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Sterility & Theatre Protocols
Goal: prevent surgical site infections (SSI). Airflow: laminar, HEPA, positive pressure. Staff: gown, glove, mask, restrict movement. Instruments: autoclave, ETO, H2O2 plasma. Preop: antibiotics within 60 min, skin prep with chlorhexidine-alcohol.
Open topicSupraspinatus — Anatomy & Clinical Tests
Origin: supraspinous fossa; insertion: superior facet of greater tuberosity; innervation: suprascapular nerve (C5–6). Action: initiates abduction, contributes to humeral head depression and centering. Blood supply: suprascapular artery; critical zone of hypovascularity near tendon insertion (degeneration site). Impingement & tears: subacromial impingement (Neer), degenerative & traumatic tears; clinical tests for integrity. Tests: Jobe (empty can), full can, drop‑arm, external rotation lag (for...
Open topicSwan Neck Deformity
Hyperextension of PIP with flexion of DIP joint. Caused by RA (most common), trauma, chronic mallet finger, spasticity. Clinical: finger looks like swan neck, loss of grip strength. Treatment: splints, silver rings, tendon balancing procedures, arthrodesis in severe cases. Differentiate from boutonniere (opposite deformity).
Open topicSyme's amputation
Syme's amputation is a through-ankle amputation in which the foot is removed while preserving the heel pad and distal tibia-fibula, allowing end-bearing ambulation. Originally described by James Syme in 1843, it provides a durable weight-bearing stump with minimal limb-length discrepancy compared with more proximal amputations. The procedure is most commonly indicated for severe foot trauma, infection, congenital deformities, and selected diabetic foot conditions when the heel pad and posterior...
Open topicTB Hip
Second most common osteoarticular TB after spine; insidious monoarthritis progressing through stages. Typical deformity: flexion, adduction, external rotation; muscle spasm and night cries common in children. Shanmugasundaram radiographic stages (synovitis → arthritis → advanced arthritis → ankylosis) guide treatment. Diagnosis: ESR/CRP, MRI for early synovitis/marrow edema; confirm with biopsy/AFB smear/culture/GeneXpert. Treatment: ATT for 9–12 months; traction/physiotherapy early; synovectomy...
Open topicTB Knee
Common site of osteoarticular TB after spine and hip; presents with chronic monoarthritis. Phemister triad on X‑ray: peri‑articular osteopenia, marginal erosions, gradual joint‑space narrowing. MRI shows synovitis, cartilage loss, and bone marrow edema—useful for early disease. Confirm by biopsy/AFB/GeneXpert; ESR/CRP typically raised. Treatment: ATT 9–12 months; synovectomy in persistent synovitis; arthrodesis/arthroplasty after disease quiescence for end‑stage joints.
Open topicTendon Healing and Rehabilitation
Phases: inflammatory (days 1–7), proliferative (days 3–21), remodeling (weeks–months). Intrinsic (tenocyte) vs extrinsic (synovial/paratenon) healing; adhesion formation from extrinsic fibroblasts. Early controlled mobilization enhances tensile strength and reduces adhesions in flexor tendons. Suture techniques: core locking (e.g., 4–6 strand) + epitendinous running improves gap resistance. Rehab protocols: Kleinert, Duran (flexor); early active motion in selected repairs.
Open topicTennis & Golfer’s Elbow
Tennis elbow = lateral epicondylitis (ECRB tendon origin degeneration). Golfer’s elbow = medial epicondylitis (flexor-pronator origin). Clinical: pain, tenderness, weakness of grip; Cozen’s, Mill’s, Maudsley’s test for tennis elbow. Investigations: clinical diagnosis; USG/MRI may show tendon degeneration. Management: rest, activity modification, NSAIDs, physiotherapy, injections; surgery if refractory.
Open topicTFCC Injuries
TFCC stabilizes the distal radioulnar joint and dissipates ulnar‑sided load. Palpable 'fovea sign', ulnar grind, and DRUJ shift test support diagnosis. MRI useful; wrist arthroscopy remains gold standard for diagnosis and treatment. Central tears → arthroscopic debridement; peripheral tears → repair; positive ulnar variance → consider ulnar shortening osteotomy. Failure to treat instability leads to chronic pain and DRUJ arthritis.
Open topicTrigger Finger & de Quervain
Trigger finger: stenosing tenosynovitis of flexor tendon sheath (A1 pulley). Symptoms: painful clicking/locking of finger; risk in diabetics, RA. De Quervain: stenosing tenosynovitis of APL & EPB tendons in 1st dorsal compartment. Finkelstein’s test positive; pain over radial styloid. Management: splints, steroid injection, surgical release if persistent.
Open topicTypes of Callus in Fracture Healing
External (periosteal) vs internal (endosteal) callus; bridging and uniting fragments. Primary (contact) healing has minimal/no callus under rigid stability; secondary healing forms abundant callus under relative stability. Radiographic callus reflects mechanical environment and biology; hypertrophic callus suggests instability. Histology: woven bone → lamellar bone remodeling along stress lines.
Open topicUlnar Collateral Ligament Injury — Skier’s Thumb
Injury to ulnar collateral ligament (UCL) of thumb MCP joint. Mechanism: valgus stress from fall on abducted thumb (ski pole). Clinical: pain, swelling, instability at MCP; Stener lesion if adductor aponeurosis interposes. Diagnosis: valgus stress test (>30° opening suggests complete tear); MRI confirms. Treatment: partial tear—immobilization; complete tear/Stener lesion—surgical repair.
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