nyuuzyou/wikis huggingface dataset:
Cervical Intervertebral Discs

The cervical disc is not a small lumbar disc, but is structurally unique. 
== Cervical Spine Overview ==
== Cervical Disc Overview ==
 	Infancy, childhood	Adult
Annulus fibrosis 	 	
Nucleus pulpusus 	 	
Gross anatomy changes of disc	 	
* transverse fissure is not horizontal but concave upwards and forwards , parallel to the curvature of the internal surfaces of the uncinated process. 
== Structure ==
The annulus is not concentric, but rather is only well developed at the anterior aspect. The collagen fibres form a thick crescentic mass anteriorly and taper laterally towards the uncinate processes. There also isn't the criss-cross pattern of collagen fibres like in the lumbar discs. Rather, the fibres converge upwards towards the anterior end of the upper vertebra. When viewed front-on, the annulus is shaped like an inverted "V", with the fibres converging towards the midline, and the apex of the V pointing to the axis of rotation. In essence, the cervical annulus is more like an anterior interosseous ligament and is not load bearing.
Posteriorly there is only a thin layer of paramedian, vertically oriented collagen fibres. The posterior aspect of the disc is really only covered by the posterior longitudinal ligament. The reason there is no posterior annulus is because it would impede rotation along the oblique coronal plane.
== Age Changes ==
At birth the nucleus pulposus is relatively small, but persists until the second decade. Following that it gradually disappears as it becomes fibrocartilage. This results in cervical discs being harder and drier than lumbar discs. Bogduk N. Degenerative joint disease of the spine. Radiol Clin North Am. 2012 Jul;50(4):613-28. doi: 10.1016/j.rcl.2012.04.012. PMID: 22643388.
In degenerative change cervical discs form internal cracks and fissures, and slowly develop fibrocartilaginous bulges and osteophytes. It is normal to have transverse fissures on the posterior aspects of the discs. These initially appear in childhood in the uncovertebral regions, and with age extend medially, finally forming transverse clefts by the third decade of life. These transverse fissures facilitate axial rotation, they are effectively joint spaces between the vertebral bodies.
== Innervation ==
The nucleus pulposus is not innervated. The outer annulus fibrosus is innervated anteriorly by the vertebral nerve, and posterolaterally by the sinuvertebral nerve.
==References==
Category:Cervical Spine Anatomy
Category:Joints of the Spine
Cervical Retrolaminar Injection

The cervical retrolaminar injection is an experimental treatment for cervical radicular pain. As a fascial plane block it is theoretically safer than epidural corticosteroid injection. The target point is the cervical retrolaminar plane - between the lamina and cervical multififus muscle. This technique may be considered safer than ESI. Injection at C6 has been shown to spread from C2-T3.
==Technique==
===Ultrasound Guided===
*Position: prone
*22G 50mm needle inserted in plane of the transducer. 
*Target point posterior aspect of lamina of target segment, under the cervical multififus muscle.
*Inject 4 mL of Lidocaine 0.5% with 10 mg (1 mL) dexamethasone was injected.
==Resources==
See closed access article
==References==
Category:Cervical Spine Procedures
Cervical Spondylotic Amyotrophy

This rare condition refers to unilateral or bilateral upper limb muscle weakness and wasting without significant sensory deficits in the context of cervical spondylosis. The weakness does not involve more than a few myotomes and can be proximal (scapula, deltoid, biceps) or distal (forearm and hand). It may present with a dropped head. Symptoms typically stabilise for years after an initial progressive pace.
Category:Spinal Cord Disorders
Chronic Pain Assessment

Acute Pain Assessment is well covered in many articles on WikiMSK, chronic and or Widespread Pain Assessment is more difficult but there are also many relevant articles
* Specific regions: Chronic Neck Pain, Chronic Low Back Pain, Chronic Neck Pain, Chronic Post-Traumatic Neck Pain, and Coccydynia for more information
* Specific conditions: Parkinsons Disease, Smoking and Chronic Pain, Obesity and Chronic Pain, CRPS, 
* Other recommended topics: Pain Oriented Sensory Testing, Fibromyalgia, Nociplastic Pain, Neuropathic Pain, Allodynia and Alloknesis, Opioid Deprescribing, Widespread Pain Differential Diagnosis
* Australian Pain Management Network provides a good resource for both patients and Health Professionals/ Trainees. Select the Health Professionals tab to find useful resources
* Faculty of Pain Medicine courses are available by payment such as those at https://www.betterpainmanagement.com/
Taking a good pain history and using a positive therapeutic approach is a skill that can be learnt by practice and observation. 
Also ensure you have a MDT virtual/ real in your area to involve in the care of those with chronic, complex and widespread pain.
== Suggested Reading ==
== References ==
Category:Miscellaneous
Chronic Progressive External Ophthalmoplegia

The cardinal manifestation of Chronic Progressive External Ophthalmoplegia (CPEO) is progressive extraocular weakness. In relation to Musculosokeletal Medicine, chronic pain affects the majority of those with this disorder, with the proximal lower limbs and head being the most common sites. Pain in the spine and calves are the next most common sites. Chronic fatigue and depression are also common.
== Genetics ==
The nuclear gene called POLG is responsible for encoding the catalytic subunit of the only known mitochondrial DNA polymerase in animals. When there are mutations in this gene, the replication of mtDNA is affected, leading to large-scale mtDNA deletions, depletion of mtDNA copy number, and point mutations in mtDNA. These mutations cause a wide range of clinical symptoms. In adults, the most common manifestation of POLG mutations is chronic progressive external ophthalmoplegia (CPEO) accompanied by the accumulation of multiple mtDNA deletions.
POLG mutations can be inherited in an autosomal dominant or recessive manner, or they can arise spontaneously as dominant mutations. The primary diagnosis for CPEO caused by mitochondrial disease is a single mtDNA deletion or the m.3243A > G point mutation in mtDNA. Other possible causes of CPEO include oculopharyngeal muscular dystrophy, myasthenia gravis, congenital myopathy, and muscular dystrophies.
== Resources ==
== External Links ==
https://eyewiki.aao.org/Chronic_Progressive_External_Ophthalmoplegia_(CPEO)
Category:Muscle Disorders
Category:Mitochondrial Diseases
Clinical Reasoning Articles

Below are a selection of articles on clinical reasoning.
==General Articles==
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*Using the Chief Complaint Driven Medical History - Nierenberg 2020
*How to Create a Differential Diagnosis
==Clinical Reasoning Practice==
The final diagnosis is intentionally not listed in the title in order to aid in practice. They are either musculoskeletal cases or are general medical but convey an important concept in clinical reasoning.
==Teaching Clinical Reasoning==
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==Problem Representation==
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*JGIM Problem Representation Overview
==Illness Scripts==
*Scripts and clinical reasoning - Charlin 2007
*:Media:Scripts and Medical Diagnostic Knowledge - Charlin 2000.pdf
*How expertise develops in medicine: knowledge encapsulation and illness scripts - Schmidt 2007
*Thirty years of illness scripts - Custers 2014
*Educational Strategies to Promote Clinical Diagnostic Reasoning - Cox 2006
*Illness Scripts Overview - JGIM
==Dual Process Theory==
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Category:Clinical Reasoning
Clonidine

== Chronic Pain ==
A few possible mechanisms for the analgesic effect of clonidine has been proposed, however no effect has been found on experimental pain in health subjects.
* α2-agonist on receptors in the dorsal horn.
* Noradrenergic effects enhancing descending pain inhibition
* Enhanced parasympathetic function leading to lower pain perception
* Reduced anxiety
== Opioid Withdrawal ==
Clonidine can be used to reduce autonomic hyperactivity in opioid withdrawal. The dose is 25-150mcg three times daily, adjusted according to response for up to 3 days. Then reduce by a quarter of third day's dose over the next 3 days and as withdrawal symptoms subside. Withhold dose if blood pressure is below 100/60 or heart rate below 60.
== Side Effects ==
Skin irritation is common with clonidine patches. The risk can be reduced by avoiding hard soaps, applying a lipid-rich moisturiser several hours before applying the patch, gently cleaning the residual adhesive after removing the patch, and rotating the site. If persistent then trial steroid ointment before applying the patch.
== References ==
Category:Pharmacology
Condyloid Joint

A condyloid joint, or an ellipsoid joint, is a type of synovial joint. It is defined as an articulation between the shallow depression of one bone and the rounded structure of another bone or bones. This type of joint is biaxial because it permits two axes of movement: flexion/extension and medial/lateral (abduction/adduction). An example is the metacarpophalangeal joints of the hand between the distal metacarpal and proximal phalanx, commonly known as the knuckle. 
== List of s ==
==References==
Category:Joint Types
Congenital Vertebral Body Anomalies

Classification of Vertebral Body Anomalies
Congenital 	Acquired
A. Asomia (Agenesis) 	A. Abnormal Size
# Small vertebral body
# Enlarged vertebral body
B. Hemivertebra 	B. Border Abnormalities
# Anterior border scalloping
# Posterior border scalloping
# Lateral border scalloping
# Anterior border straightening
# Endplate deformities
C. Coronal Cleft 	C. Vertebral tongues, spurs, and beaks
D. Butterfly Vertebra (Sagittal Cleft)	D. Miscellaneous Body Shapes
E. Block Vertebra (Congenital Fusion) 	
F. Hypoplasia 	
Category:Developmental Disorders
Category:Bone and Cartilage Disorders
Conus Medullaris Syndrome

Conus medullaris syndrome is caused by injury to the conus medullaris and lumbar nerve roots. It is a subset of the Incomplete Cord Syndromes. Injury to T12-L2 are the most likely to cause the syndrome. The conus medullaris is in close proximity to the nerve roots. The clinical features include severe back pain, and a combination of upper and lower motor neurone deficits. This is unlike Cauda Equina Syndrome which only has lower motor neurone deficits. There may be other symptoms similar to cauda equina syndrome such as saddle anaesthesia, bladder dysfunction, bowel dysfunction, and lower limbs radicular pain and/or radiculopathy.
==See Also==
*Incomplete Cord Syndromes
*Cauda Equina Syndrome
==References==
Category:Lumbar Spine Conditions
Category:Radiculopathies
Category:Spinal Cord Disorders
Coronal Balance of the Spine

Coronal balance is one of the features that needs to be assessed on long spine radiographs obtained for spinal deformity, particularly scoliosis. It measures whether or not the upper spine is located over the midline (normal) or off to one side. 
== Measurement ==
===Plumb Line=== 
To assess coronal balance, a vertical (plumb) line is drawn downwards from the mid-point of the C7 vertebral body (exactly in the same way as for the assessment of sagittal balance). This needs to be performed on erect full-length spine radiographs without lateral bending. The horizontal distance between this plumb line and the midline of the sacrum or central sacral vertical line is measured. 
The position of this line can then termed positive, neutral or negative, depending on distance and direction from the midline:
* positive balance: ​the plumb line passes to the right of the midline, by >2 cm
* neutral balance: the plumb line passes within 2 cm of the midline
* negative balance: the plumb line passes to the left of the midline, by >2 cm
===Central Sacral Vertical Line=== 
The central sacral vertical line (CSVL) is used in the assessment of spinal scoliosis. 
It is a line constructed on frontal films of the spine and pelvis to measure coronal balance, drawn as follows:
# a line connecting the top of the iliac crests is drawn
# a second line is drawn perpendicular to the first, which bisects the sacrum
==See Also==
*Sagittal Balance of the Spine
*Idiopathic Scoliosis
== References ==
Category:General Spine
Deep Somatic Pain

Deep somatic pain sits in contrast to the less common cutaneous and neuropathic pain. It is otherwise known as musculoskeletal pain as it appears to arise in the deeper tissues of the muscles, bones, and joints. The neurophysiology of deep somatic pain is likely to be different to cutaneous and neuropathic pain.
A related concept is somatic referred pain, which stands in distinction to visceral referred pain, and indicates that the somatic tissues are the source of pain referral. The pain can be referred to remote sites. The pattern is different to that found in dermatome maps, and has been termed the sclerotome.
The sensitivity of deep structures in decreasing order is periosteum, ligament, joint capsule, tendon, fascia, muscle. Pain from muscles tend to refer to the joint on which it acts. Spinal structures refer in a somewhat segmental fashion in the thoracic levels, and into the respective limbs in the cervical and lumbar levels. There are large degrees of overlap.
==Resources==
Category:Pain Types
==References==
Diabetic Amyotrophy

Diabetic amyotrophy is a complication of diabetes that affects the lumbosacral plexus, typically predominantly either the femoral nerve or the three roots that contribute to the femoral nerve. It is also known as neuralgic amyotrophy, diabetic amyotrophy of Garland, Bruns-Garland syndrome, and diabetic lumbosacral plexus radiculoneuropathy.
== Epidemiology ==
Typically seen in older diabetic patients. The diabetes is commonly relatively recently diagnosed or well controlled.
== Pathology ==
Typically the femoral nerve is affected. In other cases there are lesions of L2, L3, and L4 nerve roots rather than the femoral nerve. In this situation there is a more widespread motor deficit and wasting, with involvement of the hip flexors and adductor muscles.Patten, John. Neurological differential diagnosis. London New York: Springer, 1996.
== Clinical features ==
The onset is typically characterised by severe pain in the low back, down the anterior thigh, that often radiates down to the medial aspect of the leg and ankle. Weakness is typically proximal and generally occurs after a few days to weeks after the pain and can be severe. The patient will usually have had rapid weight loss and poor health in the weeks prior to symptoms. After a few days, the pain improves and the patient suddenly has rapid muscle wasting with weakness of quadriceps and is unable to walk. 
== Diagnosis ==
Electrophysiology is supportive
In non-diabetic consider idiopathic lumbosacral plexopathy, neoplastic infiltration of the lumbosacral plexus, lumbosacral plexus ischaemia, mass effect, sarcoidosis, vasculitis, and infection.
== Treatment ==
Treatment is supportive. There is usually eventual improvement from 6 months, but it can take up to two years for full recovery. Most patients will have some remaining neuropathic pain and motor deficits. 10% are wheelchair bound at 2 years.
==References==
Category:Pelvis, Hip and Thigh Conditions
Category:Polyneuropathies
Diagnostic Knee Ultrasound

== General Utility ==
Ultrasound is not indicated for: suspected meniscal, cruciate ligament or collateral ligament injuries. 
Ultrasound is indicated for: assessment of extensor mechanism injuries, soft tissue lesions, peri-articular cyst or Baker's cyst
==Trochlear Groove==
With knee flexion the trochlear groove can be exposed. In this view you can assess for osteoarthritis, chondral defects, morphology, and chondrocalcinosis.https://twitter.com/DrJN_SportsMed/status/1481970391371460610
==Resources==
==References==
Category:Knee and Leg
Diagnostic Schema

A diagnostic schema is an organised cognitive map that provides a structured approach or organising scaffold to a clinical problem. Schemas convert lists (e.g. specific diagnoses) into mental flow charts that are organised by clinically meaningful variables or classes of causes. This allows for better problem solving, learning, and retention. Schemas are thought to improve knowledge organisation, and can be helpful in cases where there are multiple factors for consideration.
Because they can be retrieved and manipulated as a single item within the working memory, schemas also allow clinicians to manage their cognitive load and maintain the bandwidth for effective problem-solving. Clinicians can systematically access and explore individual illness scripts as potential diagnoses.
Examples of basic diagnostic schema include:
Clinical Problem/Syndrome 	Basic Diagnostic Schema
Chronic low back pain 	Mechanical, non-mechanical, visceral disease
Chronic distal posterior thigh pain	Vascular, soft tissue, joint causes
Paediatric groin pain 	Infectious, inflammatory, mechanical, neoplastic
Bone lesions 	Benign, malignant, infectious, inflammatory, other
Sound diagnostic schemas help clinicians:
* Tether diagnostic thinking to a logical framework (i.e., structural/anatomic, physiologic, etc.) that can be more easily remembered
* Avoid missing categories of illness, or anchoring on the most familiar diagnoses
* Expand their differential diagnosis for a complex problem
* Trigger differentiating historical or physical exam manoeuvres to refine the differential diagnosis (i.e., when activated during a clinical encounter, the schema for chronic low back pain may prompt the clinician to examine the abdomen as that will help to differentiate among the potential diagnostic categories for this problem)
* Teach others how to approach a given clinical problem (‘think aloud’)
Through deliberate practice, learners adapt and individualize their schema—tying these frameworks to prior clinical knowledge and experience, which keeps them robust and accessible. Over time individuals may find that collapsing certain categories, or creating new ones, allows a schema to ‘work’ best for them.
==Resources==
*Diagnostic Schemas in General Medicine
== References ==
Category:Clinical Reasoning
Distal Biceps Tendon Disorders

The distal biceps tendon insertions on the radial tubercle just distal to the raidal head. It supinates the forearm and is a secondary flexor of the elbow. 
==Distal Biceps Tendinopathy==
==Distal Biceps Tendon Rupture==
===Assessment===
Injury can occur from forceful lifting or supination, and causes a sudden pain, which is felt in the antecubital fossa. It is the proximal ruptures that result in the Popeye sign, while distal ruptures cause swelling and bruising. There is usually tenderness over the radial tubercle, in the deep antecubital fossa, and the patient may have pain and weakness on resisted elbow flexion and forearm supination. 
Perform the hook test. A positive finding is the absence of the distal biceps tendon
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===Management===
Arrange for orthopaedic assessment for operative repair to restore supination strength.
==See Also==
Proximal Biceps Tendon Disorders
Category:Elbow and Forearm Conditions
Category:Tendinopathies
Distal Radioulnar Joint

The distal radioulnar joint is a pivot type synovial joint existing between the ulnar notch of the distal radius and the head of the ulna. The primary uniting structure of the joint is the articular disc of the distal radioulnar joint, also termed the triangular ligament, part of the Triangular fibrocartilage complex (TFCC).Hapugoda, S., Feger, J. Distal radioulnar joint. Reference article, Radiopaedia.org. (accessed on 01 Apr 2022) https://doi.org/10.53347/rID-46555
==References==
Category:Hand and Wrist Anatomy
Category:Joints of the Upper Limb
Distal Weakness

Muscle weakness can be categorised into various patterns to assist with the differential diagnosis. Reduced grip strength, weakness in wrist flexion or extension, diminished plantar flexion strength, and foot drop are common features of distal weakness. Patients with this pattern struggle to walk on their heels or toes. Foot drop can be identified by resisting the patient's attempt to dorsiflex the ankle.
==Classification==
 
==References==
Category:Presenting Complaints
Category:Neurology
Category:Muscle Disorders
Dorsal Scapular Nerve

== Origin and Course ==
The dorsal scapula nerve is mostly derived from the C5 nerve root, being a proximal branch of this nerve. It pierces the middle scalene muscle and courses inferiorly and posteriorly between teh scalenus posterior muscle, serratus posterior superior, and levator scapulae muscles. It travels with the dorsal scapula artery long the medial border of the scapula.
== Motor Distribution ==
It innervates Rhomboid Major, Rhomboid Minor, and Levator Scapulae in some research.
== Sensory Distrubtion ==
It can innervate the medial periscapular region, with entrapment being a controversial cause for pain.
Category:Nerves of the Upper Limb
Dural Ectasia

Dural ectasia is a radiological finding characterised by enlargement of the dura in the spinal cord, especially in the lower lumbosacral regions. 
== Pathology ==
The connective tissue weakness in the underlying condition is thought to lead to expansion of the dura from the pulsatile flow of the cerebrospinal fluid. The lower regions are affected because that is where subarachnoid pressure is highest. Dural ectasia can result in bony erosions of the posterior vertebral body, meningoceles, and herniation of nerve root sleeves. 
Dural ectasia is a strong indicator of having an inherited connective tissue disorder. The cardinal underlying condition is Marfan Syndrome where it is present in 60% of individuals and is one of the major criteria. However it can also be seen in neurofibromatosis type 1, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, osteogenesis imperfecta, acromegaly, and ankylosing spondylitis. It can also occur post trauma, post surgery, and from tumours. 
== Clinical Features ==
It is also associated with back pain and lumbar radicular pain and radiculopathy. The bony erosions and meningoceles can cause constipation and/or incontinence. The meningoceles can be anterior to the sacrum and be palpable as an abdominal mass. Other findings include spondylolisthesis, scoliosis, and fractures.
==Radiology==
Category:Lumbar Spine Conditions
Category:Heritable Connective Tissue Disorders
Dysautonomia

Dysautonomia, or autonomic dysfunction, is a complex medical condition that affects the autonomic nervous system (ANS), which controls the body's automatic and essential functions such as heart rate, blood pressure, digestion, and temperature regulation. Patients with dysautonomia often present with a wide range of seemingly unrelated symptoms, making it challenging for healthcare professionals to connect the dots and arrive at a correct diagnosis. These symptoms can be generalized, like fatigue and difficulty concentrating, or involve specific systems, leading to diverse manifestations such as cardiac irregularities, vasomotor issues, sensory discomfort, gastrointestinal disturbances, urogenital complications, sudomotor abnormalities, and ophthalmological difficulties.
Misinterpreting the connection between these varied symptoms and their underlying mechanism may result in incorrect diagnoses and inappropriate interventions, posing significant challenges for patients and healthcare providers alike. A further challenge is the growing online community of individuals who self-identify as being affected by autonomic dysfunction. All these factors can lead to false positive and false negative diagnoses.
Category:Miscellaneous
Category:Widespread