nyuuzyou/wikis huggingface dataset:
Apophysitis of the Pelvis and Hip

There are seven apophyseal locations in the developing hip, and apophysitis can occur at any of them. Injuries can occur In some cases apophyseal avulsion fracture can occur. Enthesopathy/apophysitis and apophyseal avulsion fractures should be excluded before considering tendinopathy. 
The common classic sites of enthesopathy about the hip are:
* Iliopsoas insertion to the lesser trochanter of the femur
* Rectus femoris origin from the anterior inferior iliac spine
* Sartorius origin from the anterior superior iliac spine
* Rectus abdominis insertion at the superior aspect of the pubic symphysis.
Enthesopathies cause activity related pain, often with sudden turning movements. Iliopsoas tendon insertion enthesopathy is most common in those that kick a ball frequently.
== Differential Diagnosis ==
Depending on the age of the child one should also consider Irritable hip (early childhood), Perthes (later childhood), and SUFE (overweight teenage boys). Septic arthritis should also be considered.
== Resources ==
Clinical Practice Guidelines : Apophysitis of the Pelvis and Hip - Emergency Department (rch.org.au)
Category:Developmental Disorders
Category:Pelvis, Hip and Thigh Conditions
Arthrocentesis diagnostic chart

===Arthrocentesis of synoval fluid===
Synovium	Normal 	Noninflammatory	Inflammatory 	Septic
Clarity 	Transparent 	Transparent 	Cloudy 	Cloudy
Color 	Clear 	Yellow 	Yellow 	Yellow
WBC 	<200 	<200-2000 	200-50,000 	
>1,100 (prosthetic joint)
>25,000; LR=2.9
>50,000; LR=7.7
>100,000; LR=28
PMN 	<25% 	<25% 	>50% 	
>64% (prosthetic joint)
>90%
Culture 	Neg 	Neg 	Neg 	>50% positive
Lactate 	<5.6 mmol/L	<5.6 mmol/L 	<5.6 mmol/L 	>5.6 mmol/L
LDH 	<250 	<250 	<250 	>250
Crystals	None 	None 	Multiple or none	None
*Viscosity of synovial fluid may actually be decreased in inflammatory or infectious etiologies, as hyaluronic acid concentrations decrease
*The presence of crystals does not rule out septic arthritis; however, the diagnosis is highly unlikely with synovial WBC < 50,000Shah K, Spear J, Nathanson LA, Mccauley J, Edlow JA. Does the presence of crystal arthritis rule out septic arthritis?. J Emerg Med. 2007;32(1):23-6.
Arthrocentesis equipment

===General arthrocentesis equipment===
*Betadine or Chlorhexadine 
*Sterile gloves/drape 
*Sterile gauze 
*Lidocaine
*Syringes 
**Small syringe (6-12cc) for injection of local anesthetic
**Large syringe (one 60cc or two 30cc) for aspiration 
*Needles 
**18 gauge: knee
**20 gauge: most other joints
**25 gauge: MTP joints 
**27 gauge for anesthetic injection
*Collection tubes (red top and purple for crystal analysis)
*Culture bottles
*Consider utilizing U/S to assess for effusion
Arthrocentesis indications

===General arthrocentesis indications===
*Suspicion of septic arthritis
*Suspicion of crystal induced arthritis 
*Evaluation of therapeutic response for septic arthritis 
*Unexplained arthritis with synovial effusion
*Evaluation of joint capsule integrity if overlying laceration
*Relative: therapeutic (decrease intra-articular pressure, injection of anesthetics/steroids)
Atlanto-occipital Joint

The atlas (C1) isn't really a true cervical vertebra both anatomically or functionally. It is more akin to an occipital vertebra as it resembles the occipital bone more than a cervical vertebra. Functionally it is also more closely linked to movement with the head than with the cervical spine.
== Overview ==
==Structure==
The atlas has two lateral masses which is the most important bony structural feature.
Superiorly they present superior articular processes and articulate with the occipital condyles, called the atlanto-occipital joint. These are synovial joints and are the only direct connection between the skull and the atlas (C1).
Inferiorly the lateral masses have inferior articular processes that articulate with the axis (C2), forming the atlanto-axial joint. 
Through the atlanto-axial joint the load from the head is transmitted to the rest of the cervical spine.
The atlas also has anterior and posterior arches. The primary purpose of these is to hold the two lateral masses in place.
==Function==
The atlanto-occipital joint provides a small amount of flexion and extension. Axial rotation is not possible due to the depth of their sockets. With axial rotation of the cervical spine, the atlas behaves passively sitting between the skull and the axis (C2)
==Innervation==
The C1 spinal nerve is unique. It does not have a typical dorsal root ganglion. The ganglion cells are located in the rootlets of the spinal accessory nerve. The dorsal ramus of C1 is found with the posterior suboccipital muscles. In some individuals there is a cutaneous branch. 
The ventral ramus of C1 runs past the posterior arch of the atlas (C1), behind the superior articular process. It innervates the atlanto-occipital joint and then enters the cervical plexus.
Category:Cervical Spine Anatomy
Category:Joints
Category:Joints of the Spine
Auriculotemporal Nerve Injection

The auriculotemporal nerve is a branch of the mandibular nerve (V3) that runs with the superficial temporal artery and vein, and provides sensory innervation to various regions on the side of the head.
==Anatomy==
The auriculotemporal nerve arises as a posterior division of the mandibular branch of the trigeminal nerve. It has somatosensory and parasympathetic roots. The somatosensory fibres supplies the auricle, external acoustic meatus, outer side of the tympanic membrane, the skin in the temporal region (superficial temporal branches), and a few fibres to the temporomandibular joint. Its proximal trunk is located superficially just anterior to the tragus. The parasympathetic root innervate the parotic gland.
The external ear innervated by four sensory nerves: greater auricular nerve, lesser occipital nerve, auricular branch of vagus nerve, and the auriculotemporal nerve.
;Cranio-cervical Dermatomes.
==Technique==
===Landmark Guided===
*Position: patient seated and physician standing beside them, or with the patient supine and their head in a neutral position. 
*Injection point is just anterior to the tragus
*Use a 5 mL syringe with a 30-gauge needle
*Insert the needle 1–2 mL into the subcutaneous tissue to a depth of about 4–6 mm. 
*Aspirate to exclude arterial puncture and inject
==See Also==
* Greater Occipital Nerve Injection
* Lesser Occipital Nerve Injection
* Paraspinous Cervical Block
* Third Occipital Nerve Injection
* Supraorbital Nerve Injection
* Supratrochlear Nerve Injection
* TMJ Injection
==References==
Category:Head and Jaw Procedures
Category:Infoboxes
Category:Partially complete articles
Ball and Socket Joint

A ball and socket joint is an articulation between the rounded head of one bone (ball) and the concavity of another (socket). It is a type of synovial joint. This type of joint is multiaxial: it permits flexion/extension, abduction/adduction, and rotation. The only two ball and socket joints of the body are the hips and the shoulder (glenohumeral). The shallow socket of the glenoid cavity permits a more extensive range of motion in the shoulder; the deeper socket of the acetabulum and the supporting ligaments of the hip constrain the movement of the femur.
== List of s ==
==References==
Category:Joint Types
Benign Paroxysmal Positional Vertigo and Pain

The MSK physician should be familiar with Benign Paroxysmal Positional Vertigo (BPPV). This is because in chronic BPPV the majority of patients have pain as a major symptom, with 87% of cases in one series. Furthermore, trauma is a major cause of BPPV in those under 50. Remembering that BPPV comes on with neck movements, it is easy to see how a misdiagnosis of "cervical vertigo" can be made when there is a history of trauma and neck pain. 
== Mechanisms of Pain ==
Postural control is primarily maintained through vestibulo-spinal and vestibulo-reticular reflexes, which aim to ensure vertical balance by modulating muscle tension in the neck, torso, and extremities. In conditions like Benign Paroxysmal Positional Vertigo (BPPV), movement of the head can trigger otoliths in the semicircular canals, leading to postural mismatches. Individuals often compensate for this imbalance through static muscle use, which can accumulate pain-inducing substances like arachnoid acid, bradykinin, and histamine. This pain subsequently disrupts motor control. Additionally, deficits in proprioception can delay protective neuromuscular reflexes, leading to potential joint damage and abnormal movement patterns. The high density of gamma-muscle spindles in the cranio-cervical joint, crucial for optimal motor control, further underscores the importance of proprioception in maintaining postural control and preventing pain.
== Diagnosis ==
Patients with chronic neck pain and episodic dizziness should generally have semicircular canal testing - Dix-Hallpike for posterior canal at minimum. Supine roll is done for horizontal canal testing which is the second most common type. Anterior canal is very rare.
== Treatment ==
Treatment of the BPPV may resolve the pain. 
== See Also ==
See https://dizziness-and-balance.com/disorders/bppv/bppv.html.
== References ==
Category:Miscellaneous
Biotensegrity

Tensegrity is a 3D structure based on envelopes and struts, derived from the words tension and integrity. The skeleton, fibrous connective tissues, and skeletal muscle are among the components that form the body. These structures have an interwoven relationship of tension and compression which maintains form and function. The concept has been used to help explain how stresses at one point in the body can lead to referred pain and help inform functional approaches to treating musculoskeletal disorders. It is a competing model to the lever system for explaining biomechanics.
== Terminology ==
"Tensegrity", a term coined by R. Buckminster Fuller, is a blend of the words 'tension' and 'integrity'. It describes a unique systemic structure devised by his student, artist Kenneth Snelson, using struts and cables." 
Snelson’s definition states, “Tensegrity describes a closed structural system composed of a set of three or more elongate compression struts within a network of tension tendons, the combined parts mutually supportive in such a way that the struts do not touch one another, but press outwardly against nodal points in the tension network to form a firm, triangulated, prestressed, tension and compression unit.” -- by Kenneth Snelson”. The TensegrityWiki has more definitions here: https://tensegritywiki.com/index.php?title=Definitions_of_Tensegrity
==Videos==
<youtube>https://youtu.be/jnpshtyvWr0</youtube>Other videos
https://www.youtube.com/watch?v=I00TU8u_y44 - Presentation by Dr Brad Fullerton
https://www.youtube.com/watch?v=RuEjQ228sy0 - build your own tensegrity system
== External Resources ==
* https://www.biotensegrityarchive.org/
* https://tensegritywiki.com/
* http://www.tensegrityinbiology.co.uk/biotensegrity/
==Articles==
*
*Papers
== Acknowledgements ==
Thank you to Susan Lowell de Solórzano for feedback on this article
Category:Physiology
Category:Stubs
Bogduk's Postulates

Bogduk's postulates are the considerations or conditions concerning whether any structure can be deemed to be a credible cause of pain, i.e. a pain generator. They are analogous to Koch's postulates for bacterial diseases. The postulates are typically applied to the spine.Bogduk. Low back pain In: Clinical and Radiological Anatomy of the Lumbar Spine. 5th Edition. Elsevier 2012
#Innervated: The structure should have a nerve supply.
#Experimental pain in normal volunteers: The structure should be capable of causing pain, similar to that seen clinically, ideally in normal volunteers, e.g. with noxious injection
#Pathology known: The structure should be susceptible to diseases or injuries that are known to be painful. Certain conditions however are not detectable using currently available imaging techniques, and in these cases the next line of evidence is used which is evidence from post-mortem studies or biomechanical studies, e.g. with facet joint pain.
#Identified in patients: The structure should be a source of pain in patients, using validated diagnostic techniques such as positive controlled nerve blocks to the sensory supply of a joint. Due to false-positive responses, diagnostic blocks must be controlled. Prevalence data can be determined here.
==See Also==
*Causes and Sources of Chronic Low Back Pain
*Causes and Sources of Neck Pain
==References==
Category:Evidence Based Medicine
Category:General Spine
Bone Lesions

Bone lesions are often termed blastic or lytic. Blastic bone lesions are characterised by bone formation in excess of bone resorption. Lytic bone lesions are characterised by bone resorption in excess of bone formation. Normally these processes held maintain the integrity of the skeleton. In reality most bone lesions have both lytic and blastic components due to the intertwined nature of bone formation and resorption, and so it can be viewed as a spectrum. Prostate cancer lies on the blastic end of the spectrum, while multiple myeloma lies on the lytic end of the spectrum.
==Diagnostic Schema==
Malignancy is the most common type of bone lesions and is divided into primary and secondary lesions. Primary bone cancers are rare and include osteosarcoma, chondrosarcoma, and Ewing sarcoma. Secondary cancers can be solid or haematological.
Category:Bone and Cartilage Disorders
Bupivacaine

Bupivacaine is an amide-type local anaesthetic. It has a slow onset but long duration of action. It is commonly used in concentrations of 0.125% to 0.75%. The reason that the concentration can be lower than lidocaine is because of the higher lipid solubility leading to higher potency. Higher concentrations generally have a faster onset of action. The onset of action is approximately 8 to 12 minutes for simple blocks of small nerves.
It binds to plasma proteins and has a plasma half-life of 1.5-5.5 hours. It is largely metabolised in the liver. 
It is the most cardiotoxic of all the local anaesthetics especially if inadvertently given intravenously. The cardiotoxic effect is enhanced by hypoxia, hypercapnia, acidosis, and hyperkalaemia. Ventricular fibrillation is a risk due to inhibition of cardiac conductivity and contractility. It should be avoided in patients with cardiac disease. The toxic dose of bupivacaine is only 80 mg which is 16 mL of a 0.5% solution when given intravascularly, but may be up to 225 mg with extravascular injection.
Category:Pharmacology
Bupropion

If combining bupropion with an SSRI, choose citalopram or escitalopram for the SSRI. This is because other SSRIs block CYP2B6. This enzyme metabolises bupropion into its active metabolite hydroxybupropion, and hence blocking it theoretically affects the noradrenergic potential of bupropion. Combining bupropion with a -pram SSRI can therefore result in increasing serotonin, dopamine, plus noradrenaline.Chris Aiken. Prescribing psychotropics. 2022. Page 114.
== References ==
Category:Pharmacology
Camptocormia

Camptocormia also known as bent spine syndrome is a usually organic disorder characterised by marked flexion (greater than 45 degrees) of the thoracolumbar spine that increases during the day and completely disappears when supine.
==Terminology==
The term comes from the Greek words "to bend" (kamptō) and "trunk" ("trunk").
==Aetiology==
There are two competing hypothesis, one is that it has a CNS cause, and the other that it has a PNS cause. In the CNS hypothesis the affected area is the striatum and its projections to the reticulospinal tract or thalamus. In the PNS hypothesis there is myopathy of the antigravity spine extension muscles. It only rarely has a psychiatric origin.
*Parkinson's disease: the most common cause, but usually only develops when the disease is severe.
*Other parkinsonian syndromes
*Multisystem atrophy
*Alzheimer's disease
*Motor neuron disease
*Myaesthenia
*Chronic inflammatory demyelinating polyneuropathy
*Dystonia
*Vascular lenticular lesions
*Primary or secondary myopathy
*Lumbar disc herniation
*Osteoarthritis
*Spinal trauma
*Myotonic Dystrophy
*Facioscapulohumeral Dystrophy
*Duchenne muscular dystrophy carriers
*MItochondrial diseases
*Paraneoplasia
*Medication side effects (olanzapine, donepezil, valproate, systemic steroids, dopamine agonist)
==Epidemiology==
In those with Parkinson's disease and camptocormia there is a male predominance, older age, longer duration of disease, and autonomic symptoms.
==Clinical Features==
As the day goes on or during walking there is a progressive marked flexion of the thoracolumbar spine. It is relieved by sitting and lying supine. It can also be relieved volitionally by extending the trunk when the patient leans against a wall. There may be associated lateral deviation of the trunk. In two thirds of patients there is a lumbar or thoracolumbar scoliosis.
The total camptocormia angle is measured according to two lines: the line between the lateral malleolus to the L5 spinous process, and the line between the L5 to C7 spinous processes.
== Treatment ==
Treatment is usually unrewarding. Where possible treatment should be directed to the underlying cause. Botox to the external oblique muscles, spinal cord stimulation, and deep brain stimulation have been trialed in case reports.
==Further Reading==
==References==
Category:General Spine
Category:Muscle Disorders
Carbamazepine

Carbamazepine is most commonly used in the treatment of epilepsy, bipolar affective disorder, and neuropathic pain especially trigeminal neuralgia. 
== Mechanism of Action ==
Carbamazepine modulates voltage-gated sodium channels (VGSC), inhibiting action potentials and reducing synaptic transmission. Similar to other anticonvulsants, carbamazepine is thought to bind to the alpha subunit of VGSC, specifically at a binding pocket formed by the external pore loop and the pore-lining part of domain IV. It is thought that carbamazepine maintains sodium channels in inactivated states, leading to fewer channels opening and thus inhibiting the generation of action potentials. Carbamazepine also binds to other voltage-gated ion channels, such as voltage-gated calcium channels.
==Contraindications==
Carbamazepine is contraindicated in patients with bone marrow depression or hypersensitivity to carbamazepine or tricyclic compounds like amitriptyline. Monoamine oxidase inhibitors should be discontinued for at least 14 days before administering carbamazepine. 
==Workup==
Before prescription, first consider pharmacogenetic testing. Certain HLA genotypes give increased risk for Severe Cutaneous Adverse Reactions (an umbrella term that refers to Steven Johnson Syndrome, Toxic Epidermal Necrolysis, and Drug Reactions with Eosinophilia and Systemic Symptoms). If positive for either of the alleles then avoid the medication if at all possible.
* HLA-B*15:02: Han Chinese or Thai
* HLA-A*31:01: Japanese, Caucasian, indigenous populations of the Americas, Hispanic populations, southern Indian, Arabic descent
Also general baseline blood tests.
== Initiation ==
It is vital to initiate the medication slowly. Generally use carbamazepine controlled release (CR). A typical regimen for trigeminal neuralgia is as follows:
* Initiation dose: 200mg nocte
* Titration 200mg every 3 days
* Dose range: 200-1200mg daily
* Frequency: 2 - 4 times a day. Twice daily usually best.
Most patients prefer a smaller dose in the morning and a larger dose in the evening to reduce the sedation effect.
Due to auto-induction of enzymes, a further increase in dose may be required at 6 to 8 weeks after initiating therapy to maintain serum levels. Note that the 200mg CR tablets can be halved and the CR effect is not lost.
Tapering is done by 200mg every 7 days.
== Side Effects ==
Dizziness, drowsiness, fatigue, ataxia, diplopia, nausea, cognitive slowing, hyponatraemia leucopenia, thrombocytopenia, skin reactions, abnormal liver function tests
== Monitoring ==
Monitor FBC, UEC, and LFTs in the first 1-2 months. Then monitor annually. Drug levels are not generally required unless there are side-effects, concern about compliance, or breakthrough seizures when used for epilepsy.
Also monitor for any mood changes.
==Resources==
==References==
Category:Pharmacology
Carpal Boss

Open access reviewVieweg H, Radmer S, Fresow R, Tabibzada AM, Kamusella P, Scheer F, Andresen R. Diagnosis and Treatment of Symptomatic Carpal Bossing. J Clin Diagn Res. 2015 Oct;9(10):RC01-3. doi: 10.7860/JCDR/2015/14820.6606. Epub 2015 Oct 1. PMID: 26557578; PMCID: PMC4625297.
Category:Hand and Wrist Conditions
Carpal Tunnel Injection

==Anatomy==
The flexor retinaculum attaches to four areas. Namely the pisoform, the scaphoid, the hook of the hamate, and the trapezium. The proximal edge lies at the distal wrist crease. The median nerve normally lies under the palmaris longus tendon (if present) at the mid wrist, and is medial to the flexor carpi radialis (FCR) tendon. The FCU attaches to the pisiform. The distal wrist crease crosses the pisiform
==Indications and Efficacy==
*Injection for Carpal Tunnel Syndrome.
==Contraindications==
== Pre-procedural Evaluation ==
The clinician has the choice between various therapeutic agents and/or methods including corticosteroid, dextrose, PRP, low volume, and high volume with hydrodissection.
Corticosteroid versus dextrose: The injection of 5mLs of D5W was more effective than corticosteroid in one RCT. Some authors have reported using 10mLs.Tsung-Ying Li, Si-Ru Chen, Yu-Ping Shen, Chih-Ya Chang, Yu-Chi Su, Liang-Cheng Chen, Yung-Tsan Wu, Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: a retrospective follow-up study, Rheumatology, , keaa361, https://doi.org/10.1093/rheumatology/keaa361
Low volume versus hydrodissection: One RCT found no difference,Wang JC, Hsu PC, Wang KA, Chang KV. Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial. Front Med (Lausanne). 2021 Sep 13;8:742724. doi: 10.3389/fmed.2021.742724. PMID: 34589506; PMCID: PMC8475784. however the study was criticised for inadequate hydrodissection and unclear methodology.Lam et al. Commentary: Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial. 13 January 2022. Frontiers in Medicine. DOI
==Equipment==
==Technique==
*Position:Hand palm up
*Needle entry site options
**Identify the point midway along the proximal wrist crease, between the FCR and median nerve.
*Insert the needle then angle proximal to distal at a 45 degree angle.
*Slide distally until it is under the midpoint of the retinaculum (feel it puncture the retinaculum)
*Reposition medially if hit nerve
*Inject as a bolus
*Have patient open and close hand to spread the injectate around the carpal tunnel.
==Complications==
Mild exacerbation of symptoms immediately or in the hours following injection. Soft tissue atrophy. Ulnar artery injury. Median nerve injury.
==Aftercare==
Rest for one week. Use a night splint. Repeat injections can be done.
==Videos==
Carpal Tunnel Injection Video
<youtube>vjpSAzEmp9c</youtube>
<youtube>kGFrFunXwsc</youtube>
<youtube>lBOciezZYYI</youtube>
==External Links==
==References==
Category:Hand and Wrist Procedures
Category:Partially complete articles
Cervical Facet Joint Injection

==Anatomy==
==Indications and Efficacy==
==Contraindications==
==Pre-procedural Evaluation==
==Equipment==
==Technique==
===Ultrasound Guided===
===Fluoroscopy Guided===
===Landmark Guided===
==Complications==
==Aftercare==
==Videos==
<youtube>https://youtube.com/watch?v=qcBekzAMQso</youtube>
==External Links==
==References==
Category:Infoboxes
Category:Cervical Spine Procedures