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Showing posts with the label Arthritis & Metabolic diseases

Kienbock's Disease

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Kienbock's disease is Osteonecrosis Of The Lunate . By a mechanism that still is not entirely understood, the blood flow to the lunate bone of the wrist is compromised to such an extent that osteonecrosis ensues and collapse and fragmentation of the  bone occurs over time . The end result can be degenerative arthritis of the radio-carpal joint and pain .  Pathogenesis Various predisposing factors exist. About 75% of patients have a shorter ulna compared to the radius, as  measured at the wrist ( Ulnar Negative Variance ). The slope of the distal radius articular surface is found   to be more horizontal . Approximately 25% of lunate are thought to have a single vessel blood supply. Repetitive micro-fracture of the bone or a single fracture have been suggested as the cause of  osteonecrosis of the lunate. Incidence More common in Males that females. It occurs more frequently between the ages of 15 and 40 years a...
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Juvenile Rheumatoid Arthritis (JRA)

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Juvenile Rheumatoid Arthritis (JRA)  or  Juvenile Idiopathic Arthritis (JIA)  is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. Juvenile rheumatoid arthritis differs significantly from the adult form. The diagnosis of juvenile rheumatoid arthritis usually is made by exclusion .  Diagnostic Criteria For Classification Of Juvenile Rheumatoid Arthritis Age of onset younger than 16 years Arthritis in one or more joints defined as swelling or effusion or by the presence of two or more  of the following signs— limitation of motion, tenderness or pain on motion, and increased heat. Duration of disease 6 weeks to 3 months Exclusion of other rheumatic diseases Rheumatoid factor is positive in less than 25% of patients. → After patients pass the age of 8 years , laboratory tests show an increasingly hig...
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SOMI Brace

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Sternal-Occipital-Mandibular Immobiliser  (SOMI) Brace  Cervico-Thoracic Orthoses (CTOs) provide greater motion restriction from C5-C7 spine from the increased leverage on the person’s body. The upper cervical spine has less motion restriction. CTOs are used in minimally unstable fractures . All CTO’s tend to control flexion better than extension . Parts 1. The SOMI is a rigid, 3-poster CTO that has an padded anterior chest plate extending to the xiphoid process, as well as two padded shoulder extension which hook over tops of the shoulder. 2. From these shoulder extension two Straps which cross in the interscapular region, pass downward and around the chest wall to attach to the lower part of the chest plate. 3. There are three adjustable uprights , which pass upward from the chest plate, two to the padded occipital support and one to the mandibular support. 4. A removable chin piece attaches...
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Skeletal Traction: Common sites

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1. Olecranon Site: 1.25 inches (3 cm) distal to the tip of olecranon just deep to the subcutaneous border of upper end of the ulna. Direction:  Medial to lateral at right angles to the longitudinal axis of ulna. Avoid: Ulnar nerve injury. 2. Second & Third Metacarpals Site:  About 1 inch (2-2.5 cm) Proximal to the distal end of Second metacarpal Direction:  The wire traverses 2nd and 3rd metacarpals transversely at right angles to the longitudinal axis of the radius. 3. Greater trochanter (upper end of femur ) Site: ...
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Pavlik Harness

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Pavlik harness is a dynamic flexion abduction orthosis used to treat DDH ( Reduction & Maintenance ) in infants up to 6 months of age. Developed by Dr. Arnold Pavlik (C zechoslovakian Orthopaedic Surgeon) in 1944. Spontaneous reduction of dislocated hip is promoted by positioning the hip in flexion while allowing free abduction. (i.e Prevents hip Adduction and Extension ) Parts of Pavlik Harness An adjustable band encircling the lower chest ( Halter - Chest Strap ). To this band are attached pair of shoulder straps which cross posteriorly and  A pair of stirrups which embrace the legs down to the heels.  The stirrups are suspended from the encircling chest band by two adjustable straps - one passing anterior to and the other posterior to the lower limb. Indications:   Infants with DDH & who are younger than six months . Contra-Indications:  Infants with a " hip-click " but a normal physical exa...
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