Morton's Neuroma
Definition
Benign enlargement of the common digital branch
- usually 3rd webspace
Anatomy
Found at level of or just distal to MT heads
- deep to the deep transverse MT ligament
Epidemiology
Classically women between 40 and 60
ultrasound
Non Union
Definition
Non-union
- arrest of progression to union at fracture site
- > 6-9 /12
- no visible progressive signs of healing for at least three consecutive months
- individualise for each fracture
- when the surgeon believes the fracture has little or no chance to heal
Delayed union
- failure of fracture to unite within expected time
- still may spontaneously unite
Ultrasound
Physics
Very high frequency sound waves
- 3 - 15 MHz
Production
Piezoelectric effect
- run electric current through a crystal
- produces ultrasound waves
Theory
Density of substance determines velocity of the US
- reflected back to the probe at different velocities
- converted into 2D image on monitor
Basic Science
Pathogenesis
Virchow's Triad
1. Venous stasis
2. Hypercoagulability
3. Endothelial damage
Starts as platelet nidus at valves
- thrombogenic materials elaborated by platelets
- leads to development of fibrin thrombus
- thrombus grows
Thrombus may
- detach as embolus
- be completely dissolved / recanalise
- organise with valve incompetence
De Quervain syndrome
Definition
Stenosing tenosynovitis of the first dorsal compartment of wrist
Epidemiology
Most are middle aged women
Aetiology
Repetitive thumb movements
- abduction & extension
- combined with RD & UD movements
Any mechanical irritation
- foreign body
- prominent bony surface
- restricted fascial compartment
Background
Definition
Full thickness tear (FTT)
- variable amount retraction from insertion
Partial thickness tear (PTT)
- incomplete
- bursal or articular sided
Calcific tendonitis
Definition
Mid-substance calcification of the rotator cuff
- part of a metaplasia secondary to hypoxia
Aetiology
2 groups of patients
Thoracic Outlet Syndrome
Definition
Symptoms & signs due to compression of brachial plexus & /or subclavian vessels at root of neck
Epidemiology
80% 30-50 years
F:M = 2:1
Incidence
Uncommon
Anatomy
Thoracic Outlet forms communication at root of neck
- for passage of nerves and vessels from mediastinum to axilla
Exertional Compartment Syndrome
Definition
Increased pressure within a closed fibro-osseous space
Aetiology
Seen in athletes, associated with repetitive exertion
Anatomy
Leg
1. Anterior compartment
- anterior tibial artery
- deep peroneal nerve
Achilles Tendon Rupture
Anatomy
Gastrocnemius tendon 10-25 cm long
- soleus 3-10 cm
- inserts superior calcaneal tuberosity
- fibres spiral 90°
- fibres that lie medially in proximal portion become posterior distally
- allows elastic recoil & energy storage
Plantaris present in 90% population
- medial to T Achilles
Poor blood supply midportion
- mesotenal vessels