercise. In more severe disease, especially in the presence of a loose body, there may be mechanical symptoms such as catching or locking. The pain may gradually get worse over several months. In OCD of the talus there may be ongoing pain after an ankle inversion injury.
On examination there is tenderness over the relevant location - medial femoral condyle, anterolateral elbow, medial or lateral talar dome
== Investigations ==
Plain films will usually show evidence of OCD. The typical findings are a subchondral bony fragment that is surrounded by an area of crescent-shaped radiolucency. If plain films are normal and suspicion remains then MRI may be indicated. MRI can also help to grade the lesion and help with management planning.
== References ==
Category:Paediatrics
Paediatric Musculoskeletal Examination

A consensus approach to the MSK examination in children was developed by Foster et al in 2011. The open access consensus document is reuploaded in the word document below, but has also been copied into bottoms of the relevant regional examination pages.
== General Principles ==
Introduction
* Introduction of assessor to child and parent / carer
* Explanation of what to be examined, Gain verbal consent to examine
* Be aware of normal variants in leg alignment, joint range, gait, developmental milestones 
Look for:
* Swellings, Rashes , Muscle wasting , Scars
* Deformity / Dysmorphism / Discomfort (nonverbal) / “Disproportions”
Feel for:
* Temperature, Swelling, Tenderness
Move
* Full range of movement – active and passive
* Restriction – mild, moderate or severe
Function and measure 
* Functional assessment of joint / anatomic region to include power of muscles and stability 
* Measurement of height / leg length 
Additional Options pending clinical scenario
== See Also ==
* Musculoskeletal Examination Principles
==References==
Category:Examination
Category:Paediatrics
Paraspinous Cervical Block

==Indication==
This can be used for all types of headache, from tension type/migraine headaches, to orofacial/dental pain, to meningitis. Also for face pain
==Procedure==
*	Landmark the C7 spinous process, which is usually the most prominent one.
*	Mark a point 1 inch lateral to the spinous process on each side, basically in the belly of the trapezius muscle overlying the transverse process.
*	Clean the area with alcohol swab.
*	Raise a wheal using lidocaine.
*	With patient in a sitting position and head held upright, insert a 25 gauge, 1.5 inch needle angled parallel to the floor. The needle should be nearly buried. Aspirate before injecting to ensure you are not in a vessel and slowly inject 1.5 cc of bupivacaine.
*	Massage the area
*	Remove needle and dress wound.
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==Anatomy==
*	this area is pretty much all muscle, with the trapezius, levator scapula, splenius capitis and splenius cervicis all in that area. 
*	If you do hit a vascular structure, it will usually be a vertebral vein, but rarely could be a vertebral artery. However, this is unlikely because it is deeper and protected by the foramen transversarium. If you are injecting over the transverse process, that will further protect you from hitting a vascular structure.
==See Also==
Cervical Spine Procedures
Head and Jaw Procedures
==References==
Category:Cervical Spine Procedures
Category:Nonmainstream Articles
Category:Stubs
Patellar Tendinopathy

== Pathophysiology ==
Proximal patellar tendinopathy is much more common than distal.
In some cases there may be a rheumatological cause with insertional patellar tendinopathy especially spondyloarthropathy. In this setting there may be associated bursal changes.
==Treatment==
===PRP===
No benefit for leukocyte rich or leukocyte poor PRP injections over saline. Scott A, LaPrade RF, Harmon KG, et al. Platelet-rich plasma for patellar tendinopathy: a randomized controlled trial of leukocyte-rich PRP or leukocyte-poor PRP versus saline. Am J Sports Med 2019;47(7):1654-1661.
===Exercise Therapy===
====Eccentric Strengthening====
One of the most effective and widely used treatments
Important considerations 
*The exercises are painful, this is normal
*Large numbers of repetitions every day required – between 90-180
*Minimum of 3 months
Eccentric loading squats on a 25 degree decline board (3 x 15, twice daily, for 3 months)
Alternatively can ddo gym based “HSR” (heavy slow resistance – eccentric-concentric isotonic)
====Isometric Exercises====
Possibly reduces pain but original study results (n=20 study) could not be replicated = isotonic as effective (n=21 replication study) Gravare Silbernagel, K., Vicenzino, B. T., Rathleff, M. S., & Thorborg, K. (2019). Isometric exercise for acute pain relief: is it relevant in tendinopathy management? British Journal of Sports Medicine, bjsports–2019–100591. doi:10.1136/bjsports-2019-100591 . May be useful pre-activity intervention or early on. Silbernagel et al note:
==Resources==
==See Also==
*Tendinopathy
==References==
Category:Knee and Leg Conditions
Patellofemoral Pain Syndrome

Patellofemoral pain is anterior knee pain involving the patella and retinaculum where other causes of anterior knee pain have been excluded.
==Clinical Features==
== Differential Diagnosis ==
==Treatment==
In the acute phase overload is very likely. Runners should reduce their running volume, and in severe cases should stop running entirely. Those with more mild symptoms may only need to reduce more strenuous activities such as hill running. In order to maintain fitness runners can be encouraged to use a stationary bike, upper body cycle, swimming, or other activities that do not cause knee pain.
Hip and knee strengthening is more effective than knee strengthening alone.
There is limited evidence for the use of NSAIDs in the short term, with naproxen being more effective than placebo.
There is no evidence to support the use of ultrasound, iontophoresis, phonophoresis, or electrical stimulation.
== Resources ==
==References==
Category:Knee and Leg Conditions
Peripheral Vascular Examination

Peripheral vascular disease can mimic musculoskeletal causes of pain. Most patients do not have intermittent claudication but have atypical leg symptoms or no symptoms at all.Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–1324McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease. associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599–1606. Therefore is important for the Musculoskeletal Medicine Doctor to know how to perform a competent peripheral vascular examination.
==Special Tests==
===Ankle Brachial Pressure Index===
*The patient should lie in a supine positive for 5 minutes before measurement
*Upper limb measurement
**Place the cuff in the usual fashion
**Inflate the cuff to 20 mmHg above systolic arterial pressure
**Record the pressure using a doppler device by placing it over the brachial artery
*Lower limb measurement
**Place the cuff above the malleoli
**Place the doppler probe over the posterior tibial and dorsal pedal arteries
*The ABP is the highest systolic pressure value of the lower limbs divided by the higher of the brachial artery pressures
*Interpretation
**≤0.9 is PAD
**0.91 - 1.0 is borderline
**>1.00 - 1.4 is normal
== References ==
Category:Examination
Peroneal Tendon Sheath Injection

==Anatomy==
The peroneal tendons are located in the lateral compartment of the leg behind the lateral malleolus. Peroneus longus then divides and passes under the arch of the foot and inserts at the base of the great toe. Peroneus brevis inserts into the base of the fifth metatarsal. The division of the two tendons can be found by having the patient hold the foot in strong eversion and palpating for the V-shaped fork of the two tendons. They are the primary structures provided foot eversion. They are important active stabilisers of the ankle joint. Three are three categories of painful peroneal tendon disorders: tendinopathy, instability (subluxation and dislocation), and tears and ruptures.
==Indications and Efficacy==
In a study of 96 patients who had peroneal tendon sheath injections, 25% progressed to surgery. 43.7% reported 0-1 weeks of pain relief, 12.6% 2-6 weeks, 6.9% 7-12 weeks, and 36.8% greater than 12 weeks. Preinjection duration of symptoms was associated with post-injection duration of pain relief (P=.036). Patients with less than 1 year of symptoms had a median 6-12 weeks of postinjection pain relief.
==Contraindications==
==Pre-procedural Evaluation==
==Equipment==
==Technique==
===Ultrasound Guided===
thumb|right|Ultrasound guided in-plane peroneal tendon sheath injection
*Position: Lateral decubitus
*Outline distal fibula with a pen
*Clean area with alcohol, and load 1mL of 1% lidocaine and 1mL of 40mg triamcinolone.
*25-gauge 1.5-inch needle
*High frequency probe in transverse position
*Visualise tendons running together at the level of the distal fibula
*Visualise needle during injection to confirm intrasheath, extratendinous injection.
===Landmark Guided===
In a study of 20 cadavers, landmark guidance was only 60% accurate, vs 100% accurate for ultrasound.
*Position: Supine with foot supported in slight internal rotation
*Identify and mark the division between the two tendons
*Insert the needle perpendicularly at the division.
*Turn the needle and slide it horizontally towards the malleolus
*Inject solution into the combined tendon sheath. There should be minimal resistance.
==Complications==
In a study of 96 patients, there were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression.
==Aftercare==
Avoid overuse of the ankle for one week. The causative factors should be addressed where possible.
==Videos==
==See Also==
==External Links==
==References==
Category:Foot and Ankle Procedures
Pivot Joint

A pivot joint is an articulation within a ligamentous ring between the rounded end of one bone and another bone. This type of joint is uniaxial because, although the bone rotates within this ring, it does so around a single axis. An example would be the atlantoaxial joint between C1 (atlas) and C2 (axis) of the vertebrae, permitting side-to-side head motion. Another example is the proximal radioulnar joint. The radius sits in the annular radial ligament, which holds it in place as it articulates with the radial notch of the ulna, which permits pronation and supination. 
== List of s ==
== References ==
Category:Joint Types
Planar Joint

A planar joint, or gliding joint, is defined as an articulation between bones that are both flat and of similar size. This type of joint is multiaxial because it permits many movements; however, surrounding ligaments usually restrict this joint to a small and tight motion. Examples include intercarpal joints, intertarsal joints, and the acromioclavicular joint. 
== List of s ==
== References ==
Category:Joint Types
Plantar Fasciitis

Plantar fasciitis is the most common cause of chronic heel pain, with a lifetime prevalence of up to 10%.
== Anatomy ==
The deep plantar fascia, also known as the plantar aponeurosis, is a thick, pearly-white fibrous tissue with longitudinally oriented fibres that are intimately attached to the skin. The thickest area is found centrally where it attaches to the medial process of the tuberosity of the calcaneal. Distally it divides into separate slips for each of the five toes.
== Aetiology ==
Risk factors are obesity, prolonged standing or jumping, flat feet, reduced ankle dorsiflexion. It can occur in isolation or in conjunction with spondyloarthritis.
==Pathophysiology==
Unknown, but thought to be a degenerative fasciopathy/enthesopathy.
== Epidemiology ==
Peak incidence is between 40-60 years. There is a younger peak in runners. It is bilateral in up to one third of cases.
Decreased ankle dorsiflexion(running on your forefoot technique) and high body mass index are risk factors for development of plantar fasciitis. (See Foot and Ankle Biomechanics)
==Clinical Features==
Medial heel pain that is worse in the first few steps in the morning.
Dorsiflex the patients toes to pull the plantar fascia taut, then palpate for tenderness.
==Investigations==
Ultrasound may show thickened plantar fascia >4mm.
==Differential Diagnosis==
==Treatment==
===First line===
Common treatments are manual therapy, exercise, stretching, heel pads, taping, orthotics, night splints, education, activity modification, NSAIDs, and weight loss.
Shoe inserts: Felt pads or rubber heel cups seem to be less effective than silicone inserts.
Mulligan calcaneal taping: The patient is seated on the bed with the foot hanging down and the hip is in abduction and external rotation. The ankle is relaxed. Two layers are applied, an under-wrap and a brown rigid over-wrap. Apply the tape diagonally on the lateral surface of the calcaneum. Hold the calcaneum in external rotation and adduction. Pull the tape around the ankle medially and around superior to the Achilles tendon while sustaining the glide.Full Text
===Second line===
Second line treatments include extracorporeal shockwave therapy (ESWT), corticosteroid injection, PRP injection, dextrose prolotherapy, and fasciotomy.
Dextrose prolotherapy: In a systematic review of 8 studies (2 RCTs, 444 patients total), dextrose prolotherapy was found to be more effective than exercise and normal saline injection, however better quality studies are needed. In the 2 RCTs dextrose prolotherapy showed no significant difference to other treatments after 6 months. The concentrations used were 13.5-20% but one study used 1.5%. Generally 2-3 injections were given in intervals of 1-3 weeks.
==Resources==
==References==
Category:Foot and Ankle Conditions