Deputy Director, Frank H. Netter M.D. School of Medicine at Quinnipiac University
The tarsal tunnel is a fibro-osseous space formed proximal extension of fluid into the lateral gutter (greater by the talar surface back spasms 6 weeks pregnant order genuine tizanidine online, the sustentaculum tali spasms coughing order tizanidine in united states online, and the cal- than 1 cm) aid in making the diagnosis muscle relaxant robaxin generic 4 mg tizanidine with amex. It is traversed by the posterior tibial, flexor dig- Medial Collateral Ligament itorum longus, and flexor hallucis longus tendons, the tibial nerve and its branches and accompanying vessels. The medial collateral ligament plays an important role in In about 50% of cases, tarsal tunnel syndrome is idio- medial ankle instability. Marked inter-individual differ- pathic, whereas in the other 50% a specific cause is iden- ences are found for the main components (tibionavicular, tified, such as space occupying lesions including gan- tibiospring, tibiocalcaneal, deep posterior and anterior glion, varicosities, lipoma, accessory muscles, and nerve- tibiotalar and superficial posterior tibiotalar bands). The sheath tumors, as well as pronation or hindfoot valgus de- tibionavicular ligament is a thickened fibrous layer of the formity, and fracture of the medial malleolus and calca- ankle capsule. Patients present with a positive Tinel’s sign and ments are the longest, while the tibiocalcaneal and poste- pain, burning and numbness along the plantar surface of rior deep tibiotalar ligaments are the thickest. Spring Ligament Entrapment neuropathies of branches of the tibial nerve include entrapment of the first branch of the lateral plan- The spring ligament plays an important role in the stabi- tar nerve (Baxter’s nerve), which presents with heel pain lization of the longitudinal arch in the midfoot. Zanetti is often associated with hypertrophy of the abductor hal- decrease in diameter is most likely caused by a change in lucis muscle but is also produced by inflammation asso- the location of the neuroma, which, as it becomes dislo- ciated with plantar fasciitis and heel spur. Another cause of heel pain, often seen in joggers and long-dis- tance runners is jogger’s foot, which is produced by en- Sinus Tarsi Syndrome trapment of the medial plantar nerve secondary to valgus heel deformity. Sinus tarsi syndrome most commonly develops after an Treatment of the entrapment neuropathies is initially inversion injury (70%) and is often associated with tears conservative but may require surgical release of the of the lateral collateral ligaments. More medially, the sinus tarsi is continuous with the tarsal canal in which the in- Morton’s Neuroma terosseous talocalcaneal ligaments traverse. Although the latter are not truly lateral structures, they are impor- Morton’s neuroma is a benign non-neoplastic abnormali- tant in the overall function of the lateral ankle and hind- ty characterized by neural degeneration and perineural foot complex. The plantar interdigital nerves of the second and Patients with sinus tarsi syndrome present with hind- third intermetatarsal spaces are most commonly involved. The use of in- the subtalar joint and subchondral cysts may be present travenous gadolinium contrast is not recommended be- in advanced cases. The plantar fascia is a multilay- in location or number occurs in one-third of the remain- ered fibrous aponeurosis that extends from the postero- ing cases. These changes in diagnosis and location medial calcaneal tuberosity to the plantar plates of the prompt a change in the treatment plan in more than 50% metatarsophalangeal joints, the flexor tendon sheaths, of the feet. Large Morton’s neuromas (> 5 mm-diameter) are more When the metatarsophalangeal joints are dorsiflexed dur- commonly symptomatic than smaller ones. Over time, with repetitive stress, microtears ter post-surgical prognosis than a smaller one. When the patient is in the prone rum brevis and abductor digiti minimi muscles directly position and the foot is plantar-flexed, Morton’s neuroma beneath the plantar fascia, which account, at least in part, increases in size and appears 2 mm wider than with pa- for the calcaneal spurs often seen at or close to the origin tient in the supine position with the foot dorsiflexed. Progression of the inflammatory Imaging of the Foot and Ankle 45 process leads to periostitis or even fatigue fractures of the found laterally in association with a phalangeal collateral medial calcaneal tuberosity and/or calcaneal spur. The plantar plate is low in signal tar fasciitis include superficial or deep perifascial edema, and may be difficult to distinguish from the more super- heterogeneity and fusiform thickening of the fascia at its ficial flexor tendon. Discontinuity of attachment of the plate, best seen on sagittal images, the fibers of the plantar fascia represents rupture. Degeneration and Rupture of the plantar fascia is often seen secondary to rupture of the plate manifest as heterogeneity and indis- corticosteroid injections for plantar fasciitis. Hyperextension at the joint, capsu- may develop a considerable time after the injection and lar distension, synovitis, intermetatarsal bursitis, and usually occurs distal to the calcaneal origin.
Lymph nodes Any of numerous oval or round bodies that supply lymphocytes to the bloodstream and remove bacteria and foreign particles from the lymph spasms muscle twitching buy discount tizanidine line. It can lead to ear infection spasms near belly button buy generic tizanidine 4 mg line, pneumonia muscle relaxant essential oils buy tizanidine 2 mg on-line, seizures (jerking and staring), brain damage and death. Measles, mumps, A combined vaccination that protects against measles, mumps rubella vaccine and rubella. It can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling of the testicles or ovaries and, rarely, death. Nymph The larval form of certain insects, usually resembling the adult form but smaller and lacking fully developed wings. Occupational Infectious diseases that are contracted through the course of a disease person performing his or her work. These contagious diseases are usually caused by virusesor bacteria, though in some occupations parasitic agents are important. Occupationally contracted contagious diseases are considered compensable through the workers’ compensation system, just like any other occupationally-caused disease. Occupational An event that occurs during the performance of job duties and exposure may place a worker at risk of infection. Parenteral Situated or occurring outside the intestine (as in parenteral drug administration by intravenous, intramuscular, or subcutaneous injection); introduced otherwise than by way of the intestines Pathogen An agent that causes disease, esp. Plague An infectious disease of animals and humans caused by a bacterium named Yersinia pestis. Polio A viral infection that occurs in the gastrointestinal tract with spread to lymph nodes and, possibly, the nervous system. Prevalence The number of existing cases of a particular disease present at a given time in a defined population. The prevalence is usually expressed as a proportion or a percentage of the population under study. A-68 January 2007 Infectious Diseases International Association Appendices of Fire Fighters Term Definition Prevention Taking measures for anticipation, avoidance, detection and early treatment of disease. Preventive medicine A branch of medical science dealing with methods of preventing the occurrence of disease or illness. Quarantine A restraint on the activities of persons or the transport of goods that is designed to prevent the spread of disease. Rabies A preventable viral disease of mammals most often transmitted through the bite of a rabid animal. If a fire fighter is bitten or scratched by a wild animal or stray domestic animal, he or she should seek medical evaluation immediately. Resistance The ability of microbial strains or pathogens to withstand effects of antimicrobial agents. If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects. Serology The branch of science concerned with the study of the immune components of the serum (antigens and antibodies). Severe Acute A viral illness spread person to person through close contact with Respiratory respiratory secretions.
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Tuberculous arthritis and tuberculous spondylitis have a tendency to be associated with a cold abscess [22] spasms hands and feet order 4 mg tizanidine visa. The abscess may predominate muscle relaxant skelaxin 800 mg discount 4mg tizanidine amex, giving a mis- leading clinical picture that this is a soft-tissue tumor spasms in intestines order 2 mg tizanidine with mastercard. This man had lacerations over the knuckles after hitting Coccidioidomycosis is endemic in Mexico and the someone in a bar fight. The radiograph of this closed-fist injury was taken a week after the fight and shows destruction of the third southwestern United States. The fungus is disseminated metacarpal-phalangeal joint due to infection by mouth bacteria in dust that is inhaled. Radiol Clin North Am 42:61-71 small percentage of infected patients will develop mus- 7. Aliabadi P, Nikpoor N, Alparslan L (2003) Imaging of neuro- culoskeletal infection. Unlike tuberculosis of the musculoskeletal 102(1A):30S-34S system, the joints are less commonly infected than the 10. Rheum Dis Clin of North Am 24:275-86 histologically viewing the organism on a biopsy speci- 13. Can Assoc Radiol J count the clinical presentation, physical appearance and 4:299-301 the results of appropriate lab tests, can lead to prompt 17. Skeletal Radiol Imaging of osteomyelitis and musculoskeletal soft tissue in- 33:244-247 fections: current concepts. The radiographic findings may be either process is limited to one joint (monoarticular) or involves consistent or inconsistent with the clinical diagnosis. Each joint disease has a inconsistent, alternative diagnosis should be made on the characteristic distribution of joint involvement (Fig. This pattern is based on the or asymmetrically (involvement of a joint on one side Fig. The more common sites are encircled with thick lines and the less common sites with thin lines. Note the periosteal reaction or new-bone forma- tion classically identified in Reiter’s disease. When joints are encircled in isola- tion, the distribution is random and may be isolated to any joint 144 L. Resnik without simultaneous involvement of the corresponding The distribution of joint involvement is characteris- joint on the opposite side). In some cases, the joints are the following: (1) whether the joint space narrowing of the hand and wrist are equally affected, but in others is symmetrical or asymmetrical; (2) whether soft-tissue the destructive process may be much more severe in the swelling is present and whether it is symmetrical (indi- hand than in the carpus. In still others, it may be more cating a joint effusion) or asymmetrical (indicating a pe- severe in the carpus than in the hand. In fact, characteristic changes of Ancillary radiographic findings include the presence erosion may be present in the heads of the fourth or or absence of periosteal reaction of bones in the vicinity fifth metatarsal when the radiographic changes of the of the involved joint. Therefore, it is im- calcification within the joint cartilage (chondrocalci- portant to examine not only the hands but also the feet nosis) is to be noted. Laboratory values of importance are the erythro- granulation tissue (pannus) at the peripheral margin of cyte sedimentation rate; the presence or absence of serum the joint cartilage. These appear as small foci of destruc- rheumatoid factor; and the serum levels of uric acid. They may be very minute, but they represent one of the most significant roentgenographic observations of early Rheumatold Arthritis disease.
Remember spasms in upper abdomen discount 2 mg tizanidine overnight delivery, too muscle relaxant benzodiazepine generic 2mg tizanidine with visa, that The diseases most often diagnosed in women after a person is exposed to herpes spasms the movie buy 2 mg tizanidine overnight delivery, herpes anti- who have been sexually assaulted are trichomoni- bodies may not show up in the blood for any- asis, bacterial vaginosis, chlamydia, and gonor- where from two weeks to three months. Exam- women because of the possibility of ascending ples are vibrators and dildos. In they may be reassured by treatment or prophylaxis addition, if a person is exposed to hepatitis B virus for possible infection. The following prophylactic during an assault, postexposure administration of regimen is recommended: hepatitis B vaccine and hepatitis B immune glob- ulin can prevent infection. Hepatitis B vaccine should be given to victims of sexual assault at the time of the initial • Cultures for Neisseria gonorrhoeae and Chlamy- exam. Follow-up doses of vaccine should be dia trachomatis are made from specimens col- administered one to two and four to six months lected from any sites of penetration or attempted after first dose. If a nonculture test is used, a positive test result should be verified with another test. Because of these week follow-up visit, unless prophylactic treatment results and the effectiveness of antiretroviral was already provided. Most In children, finding sexually transmissible people probably benefit from prophylaxis because agents after the neonatal period is indicative of follow-up for sexual assault victims is difficult, and sexual abuse. Exceptions are the following: sexual ethics 195 • Rectal or genital infection with chlamydia that third follow-up 12 weeks after the sexual event. When the only evidence of men for Trichomonas vaginalis (presence of clue sexual abuse is the isolation of an organism or the cells in the wet mount or a sign such as a posi- detection of antibodies to a sexually transmissible tive whiff test finding suggest bacterial vaginosis agent, findings should be confirmed and implica- in girls with vaginal discharge) tions scrutinized. The determination of whether sexual abuse has occurred should be made by peo- • Collection of a serum sample to be tested imme- ple who are experts in evaluating abused and diately, preserved for later analysis, and used as assaulted children. A child’s risk for sexually transmit- testing are the following: ted diseases from sexual abuse is undetermined. Active sex- not further traumatized physically and psychologi- ual communication is recommended in order to cally. Ideally, the person doing the examination and promote greater “global” protection of sexually collecting of specimens should be someone with active individuals. Also, the child needs a follow- up visit two weeks after the sexual exposure for sexual ethics A code of sexual behavior that another examination and a second collection of requires ethical treatment of partners, including specimens. To make sure there has been time for safe sex and protection of others from transmission development of antibodies, the child should have a of sexually transmitted diseases. Usually sexual intercourse In some cases, a woman can become infertile involves penetration by the penis. Every year emphasizes that a great deal of scientific evidence the hotline gets hundreds of thousands of condom- suggests that the presence of sexually transmitted related calls, many from adolescents who are seek- disease(s) in an individual enhances his or her like- ing reliable information on proper use of condoms. In sexually transmitted diseases appears to be espe- addition to preventing complications and trans- cially important. Later, have a follow-up test to include scabies, pubic lice, trichomoniasis, and make sure the infection is gone. In the realm of sexually transmitted diseases, sex without penetration is • Be monogamous (have one partner). These lesions, • Avoid having sex during menstruation, because which pop up for several days to three weeks, you are more susceptible to infection. Within several weeks, they contain may suffer from Kaposi’s sarcoma, dry skin, mol- pus and crust over; by the time they are crusting, luscum contagiosum, herpes simplex, shingles, they do not contain virus. The person with shingles feels better in a few • Gonorrhea: There may be skin lesions on the weeks, but the area of the nerve may continue to arms or legs that appear to be sores filled with be painful for months (and in rare cases, for pus or blood and that are set amid reddened skin.
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