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Examination of the Ulnar Side of the Wrist
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Samuel Cohen-Tanugi, R Glenn Gaston
If an older patient has pain with direct palpation of the pisiform in the absence of trauma, PT arthritis should be considered as a diagnosis. PT arthritis is easily overlooked as a source of ulnar wrist pain and can confound the accurate testing of other structures, in particular the LT. The pisiform tracking test or PT grind test is performed with the patient's wrist in slight flexion, which relaxes the FCU tendon. The examiner then grasps the pisiform between index and thumb, while stabilizing the dorsal aspect of the wrist with the other hand. As pressure is applied onto the pisiform and into the PT joint, the pisiform is “shucked” radially and ulnarly. Pain and possibly crepitus should be present in patients with pathology at this joint [2].
Orthopaedics
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
A break in the continuity of bone is known as a fracture. Unless the bone is weakened by some other condition, it requires a great deal of force to cause it to break. Clinically, a fractured limb is painful, swollen and deformed, and movement causes crepitus—a grinding sensation. Local soft tissues may be damaged.
Anorectal Conditions Requiring Urgent or Emergency Intervention
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Like other necrotising infections, Fournier’s gangrene results in a characteristic appearance of grey necrotic tissue, lack of bleeding, thrombosed vessels, ‘dishwater’ pus and non-contractile muscle. All necrotic tissue, including skin, subcutaneous tissue, fascia, and muscle, must be excised down to healthy, bleeding tissue. Again, there is usually much more necrotic tissue than the superficial appearance suggests, and the surgeon must be psychologically prepared for this. If crepitus is present over an area of what appears to be normal skin, the area should be explored to make sure the underlying soft tissue is viable. Although rarely involved, it may be necessary to debride the anal sphincters, irrespective of the concerns about post-operative incontinence. Vulvar, penile and scrotal skin should be excised if involved. However, an orchiectomy is almost never necessary as the blood supply to the testicles is usually preserved.16,41–42
Manual therapy for work-related wrist pain in a manual physical therapist
Published in Physiotherapy Theory and Practice, 2021
Alexandra R. Anderson, Craig P. Hensley
The passive accessory motion was tested in a neutral wrist position. Hypermobility and crepitus were found at the radiocarpal joint in all directions on the involved side without pain. Anterior to posterior mobility of the triquetrum on the lunate reproduced the patient’s pain and was hypomobile. Intercarpal mobility throughout the remainder of the involved wrist was hypomobile and pain-free in both anterior to posterior and posterior to anterior directions, except at the scapholunate joint where hypermobility was found in both directions. Passive physiological movement revealed hypermobility of the radiocarpal joint into flexion and extension and hypomobility of distal on proximal carpal row into flexion and extension. The patient denied joint line tenderness, ligamentous tenderness, or muscular/tendon tenderness of the wrist flexors and extensors. It should be recognized that while reliability and validity of joint mobility testing at the wrist has not been tested, both reliability in the lower extremities (van Trijffel, van de Pol, Oostendorp, and Lucas, 2010) and validity in the spine (Landel et al., 2008) have been questioned. Palpation was pain-free throughout bilateral wrists.
Psoriatic arthritis for dermatologists
Published in Journal of Dermatological Treatment, 2020
Alice Gottlieb, Joseph F. Merola
Recognizing subtle symptomatic differences between inflammatory and non-inflammatory arthritis is critical for proper diagnosis, as these diseases share similar characteristics such as pain and joint stiffness. In general, clinical characteristics of inflammatory arthritis include prolonged stiffness upon immobility, joint pain, joint tenderness, joint swelling, pain at entheses, swollen digits, and worsened back pain upon immobility (9,31). Patients with non-inflammatory arthritis typically present with normal acute-phase reactants, bony crepitus, asymmetric joint involvement, distal interphalangeal (DIP) joint involvement, a lack of prolonged morning stiffness, and bony outgrowths around the joints (9,31). Of note, non-inflammatory arthritis may be suspected in patients with PsA because inflammatory markers are normal in ∼50% of patients with PsA and DIP involvement in PsA may be confused with osteoarthritis on plain radiography (31,32). Questions to help practitioners identify inflammatory arthritis are presented in Table 1.
Spontaneous pneumomediastinum secondary to electronic cigarette use
Published in Baylor University Medical Center Proceedings, 2020
Sean Burgwardt, Arnes Huskic, Gary Schwartz, David P. Mason, Leonidas Tapias, Eitan Podgaetz
The patient was admitted for observation, withholding food and fluids by mouth. Physical exam showed crepitus along the supraclavicular region, extending to the anterior chest and neck. This slowly improved over the next 2 days. Additional imaging with a soluble contrast esophagram showed no esophageal perforation. Upon further questioning, the patient stated he had begun vaping with NJOY Ace Pods 6 weeks earlier in an attempt to quit smoking. He had smoked approximately 1 pack of cigarettes per week for the past 6 to 7 years without any acute complications. The night before admission, however, at a social gathering he utilized his e-cigarette in much greater frequency than normal. After careful observation for 48 h, the patient was discharged home without operative intervention. Strong recommendations to stop utilizing e-cigarettes were given as well as smoking cessation advice and counseling.